[Structural and functional features of the eye in Marfan syndrome. Report 2. Changes in the anatomical complex of the lens]. / Strukturno-funktsional'nye osobennosti glaza pri sindrome Marfana. Soobshchenie 2. Izmeneniya anatomicheskogo kompleksa khrustalika.

Analysis of lens changes in Marfan syndrome (MS), in addition to assessing the position of the lens itself, should include the possibility of examining its supporting and accommodative components (ciliary zonule and ciliary body), or what can be called the entire anatomical complex of the lens. Optical methods of studying the structures of the anterior segment of the eye, due to iris opacity, allow only to analyze the state of the lens within the natural or medically enlarged pupil width. Visualization of the structures located behind the iris is possible with the use of radiation diagnostic methods, in particular ultrasound biomicroscopy (UBM). PURPOSE: This study assesses the state of the anatomical complex of the lens in MS using UBM. MATERIAL AND METHODS: The study was carried out on clinical material previously used by us to analyze changes in the fibrous membrane of the eye in MS. At the first stage, the main (19 patients with MS, 38 eyes) and the control (24 patients with myopia, 48 eyes) groups were formed for comparative evaluation. The formed groups were standardized according to the age of the patients and the axial length of the eye. At the second stage, patients with MS were divided into subgroups depending on the absence or presence of biomicroscopic signs of ectopia lentis (22 and 16 eyes, respectively). For UBM, an ultrasound linear sensor with a scanning frequency of 50 MHz was used (Aviso device, Quantel Medical, France). Various biometric UBM indicators were determined: lens thickness, diameter of the lens, lens-axial length factor, iris-lens angle, iris-lens contact distance, posterior chamber depth, length of the fibers of ciliary zonule, thickness of the ciliary body, sclera-ciliary process angle. RESULTS: There are changes in the anatomical complex of the lens as a whole in MS (in the lens itself, the ciliary zonule, and the ciliary body), which are characterized by an increase in lens thickness and a decrease in the diameter of the lens, an increase in the length of the fibers of the ciliary zonule and a decrease in the thickness of the ciliary body. At the same time, the displacement of the lens detected by optical biomicroscopy (ectopia lentis) can be considered as an advanced stage of changes in the anatomical complex of the lens. CONCLUSION: UBM provides the possibility of full-fledged visualization of all components of the anatomical complex of the lens in terms of both diagnostics, and monitoring of changes in MS. The question of the advisability of including this method in the algorithm for diagnosing ocular manifestations in order to verify the MS remains open. Possible obstacles may be, on the one hand, related to the need for special and expensive equipment, and on the other hand, the absence of a generally accepted «normal¼ values of UBM indicators of the anatomical complex of the lens.

[Hemangiomas of the optic nerve head]. / Gemangiomy diska zritel'nogo nerva.

The article presents five cases of various forms of hemangiomas of the optic nerve head (ONH) and juxtapapillary retina that were monitored and analyzed using ocular visualization methods. The obtained data allowed a conclusion that capillary hemangioma of the ONH features clearly-seen boundaries of the lesion both on ophthalmoscopy and optical coherence tomography (OCT) images; on the other hand, juxtapapillary granuloma can be characterized by blurred outlines on ophthalmoscopy and a gradual transition of the altered retina on OCT images with secondary changes seen in the macular area. When comorbid, capillary hemangioma of the ONH and retina feature a combination of these visualization signs.

[Changes in ocular hemodynamics in patients recovered from COVID-19]. / Oftal'mogemodinamicheskie narusheniya posle perenesennoi koronavirusnoi infektsii, vyzvannoi virusom SARS-CoV-2.

PURPOSE: To evaluate the severity of hemodynamic changes in the ocular vessels of patients recovered from COVID-19. MATERIAL AND METHODS: The study included 44 patients (88 eyes) aged 28-60 years, among them 24 (54.5%) women and 20 (45.4%) men, with SARS-CoV-2 infection confirmed by PCR no more than 2 months prior to enrollment and with no ophthalmological complaints within 2 months before the disease, as well as 20 healthy volunteers (40 eyes). At the time of the study all patients had a negative PCR result for SARS-CoV-2. The patients were divided into 2 groups. The first group comprised 24 patients who did not take any anticoagulants during the treatment. The second group consisted of 20 patients who received anticoagulants (Rivaroxaban (Xarelto)) at a dosage of 10 mg per day for 1-1.5 months. The maximum systolic (Vs), end-diastolic (Vd) blood flow velocity, as well as resistance index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were measured in all study patients with the ultrasound imaging system VOLUSON E8 Expert («Kretz¼, USA). Additionally, the flowmetry method was used to assess the volumetric ocular blood flow (VOBF) on Ocular Blood Flow Analyzer system («Paradigm Medical Industries, Inc.¼, USA). RESULTS: In the first group, a decrease in Vs and Vd was noted amid a significant increase of RI in CRA and SPCA, as well as an increase of RI in OA compared with the age-normal values (p<0.05). In the second group, a decrease in Vs and Vd was noted amid a significant increase of RI in CRA, as well as a decrease in Vs in SPCA and an increase of RI in OA relative to the age-normal values (p<0.05). A decrease in VOBF was noted in the first group in comparison to the second group and the age norm (p<0.05). CONCLUSION: Blood flow velocity parameters in the ocular vessels are reduced in patients recovered from COVID-19 compared to the age-normal values. There was a significant decrease in volumetric ocular blood flow parameters in COVID-19 patients who did not take any anticoagulants compared to the age-normal values. Anticoagulants intake has a positive impact on hemodynamic characteristics in the ocular vessels and volumetric ocular blood flow in patients with COVID-19.

