Journal of Ophthalmology (Ukraine)

A Corneal macular dystrophy. Case Presentation.

Leopoldo Garduno-Vieyra — 2022-12-30

УДК 617.713-007.17

http://doi.org/10.31288/oftalmolzh202265961

Among the stromal corneal dystrophies corneal macular dystrophy is one of the most frequent. It is an autosomal recessive disorder linked to chromosome 16, in which a mutation occurs in the CHST6 gene, causing an alteration in keratan sulfate metabolism. This alteration produces extracellular deposits of glycosaminoglycans between the stromal lamellae of the cornea, as well as in the cytoplasm of the endothelial cells. Clinically, the presence of centrally predominant white-greyish focal stromal corneal opacities is observed in early stages. Symptoms begin between the second and third decade of life and consist of progressive decrease in visual acuity and photophobia. In this work, we present the clinical case of a 56-year-old male patient who came to the clinic due to progressive decrease in visual acuity and photophobia. On physical examination, multiple intrastromal macules, whitish in color, were found by biomicroscopy in both eyes that were accentuated in greater quantity in the central 5 mm of the cornea. According to the findings obtained in the examination, the diagnosis of corneal macular dystrophy is established.

Undiagnosed nevus of Оta, facial hemiparesis and esotropia: a case report

Leopoldo Garduno Vieyra — 2022-12-30

УДК 616.5/617.7-003.829.5+616.833.17+617.758.11

http://doi.org/10.31288/oftalmolzh202266264

Perinatal history is often underrated in ophthalmologic consultation and may provide important information in order to establish an assertive diagnosis.

Purpose: To report a case of a patient who was evaluated in two hospitals as a child and misdiagnosed with Goltz syndrome.

Material and Methods: it was ruled out a syndrome and the existence of three independent diagnoses was proposed: nevus of Ota, non-accommodative esotropia and left facial hemiparesis due to involvement of the VII cranial nerve.

Results: A combined left eye strabismus surgery and neodymium Yag laser treatment were performed under sedation over the entire length of the nevus.

Conclusion: The presence of facial palsy, strabismus or a nevus directs the physician to interrogate prenatal and perinatal issues to establish a complete diagnosis. The patient received treatment after several years and now she is satisfied.

A case of Susac’s syndrome: bilateral retinal vessel occlusion in the presence of autoimmune inflammatory endotheliopathy

Nadiia Ulianova — 2022-12-30

УДК 617.73-018.2-06:616.831-008.6

http://doi.org/10.31288/oftalmolzh202266569

The paper presents a case with a classic triad (bilateral inferotemporal branch retinal artery occlusion (BRAO), multifocal callosal micro-infarcts, and sensorineural hearing loss) of Susac’s syndrome in a female patient following COVID-19 infection. We report clinical examination data, particularly, eye examination data and neurological status with brain magnetic resonance imaging (MRI) results. Special attention was given to the diagnostic value of optical coherence tomography (OCT) in Susac’s syndrome, which allows detecting characteristic focal atrophic changes in the inner retina with a preserved structure of the photoreceptor layer. Identification of the typical neurological, ocular or otological symptoms should raise suspicion for the syndrome, which is critical for early administration of the systemic steroid therapy.

Value of morphological OCT changes in the posterior lens capsule in optimization of surgical treatment for posterior capsular cataracts

Nina Lutsenko — 2022-12-30

УДК 617.741-004.1-089.168-06-073.756.8

http://doi.org/10.31288/oftalmolzh2022639

Background: It is reasonable and important to optimize the diagnostic and surgical measures for faster visual rehabilitation of patients with posterior capsular cataract (PCC).

Purpose: To investigate morphological changes (as assessed by optical coherence tomography (OCT)) in the posterior lens capsule (PLC) in PCC, and to assess their value in the optimization of phacoemulsification for these cataracts.

Material and Methods: Of the 1780 eyes (1200 patients) with cataract examined, 512 eyes (28.8%) were diagnosed with PCC. Patients had OCT of the anterior segment (AS-OCT) and phacoemulsification. The morphological changes in the PLC as assessed by OCT, the course of surgical treatment and perioperative complications were reviewed.

