Parkinson's disease (PD) is a slowly progressive neurodegenerative disease, the main symptoms of which are motor impairments (bradykinesia, rigidity, tremor and postural instability). However, the longer this disease is studied, the more new (non-motor) manifestations of the disease are detected. The article discusses visual disturbances that occur in patients with PD, the underlying pathogenetic mechanisms and methods of their treatment.
Neurodegenerative Diseases , Parkinson Disease , Vision Disorders , Humans , Parkinson Disease/complications , Parkinson Disease/diagnosis , Tremor/diagnosis , Tremor/etiology , Dry Eye Syndromes
In recent years, an increasing amount of attention has been paid to medicinal products as possible risk factors in the development of eye diseases. The frequency of diagnosed drug-induced uveitis is growing yearly, which can be attributed to the appearance of new drugs - biological agents (immune checkpoint inhibitors, BRAF and MEK inhibitors, vascular endothelial growth factor inhibitors, tumor necrosis factor-α inhibitors), as well as systemic bisphosphonates and some antiviral drugs. The time interval between the beginning of the drug use and the appearance of uveitis symptoms varies from several days to months. Common symptoms include eye pain, photophobia, the appearance of floating opacities, and reduced vision associated with active inflammatory changes in the retina and optic nerve and outcomes of those inflammations. Timely diagnosis, cancellation of the drug that caused uveitis and appointment of adequate anti-inflammatory therapy in most cases effectively stops the symptoms of the disease, which determines the relevance of attention to the prevalence, pathogenesis, diagnosis and treatment of drug-induced uveitis.
Pharmaceutical Preparations , Uveitis , Anti-Inflammatory Agents/therapeutic use , Humans , Inflammation , Uveitis/chemically induced , Uveitis/diagnosis , Vascular Endothelial Growth Factor A
Drug-induced optic neuropathy is a group of disorders in which medications cause degeneration of the optic nerve. The true prevalence of drug-induced neuropathy has not been studied, although the percentage of patients who develop optic nerve damage is known for individual medications. The common pathophysiological mechanisms are believed to be mitochondrial damage and imbalance of intracellular and extracellular free radical homeostasis. Typical symptoms of drug-induced neuropathy are reduced visual acuity in the central area, which is often bilateral, visual field disturbances, dyschromatopsia, and edema of the optic nerve head. Early detection of drug-induced optic neuropathy can potentially prevent or minimize serious complications. For patients who develop drug-induced optic neuropathy, treatment is based on timely diagnosis and cancellation of the provoking drug. In most patients, vision usually recovers a few weeks or months after discontinuation of previous therapy, but there have been cases of irreversible vision loss. In addition to withdrawal of the drug that caused optic nerve lesion, treatment of drug-induced neuropathy may include use of drugs and treatment methods prescribed by neurologists for peripheral neuropathy, however, such treatment is seldom based on evidence.
Optic Disk , Optic Nerve Diseases , Humans , Toxic Optic Neuropathy , Visual Acuity
Glaucoma is seen as a heterogeneous group of diseases characterized by optical neuropathy with associated visual field loss; one of the main risk factors for its development is increased intraocular pressure (IOP). In the case of drug-induced glaucoma (DIG), patients develop elevated IOP, optic neuropathy and visual field defects associated with the use of certain drugs. Corticosteroids are one of the most well-known classes of drugs that can cause an increase in IOP through the open-angle mechanism. Drug-induced glaucoma, which develops similarly to open-angle glaucoma, can also be caused by some non-steroidal anti-inflammatory agents, antibodies to the endothelial growth factor, etc. Classes of drugs that can cause angle-closure glaucoma include topical anticholinergic or sympathomimetic drops, tricyclic antidepressants, monoamine oxidase inhibitors, antihistamines, antiparkinsonian drugs, antipsychotic drugs, antispasmodics. Products containing sulfa group drugs can cause DIG due to a different closing angle mechanism involving a forward rotation of the ciliary body. It is important for medical practitioners to be aware of this unwanted drug reaction in order to prevent, detect and treat DIG. In the case of drug-induced increase in IOP, if the underlying disease allows discontinuation of drugs, this measure usually leads to normalization of IOP. In cases when the patient's IOP does not normalize after discontinuation of steroids or when they must continue to take corticosteroids, the administration of topical drugs for the treatment of glaucoma should be considered.
