[Summary of the 2023 European Society of Cardiology clinical guidelines on the management of cardiovascular disease in patients with diabetes mellitus].

The prevalence of cardiovascular diseases (CVDs) is well known. According to the World Health Organization (WHO), almost 18 million people die from CVDs worldwide every year, accounting for 31% of all causes of death [1]. CVDs often develop concomitantly with diabetes mellitus (DM), with approximately 20% of cardiovascular deaths attributed to elevated blood glucose levels [2]. Notably, CVDs are the leading cause of death among patients with type 2 diabetes (T2DM). Based on data from the Federal Register of Diabetes 2022 in Russia, chronic heart failure was the direct cause of death in 24.2% of T2DM cases, followed by acute heart failure (13.1%), cerebrovascular events (10.0%), and myocardial infarction (3.7%) [3].The pathophysiological interplay between atherosclerotic cardiovascular disease and DM has led to a situation where cardiologists are increasingly involved in the treatment of patients with DM, while endocrinologists are encountering a growing number of patients with CVDs. This association has become so apparent that in a recent article published in the European Journal of Cardiology, Yu. Braunwald speculated about the emergence of a new subspecialty - diabetocardiology [4]. Unfortunately, experts predict that the global number of diabetic patients will reach 783 million [5].Recent data on the CV benefits of certain hypoglycemic drugs (primarily, certain SGLT2 inhibitors, several GLP-1 receptor agonists, and a novel non-steroidal mineralocorticoid receptor antagonist finerenone) prove the need for a unified interdisciplinary approach to managing CVDs and DM.Given the importance of integrated and coordinated efforts in managing patients with CVD and DM, the Task Force of the -European Society of Cardiology (ESC) updated, formulated, and published clinical guidelines on the treatment of CVD in diabetic patients in 2023 [6]. This article provides a concise overview of the key provisions outlined in the guidelines.

[Primary hypothyroidism and postmenopause as the causes of delayed diagnosis of panhypopituitarism in a patient with nonfunctional pituitary adenoma].

Hypopituitarism is a state of complete or partial deficiency of pituitary hormones, including adrenal insufficiency, hypothyroidism, hypogonadism, growth hormone deficiency, and, rarely, diabetes insipidus.The article describes a clinical case of hypopituitarism due to a pituitary tumor in a postmenopausal woman. Difficulties in diagnosing hypopituitarism were due to a history of primary hypothyroidism. The first identified component of panhypopituitarism in the patient, (central hypothyroidism) had previously been seen as laboratory indications of medication-induced hyperthyroidism.The non-specific nature of the clinical symptoms, as well as a relatively rare combination of endocrine diseases, led to a long examination period and delayed diagnosis of the pituitary tumor.Whether the development of hypopituitarism in a patient with a nonfunctional pituitary tumor is an indication for transsphenoidal pituitary surgery remains a controversial issue. The decision for surgery is made taking into account the characteristics of the course of the disease in a particular patient. In this clinical case, a conservative tactic was chosen with hormone replacement therapy for glucocorticoid and thyroid deficiency.

[Energy load and state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification]. / Énergeticheskaia nagruzka i sostoianie éndoteliia rogovitsy pri gibridnoi (femtolazernoi) i torsionnoi fakoémul'sifikatsii.

Postoperative state of the corneal endothelium is the most important criterion for evaluating the safety of cataract phacoemulsification. PURPOSE: To compare the intraoperative energy load and postoperative state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification. MATERIAL AND METHODS: The study analyzed surgical outcomes of 603 patients (714 eyes) divided into 3 groups: 225 patients (267 eyes) underwent modified femtosecond laser-assisted phacoemulsification (1st group), 237 patients (278 eyes) underwent standard femtosecond laser-assisted phacoemulsification (2nd group), and 141 patients (169 eyes) who underwent torsional phacoemulsification (3rd group). The follow-up period lasted up to 2 years. RESULTS: In patients with grade II lens density (here and further - L. Buratto classification is used), effective ultrasound time was 0.56±0.11 s in the 1st group, 0.83±0.17 s in the 2nd group, and 2.78 ± 0.51 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade III lens density effective ultrasound time was 2.04±0.37 s in the 1st group, 2.97±0.53 s in the 2nd group, and 4.59±0.91 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, effective ultrasound time was 3.95±0.81 s in the 1st group, 5.11±1.03 s in the 2nd group, and 8.37±1.73 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade II lens density, loss of endothelial cells was 3.3±1.1% in the 1st group, 3.7±1.2% in the 2nd group, and 4.3±1.2% in the 3rd group (p(1-2)>0.05; p(1- 3)<0.05; p(2-3)<0.05). In patients with grade III lens density, loss of endothelial cells was 5.1±1.4% in the 1st group, 5.7±1.5% in the 2nd group, 7.2±1.7% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, loss of endothelial cells was 8.9±2.1% in the 1st group, 10.1±2.3% in the 2nd group, and 13.3±2.5% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2- -3)<0.05). CONCLUSION: Both techniques of femtosecond laser-assisted phacoemulsification significantly reduce the effective ultrasound time (p<0.05) and the degree of corneal endothelial cells loss (p<0.05) compared with torsional phacoemulsification.