Results: Three types of morphological changes in the PLC were identified. Type 1 changes were characterized by a clear PLC margin and found in 312 of the 512 eyes (61%). A posterior capsule-sparing phacoemulsification (i.e., with low power, vacuum and irrigation settings) was used only in 28% of eyes. In type 2 changes, the PLC margin was not uniform in reflectivity and thickness, but appeared clear at the retrolenticular space. Type 2 changes were found in 185 of the 512 eyes (36%). We refrained from hydrodissection in 95.1% of cases, used a posterior capsule-sparing phacoemulsification in 97% of cases and posterior capsule polishing in all cases of PLC with type 2 changes. Type 3 changes were characterized by PLC bulging into the retrolenticular space, and were found in 15 eyes (3%). A capsule rupture was observed in 53% of eyes with type 3 changes, although we used a posterior capsule-sparing phacoemulsification with viscodilation in these cases.

Conclusion: AS-OCT allows detailed assessment of morphological changes in the PLC and identification of three types of these changes. It is reasonable to take in account these facts when selecting a surgical treatment strategy.

Our experience of laser iridotomy in patients with chronic angle closure glaucoma

Rostyslav Lopadchak — 2022-12-30

УДК 617.7-007.681-036.12:617.721-089.85-085.849.19

http://doi.org/10.31288/oftalmolzh202261013

Background: Determining the strategy of surgical treatment for chronic angle closure glaucoma (CACG) is still important.

Purpose: To assess the efficacy, rates of successful intraocular pressure (IOP) lowering and the increase in anterior chamber angle for laser peripheral iridotomy (LPI) in patients with CACG.

Material and Methods: We examined 31 patients (31 eyes; 18 women and 13 men) who had undergone LPI for CACG. Patient age ranged from 49 to 77 years (mean age, 64.8 ± 5.3 years). The indication for LPI was an anterior chamber angle of Shaffer grade 2 to 3 and the presence of optic neuropathy. Mean Maklakoff intraocular pressure (IOP) was 23.4 ± 1.2 mmHg.

Results: Thirteen patients required surgery during the follow-up after LPI. Particularly, 10 eyes required phacoemulsification (PHACO) only, and 3 eyes, PHACO plus goniosynechialysis (GSL), because of decompensated IOP and an anterior chamber angle narrower than Shaffer grade 2 by gonioscopy. Kaplan-Meier survival analysis showed that the rates of successful IOP lowering for laser peripheral iridotomy (without the need for surgery, PHACO alone or PHACO plus GSL) at 12 months, 24 months and 36 months were 87.1%, 71.0% and 58.06%, respectively.

Conclusion: The LPI is effective for opening the anterior chamber angle and reducing IOP over 6 months, but is less effective and does not allow opening the anterior chamber angle over a period exceeding 6 months. The LPI may be considered as a preparatory procedure in CACG, particularly in the presence of an acute angle-closure glaucoma attack in the fellow eye.

Assessing factors of endothelial vascular dysfunction in patients with primary open-angle glaucoma

Adolat Dusmukhamedova — 2022-12-30

УДК 617.007.681-06:616.145.15/16-018.74

http://doi.org/10.31288/oftalmolzh202261418

Background: Glaucoma is a leading cause of visual disability and irreversible blindness worldwide, and significantly affects quality of life. An improvement in the early diagnosis and prevention of primary glaucoma has a special value due to increasing social significance of the disease.

Purpose: To investigate the value of the factors affecting vascular endothelium (oxidative stress, complement components and blood lipid profile) in patients with primary open-angle glaucoma (POAG).

Material and Methods: Ninety two patients (age, 65 to 80 years) with POAG and 30 controls (somatically healthy individuals of a similar age and no known eye disease) were included in the study. They underwent an eye examination including visual acuity, Maklakoff tonometry, non-contact tonometry, biomicroscopy, gonioscopy, and pachymetry. Plasma lipid peroxidation and antioxidant activity levels, blood lipid composition and blood C3 and C5a levels were assessed.

Results: Blood malondialdehyde (MDA) levels in patients with POAG were 87% higher compared to controls. Blood C3 levels in patients with POAG were 18% higher compared to controls. The C5a complement is a multicomponent plasma enzyme system that exhibits lysis and opsonization functions during activation. Blood C5a levels were 6 times higher in patients with POAG than in controls (13.86 ± 0.44 mg/scale division versus 2.33 ± 0.11 mg/scale division).

