Journal of Ophthalmology (Ukraine)

Characteristics of redox processes, thiol system and mucin in the tear fluid in type 2 diabetics

T.M. Zhmud — 2024-10-29

Purpose: To assess the characteristics of redox processes, thiol system and mucin in the tear fluid in patients with T2DM.
Material and Methods: Thirty type 2 diabetics (60 eyes) with ocular surface changes were included in the study. Patient eyes were divided into groups based on the bulbar conjunctival changes corresponding to the Nelson grade: group 1 (33 eyes with Nelson grade 2 to 3 changes in the bulbar conjunctiva) and group 2 (27 eyes with Nelson grade 0 to 1 changes in the bulbar conjunctiva). Tear lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (G6PDH), malate dehydrogenase (MDH), and glutathione peroxidase (GPX) activities and tear mucin, reduced glutathione (GSH) and oxidized glutathione (GSSG) levels were determined by routine techniques.
Results: We found alterations in tear redox reactions (LDH, G6PDH and MDH activities), GPX activity and thiol status (GSH and GSSG levels) in the setting of cytological conjunctival changes (i.e., different Nelson grades of squamous metaplasia) in type 2 diabetics. In addition, we found decreased tear mucin levels, which could be associated with alterations in the above biochemical processes and/or cytological conjunctival changes in patients of these groups.
Conclusion: Determining characteristics of tear redox reactions, glutathione system and mucin level can be considered as a method for monitoring the course of ocular surface disease based on the grade of squamous metaplasia of the bulbar conjunctiva in type 2 diabetics.

Our experience in the diagnosis and treatment of peripheral exudative hemorrhagic chorioretinopathy

I. O. Nasinnyk — 2024-10-29

Purpose: To present our experience in the examination and treatment of patients with peripheral exudative hemorrhagic chorioretinopathy (PEHCR).

Material and Methods: We retrospectively reviewed the medical records of patients who were finally clinically diagnosed with PEHCR in the 2022-2023 period. History was collected and patients underwent ophthalmological examination including visual acuity, slit-lamp biomicroscopy, color fundus photography, fluorescein angiography and ocular ultrasound. All patients were treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapy. One patient underwent vitreoretinal surgery.

Results: PEHCR was diagnosed in 11 patients (13 eyes), including two patients diagnosed with bilateral lesions. Clinical signs identified included a dome-shaped hemorrhagic detachment of the peripheral retinal pigment epithelium (RPE) with massive exudations. One patient underwent vitreoretinal surgery for vitreoretinal hemorrhage. On B-scan ultrasonography, the PEHCR lesion commonly presented as a dome or plateau-shaped mass with hollow or solid acoustic quality. Ten patients were treated with intravitreal aflibercept.

Conclusion: PEHCR is a chronic disease commonly associated with AMD. Detachment of the peripheral RPE is a major clinical manifestation of the disease, and may be complicated by sub-RPE hemorrhage in early disease. Anti-VEGF therapy is a major method of treatment whereas vitreoretinal surgery is indicated in complications accompanied by massive intravitreal hemorrhage or macula-threatening subretinal hemorrhage. Further investigation is needed to elucidate the etiology and pathogenesis of this entity and demonstrate the efficacy and safety of the aforementioned treatment modalities for PEHCR.

Macular thickness analysis using optical coherence tomography data, stereopsis and binocular vision in premature infants who underwent retinal laser photocoagulation due to retinopathy of prematurity in an age-related perspective

A. O. Adakhovska — 2024-10-29

The purpose was to establish reference values for macular thickness, binocular vision, and stereopsis in premature infants aged 5-9 years and 10-13 years who underwent laser photocoagulation of avascular retinal zones due to retinopathy of prematurity (ROP); to assess and compare the data in an age-related perspective.
Methods. Data from 24 premature infants who underwent ophthalmological examination, including optical coherence tomography, Titmus Stereo Fly Test, and the Worth 4 Dot Test, at ages 5-9 years and again at ages 10-13 years were analyzed. All children had undergone laser photocoagulation of avascular retinal zones due to ROP in infancy.
Results. At ages 5-9 years, the mean central macular volume was 9.2 mm3, and the retinal thickness in the central fovea was 313.7 μm. At ages 10-13 years, the mean central macular volume was 9.1 mm3, and the retinal thickness in fovea was 320.8 μm. Normal binocular vision and stereopsis were observed in 79.2% and 33.3% of the children at the first time point, and in 87.5% and 45.8% at the second time point.
Conclusions. No statistically significant difference in the central macular volume and macular thickness was detected between the two time points, (p>0.05). The thickest part of the macula was identified in the inner macula, followed by the outer macula, with the nasal quadrant being the thickest. Despite the anatomical peculiarities, high rates of binocular vision were observed at both time points, along with stereopsis at the second examination.