[Prevention of intraoperative miosis in femtosecond laser-assisted phaco surgery]. / Preduprezhdenie intraoperatsionnogo mioza v fakokhirurgii c primeneniem femtosekundnogo lazera.

INTRODUCTION: Prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification is a relevant problem of cataract surgery. PURPOSE: Development and clinical study of an effective method for preventing intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification. MATERIAL AND METHODS: Hybrid phacoemulsification was performed in 300 patients (300 eyes). The first group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day and 3 times in 2 hours before surgery at 30 minute intervals. The second group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day, 3 times in 2 hours before the surgery at 30 minute intervals, and 1 hour before the surgery an additional intramuscular injection of diclofenac. The third group (control, 100 eyes) 2 hours before the operation was prescribed instillations of 0.1% indomethacin, 3 times at 30 minute intervals. The diameter of the pupil was evaluated before the beginning of femtosecond laser stage and before the opening of anterior chamber during the second stage of the operation. RESULTS: When the interval between the femtosecond laser stage and emulsification of the nucleus fragments was maintained at less than 15 minutes, pronounced decrease of the pupil (more than 2 mm) was noted in 8.2% of cases in the first group, 6.7% in the second group and 14.1% in third (control) group; mean values of pupil narrowing were 0.68±0.27 mm in the 1st group, 0.63±0.25 mm in the 2nd group, and 0.93±0.39 mm (p<0.05) in the third group. CONCLUSION: The clinical study showed high efficiency of the proposed methods for prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phaco surgery. An important factor affecting intraoperative narrowing of the pupil is the time interval between the femtolaser stage of the operation and emulsification of the nucleus fragments, which should not exceed 15 minutes.

[Morphofunctional changes and complications after out-of-the-bag intraocular lens implantation]. / Morfofunktsional'nye izmeneniia i oslozhneniia vnekapsul'noi implantatsii intraokuliarnoi linzy.

The article reviews morphofunctional changes and complications after using modern methods of out-of-the-bag implantation of the intraocular lens (IOL). Literature data shows that the smallest morphofunctional changes in intraocular structures and the best results are obtained after retropupillary implantation of an iris-claw lens and transscleral fixation of posterior chamber IOL.

[Intraocular lens power calculation in silicone-filled eyes].

AIM: to evaluate the accuracy of different modified methods for axial length (AL) measurement in silicone-filled eyes. MATERIAL AND METHODS: The study was conducted in a group of 60 patients (60 eyes) with silicone oil tamponade (Oxane 1300 cst). Axial length measurements were taken using IOL Master optical coherence biometry ('silicone-filled eye' mode) and modified A-scan ultrasound biometry (velocity of ultrasound passing through the vitreous body set at 980 m/s and 1000 m/s). After phacoemulsification and silicone oil removal, AL measurements were repeated on same devices switched to standard pseudophakia modes. The results were then compared to those obtained in modified modes before the surgery. RESULTS: Preoperative axial lengths measured by A-scan at 980 m/s tended to be 0-1.5 mm (the median of 0.52 mm) shorter than those obtained after silicone oil removal. With 1000 m/s ultrasound velocity the error was much less--from 0 to 0.5 mm (the median of 0.15 mm). As for preoperative ALs by IOL Master in the 'silicone-filled eye' mode, they were 0-1.2 mm (the median of 0.3 mm) longer than postoperative ones. CONCLUSIONS: In cases of impossibility or inaccessibility of optical biometry, measurements taken with an A-scan device set at 1000 m/s are sufficient. The true AL of an eye with silicone oil tamponade falls somewhere between the values obtained with 1000 m/s ultrasound and IOL Master in the 'silicone-filled eye' mode.

[Modern methods of astigmatism correction in cataract surgery].

Modern methods of astigmatism correction in lens surgery are reviewed in the article. Keratorefractive, including laser-assisted, and intraocular techniques employing different models of toric intraocular lenses (IOL) are described. Current state of the problem is analyzed. Implantation of toric IOLs enables precise correction of corneal astigmatism simultaneously with cataract phacoemulsification.

