Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

Antipsychotics are widely used in psychiatric practice for treating schizophrenia, bipolar disorder, and other diseases, including those treated off-label. They manifest many adverse effects, including ophthalmic ones. Some of these effects, such as persistent mydriasis, cycloplegia, extraocular muscle dystonia, and visual hypersensitivity attacks are reversible, since they disappear after dose reduction or drug withdrawal. Yet other side effects, such as cataracts, corneal edema, acute angle closure glaucoma and retinopathy are threatening for sight and may lead to permanent visual acuity decline and even blindness. The review provides data on the incidence of ocular side effects (both typical and atypical) of multiple antipsychotics, their clinical manifestations, pathogenesis and treatment. Eye examination is recommended for patients taking antipsychotics in the early periods of treatment and then twice a year. The psychiatrists need to know about the adverse effects of individual drugs whilst the ophthalmologists should be aware of their semiotics, pathogenesis and treatment, since timely diagnosis and treatment of pathological changes, together with antipsychotic therapy modification, prevent the development of severe and irreversible visual impairment in the majority of cases.

Bilateral phacoemulsification of cataract: the opinion of foreign ophthalmologists

Рurpose: to present the opinion of foreign ophthalmic surgeons on simultaneous bilateral phacoemulsification of cataract (SBPEC) by analyzing literature data. We performed an analysis of papers listed by Pubmed in 2000–2020 which contained expert assessments of SBPEC effectiveness based on polling. Ophthalmic surgeons were offered special questionnaires largely close in content, which were designed to establish the rating of factors that affected the respondents’ decision for or against the surgery. Our results indicate that, depending on the country, from 13.9 to 86 % of ophthalmic surgeons practice SBPEC, while from 14.0 to 67.2 % refrain from using this technology. The surveys revealed three major factors in favor of SBPEC — reduced number of clinical visits, the patient’s convenience during rehabilitation, and a high risk of complications after a second general anesthesia. The main factors against SBPEC are the risk of endophthalmitis (noted by 69–73 % of respondents), the absence of information on the postoperative refractive result in the first eye, which could determine the choice of the intraocular lens on the second eye (74–80 %), the risk of bilateral vision loss (73–79 %), as well as possible forensic problems (52–58 %).Conclusion. The surveying highlights certain negative factors that need to be overcome in order for SBPEC to become more widespread. Raising the awareness of SBPEC practice and approval by the ophthalmic community is essential for a sustainable culture change regarding this technology. To achieve this aim, standardization of the SBPEC procedure is needed, followed by the development of training manuals and protocols for surgical intervention.

Experimental Models of Glaucoma

Optic nerve pits are a mono- or bilateral congenital anomaly represented by optic disc depressions of various sizes. In half of the cases, the pits are complicated by edema, central retinal detachment and retinoschisis, and cause visual function decrease. Visual acuity losses can be either insignificant or pronounced. Optic discs pits have been investigated massively over the last century and a half, but their etiology is still underresearched. In recent years, however, due to the development of digital scanning and data processing technologies and the emergence of non-invasive highly informative diagnostic methods, it has become possible to reveal structural and functional changes of the optic disc in vivo, in addition to the traditional detection of histological changes in cadaveric eyes.Glaucomatous process modeling is one of the challenges in ophthalmology. And this is due primarily to the fact that, so far, the main reasons for the onset and progression of glaucoma. Numerous works on experimental research in its core model ocular. However, there are forms of glaucoma, which are independent of the level of intraocular pressure. Ideal model of glaucoma is considered a model with the development of the characteristic symptom in which a key symptom is a slowly progressive excavation of the optic nerve. But given the new knowledge in the pathogenesis of neurodegenerative changes in glaucoma in this model should be added and the opportunity to study the brain, vascular factors of progression, the level of neurotransmitters, trophic factors, etc. Therefore, we tried to make the analysis of models of glaucoma in various experimental animals and determine the most appropriate model for studying the pathogenesis of glaucoma.

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.