Psychological and neuropsychological status of patients with both blast-related ocular injury and mild traumatic brain injury late after the traumatic event

N. G. Bakuridze — 2024-10-29

Purpose: To determine the psychological and neuropsychological status of patients with both blast-related ocular injury and mild traumatic brain injury (TBI) late after the traumatic event.
Material and Methods: Thirty patients with blast-related ocular injury, reduced visual function and comorbid mild TBI were included in the study. The following methods of psychological and neuropsychological assessment were used: formalized interview; Suicidality, Post-traumatic Stress Disorder (PTSD), Alcohol Dependence, and Drug Dependence scales of the Mini-International Neuropsychiatric Interview (MINI); Raven’s Progressive Matrix scale; Personal and Social Performance (PSP) scale; PROMIS® Pain-Interference scale; Hospital Anxiety and Depression Scale (HADS); Mazes subtest of the Neuropsychological Assessment Battery (NAB); and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).
Results: The following significant correlations were found: PSP functioning and support from the family (r = 0.533, p = 0.002); total RBANS score and Mazes subtest score (r = 0.466, p = 0.009); total RBANS score and self-reported stress score (negative correlation, r = -0.492, p = 0.006); HADS depression and self-reported stress score (r = 0.646, p = 0.000114); PROMIS pain scale and PTSD scale (r = 0.482, p = 0.007). No association was found between the number of mild TBI events experienced and neuropsychological and psychological measurements.
Conclusion: Blast-related mild TBI concomitant with ocular injury has a substantial and long-term impact on casualty’s cognitive and psychological functions. In such patients, the most prominent cognitive deficits occur in the domain of executive function (including cognitive control and planning and problem-solving skills). In the presence of reduced visual function, these deficits have a substantial impact on total cognitive scores, scores of other psychic functions (namely, attention and memory) and significantly affect the patient’s capacity for independent functioning.

Tevrat Usupovych Gorgiladze: a brilliant surgeon who contributed to further advances in the Filatov’s method of penetrating keratoplasty

N. F. Bobrova — 2024-10-29

The present article reports on the life and scientific and clinical activities of Prof. Tevrat Usupovych Gorgiladze and his contributions to further advances in the Filatov’s method of partial penetrating keratoplasty (PPK). T.U. Gorgiladze, a Filatov’s pupil and a brilliant surgeon, was heading the Corneal Transplantation Department for 20 years. During this period, he elucidated various problems in, and proposed many techniques for the diagnosis and treatment of anterior segment pathology. The Corneal Transplantation Department was the first department established by Acad. Filatov at the institute that now bears his name.

Retinal morphological changes in non-infectious uveitis in rabbits experimentally treated with citicoline versus non-treated rabbits

I. S. Horianova — 2024-10-29

Purpose: To identify retinal morphological changes in a model of non-infectious anterior and intermediate uveitis and to assess the efficacy of experimental neuroprotective citicoline therapy in the treatment of the disease.
Material and Methods: Forty rabbits were divided in two experimental groups, the non-treatment group (18 non-treated rabbits) and treatment group (22 rabbits treated with the neuroprotector). A horse serum rabbit model was used for inducing uveitis. Histological structure of the retina was assessed on days 33 to 54 after the onset of uveitis.
Results: In the non-treatment group, there were retinal areas exhibiting marked destructive changes (sites of edema and disorganization in the inner nuclear layer, tractions between the retina and vitreous, reduced numbers of neuronal layers in the nuclear layers, and reduced numbers of ganglion cells) as well as areas of relatively well-preserved retina. At late time points after the onset of uveitis, animals treated with citicoline exhibited an almost normal retinal structure.
Conclusion: Horse serum-induced non-infectious anterior and intermediate uveitis contributed to retinal neurodegenerative changes, but uveitic animals treated with the neuroprotector for 33-54 days exhibited only minor neurodegenerative changes.

