Modern concept of a new group of retinal vasculitis

Retinal vasculitis is a rare condition that occurs both in systemic severe diseases and as an adverse event of intraocular drug injections. With the emergence of new anti-VEGF drugs, a number of international authors report on the occurrence of retinal occlusive vasculitis, which led to a decrease in visual acuity. The review presents possible pathogeneses of this condition, approaches to its diagnosis and an algorithm for managing the patients with occlusive vasculitis.

Ozurdex in the lens is a rare complication of intravitreal injection (clinical case)

A clinical case of unintentional implantation of the Ozurdex dexamethasone implant (Allergan, Inc., Irvine, CA, USA) into the lens is presented. The patient was treated for a long time with intravitreal injections of Lucentis (5) and Ozurdex (4) in various clinics of the Russian Federation for recurrent macular edema associated with thrombosis of the n/temporal branch of the central retinal vein. After the last injection of Ozurdex, he noted a decrease in visual acuity. I applied to the Eye Surgery clinic after 5 months due to a significant decrease in visual acuity. After the examination, a cataract was diagnosed, an implant in the thickness of the lens. Phacoemulsification was successfully performed with the implantation of an intraocular lens into a capsule bag (UltraSert, Alcon). An attempt during the operation to preserve the Ozurdex implant and move it into the retrolental space failed, which was due to the long period of its stay in the eye and rapid hydrotation and destruction under the action of irrigation solution. High visual acuity was obtained. The optical coherence tomogram revealed complete relief of macular edema. Key words: Ozurdex®, intralenticular implantation Ozurdex®, complications of intravitreal injections, macular edema, iatrogenic cataract.

Surgical treatment of damage to the posterior capsule of the lens after laser vitreolysis

Damage to the posterior capsule of the lens after laser vitreolysis causes the formation of traumatic cataracts and a decrease in visual acuity. The search for surgical methods of treating such complications is relevant. Purpose. To develop and improve the technique of posterior capsulorexis during phacoemulsification and implantation of IOL combined with vitrectomy in the presence of an initial injury of the posterior lens capsule. Material and methods. Clinical case - a patient came to the clinic with complaints about a decrease in visual acuity and quality after laser vitreolysis performed in another clinic. Observed the damage of the posterior capsule of the lens. The operation was performed according to the developed technique. Results. A method of primary posterior capsulorexis during phacoemulsification and implantation of IOL after vitreolysis, combined with vitrectomy, is proposed. Achieved high visual acuity after the operation, OD=1.0. Conclusions. 1) The developed technique of primary posterior capsulorexis is safe and allows partially preserving the posterior capsule of the lens, while forming a «window» in the area of damage, and implanting the IOL into a capsule bag. 2) The installation of scleral ports during primary posterior capsulorexis makes it possible to successfully combine this operation with vitrectomy and prevent the displacement of lens fragments to the fundus. Key words: сataract, posterior capsulorexis, laser vitreolysis, phacoemulsification, pseudophakia, IOL, vitrectomy, vitreous body.

Corneal collagen crosslinking in a child with keratoconus

This clinical case describes medical history of the patient who came to the clinic with complaints of progressive decrease in visual acuity and intolerance of spectacle correction. In the following article all methods of diagnostic are fully described. We are also mentioning and discuss aspects of modern methods of diagnostic and treatment of keratoconus in children such as corneal collagen crosslinking. Key words: keratoconus, keratoconus in children, corneal collagen crosslinking.

Ocular form of pituitary tumor Hirsch (Presse med., 1926, № 37)

Hirsch (Presse med., 1926, No. 37) based on 100 operated cases of pituitary tumors, distinguishes, in addition to the commonly mentioned forms, acromegalic and pituitary obesity the ocular form (la forme oculaire). This syndrome is characterized by visual disturbances without significant changes In patients, a decrease in visual acuity and a narrowing of the field of vision are found.

Sorsby Pseudoinflammatory Fundus Dystrophy, North Carolina Macular Dystrophy, and Occult Macular Dystrophy; Pathophysiology, Findings, Diagnosis, and Treatment

In this review, Sorsby's pseudoinflammatory fundus dystrophy, North Carolina macular dystrophy, and occult macular dystrophy, which can lead to a decrease in visual acuity in both eyes, are discussed. The current pathophysiology, findings, diagnosis, and treatment of these diseases, which are rarely seen in our country, are discussed.