[Ophthalmological manifestations of post-COVID-19 syndrome]. / Oftal'mologicheskie proyavleniya postkovidnogo sindroma.

The review presents data on damage to the organ of vision in patients recovered from the new coronavirus infection reflecting on the results obtained by various researchers from examining patients with varying severity of the disease, both during the active stage and after recovery. Possible ways of transmission of the infectious agent into the organ of vision were analyzed. The most common ocular manifestation of COVID-19 is conjunctivitis, while lesions of the retina and optic nerve were noted less often. The article also outlines the strategy for treatment and describes infection prevention measures for doctors and patients.

[Differential diagnosis of age-related macular degeneration and choroidal tumor (a clinical case)]. / Differentsial'naia diagnostika vozrastnoi makuliarnoi degeneratsii i novoobrazovaniia khorioidei (klinicheskoe nabliudenie).

Differential diagnostics of age-related macular degeneration and choroidal tumor is a challenging task for ophthalmologists. Difficulties arise on various stages during establishing the diagnosis: when interpreting ophthalmoscopic picture, or when evaluating the results of visualization methods. The article describes a clinical case of differential diagnostics of age-related macular degeneration and choroidal tumor. The difficulties emerged when interpreting results of ultrasound examination. Optical coherence tomography helped exclude choroidal tumor.

[Ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome (a clinical case study)]. / Tromboticheskaia mikroangiopatiia glaza pri atipichnom gemolitiko-uremicheskom sindrome (klinicheskoe nabliudenie).

The article presents a clinical observation of ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome - a rare genetic disease characterized by systemic thrombosis caused by uncontrolled activation of alternative complement pathway. A typical manifestation of this ocular lesion in this disease is bilateral Purtscher-like retinopathy. Timely diagnostics of atypical hemolytic-uremic syndrome, including ophthalmologic examination, determines the early start of a highly effective pathogenetic therapy with complement inhibitor eculizumab.

[Effects of blood flow properties on ocular hemodynamics].

AIM: to study the effects of blood rheology on ocular blood flow (OBF) parameters and estimated individual normal range of intraocular pressure (IOP). MATERIAL AND METHODS: A total of 15 patients (15 eyes) taking warfarin were enrolled. Volumetric parameters and linear velocity of OBF under warfarin treatment and after its cessation were obtained by means of flowmetry (Paradigm's Blood Flow Analyzer) and color Doppler flow mapping (Voluson 730), respectively. On the basis of flowmetry results an individual normal range of IOP was calculated in all patients. RESULTS: Pulsatile OBF does not appear to correlate with warfarin-induced changes in blood rheology (p = 0.09), however, depends on IOP fluctuations (p = 0.02). Resistance index of retinal vessels is found to rise significantly with increasing blood viscosity (p < 0.05). CONCLUSION: The use of warfarin, an indirect thrombin inhibitor, has no effect on estimated individual normal range of IOP, which is crucial for glaucoma diagnosis and monitoring.

[Ocular blood flow and carotid artery malfunction].

AIM: to evaluate ocular hemodynamics and informativity of estimated individual normal range of intraocular pressure (IOP). MATERIALS AND METHODS: A total of 12 patients (22 eyes) with carotid artery malfunction were examined. Ocular blood flow (OBF) and IOP were measured with Ocular Blood Flow Analyzer. Actual OBF was then compared with what is considered normal for a given axial length (AL). Individual normal range of IOP was calculated according to an original formula (described in previous publications). Doppler imaging of ocular vessels enabled blood flow velocity measurement. Morphological parameters and functional status of the retina and optic nerve were judged on automated perimetry (Octopus 900) and optical coherence tomography (Cirrus HD-OCT) findings. Statistical analyses were performed using Statistica 10 software. RESULTS: Generally, OBF showed no correlation with the grade of carotid artery stenosis (p < 0.05), however, was significantly reduced as compared to its AL-dependent norm in patients with greater than 85% narrowing of the internal carotid artery, which can cause misestimating of their individual normal range of IOP. A negative relationship was established between the blood flow velocity in short posterior ciliary arteries and the grade of internal carotid artery stenosis (p < 0.005). Ocular blood flow deficit relative to the AL-dependent norm correlated with ophthalmic artery resistance index. CONCLUSION: OBF-based estimation of individual normal range of IOP is inexpedient in patients with greater than 80% carotid artery stenosis due to its possible influence on ocular hemodynamics. In most cases of less than 80% carotid artery stenosis OBF is adequate or slightly reduced as compared to its AL-dependent norm and thus, has no significant impact on estimated individual normal range of IOP.

