Journal of Ophthalmology (Ukraine)

Assessing the impact of short-term intraocular pressure fluctuations on primary open-angle glaucoma progression

Nina Lutsenko — 2024-02-29

Purpose: To examine the impact of short-term intraocular pressure (IOP) fluctuations on the progression of glaucomatous optic neuropathy based on optical coherence tomography (OCT) data.

Material and Methods: Totally, 32 patients (62 eyes) with primary open-angle glaucoma (POAG) were included in the study and divided into two groups. Group 1 comprised 15 patients (30 eyes) with a standard deviation (SD) of IOP of less or equal to 3 mmHg, and group 2, 17 patients (32 eyes) with an SD of IOP greater than 3 mmHg. Patients were followed over 12 months. At baseline, at 6 and 12 months, they had a routine eye examination and OCT of the optic nerve and macula, with retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses determined. At 12 months, the rebound tonometer ICare Home2 was used for diurnal IOP measurements, and an SD of IOP was determined.

Results: In group 1 and group 2, annual losses in RNFL were 3.20 ± 3.86 µm/year and 8.11 ± 9.1 µm/year, respectively (р = 0.03), and global GCC losses, 0.87 ± 3.98% and 5.24 ± 8.05%, respectively (р = 0.04). There was a statistically significant positive correlation of the SD of IOP measurements with annual loss in GCC thickness (r = 0.5161; р = 0.02) and global GCC loss (r = 0.6258; р = 0.03) for group 2, but no significant correlation for group 1.

Conclusion: IOP fluctuation (SD > 3 mmHg) is a factor of glaucoma progression which impacts particularly on retinal GCC losses.

Tear lactoferrin and ceruloplasmin levels in patients with traumatic and recurrent corneal erosions

Iryna Gavrylyak — 2024-02-29

Background: Studies on the mechanisms of corneal wound healing are still important. Apart from the integrity of the corneal epithelium, tear fluid is important for maintaining homeostasis of the ocular surface; it is composed of a variety of proteins, lipids and metabolites. Studies on changes in concentrations of biochemical tear components are important for the diagnosis and treatment of corneal injuries.

Purpose: To assess changes in tear lactoferrin (Lf) and ceruloplasmin (Cp) levels over the course of comprehensive treatment for patients with traumatic corneal erosions (TCE) and recurrent corneal erosions (RCE).

Material and Methods: The study sample included 62 patients (19 to 65 years of age; mean age plus or minus standard deviation, 43.5 ± 2.4 years). Group 1 included 44 patients with TCE, and group 2, 18 patients with recurrent RCE. Each patient group was divided into two subgroups on the basis of the treatment method. Subgroup 1 was administered eye broad-spectrum antibiotic (AB) eye drops and dexpantenol over a course of treatment. Subgroup 2 received AB eye drops and dexpantenol plus adjunct lactoferrin (Lf)-containing eye drops. An eye examination included visual acuity, biomicroscopy and fluorescein test. Monospecific antibodies were used to determine tear Lf and Cp levels. Tears from healthy volunteers were used as controls.

Results: At baseline, the tear Lf level in patients with TCR was lower than in controls (3.94 ± 0.45 arbitrary units (a.u.) versus 10.3 ± 0.4 a.u., respectively; p < 0.05), resulting in reduced ocular surface protection. In subgroup 1 of the TCE group, after treatment with an AB plus dexpantenol only, the tear Lf level increased to 6.38 ± 0.55 a.u. (p < 0.05), and the mean period of treatment was 7.6 ± 0.43 days (p ≥ 0.1). In subgroup 2 of the TCE group, after treatment with an AB plus dexpantenol plus Lf-containing eye drops, the tear Lf level was 12.23 ± 0.6 a.u. (p < 0.05) and the mean period of treatment was 6.0 ± 0.23 days. The presence of Cp in the tear fluid prior to treatment for TCE or RCE indicated activation of acute inflammation; at baseline, the tear Cp level in patients with TCE was 2.37 ± 0.25 a.u. compared to controls (p < 0.05), and in those with RCE, 1.78 ± 0.2 a.u. On completion of treatment with Lf-containing eye drops, the tear Lf level increased and the tear Cp level decreased to the levels in controls, and there was a negative correlation between the tear Lf level and the tear Cp level (r = -0.491, p < 0.001).