Relationship between Higher Order Aberrations and Astigmatism in Hyperopic Amblyopia

Aim. To study the dynamics of changes in the values of higher order aberrations in amblyopia treatment and the correlation between higher-order aberrations and astigmatism in patients with hyperopic amblyopia.Methods. This cohort prospective study included 36 patients (36 eyes) with refractive amblyopia aged 4 to 16 years. All patients had anisometropia: emmetropia in one eye and hyperopic astigmatism combined with refractive amblyopia of varying degrees in the other eye. Patients were divided into two groups depending on the degree of astigmatism. Astigmatism greater than 1.5 D was detected in 20 patients (55.5%) and astigmatism less than 1.5 D was detected in 16 patients (44.5%). All patients underwent a complex treatment, including twenty half-hour sessions of videocomputer autotraining using “Amblyotron” device during 20 days, in addition to constant wearing of glasses. Higher order aberrations were measured using the WaveScan Wavefront System aberrometer at the first visit and at 3-, 6 - and 12-month follow-up. A correlation analysis was performed to assess the relationship between higher order aberrations and astigmatism.Results. There was a statistically significant difference in treatment success between groups with high and low astigmatism. In both groups, higher order aberrations were reduced during the treatment of amblyopia. When comparing the two groups, a significant difference in coma was found at 12-month follow-up (p = 0.043). At 12-month follow-up, coma showed a statistically significant correlation with astigmatism, and a stronger correlation with astigmatism was found in the group of patients with high astigmatism.Conclusions. In patients with refractive amblyopia associated with astigmatism, the decrease in visual acuity is directly dependent on the values of higher-order aberrations, especially on the values of coma, which should be considered as the cause of the development of amblyopia.

Vision impairment as the first symptom of encephalomyelitis in a paediatric patient

An 8-year-old boy was admitted to the Ophthalmology Department due to a vision impairment with an accompanying decrease in visual acuity and bilateral optic disc oedema. As a result of interdisciplinary diagnostics, acute disseminated encephalomyelitis, probably related to preceding infection, was diagnosed.

Photoablation with riboflavin as an alternative to the application of Mitomycin-C in excimer laser corneal surgery

Purpose. To substantiate the advantages of photoablation with riboflavin as an alternative to the use of Mitomycin-C in excimer laser surgery of the cornea. Material and methods. The work is based on clinical observations of the results of 598 photorefractive and phototherapeutic operations. In all cases, keratoablation was performed after drip, aerosol, or combined saturation of the stroma with 0.1% or 0.25% isotonic riboflavin solution. Corneal OCT was performed on RTVue 100 and RTVue XR100 devices. Keratotopographic and densitometric studies were performed on a TMS-5 device. Results. With photokeratoablation of the stroma saturated with riboflavin, the response aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome decreased. In densitometry and OCT studies, an increase in optical density was noted with the formation of a membrane structure on the ablation surface and the effect of cross-linking in the stromal layers adjacent to the ablation zone. Shielding of induced secondary radiation by riboflavin and the formation of a Bowman-like membrane structure made it possible to avoid the development of an irreversible form of fibroplasia and a decrease in visual acuity. The formed membrane structure with cross-linking in the underlying stromal layers was a barrier between pro-inflammatory epithelial and stromal cytokines, which predetermine the development of fibroplasia during photokeratoablation. Conclusion. Photokeratoablation with riboflavin prevents the development of an irreversible form of fibroplasia and can be considered as an alternative to the use of Mitomycin-C in photorefractive and phototherapeutic operations on the cornea by radiation from an argon-fluorine excimer laser. Key words: Mitomycin-C, riboflavin, fibroplasia, excimer laser corneal surgery, laser-induced crosslinking.

Laser treatment of the anterior capsulorhexis shrinkage syndrome in patients with pseudophakia

The article describes results of laser treatment applied in seven patients (eleven eyes) due to capsulorhexis margin shrinkage and the subsequent wrinkling of the anterior capsule in eyes with pseudophakia. Almost total loss of the anterior capsulorhexis aperture caused a significant decrease in visual acuity, to the level of counting fingers right in front of the eyes in three patients (four eyes). The laser cut of the anterior capsulorhexis margin using the Nd-Yag laser led to an immediate increase in the capsulorhexis size in each case. Visual acuity improved in the eyes with an extreme decrease in the capsulorhexis size. In the remaining eyes, where the decrease of the capsulorhexis size did not lead to the appearance of anterior capsule wrinkling, visual acuity did not change. The progressive decrease in the capsulorhexis size, accompanied by the appearance of white tissue on its margin, containing shrinking elements, constitutes an indication for the implementation of laser therapy.