Treatment of macular diseases: an overview of key randomized clinical trials

Macular diseases are traditionally a serious issue in ophthalmology, which has great social impact due to widespread occurrence and significant vision loss, often irreversible. Over the past few decades, the possibilities for the diagnosis and treatment of pathologies of the retina and choroid have been significantly expanded. Randomized clinical trials provided ophthalmologists with valuable information on the natural course and treatment strategies of common retinal diseases from the viewpoint of evidence-based medicine. However, due to the large number of trials conducted, it is often difficult to make an adequate choice of data to be used in daily practice. In this review, we systematize the most valuable randomized clinical trials. To this end, we selected 42 randomized clinical studies conducted between 1979 and 2019 and focused on the treatment of age-related macular degeneration (AREDS 1, AREDS 2, ANCHOR, MARINA, PrONTO, CATT, IVAN, VIEW 1, VIEW 2, EVEREST II, PLANET, SEVEN-UP, ALTAIR, HAWK, HARRIER), choroidal neovascularization of multiple etiology (myopic, post-inflammatory, angioid-streak-related, etc. — RADIANCE, REPAIR, MYRROR, MINERVA), diabetic eye lesions (diabetic retinopathy and diabetic macular edema — ETDRS, DRCR.net Protocols B, I, S and T, RISE, RIDE, VIVID-DME, VISTA-DME, MEAD, FAME), retinal vein occlusions (BVOS, CVOS, SCORE-CRVO, SCORE-BRVO, BRAVO, CRUISE, GALILEO, COPERNICUS, VIBRANT), as well as retinopathy of prematurity (CRYO-ROP, ETROP, RAINBOW). The review summarizes the main results of these studies, which confirm the effectiveness and safety of such treatment methods as antiVEGF and photodynamic therapy, retinal laser photocoagulation, cryotherapy, corticosteroids and nutraceuticals from the viewpoint of evidence-based medicine. For greater clarity, we provide a table summarizing information on each of the randomized clinical trials considered.

Historical aspects and current views of the etiopathogenesis and clinical manifestations of optic nerve pits

Optic nerve pits are a mono- or bilateral congenital anomaly represented by optic disc depressions of various sizes. In half of the cases, the pits are complicated by edema, central retinal detachment and retinoschisis, and cause visual function decrease. Visual acuity losses can be either insignificant or pronounced. Optic discs pits have been investigated massively over the last century and a half, but their etiology is still underresearched. In recent years, however, due to the development of digital scanning and data processing technologies and the emergence of non-invasive highly informative diagnostic methods, it has become possible to reveal structural and functional changes of the optic disc in vivo, in addition to the traditional detection of histological changes in cadaveric eyes.

Preservative free travoprost and timolol fixed combination in the initial treatment of primary glaucoma: an assessment of hypotensive efficiency and safety

Purpose. To evaluate the efficacy and safety of Travapress Duo with respect to hypotensive results, changes in functional parameters, and adverse reactions. Material and methods. 30 patients aged 65–75 (averagely 71.3 ± 3.2 years) with a newly diagnosed primary open-angle glaucoma (POAG) received Travapress Duo in the evening, once a day. Goldman tonometry was performed during the screening, then 1 week, 1 month and 3 months from the treatment start. Static perimetry and optical coherence tomography (OCT) were performed before treatment and at the end of the 3rd month since the treatment start. Adverse events were recorded at each stage of the study.Results. As a result of a 3 month long therapy with Travapress Duo, a significant decrease in IOP was noted starting from the 1st week of instillations (by 34 %), after 1 month, by 35 % and after 3 months of observation by 36 %. By the end of the 3rd month of treatment, we noted an insignificant increase in visual acuity, a positive dynamic of the standard deviation and the standard deviation pattern, as well as OCT indicators, such as average thickness of the layer of retinal nerve fibers and the layer of retinal ganglion cells in the macula, stabilization of the thickness of the retinal ganglion cell complex layer and the size of the inner plexiform layer. One patient complained of discomfort and hyperemia by the end of the 1st week of drug instillation. No systemic side effects were noted during the follow-up, and in no case drug withdrawal was require. Conclusion. The preservative-free Travapress Duo drug displayed a high hypotensive efficacy, reducing the IOP to 36% of the initial value. The hypotensive effect was accompanied by indirect neuroprotection, which manifested itself in the positive changes observable in the results of functional studies with varying degrees of reliability. Travapress Duo is characterized by a low level of local side effects and can be recommended for both for the initial and long-term therapy of primary glaucoma of developed and advanced stages.