Conclusion: The results confirmed the feasibility of utlizing Lf-containing eye drops as an adjunct in the treatment of TCE and RCE. This approach contributed to the restoration of ocular surface homeostasis, thus promoting corneal epithelialization and enabling a reduction in treatment duration.

Neutrophil activation marker CD15+ as a prognostic factor of ocular surface damage in type 2 diabetics

T. M. Zhmud — 2024-02-29

Purpose: To evaluate the prognostic value of the neutrophil activation marker CD15+ in ocular surface damage in type 2 diabetics.

Material and Methods: This study was conducted from January 2021 to January 2021 at the Pirogov Vinnytsia Regional Clinical Hospital, the clinical site of the Medical University. A total of 60 type 2 diabetics (120 eyes) were enrolled, with an average age of 62.1 ± 5.24 years.

Results: The prognostic value of the percentage expression of CD15+ in ocular surface damage in type 2 diabetics was for the first time evaluated. A rather high sensitivity of the percentage expression of CD15 (88.3%) allows using it as a parameter for screening for the presence of ocular surface damage in type 2 diabetics. Type 2 diabetics with a percentage of >27% of CD15+ cells had 10.52 times increased odds of ocular surface damage (95%CI, 4.34–25.50; p < 0.0001), and this value of the percentage of CD15+ cells can be used for the purpose of screening for ocular surface damage with a sensitivity of 88.3% (95% СІ, 77.8-94.2) and specificity of 63.3% (95% СІ, 50.7-74.4).

Association of TLR4 rs1927911 polymorphism with diabetic retinopathy and diabetic macular edema in type 2 diabetic patients

S. O. Rykov — 2024-02-29

Background: Genetic susceptibility is a factor in the development of ophthalmic complications in type 2 diabetes mellitus (T2DM). There are differences between polymorphisms of toll-like receptor-4 (TLR4) in terms of their association with microvascular complications of T2DM.

Purpose: To assess the association of TLR4 rs1927911 polymorphism with diabetic retinopathy (DR) and diabetic macular edema (DME) in T2DM.

Material and Methods: This study involved 81 type 2 diabetics (81 eyes) with both DR and DME and 50 type 2 diabetic controls (50 eyes) having normalized carbohydrate metabolism and neither DR nor DME. TLR4 rs1927911 genotypes were investigated by real time polymerase chain reaction (PCR) using Gene Amp® 7500 PCR System (Applied Biosystems, Foster City, CA) and TaqMan Mutation Detection Assays (Life Technologies, Carlsbad, CA).

Results: TLR4 rs1927911 polymorphism was associated with DR and DME (р = 0.021), and the risk of these complications was lower (OR = 0.42; 95% CI, 0.23–0.77) in allele A carriers than in ancestral allele G carriers. rs1927911 genotype distribution was significant by Pearson chi-square test under a dominant model (GG versus GA+AA; χ2 = 6.38; р = 0.012; OR = 0.37; 95% CI, 0.18-0.76). After patients were stratified by the stage of DR and the severity of DME, significant differences with regard to genotypes were observed only in proliferative DR and severe DME. Carriers of the heterozygous genotype and minor genotype AA showed less severe glycemia, lower HbA1c, and smaller central retinal thickness and total retinal volume than carriers of the ancestral genotype GG; this corresponded to less severe carbohydrate metabolism abnormalities and less severe retinal damage.

Conclusion: Pro-inflammatory pathways involve TLR4 under hyperglycemic conditions. Given the role of TLR4 in the mechanisms triggering the immune response, it may be supposed that the activity of these pathways is reduced in carriers of rs1927911 polymorphism, and it is this that causes reduced diabetic retinal damage.