Glaucoma, Open-Angle , Glaucoma, Angle-Closure , Glaucoma, Open-Angle/chemically induced , Humans , Intraocular Pressure , Tonometry, Ocular
In recent years, ß-adrenergic blockers have become the first choice drugs for glaucoma treatment. Timolol holds the main position among them, being a part of most combined antiglaucoma preparations. The use of timolol maleate in clinical practice may be accompanied by severe side effects affecting different organs and systems. The fact that cells with ß-adrenergic receptors are widely common within the human body explains pharmacodynamic effects of timolol maleate. Because of these undesirable side effects, timolol maleate often evokes negative reaction from doctors and patients, which to certain extent limits its usage in ophthalmological practice. Obviously, efficacy and safety of timolol administration depends on individual characteristics making personalized approach necessary for every patient. Such particular approach, being the foundation of personalized medicine, increases efficacy and safety of timolol while reducing costs by using targeted doses.
Pharmacogenetics , Timolol/pharmacology , Adrenergic beta-Antagonists , Humans , Intraocular Pressure
The review presents data of clinical and pharmacogenetic research by Russian and foreign authors conducted within the last three years on the effectiveness of anti-angiogenic treatment against wet age-related macular degeneration (AMD). Scientific results on the association between angiogenesis-related gene polymorphisms responsible for predisposition to AMD on the one hand and a positive response to anti-VEGF therapy on the other are presented. Particular attention is paid to the main regulator of angiogenesis - the VEGF-A gene.
Angiogenesis Inhibitors , Macular Degeneration , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Aged , Angiogenesis Inhibitors/classification , Angiogenesis Inhibitors/pharmacology , Genetic Markers , Humans , Macular Degeneration/diagnosis , Macular Degeneration/drug therapy , Macular Degeneration/genetics , Neovascularization, Pathologic/drug therapy , Pharmacogenomic Testing
High prevalence of retinal vein occlusion in young people as well as treatment complexity and inadequate control of hemostatic parameters of blood and lacrimal fluid determine the significance of relevant research in patients with retinal vascular pathology. The data thus obtained may be useful for disease prognosis, severity evaluation and therapy control. This review is aimed to study hemostasis-related parameters of blood and lacrimal fluid in such patients.
Hemostasis/physiology , Retinal Vein Occlusion , Tears/metabolism , Blood Coagulation/physiology , Humans , Platelet Activation/physiology , Retinal Vein Occlusion/blood , Retinal Vein Occlusion/metabolism , Retinal Vein Occlusion/prevention & control
In recent years, more and more attention has been paid to the role of polymorphisms in genes that code for the components of vitamin K cycle in the development of retinal vascular occlusion. Vitamin K serves as a cofactor for a number of blood coagulation factors, namely, factor II, VII, IX, and X, and also for anticoagulation proteins C and S. According to the literature, 1639G4A polymorphism of the vitamin K epoxide reductase complex subunit 1 gene (VKORC1) is likely to be a new risk factor of retinal vascular occlusion.
Retinal Artery Occlusion/genetics , Retinal Vein Occlusion/genetics , Vitamin K Epoxide Reductases/genetics , Vitamin K/metabolism , Blood Coagulation/genetics , Genetic Predisposition to Disease , Humans , Polymorphism, Single Nucleotide
AIM: to investigate changes in clinical, functional, and morphological parameters of the retina in type 2 diabetes patients with diabetic retinopathy (DR) and those with combined fundus pathology (DR plus age-related macular degeneration (AMD)) before and after a course of antioxidants and angioprotectors in the form of mono- or combination therapy. MATERIAL AND METHODS: The study included 180 patients (180 eyes) with type 2 diabetes divided into 6 groups of 30 each. DR was graded according to E. Kohner and M. Porta classification, AMD--AREDS classification. Thus, group 1 consisted of patients with DRO,; group 2--DR1 without DM, group 3--DR1 with DM, group 4--DRO and "dry" AMD (AREDS 1-3), group 5--DR1 with no DM but with AMD (AREDS 1-3), and group 6--DR1 with DM and AMD (AREDS 1-3). A drug containing lutein 6 mg, zeaxanthin 0.5 mg, vitamin C 60 mg, vitamin E 7 mg, vitamin A 1.5 mg, vitamin B2 1.2 mg, rutin 25 mg, zinc 5 mg, selenium 25 mcg, and bilberry extract 60 mg was used for antioxidative therapy. Ginkgo biloba leaf extract 60 mg was chosen as the angioprotector. In all patients visual acuity, macular thickness and morphology (OCT) as well as light sensitivity (microperimetry) were assessed before and after the treatment course. RESULTS: Analysis of baseline measurements demonstrated a significant decrease in best corrected visual acuity (p < 0.05) in study groups 2-6 as compared with group 1. Macular thickness was increased in all groups, however, the changes were statistically significant only in groups 3 and 6 (p<0.05). Light sensitivity of the macula showed a reduction, which was statistically significant in groups 4-6 (p < 0.05). After the course of antioxidant and angioprotective therapy, these parameters improved in all groups. The greatest effect was achieved with simultaneous antioxidant and double-dose angioprotective therapy (240 mg per day): visual acuity increased significantly (p < 0.05) in all groups except group 1; macular thickness decreased in all groups, however, the changes were statistically significant (p < 0.05) only in groups 1-3 and 5; light sensitivity also improved in all groups, significantly (p < 0.05) in groups 1-3 and 4. CONCLUSIONS: Extended analysis of clinical, functional and morphological changes in the retina at the onset of DR in type 2 diabetes patients with concomitant "dry" AMD enables timely diagnosis, prognosis, prevention, and early treatment. Conservative treatment with antioxidant and angioprotective agents has been proved effective in type 2 diabetes patients with preclinical (DRO) and early (DR1) diabetic retinopathy and those with DR and "dry" AMD (AREDS 1-3) in terms of functional and morphological parameters of the retina. From all the regimens, a combined antioxidant and double-dose angioprotective (240 mg) therapy appeared to be the most effective and can be considered not only a preventive, but also a therapeutic measure in type 2 diabetes patients with initial stages of DR (DRO, DR1) or those with DR and DM or combined DR and AMD (AREDS 1-3).
Angiogenesis Inhibitors/therapeutic use , Antioxidants/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Diabetic Retinopathy/drug therapy , Macular Degeneration/drug therapy , Aged , Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy/complications , Diabetic Retinopathy/diagnosis , Drug Therapy, Combination , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Macular Degeneration/complications , Macular Degeneration/diagnosis , Male , Tomography, Optical Coherence , Treatment Outcome
The review gives information on the anatomy and functions of the lenticular capsule, the evolution of development, and current techniques of capsulotomy (capsulectomy) in the surgery of cataract. It discusses the advantages and disadvantages of anterior continuous curvilinear capsulorhexis, Kloeti radiofrequency bipolar capsulotomy, vitrectorhexis, Fugo plasma blade, and other anterior lenticular capsule opening techniques.
Capsulorhexis/methods , Capsulorhexis/trends , Lens Capsule, Crystalline/anatomy & histology , Lens Capsule, Crystalline/surgery , Humans
The review gives information on the development, current techniques, and complications of capsulotomy (capsulectomy) in the surgery of cataract. It discusses the elaboration of the authors' low-energy femtosecond laser procedure for anterior and posterior capsulotomy.
Cataract Extraction/methods , Humans , Laser Therapy
In this review, etiopathology and non-surgical management of branch retinal vein occlusion (BRVO) are considered. To date, retinal laser photocoagulation is the only therapeutic modality proven to be efficient in the treatment of BRVO complications. Although intravitreal injections of inhibitors of the vascular endothelial growth factor and triamcinolone acetonide appear to be the most promising tools for the reduction of persistent macular edema and neovascular retinal complications, they are still prescribed for off-label applications. The use of isovolemic hemodilution and intravitreal injections of fibrinolytics is limited in patients with BRVO and does not resolve the main problem, i.e. elimination of vein occlusion. Other medicamentous modalities proposed for the management of BRVO proved inefficient. In conclusion, further studies are needed to develop new methods for the treatment of BRVO.
Angiogenesis Inhibitors/therapeutic use , Fibrinolytic Agents/therapeutic use , Glucocorticoids/therapeutic use , Laser Therapy/methods , Retinal Vein Occlusion , Animals , Diagnosis, Differential , Fluorescein Angiography/methods , Fundus Oculi , Humans , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/etiology , Retinal Vein Occlusion/therapy , Treatment Outcome
The review of literature describes the structure and function of the internal limiting membrane (ILM) of the retina, shows indications for its removal, the mechanisms of action of and the efficiency of ILM peeling in various macular pathologies, as well as ILM removal techniques.