Comparing histopathological effects of the neodymium and diode laser transscleral cyclophotocoagulation: an experimental study

O. V. Guzun — 2024-10-29

Background: Cyclodestructive procedures with high laser energy settings achieve their IOP reduction effect at the expense of damage to the secretory epithelium of the ciliary processes and adjacent structures, which may result in such complications as hypotony and ocular subatrophy.
Purpose: To experimentally evaluate the histopathological features in the rabbit eye after exposure of the distal ciliary body to transscleral selective laser radiation at the 810 nm wavelength versus the 1064 nm wavelength, and to compare the histopathological effects of the diode and neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers.
Material and Methods: Four Chinchilla rabbits (8 eyes) were included in this experimental study. In four eyes, transscleral cyclophotocoagulation (TSCPC) of the ciliary body was performed with an 1064-nm Nd:YAG laser (energy, 1.0 J/ pulse; pulse duration, 3 ms) equipped with a 600-µm fused-silica fiber optic tip. In another four eyes, an 810-nm diode laser TSCPC of the ciliary body was performed using a Vitra 810 apparatus (Quantel Medical Instruments, France) with a laser power of 1W and exposure duration of 1.5 s (energy, 1.5 J/pulse).
Results: Our experimental histopathological study of rabbit eyes demonstrated no significant difference in the development of ciliary stromal edema (р = 0.425) and focal necrosis of the non-pigmented ciliary epithelium (р = 0.764) between the eyes that received the transscleral contact cyclodestruction with an 810-nm diode laser at an energy of 1.5 J and the eyes that received transscleral contact-and-compression cyclodestruction with a 1064-nm Nd:YAG laser at en energy of 1.0 J.
Conclusion: The use of 810-nm laser radiation at energy of 1.5 J in the transscleral contact cyclodestruction and the use of 1064-nm laser radiation at energy of 1.0 J in the transscleral contact-and-compression cyclodestruction were similar in enabling selective thermal effects on the ciliary epithelium with limited damage to adjacent structures in rabbits.

Edema and features of optic nerve architecture in inflammatory and ischemic neuropathies. Clinical cases

N. M. Moyseyenko — 2024-10-29

Purpose. To describe clinical cases of optic nerve edema in inflammatory and ischemic neuropathies and features of optic disc architecture revealed by optical coherence tomography.
Methods. 4 patients were examined. Two patients were diagnosed with optic neuritis, and the other two with ischemic neuropathy. Ophthalmoscopically, signs of optic disc edema were found in all patients. Visometry, ophthalmoscopy, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) were used.
Result. Changes in the architecture of the optic nerve head were detected in cases of optic nerve edema in inflammatory (2 patients) and ischemic neuropathy (2 patients). In all examined patients, according to the conducted study, the results of OCT showed that optic nerve edema, except for case № 4, does not extend to the temporal segment of the head. In cases of inflammatory damage, cases 1 and 2, optic nerve atrophy was observed at later stages during repeated examinations. A light crescent zone is observed in the peripapillary area, which separates the temporal border of the optic nerve head (sectoral atrophy).
Conclusion. Optic nerve edema in inflammatory and ischemic neuropathies is characterized by an increase in the thickness of the nerve fiber layers and a change in the configuration of the disk, which later transforms into segmental atrophy. The changes in the architecture of the optic disc were found to be the basis of diagnosis, monitoring, and evaluation of the effectiveness of treatment in acute optic neuropathies.

Uveitis Masquerade Syndrome

M. K. Shields — 2024-10-29

The ‘uveitis masquerade syndrome’ is a large group of neoplastic and non-neoplastic conditions that mimic and are initially misdiagnosed as uveitis. These eye diseases account for approximately 5% of all presentations at tertiary referral uveitis clinics. Vitreoretinal lymphoma is one of the most common of the neoplastic conditions that present as uveitis. With a 5-year survival rate under 50%, it is vitally important to recognize this diagnosis promptly. Other malignancies that may masquerade as uveitis include systemic lymphomas, primary uveal lymphoma, leukemias, multiple myeloma, uveal melanoma, metastatic cancers, and in children, retinoblastoma, medulloepithelioma, and post-transplantation lymphoproliferative disorder. Paraneoplastic syndromes are also possible uveitis mimics. Non-neoplastic conditions that may present as uveitis include the ocular ischemic syndrome and other vascular eye diseases, central serous chorioretinopathy, inherited retinal diseases, rhegmatogenous retinal detachment, pigment dispersion syndrome, intraocular foreign bodies, and in children, juvenile xanthogranuloma and Coats disease. In this article, we review the uveitis masquerade syndrome. Our major focus is vitreoretinal lymphoma, but we also summarize the other neoplasms and non-neoplastic diseases that may masquerade as uveitis.