Detecting diabetic retinopathy using an artificial intelligence-based software platform: a pilot study

A. O. Nevska — 2024-02-29

Purpose: To examine the potential for the detection of diabetic retinopathy (DR) using the artificial intelligence (AI)-based software platform Retina-AI CheckEye©.
Material and Methods: This was an open-label, prospective, pilot observational case-control study for the detection of DR using an AI-based software platform. The study was conducted at the sites of healthcare facilities in Chernivtsi oblast. Four hundred and eight diabetics and 256 non-diabetic controls were involved in the study. All fundus images were analyzed using the artificial intelligence (AI)-based software platform Retina-AI CheckEye©. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of the DR diagnosis method.
Results: Using the AI-based software platform, signs of DR in at least one eye were detected in 143 diabetics (22% of total study subjects (664 individuals; 1328 eyes) or 35% of the diabetics (408 patients)). No DR signs were detected in 322 individuals (48% of total study subjects). In 199 individuals (30% of total study subjects), the results were not obtained due to the features of the optical media and presence of certain eye diseases (in most cases, unilateral cataract or corneal opacity). This trial found 93% sensitivity and 86% specificity for the Retina-AI CheckEye-assisted detection of DR.
Conclusion: An AI-based software platform, Retina-AI CheckEye©, has been for the first time developed in Ukraine. The platform was demonstrated to have a high accuracy (93% sensitivity and 86% specificity) in diagnosing DR in diabetic patients and can be used for large-scale DR screening.

Effects of vitreous angiopoietin-2 levels in rhegmatogenous retinal detachment on the macular microvascular bed

Iryna Bezkorovaina — 2024-02-29

Background: Our previous optical coherent tomography angiography (OCTA) study of rhegmatogenous retinal detachment (RRD) treatment has found an impaired retinal microvascular bed over a 12-month postoperative follow-up and warranted for the study of vitreous angiopoietin (Ang)-2 levels as a vascular destabilizing factor in patients treated for RRD.

Purpose: To assess vitreous Ang-2 levels in patients with primary RRD and their association with OCTA-based changes in the macular microvascular bed in patients with RRD.

Material and Methods: Eighty-seven patients with primary RRD were involved in the study and divided into two groups depending of the state of the macula: patients that underwent surgery for macular-on RRD (group 1) and those that underwent surgery for macular-off RRD (group 2). All patients had their vitreous samples taken and underwent subtotal posterior vitrectomy. Concentrations of Ang-2 in these samples were measured by an enzyme-linked immunosorbent assay (ELISA) kit (Human Angiopoietin-2 ELISA Kit, Thermo Fisher SCIENTIFIC, Rockford, IL, USA) in accordance with the manufacturer’s protocol. We assessed correlations of vitreous Ang-2 levels and OCTA-based parameters in patients.

Results: At the preoperative vitreous Ang-2 level of 129.7 ± 51.99 pg/ml in group 1, there was a strong correlation of preoperative OCTA-based foveal avascular zone (FAZ) area, parafoveal deep capillary plexus density (PDCPD) and foveal deep capillary plexus density (FDCPD) with vitreous Ang-2 levels over the study period for group 1. At the preoperative vitreous Ang-2 level of 693.8 ± 634.7 pg/ml in group 2, there was a strong correlation of OCTA-based FAZ area, FDCPD, and PDCPD with vitreous Ang-2 levels at baseline and 12 months, and a moderate direct correlation of OCTA-based FAZ area, FDCPD, and PDCPD with vitreous Ang-2 levels at months 3 and 6.

Conclusion: Vitreous Ang-2 levels were significantly lower in macula-on RRD eyes than in macula-off RRD eyes (129.7 ± 51.99 pg/ml versus 693.8 ± 634.7 pg/ml, p < 0.001). There was a strong direct correlation (p < 0.05) of Ang-2 with OCTA-based characteristics of the retinal microvascular bed (FAZ area, PDCPD and FDCPD) for both groups, which indirectly indicates the effect of the vascular destabilizing factor on the postoperative best-corrected visual acuity.