Conclusion: Increased C5a activity, hypersecretion of active oxygen species (in the presence of insufficiently efficacious antioxidant system of blood), and increased atherogenic plasma index (in the presence of low levels of high-density lipoproteins) are a mechanism of endothelial dysfunction in POAG. We found an imbalance between the prooxidant and antioxidant systems, abnormal composition of blood lipids (e.g., hypercholesterolemia and hypertriglyceridemia) and elevated C5a levels in patients with POAG.

Prognostic risk factors for diabetic retinopathy in patients with type 2 diabetes mellitus

Igor Alifanov — 2022-12-30

УДК 616.379-008.65-06:617.735-008.6-036.3-07-037

http://doi.org/10.31288/oftalmolzh202261923

Purpose: To establish a relationship of diabetic retinopathy with the presence of lesions of other target organs, disease severity and the requirement for insulin therapy in patients with type 2 diabetes mellitus, and to determine the most significant prognostic markers.

Material and Methods: We examined 270 patients (270 eyes) with type 2 diabetes mellitus. They were divided into the diabetic retinopathy group and no-diabetic retinopathy group. The status of diabetic target organs was determined as per endocrinologist’s, cardiologist’s, nephrologist’s, neurologist’s and vascular surgeon’s conclusions. Statistica v6.1 (Statsoft, Tulsa, OK) software was used for statistical analysis. The level of significance р < 0.05 was assumed.

Results: Diabetic retinopathy positively correlated with severe diabetes (r = 0.383, p < 0.001), insulin therapy requirement (r = 0.389, p < 0.001), diabetic nephropathy (r = 0.350, p < 0.001), chronic kidney failure (r = 0.390, p < 0.001), and lower-extremity angiopathy (r = 0.312, p < 0.001). In addition, the risk of diabetic retinopathy was high in patients on insulin therapy (odds ratio (OR) 6.1; 95 % СІ 3.40-10.93), patients with diabetic nephropathy (OR 17.34; 95 % СІ 4.94-60.83), chronic kidney failure (OR 6.88; 95 % СІ 3.66-12.94), lower-extremity angiopathy (OR 19.15; 95 % СІ 4.24-86.45), coronary heart disease (OR 2.4; 95 % СІ 1.21-4.76) and essential hypertension (OR 4.29; 95 % СІ 1.22-15.10). The risk of diabetic retinopathy was higher in patients with severe diabetes (OR 5.79, 95% CI 3.26-10.26) as compared to patients with mild to moderate diabetes.

Conclusion: The positive associations of diabetic retinopathy with chronic kidney failure, diabetic nephropathy and lower-extremity angiopathy were stronger than the positive associations with other diabetic target organs. In addition, there was a moderate positive correlation of diabetic retinopathy with severe diabetes and insulin therapy requirement. The association of diabetic retinopathy with acute coronary and cerebral events was not significant.

Ophthalmological involement and laboratory changes in patients with ANCA-associated vasculitis and polyarteritis nodosa

Oleg Iaremenko — 2022-12-30

УДК 617.7-02:616.13/14-002.151]-07

http://doi.org/10.31288/oftalmolzh202262429

Background. Ophthalmic involvement (OI) is an early manifestation of systemic vasculitis and may lead to blindness.

Purpose. Aim of the study was to identify the frequencies and patterns of OI in patients with ANCA-associated vasculitis (AAV) and polyarteritis nodosa (PAN) and evaluate the laboratory changes depending on OI.

Material and Methods. This work included retrospective study (112 patients with PAN and 80 patients with AAV) and prospective cohort study, which evaluated serum levels of endothelin-1 (ET-1) in 36 patients and 26 healthy сontrols.

Results. OI at diagnosis in AAV occurred 4 times more often compared to PAN and consisted of conjunctivitis/episcleritis (16% AAV patients), optic neuropathy (5% PAN patients), orbital mass, uveitis, scleritis, epiphora or dry eyes. OI was more commonly detected in PR3-ANCA(+) vs PR3-ANCA(-) patients. The levels of ET-1 were elevated in patients without OI compared with control group and patients with OI, but ability of ET-1 to differentiate such patients was poor.