[Intraocular pressure and ocular blood flow features intravitreal infection of anti-vascular endothelial growth factor agents].

OBJECTIVE: to investigate intraocular pressure (IOP) and ocular blood flow (OBF) changes as well as the individual normal range of IOP in patients with age-related macular degeneration (AMD) with or without concomitant glaucoma after intravitreal anti-vascular endothelial growth factor (VEGF) therapy. MATERIAL AND METHODS: Group 1 included 34 patients (34 eyes) with AMD and no glaucoma, group 2-34 patients (34 eyes) with both AMD and glaucoma. In all patients the IOP and OBF were measured (with Ocular Blood Flow Analyzer) and the individual normal range of lOP calculated before the treatment, on the third day after the injection and at the 1-month follow-up visit. Statistical analysis was performed by STATISTICA 10. RESULTS: In group 1 there were no significant changes in ocular blood flow at different times after ranibizumab injection. In group 2 a considerable decrease in OBF was detected 1 month after the injection (p<0.001). In group 1 the intraocular pressure was at the same level before and after the treatment. In group 2 the IOP significantly decreased on the third day after the anti-VEGF injection (p=0.03) but was back to the initial level in 1 month. The individual normal range of lOP, when calculated on the third day after the injection, appeared to be much lower than before due to a moderate decrease in both IOP and OBF. At the 1-month follow-up the individual normal range of IOP was back to initial values in non-glaucoma patients but remained low in the glaucoma group due to reduced OBF. CONCLUSION: The established decrease in the individual normal range of IOP in the late period after an anti-VEGF injection should be taken into account when managing patients with both AMD and glaucoma.

[Calculation of intraocular lens power in non-standard clinical situations].

Methods of intraocular lens (IOL) calculation in non-standard clinical situations have been developed and introduced. These include a formula that improves the calculation accuracy in patients with relatively short anterior-posterior axis and another method for eyes after previous radial keratotomy. A comparative clinical evaluation of the proposed methods has been performed. The results indicate good perspectives for their use in ocular surgery.

[Results of clinical evaluation of a new screening method for determining the individual normal level of intraocular pressure].

The paper presents the results of practical application of a new screening method for determining tolerant intraocular pressure (TIOP) on a Blood Flow Analyzer (Paradigm, USA). Studies were conducted on 331 eyes (205 subjects). Group 1 consisted of 80 patients (126 eyes) without glaucoma being found, with intraocular pressure (IOP) in the average normal range, but with a TIOP excess of 1-8 mm Hg (a risk group); Group 2 included 15 subjects (20 eyes) without glaucoma with normal IOP in whom TIOP exceeded the existing IOP by 1-7 mm Hg; Group 3 comprised 110 patients (185 eyes) with Stage I-III primary open-angle glaucoma (POAG) with compensated IOP. Morphofunctional studies revealed glaucoma in 95 (75%) eyes in the risk group: Stages II and I in 61 and 30%, respectively; and advanced glaucoma in 9%. At the same time, there was a close correlation of the probable detection of glaucoma with the existing degree of a TIOP excess. No cases of glaucoma were observed in Group 2. The determination of TIOP and morphofunctional changes over time in Group 3 revealed a stable glaucomatous process in 99% of cases in which IOP was lower than or equal to TIOP, as well as progressive glaucomatous neuropathy in 91% in which compensated LOP exceeded TIOP. The results of the study in Group 3 suggest that the index TIOP may be used as a guide of IOP in the treatment and monitoring of POAG. The presented data indicate that the determination of the level of TIOP is a required element of both standard ophthalmological examination and monitoring of glaucoma.

[A new screening method for determining tolerant intraocular pressure].

The authors proposed a new screening for determining individual tolerant intraocular pressure (TIOP). The investigation covered 107 individuals (167 eyes). All the examinees were divided into three groups. Groups 1 and 3 comprised healthy volunteers without the signs of vascular changes and glaucoma; Group 2 included patients with new-onset glaucoma with uncompensated intraocular pressure (IOP). There was a regression relationship of ocular blood flow (OBF) to the length of the anteroposterior ocular axis (APOA), which showed a high correlation between OBF and APOA. To determine TIOP, the authors proposed the calculation formula: TIOP = P x K/K(n), where P is the tonometric IOP (mm Hg); K is the flowmetric value of OBF (microl/sec); K(n) is the individual normal OBF value (microl/sec) determined by the nomogram developed by the authors, by taking into account the value of APOA (mm). It is suggested that the eye has a certain buffer range of excessive tolerant pressure within which increased ophthalmotonus results in abnormal sequels. The patients with TIOP that is lower than the existing IOP in the absence of glaucoma symptoms should be classified as a risk-group.