Risk factors for the progression of age-related macular degeneration in patients of the Ukrainian population

Sergiy Mogilevskyy — 2024-02-29

Background: Researchers need to find informative age-related macular degeneration (AMD) criteria which could be used for developing expert systems for the prediction of the course of the disease.
Purpose: To evaluate risk factors of AMD progression on the basis of clinical and ophthalmological characteristics in patients of the Ukrainian population.
Material and Methods: Totally, 302 eyes (152 patients) with AMD were included in the study. The stage of AMD was determined based on the Age-related Eye Disease Study (AREDS) guidelines. Median patient age (95% confidence interval (CI)) was 71.18 (69.47 – 72.89) years, most (82.9%) patients were of 60 – 85 years, and the percentage of women was 59.9%. Visual acuity, best-corrected visual acuity (BCVA), numbers of small, intermediate and large drusen, presence of retinal pigment epithelium (RPE) changes, subretinal neovascular membranes (SNM), and geographic RPE atrophy were assessed at baseline and at 1 year and 2 years. Statistical analyses were conducted using MedStat and MedCalc v.15.1 (MedCalc Software bvba, Ostende, Belgium) and EZR v.1.64 software (R Foundation for Statistical Computing, Austria).
Results: There was a slow but statistically significant reduction in median BCVA (interquartile range (IQR)) from 0.4 (0.1–0.85) at baseline to 0.325 (0.1 – 0.8) (p < 0.001) at 2 years. Over the first year and over the second year, the frequency of RPE changes increased by 6.3% and 10.9%, respectively (p < 0.001), the frequency of SNM detection increased by 13.3% and 21.2%, respectively (p < 0.001), and the frequency of geographic atrophy detection, by 5.7% and 8.0%, respectively (p < 0.001). A multivariate logistic regression model was developed to select four covariates for the risk of AMD progression (the male gender, BCVA, number of small drusen and AREDS category at baseline). The BCVA was negatively associated (р = 0.026; OR = 0.12; 95% CI, 0.03 – 0.60), whereas the number of small drusen was positively associated with the risk of AMD progression (р = 0.009; OR = 1.02; 95% CI, 1.00–1.04). The risk of AMD progression was the highest for eyes with the AREDS category 2 (63.0%, 95% CI, 48.7% – 75.7 %), and the lowest for eyes with the AREDS category 3 (41.2 %, 95% CI, 29.4% – 53.8%, р = 0.049).
Conclusion: First, over 24 months, we observed a slow but statistically significant reduction in visual acuity, with an increase in the frequency of RPE changes and detection of SNM and geographic atrophy. Second, a multivariate logistic regression model was developed to select four covariates for the risk of AMD progression (the male gender, BCVA, number of small drusen and AREDS category at baseline). The BCVA was negatively associated, whereas the number of small drusen was positively associated with the risk of AMD progression. Finally, the risk of AMD progression was the highest for eyes with the AREDS category 2, and the lowest for eyes with the AREDS category 3.

Retinal function as assessed by multifocal electroretinography and central perimetry before and after vitrectomy with conventional versus fovea-sparing internal limiting membrane peeling for idiopathic macular hole

I. Buallagui — 2024-02-29

Purpose: To perform multifocal electroretinography (mfERG)- and central perimetry-based evaluation of the function of the macula before and after vitrectomy with conventional internal limiting membrane (ILM) peeling versus fovea-sparing ILM peeling for idiopathic macular hole (IMH).

Material and Methods: This study included 70 patients (71 eyes) who received 25-G vitrectomy with conventional or fovea-sparing ILM peeling and gas tamponade with 20% SF6 or 15% С3F8 for stage-2 to stage-4 holes as per the classification by Gass. Eyes of study patients underwent optical coherence tomography angiography (OCTA) evaluation of IMH diameter and choriocapillaris perfusion density, ten-degree static perimetry and 20-degree 5-ring mfERG before and 1 month after surgery.