Conclusion. The most common OI in patients with AAV was episcleritis. Optic neuropathy was the only manifestation of OI in patients with PAN. OI were more commonly detected in PR3-ANCA(+) vs PR3-ANCA(-) patients. The serum levels of ET-1 were significantly elevated in patients without OI compared with patients with OI and control group, but its diagnostic value was not approved in the ROC analysis.

INTRAOCULAR NEUROGENIC TUMORS IN ADULTS: MORPHOLOGICAL FEATURES AND THE PROBLEM OF DIAGNOSIS

Marianna Lytvynenko — 2022-12-30

УДК 617.741-004.1-089.168-06-073.756.8

http://doi.org/10.31288/oftalmolzh202263034

Background: The histological diagnosis of neurogenic tumors remains a challenge, which may be indicated particularly by the fact that new entities appeared in the new edition of the World Health organization (WHO) classification.

Purpose: To review the histomorphologic and immunohistochemic features of rare variants of neurogenic ocular (retinal) tumors in adults.

Material and Methods: Six rare ocular tumors were selected for the study from all clinical material submitted for pathohistological examination from 2017 to 2020 based on the presence of morphological evidence of neurogenic differentiation.

Results: The study sample of six rare neurogenic retinal tumors in adults was conventionally divided into three types: (1) retinal tumors immunohistochemically similar to cellular ependymoma, but histologically similar to retinoblastoma; (2) tumors showing no histological pattern characteristic for dictyoma, but the immunohistochemical features of neuroepithelial differentiation; and (3) tumors showing histological patterns similar to medulloepithelioma, but the immunohistochemical features of glial markers.

Conclusion: Obviously, when dividing these tumors into histogenetic groups, not only the histological structure and immunohistochemical profile, but also tumor location and typical patient age should be taken into account.

ХІРУРГІЧНА ТАКТИКА ПРИ РОЗПОВСЮДЖЕННИХ ЗЛОЯКІСНИХ ПУХЛИН РЕШІТЧАСТОГО ЛАБІРИНТУ

Fedir Ievchev — 2022-12-30

УДК 617.212.1:617.089.844

http://doi.org/10.31288/oftalmolzh202263538

Purpose: To assess the efficacy of exenteration of the orbit and sinus in the presence of the tumor of the ethmoidal labyrinth spreading to the eye.

Material and Methods: Sixty-two patients with a malignant tumor of the ethmoidal labyrinth spreading to the eye received surgery during 2017 through 2022. Of these, 42 (75.8%) were females and 20 (32.2%) were males, with patient age ranging from 55 to 75 years. Diagnostic assessment included computed tomography (CT) of the paranasal sinuses and orbit and tumor biopsy from the nasal cavity. Patients underwent a radical surgical procedure, an exenteration of the orbit and sinus. One month after surgery, they received preventive radiotherapy, with a dose of 40-45 Gy applied to the bed of the primary tumor.

Results: Intraoperative course was unremarkable, and no postoperative complications were found. All the patients (100%) showed no evidence of tumor recurrence or regrowth and no metastasis over a 6-month and 3-year follow-up.

Conclusion: A radical surgical procedure, an exenteration of the orbit and sinus followed by postoperative radiotherapy for a moderately differentiated tumor of the ethmoidal labyrinth spread to the orbit allowed achieving a positive treatment outcome, both in terms of local status (i.e., no tumor recurrence or regrowth) and disease process (no metastasis), over a 3-year follow-up in all the patients (100%). The decision of the extent of surgery should be made by a multispecialty team including an otorhinolaryngologist, eye cancer specialist and neurosurgeon.

Optic Neuritis or Inflammatory Optic Neuropathy: a review

Nataliya Moyseyenko — 2022-12-30

УДК 616.833.152-002

http://doi.org/10.31288/oftalmolzh202264449

According to the literature, there are two equivalent terms "optic neuritis" and "inflammatory optic neuropathy". Classification, pathogenesis and clinical manifestations are ambiguous. However, the growing interest in the problems of demyelinating and infectious diseases contributes to detailing the data on the mechanisms of certain forms of optic nerve inflammation.

Purpose. To study the current views on the pathogenesis of optic nerve inflammation.

Methods. The literature search in Ukrainian and foreign scientific sources was performed.