Epiretinal Membrane/surgery , Ophthalmologic Surgical Procedures/methods , Retina/pathology , Animals , Epiretinal Membrane/pathology , Humans , Retina/surgery , Treatment Outcome
The paper reviews specific complications of conventional peeling of the internal limiting membrane (ILM) of the retina in various macular pathologies. It also considers the promising directions of development of ILM surgery, including enzymatic lysis and femtosecond laser ablation of the ILM.
Epiretinal Membrane/surgery , Laser Therapy/methods , Ophthalmologic Surgical Procedures/methods , Animals , Epiretinal Membrane/pathology , Humans , Macula Lutea/pathology , Treatment Outcome
The effect of dipeptide carnosine on proteolytic processes accompanying inflammation was investigated in lacrimal fluid of patients with eyeball contusion. Eye drops containing 5% carnosine in combination with traditional treatment reduced elastase-like activity in lacrimal fluid and increased effectiveness of therapy.
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Carnosine/therapeutic use , Contusions/drug therapy , Eye Injuries/drug therapy , Pancreatic Elastase/antagonists & inhibitors , Panophthalmitis/drug therapy , Wounds, Nonpenetrating/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Carnosine/administration & dosage , Contusions/enzymology , Eye Injuries/enzymology , Humans , Ophthalmic Solutions , Panophthalmitis/enzymology , Tears/enzymology , Wounds, Nonpenetrating/enzymology
Ophthalmologic symptoms were analyzed in 76 children with periventricular leucomalation (PL). Clinical or functional ophthalmic disorders were detected in 100% of patients. Changes in the optic nerve disc were diagnosed in 93.4% of patients. The syndrome of dilated excavation (SDE), i.e. dilation and cupping of the optic nerve disc combined in all cases with affection of postgenicular visual paths (of optic radiation and/or striatal cortex) verified by neuroradiology, was most frequently (80.3%) encountered in children with PL. Presumably, the progression of SDE is associated with transsynaptic retrograde degeneration conditioned by the hypoxic-ischemic affection of the CNS in the projection of postgenicular visual paths at pre- and perinatal stages. SDE is an important criterion in the diagnosis of lesions of postgenicular visual paths in babies.
Leukomalacia, Periventricular/complications , Optic Nerve Diseases/etiology , Child , Child, Preschool , Disease Progression , Humans , Infant , Infant, Newborn , Leukomalacia, Periventricular/diagnosis , Magnetic Resonance Imaging , Optic Disk/diagnostic imaging , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/physiopathology , Prognosis , Severity of Illness Index , Tomography, X-Ray Computed , Ultrasonography , Visual Acuity/physiology , Visual Fields/physiology
The efficiency of the combined use of amixin and anti-herpetic vaccination (AHV) to prevent the relapses of herpetic keratitis (HK) is investigated. One hundred and four patients with HK were followed up. The efficiency was found to be higher in the group of patients who received both amixin and AHV: in 29 (87.9%) patients with surface HK and in 10 (90.9%) patients with deep HK. No effect was registered in 4 (12.1%) persons with surface HK and in 1 (9.1%) person with deep HK. Amixin, when combined with AHV, cuts the number of relapses, therefore, it extends the remission period. The suggested scheme of amixin administration is as follow: 125 mg, once per week, for 10 weeks, 10 pills per one treatment course.
Antiviral Agents/administration & dosage , Herpes Simplex Virus Vaccines/administration & dosage , Keratitis, Herpetic/therapy , Tilorone/administration & dosage , Adult , Age Factors , Female , Humans , Immunotherapy, Active , Keratitis, Herpetic/drug therapy , Male , Recurrence , Sex Factors , Time Factors , Treatment Outcome
Fifty children with Coats disease, aged 2 months to 12 years (mean age 8.25 +/- 2.72 years), were observed. Four stages are distinguished in the disease course: initial, moderate, advanced, and terminal. Treatment including extensive retinal argon laser coagulation, cryotherapy, scleral bucking, and subretinal liquid draining was carried out in 32 children (33 eyes). Stable anatomic results were attained in 97% eyes. Visual acuity of at least 0.02 was retained in 87.9% children.
Retinal Diseases/therapy , Child , Child, Preschool , Female , Humans , Infant , Male , Retinal Diseases/physiopathology , Visual Acuity