Results: Before surgery, eyes with IMH showed significantly reduced foveal light sensitivity and overall parafoveal sensitivity, increased Pattern Standard Deviation (PSD), and reduced retinal response density in mfERG rings 1 and 2 compared to fellow eyes. The foveal threshold sensitivity in the affected eyes was found to be correlated with minimal diameter of IMH (r = -0.77; р < 0.05) and the postoperative BCVA (r = 0.66; р < 0.05), whereas the overall retinal sensitivity, with the maximal diameter of IMH (r = -0.56), preoperative BCVA (r = 0.6) and postoperative BCVA (r = 0.7). MfERG retinal response density in ring 1 was significantly reduced (р = 0.00001) and correlated with the preoperative foveal threshold sensitivity (r = 0.6) and choriocapillaris perfusion density (r = 0.39). After macular hole closure, median BCVA (interquartile range) in the fovea-sparing ILM peeling group and the conventional ILM peeling group improved to 0.55 (0.35–0.7) and 0.43 (0.35–0.6), respectively. In addition, the foveal threshold sensitivity within 10-degree area in the former and latter groups improved, but was 13.6% (р = 0.009) and 15% (р = 0.0001), respectively, lower than in the fellow eyes (34.5 ± 2.9 dB). The overall retinal sensitivity in the fovea-sparing ILM peeling group improved more substantially, to 509.6 ± 13.9 dB, and almost reached the fellow-eye value (528.0 ± 25.8 dB). Moreover, the retinal response density in the conventional ILM peeling group improved in rings 1-5, whereas that in the fovea-sparing ILM peeling group, in rings 2-4, but not in ring 1.

Conclusion: In eyes with IMH, retinal photoreceptor function as assessed by perimetry and mfERG was found to be impaired at baseline and improved after macular hole closure. In the fovea-sparing ILM peeling group, the overall retinal sensitivity in the affected eyes improved more substantially than in the conventional ILM peeling group.

Retinal changes as evidenced by fundoscopy and their frequencies in patients with COVID-19 with different variants of the angiotensin-converting enzyme gene

K. M. Hutsaliuk — 2024-02-29

Purpose: To evaluate the relationship between angiotensin-converting enzyme (ACE; rs4340) gene variants and the retinal changes as evidenced by fundoscopy in patients with various clinical courses of COVID-19.
Material and Methods: Ninety-four COVID-19-positive patients (188 eyes) were included in the study. They had an extremely severe course, severe course, or moderately severe course of the disease with decompensated or compensated comorbidity. We evaluated the distribution of ACE ACE genotypes among patients and determined the retinal changes in COVID-19 patients with different ACE genotypes. Fundus images were obtained with a handheld fundus camera to identify clinically significant and insignificant retinal changes. A molecular and genetic study of ACE gene (rs4340) variants was carried out using allele-specific polymerase chain reaction (PCR). Statistical analysis of correlations between the course of COVID-19 and the presence of retinal changes as well as between the ACE gene variant and the presence of retinal changes was conducted.
Results: Among the analyzed individuals, 28 (29.6%), 47 (50.5%) and 19 (19.9%) were found to have the II genotype, ID genotype, and DD genotype, respectively. We found no significant correlation between metabolic status, severity of COVID-19 course and the ACE gene variant. No significant difference was found among groups of COVID-19 patients of different ACE genotypes with respect to the distribution of particular retinal changes. There was an increase (p < 0.001) in the risk of clinically significant retinal changes in patients with the DD genotype compared to patients with the II genotype and those with the ID genotype (p < 0.05).
Conclusion: The risk of clinically significant retinal changes is higher in COVID-19 patients with ACE genotype DD than in those with genotype II or ID (p < 0.001).