Modern diagnostic methods such as optical coherence tomography (OCT), magnetic resonance imaging (MRI), immunological and virological tests allow studying i) the role of factors, individual and in combinations, in the development of neuritis, ii) the changes in visual functions, iii) damage to individual structural elements of the visual system, and iv) recovery from the damage received.

Conclusion. The analysis of literature data on optic neuritis and/or inflammatory optic neuropathy showed a high topical interest of the scientific community. Further studies are likely to improve the current classifications of optic nerve inflammation and develop a differentiated approach to the treatment of optic nerve inflammation.

Heat exchange in the human eye: a review

Oleg Zadorozhnyy — 2022-12-30

УДК 617.7:612.5

http://doi.org/10.31288/oftalmolzh202265058

Thermal homeostasis is required in order to ensure that the normal function of the human body is maintained under various environmental conditions. Various pathological processes impacting metabolism in tissues and organs (e.g., the human eye) are accompanied by changes in relative internal heat balance. Although numerous relevant studies have been conducted, heat exchange processes in the human eye have not been yet sufficiently investigated. Further research on the features of heat exchange in the eye is required not only to improve our knowledge in the field of physiology of the eye, but also to use the data obtained for developing novel advanced techniques for eye disease diagnosis and treatment.

Clinical and ultrastructural changes in the rabbit retina at various doses and numbers of intravitreal melphalan injections

N.F. Bobrova — 2022-12-30

УДК 617.735-085.457.015.13-092.9

http://doi.org/10.31288/oftalmolzh202263943

Purpose: To assess clinical and ultrastructural changes in the rabbit retina and choroid with an increase in the dose and number of intravitreal melphalan (IVM) injections.

Material and Methods: Thirteen eyes of seven Chinchilla rabbits (age, 5–6 months; weight, 2.5–3 kg) underwent a clinical electron microscopy (EM) examination. Rabbit eyes were divided into five groups based on the dose and number of IVM injections given. Group 1 (4 eyes) received three 5-?g IVM injections; group 2 (2 eyes), two 10-?g injections; group 3 (2 eyes), two 20-?g injections; group 4 (3 eyes), two 30-?g injections; and group 5 (4 eyes), two 40-?g injections. The interval between IVM injections was one month. Enucleation was performed at week 4 after the last injection.

Results: In group 1, ophthalmoscopic changes in the retina (small isolated areas of mild depigmentation) stayed the same until the end of the observation period. On EM, some retinal pigment epithelium (RPE) cells showed signs of destruction, whereas others showed signs of compensatory-and-restorative processes. In addition, discs of the outer segments (OS) of photoreceptors showed pathological changes varying in severity. Other photoreceptor layers and retinal neural cells showed no ultrastructural changes. In group 2, fundus changes were more severe than in group 1, and somewhat increased in severity with each injection. There was EM evidence of significant pathology in RPE cells, extracellular edema in the photoreceptor layer, damage to the photoreceptor inner segments and OS, and focal necrosis of the neural tissue. In group 3, there was retinal pigment redistribution after the first injection, with an increase in the degree and area of depigmentation after subsequent injections. In addition, EM found RPE cells showing various pathological changes (e.g., as severe as destruction), pigment granules scattered throughout the retina, and retinal gliosis due to growth of hypertrophic M?ller cell processes. In groups 4 and 5, there were large regions of marked depigmentation which increased in area with each injection, becoming almost confluent, which resulted in a complete discoloration of the retina. In addition, EM found necrosis of RPE cells and photoreceptors and RPE cell debris in the inner retinal layers, and the outer and inner retinal layers were lost and replaced by glia. Ganglion cells exhibited signs of degenerative changes. The choroid showed almost complete loss of choriocapillaries with signs of destruction of choroidal vascular walls.

Conclusion: We demonstrated experimentally that repeated IVM injections at various doses did not affect media transparency and the structure of the anterior segment of the eye, and produced no general toxic effects on experimental animals. The clinical and ultrastructural changes in the retina depended on the dose of melphalan, with repeated 5-?g and 10-?g IVM injections being relatively safe and causing mild changes only in the outer retinal layers. Care should be taken when using IVM injections at larger (20-?g – 30-?g) doses, taking into account that toxic changes with various degrees of degeneration (e.g., as severe as gliosis of the retina and destruction of some choroidal capillaries) can develop due to poor blood supply to the retina and choroid.