[Results of regional ocular hemodynamics examination in patients with vitreous hemorrhage].

150 patients were examined to study ocular hemodynamics in vitreous hemorrhage. 64 patients had diabetes mellitus associated vitreous hemorrhage and 86 patients had hypertension background. Besides routine ophthalmological examination color Doppler mapping of ocular vessels and evaluation of hemorrhage volume and acoustic density in 3D mode were performed. Hence hemorrhage volume was found to have correlation with diastolic blood flow velocity in central retinal artery (CRA), systolic and diastolic blood flow velocities in CRA were showed to be reduced in vitreous hemorrhage.

[Differentiation of concomitant glaucomatous optic neuropathy in optic disc drusen].

Characteristics of ocular blood flow (OBF) in primary open-angle glaucoma (POAG) in eyes with optic disc drusen have been investigated. The study enrolled 21 patient (35 eyes) with optic disc drusen, of which 7 (8 eyes) were diagnosed with POAG. Besides the standard tests, the ophthalmological assessment included evaluation of OBF (flowmetry) and an individual normal range of intraocular pressure (IOP). The results showed that optic disc drusen are not associated with OBF changes. Concomitant POAG might be suspected in a patient with optic disc drusen whose OBF is significantly decreased and IOP is above the individual normal range. Differentiation of morphofunctional changes in chronic optic neuropathy, which might be due to either glaucomatous optic neuropathy or optic disc drusen, is complicated when actual IOP lies within the average normal range. Ocular blood flow evaluation by means of flowmetry with calculation of an individual normal range of IOP has been demonstrated as a highly effective predictor of concomitant POAG in patients with optic disc drusen.

[Peculiarities of ocular blood flow in ischemic optic neuropathy and normal tension glaucoma].

Characteristics of ocular hemodynamics in ischemic optic neuropathy (ION) outcome and normal tension glaucoma (NTG), the conditions that are difficult to be differentially diagnosed, have been investigated. The study enrolled 32 patients (40 eyes) with ION outcome, 26 patients (46 eyes) with NTG, and 20 patients (32 eyes) with no ocular pathology. Besides the standard ophthalmological examination, color Doppler imaging of ocular vessels, evaluation of ocular blood flow volume and individual normal range of intraocular pressure (flowmetry) were performed in all cases. The results showed that an excess of the actual intraocular pressure (IOP) over the individual normal range was much higher in patients with NTG than in patients with ION (39% and 14.5% correspondingly). It was also found that NTG is associated with a more significant decrease of ocular blood flow volume (30.1% in average) in comparison to ION outcome (11%). In both conditions a decrease in velocity parameters of the blood flow in main ocular vessels was registered, however, ocular hemodynamics changes appeared to be more severe in patients with glaucomatous optic neuropathy. A statistically reliable correlation between volumetric and velocity parameters of ocular blood flow has been discovered.

[Hemodynamic changes in myopia of different degrees].

A total of 78 patients (143 eyes) with low, medium and high degree myopia were assessed. Apart from standard ophthalmological tests, flowmetry and duplex ultrasound of ocular vessels were performed in all cases to evaluate volumetric and velocity parameters of ocular blood flow in relation to the length of anterior-posterior axis and the degree of myopia. It is found that both parameters of regional blood flow progressively decrease as the anterior-posterior axis increases.

[Morphological and functional features of vitreous].

The structure of vitreous is discussed in the article. Its morphologic characteristics are described with consideration of topography and structural features. General vitreous anatomy and its distinct compartments are highlighted. Native and foreign literature concerning biological, biochemical and biophysical properties is analyzed. The value of vitreous developmental and structural features in pathogenesis of some pathologic conditions is estimated The parameters of distinct analyzed characteristics essential to form spatial sonographic image are shown.

[Characteristics of vitreous structure in rhegmatogenous hyaloid membrane detachment].

Special characteristics of volumetric acoustic digital images of different vitreous and hyaloid membrane changes were studied based on the analysis of results of ultrasound spatial examination of young healthy adults (30 patients) and patients with posterior hyaloid membrane detachment (329 patients). Morphological features of vitreous are presented considering topography and its acoustical structure. Spatial characteristics of planar and volumetric images are determined, special acoustic signs are revealed for normal vitreous and in different changes of posterior hyaloid membrane. These presentations are compared with earlier characterized changes of detached hyaloid membrane. Structural changes of vitreous resulted from posterior hyaloid membrane rapture after blunt trauma or total lens dislocation are estimated.