Changes in visual abnormalities after endonasal endoscopic surgery for giant pituitary adenoma with extension to the ventricular system

Kateryna Iegorova — 2024-02-29

Purpose: To assess the features of visual impairments in patients with giant pituitary adenoma (GPA) with extension to the ventricular system showing different directions of tumor growth and chiasm positions to improve the early diagnosis of the chiasmal syndrome.

Material and Methods: We retrospectively examined medical records of 41 patients with GPA showing extension to the ventricular system who were treated at the Endonasal Neurosurgery Department, the Romodanov Neurosurgery Institute between 2016 and 2021. Patients were divided into three groups based on the direction of tumor extension and chiasm position: group 1, antesellar extension and/or postfixed chiasm (14 patients); group 2, suprasellar extension and/or normal chiasm (12 patients); group 3, retrosellar extension and/or prefixed chiasm (15 patients). Patients underwent clinical neurological, otoneurological and eye examination.

Results: Of the 41 patients, 38 (92.7%) had reduced visual acuity and/or or visual field defects. In the current study, 53.7% of patients had nonfunctional GPA, which makes diagnosis in the early stages (when the tumor is small) challenging. Bitemporal hemianopsia and severe chiasmal syndrome were prevalent among patients with normal or postfixed chiasm, and 14% of eyes were blind among these patients. Moderate chiasmal syndrome was prevalent, 1.2% of eyes were blind and 7.3% of patients had no visual deficiency among patients with prefixed chiasm. In addition, homonymous hemianopsia was found in 7 patients (17.5%) with prefixed chiasm, and was caused by the effect on the posterior chiasm and visual pathways. Mean visual acuity and visual field mean defect (MD) values were statistically significantly better in patients with post-fixed or normal chiasm.

Conclusion: Visual field defects atypical for tumors of the chiasmal and sellar region may emerge depending on the topographic relationship between the chiasm and the GPA.

Neuro-ophthalmological abnormalities in cerebrovascular disease

Volodymyr Usov — 2024-02-29

Purpose: To assess the incidence of various neuro-ophthalmological symptoms in patients with chronic cerebrovascular disease (CVD).

Material and Methods: This study was conducted at the clinical departments of the Petro Mohyla Black Sea National University (Mykolaiv) in 2018-2022. Two hundred and sixteen patients with CVD were involved in the study. Mean patient age was 62.3 ± 1.2 years and most patients (133 or 60.2%) were males. A neuroophthalmological examination included visual acuity testing, intraocular pressure measurement, perimetry, type of vision and heterophoria assessment, evaluation of ocular motility, convergence, and strabismus in the cardinal positions of gaze, and ophthalmoscopy. In addition, patients had optical coherence tomography with Оptovue Avanti XR apparatus, if indicated.

Results: Of 216 patients, 45 (20.8%) had cerebral small-vessel disease, 157 (72.7%), a prior history of transient ischemic attack (TIA), and 118 (46.1%), a prior history of acute cerebrovascular events (ACVE). All patients exhibited signs of hypertensive angiopathy. Of 216 patients, 22 (10.2%) had grade 3, and 6 (2.8%), grade 4 hypertensive angiopathy. There was evidence of posterior ischemic optic neuropathy in the presence of cerebral small-vessel disease in 27 patients (12.5%). Retinal microvascular changes were seen in 133 patients (61.6%). In addition, 10 patients (4.6%) exhibited isolated retinal hemorrhages, 16 (7.4%), hard exudates, and 1 (6.3%) cotton-wool exudates. Moderate retinal and optic disc edema was seen in 23 patients (10.6%). Isolated homonymous visual field defects were found in 13 patients (6.0%); all these patients had a prior history of ACVE.

Conclusion: In patients with CVD, we found fundus changes which were mostly ischemic and more severe in the presence of cerebral small-vessel disease. There is a need for an integrated multispecialty/interdisciplinary approach to further research on the neuroophthalmological aspect of CVD.