An experimental study of the wound healing effect of ophthalmic drug films with 6-methyl-3-(thietan-3-yl)uracil and methyluracil

Purpose: to study experimentally the wound-healing effect of ophthalmic drug films (ODF) with 6-methyl-3-(thietan-3-yl) uracil and methyluracil. Material and methods. The study involved 17 Chinchilla rabbits (34 eyes), whose corneas were histomorphologically studied after an experimental chemical acid burn and treatment. ODF with 6-methyl-3-(thietan-3-yl)uracil were deposited in the right eyes of 15 rabbits (15 eyes), and ODF with methyluracil — in the left eyes of these rabbits. Two rabbits served as control: their right eyes were left without wound healing therapy, while the left eyes received dexpanthenol 5 % gel (corneregel) 4 times a day. All animals were monitored daily for 21 days. The morphological changes in the cornea were recorded on the 2nd, 7th, 14th and 21st days after the experimental chemical burn.Results. The course of reparative processes of the chemical burns of the cornea was found to be different depending on the drugs used. Our results show that the ODF with methyluracil led to the resorption of the edema and the turbidity, as well as to a total closure of the desquamation sites of the corneal epithelium on the 7th day. With the ODF containing 6-methyl-3-(thietan-3-yl) uracil, the effect was achieved on the 14th day. In contrast to the control, ODF enhanced the growth and reproduction of cells, rapidly improved the trophism, and stimulated the regeneration process in damaged corneal tissues. ODFs produced no toxic reactions, such as destruction of the collagen framework, maceration, pronounced edema, and hyperemia. On the 21st day of observation, the microscopic picture of rabbit cornea showed the usual normal structure. Conclusion. ODF therapy with methyluracil and 6-methyl-3-(thietan-3-yl)uracil leads to accelerated centripetal epithelialization of corneal erosion, more structured and histologically correct restoration of the epithelial-stromal layer.

The role of optical coherence tomography angiography biomarkers in assessing the outcome of long-term anti-VEGF therapy of diabetic macular edema

The purpose of the study was to assess the changes of biomarkers of diabetic macular edema activity by optical coherence tomography angiography (OCTA) data and the relationship of these biomarkers with the response to anti-VEGF therapy during a two-year follow-up. Material and methods. The study included 59 patients (101) eyes, averagely aged 60.27 ± 9.50 years. The average number of intravitreal injections of aflibercept over the treatment period was 12.87 ± 3.50. The initial size of the foveolar avascular zone (FAZ) area — 0.37 ± 0.22 mm2 , and the acircularity index — 0.56 ± 0.14 remained unchanged after 5 months: 0.36 ± 0.24 mm2 and 0.56 ± 0.12, respectively, and being practically in the same level in 12 and 24 months. The large FAZ area, noted in the group where disorganization of retinal inner layers (DRIL) was observed (0.39 ± 0.21 mm2 ), correlated with a lower visual acuity (r = 0.67, p = 0.003). The acircularity index remained unchanged; no significant differences were found in the DRIL patient groups. After 5 loading injections, the average initial density of vessels in the macular region increased from 12.33 ± 3.86 mm to 12.75 ± 1.14 mm, after 1 year it was 13.48 ± 1.15 mm, after 2 years — 13.25 ± 3.39 mm. The average density of retinal perfusion increased at the 5th month from 29.81 ± 10.85 % to 31.55 ± 2.34 %, after 12 months to 32.91 ± 3.45, and by the end of the observation period to 31.41 ± 9.79 %. In the DRIL group, the baseline vascular density and mean perfusion volume were significantly lower: 11.17 ± 2.09 mm vs. 13.49 ± 1.14 mm and 28.40 ± 4.53 % vs. 31.20 ± 2.44 %). Conclusion. DRIL, a biomarker reflecting impaired capillary blood flow in the superficial capillary plexus and correlating with functional results, can be used as a predictor of antiangiogenic therapy effectiveness. After antiangiogenic therapy with DMO, the microcirculation indices (FAZ and acircularity) remained stable, and the vascular density and perfusion volume tended to increase, which testifies to the absence of ischemic damage.

A personalized approach to preclinical diagnosis and initial therapy of primary glaucoma based on a comprehensive structural and functional examination. A clinical case

The principles of personalized approach to early diagnosis and monitoring of primary glaucoma are shown by a clinical example. We analyzed the potentials of contemporary electrophysiological tests for preclinically diagnosing glaucoma optic neuropathy and monitoring drug treatment. For the first time, we demonstrated the experience of using a new fixed combination of brinzolamide + brimonidine by a clinical case from our practice. The test results confirm the hypotensive effect of the medication (IOP reduction by 36.2 %) so that it can be recommended for the treatment of patients with glaucomatous optic neuropathy and that combined with vascular pathology.