[Efficacy of enzyme treatment in patients with haemophthalmos].

70 patients with haemophthalmos in arterial hypertension were examined using ultrasonography for estimation of blood area in the vitreous and for treatment efficacy evaluation. Enzyme treatment with collalizine periocular injections was performed in combination with conventional resorption therapy. The efficacy of complex resorption treatment of haemophthalmos is proved.

[Three-dimensional echography in the diagnosis of hemophthalmia].

Ultrasound study involving three-dimensional echography was made in 250 patients aged 25 to 70 years who had vitreous body hemorrhage of varying etiology. Three degrees of acoustic hemophthalmia density: 1) low (from 5 to 25 MG); 2) moderate (from 25.1 to 40 MG); 3) high (from 40.1 to 55 MG or higher). According to the extent of a pathological focus, the authors identified total hemophthalmia (from 50 to 100% of the volume of the vitreous body) that is equal to a volume of 2.61 cm3 or more; disseminated hemophthalmia (from 25 to 50% of the volume of the vitreous body) that corresponds to a volume of 1.31 to 2.6 cm3; partial hemophthalmia (up to 25% of the volume of the vitreous body) to a volume of 0.1 to 1.3 cm3. Three-dimensional echography makes it possible to measure the extent of intraocular hemorrhage, its acoustic density, to define criteria for evaluating the severity of intraocular hemorrhage, and to assess the risk of retinal detachment.

[Role of pentoxifylline retard dosage forms in the correction of hemodynamic disorders in retinal venous occlusion and diabetic retinopathy].

The investigation was undertaken to study the effect of the pentoxifylline retard dosage form Vasonit on ocular hemodynamics in patients with retinal vein occlusions and non-proliferative diabetic retinopathy (DR). Forty-two patients aged 45 to 75 years, including 20 patients (20 eyes) with retinal vein occlusion in the presence of hypertensive disease and atherosclerosis (Group 1) and 22 patients (44 years) with non-proliferative DR (Group 2), were examined. All the patients received the pentoxifylline retard dosage form Vasonit, 600 mg twice a day, for 2 months. After a course of pentoxifylline therapy, the patients were observed to have improved visual functions, positive clinical changes in the fundus of the eye as a reduction in the frequency and extent of retinal hemorrhages, in the degree of manifestations of macular edema, in the number of retinal microaneurysms and ischemic areas. The results of color Doppler mapping of ocular and orbital vessels are indicative of improved hemodynamics as an increase in the values of blood flow velocity and normalization of blood flow resistance and pulsation indices in the arteries supplying blood to the retina and optic nerve.

[Hemophthalmia in patients with hypertensive disease].

A hundred patients with hemophthalmia were examined by ultrasound B-scanning to estimate the volume of the blood that had bled into the vitreous body and to check up the efficiency of conservative treatment. The latter used the enzyme collalysine as parabulbar injections in combination with resolving therapy. There is evidence that complex resolving therapy is an effective treatment of hemophthalmia.

[Hemophthalmos in patients with diabetes mellitus]. / Gemoftal'm u bol'nykh sakharnym diabeteom.

A total of 110 patients with diabetes mellitus with intraocular hemorrhages were examined using computer densitometry of ultrasonic beta-scanograms of the eyes. Indications for various treatments were determined and the outcomes of hemophthalmia predicted, depending on its topography, intensity, and volume of blood released into the vitreous. Hemorrhages were located mainly in the posterior segments of the vitreous body in diabetics with hemophthalmia. High efficiency and good prospects of using objective methods of computer analysis of beta-scanograms for evaluating the status of the vitreous and extending the diagnostic potentialities of modern ophthalmology are shown.

[The enzyme therapy within a complex treatment of hemophthalmos in patients with diabetes mellitus]. / Fermentoterapiia v kompleksnom lechenii gemoftal'ma u bol'nykh sakharnym diabetom.

The efficiency of the enzyme therapy was studied in patients with hemophthalmos concurrent with diabetes mellitus of different types. Sixty-eight patients received parabulbar injections of the hemase and collelizin enzymes and another 25 patients underwent the routine therapy comprising injections of dicynone, emoxipin and heparinum. The method of ultrasound B-scanning was used to determine the area of hemorrhage spread into the vitreous body. A high efficiency of the enzyme therapy, as used within the complex treatment of hemophthalmos in patients with diabetes mellitus, was demonstrated. Ultrasound B-scanning is a highly informative technique in evaluating the enzyme-therapy efficiency. The enzyme therapy can be recommended as the most effective method for the treatment of hemophthalmos in patients with diabetes mellitus.