Anna A. Voskresenskaya

Introduction . Primary vitreoretinal lymphoma (PVRL) is a subtype of lymphoma of immune-privileged organs. Both diagnosis and treatment decisions pose significant challenges for PVRL. Aim : to present a clinical observation in treating patients with PVRL and possibilities for improving diagnosis and treatment outcomes. Main Findings . Since 2024, two patients with PVRL, aged 66 and 75 years, have been treated at the National Medical Research Center for Hematology. Modern diagnostic methods based on molecular analysis to detect mutations in the MYD88/ CD79b genes in vitreous fluid were used to establish the diagnosis. A two-stage approach was used for treatment: remission induction using the R-MPV protocol with the addition of lenalidomide and ibrutinib, followed by consolidation auto-HCT in a conditioning regimen according to the “BBC” program. Disease relapses were detected in both patients early after auto-HCT. Thus, for timely diagnosis, it is advisable to implement minimally invasive methods for studying the molecular profile of PVRL. The development of new therapeutic approaches, integrating innovative cell therapy into first-line treatment and the use of thiotepa-based conditioning regimens, is also advisable.

Background . Corneal endothelial dystrophy is one of the most common indications for lamellar keratoplasty. Selection of donor corneal tissue that meets established quality standards is a key step in preoperative preparation. Therefore, the development of new, readily available, and low-cost methods for preoperative evaluation aimed at improving donor tissue assessment remains a relevant and clinically important task. Purpose : To evaluate the effectiveness of retroillumination biomicroscopy in detecting defects in donor corneal tissue compared with conventional slit-lamp biomicroscopy. Materials and methods . Fifty donor corneas were examined using retroillumination biomicroscopy and standard slit-lamp biomicroscopy to identify various corneal defects, including epithelial defects, corneal nerve fibers, corneal scars after radial keratotomy, corneal scars after refractive surgery (LASIK, FemtoLASIK), postoperative scars resulting from tunnel incisions and paracenteses, stromal defects, including opacities, stromal infi ltrates, and endothelial defects, including Descemet membrane folds and localized endothelial damage. Retroillumination biomicroscopy was performed by adding diffuse light sources behind the slit lamp. Results . In donor corneal tissue, retroillumination biomicroscopy allowed significantly more frequent detection of epithelial defects (p = 0.01), stromal changes (p = 0.04), and endothelial defects (p = 0.04) compared with conventional biomicroscopy. Corneal nerve fibers were detected in four cases using retroillumination biomicroscopy and were not identifi ed with slit-lamp biomicroscopy (p = 0.04). Scars after radial keratotomy were detected with the same frequency using both examination methods (p = 1.0). Conclusion . Retroillumination biomicroscopy allows defects in donor corneal tissue to be detected, visualized, and documented with greater accuracy than conventional biomicroscopy. Detection of defects in donor corneal tissue allows preoperative stratifi cation of tissue suitability for different types of keratoplasty.

PURPOSE. To evaluate the clinical effectiveness of combined mechanical trabecular peeling and phacoemulsification (PE) in patients with primary open-angle glaucoma (POAG) and complicated cataract. METHODS. The study included 72 patients (72 eyes) with POAG and complicated cataract (46 women, 26 men). Early stage POAG was present in 52 (72.2%) eyes, and moderate stage POAG in 20 (27.7%) eyes. Patients were divided into two groups. In the main group (37 patients, 37 eyes), subjects underwent mechanical trabecular peeling combined with phacoemulsification and intraocular lens (IOL) implantation. The control group (35 patients, 35 eyes) underwent isolated phacoemulsification with IOL implantation. Baseline intraocular pressure (IOP) measured by Maklakov tonometry was 23 [19; 24] mm Hg in the main group and 23 [21.0; 25.0] mm Hg in the control group (p=0.553). The number of hypotensive medications used preoperatively was 2 [0; 4] in the main group and 2 [0; 3] in the control group (p=0.135). The follow-up period was 12 months. RESULTS. At 12 months, IOP in the main group was 18.0 [18.0; 20.0] mm Hg with complete discontinuation of hypotensive therapy. In the control group, IOP was 20.0 [19.5; 22.5] mm Hg, with additional hypotensive therapy required in 9% of cases. The reduction in IOP from baseline was 15.37% in the main group and 11.46% in the control group (p=0.031). A significant difference between groups was observed in the ease of outflow coefficient (p=0.007). CONCLUSION. The developed combined technique of phacoemulsification with mechanical trabecular peeling results in a 15.37% reduction in IOP from baseline at 12 months postoperatively, exceeding the hypotensive effect of isolated PE. The method is associated with a minimal risk of complications and may be recommended for the treatment of patients with early and moderate POAG and complicated cataract.

The retina and the visual analyzer are integral parts of the central nervous system. According to international sources, visual impairment may place a person’s mental health at substantial risk. Cataract is currently one of the leading causes of visual impairment and blindness, and cataract surgery is the most commonly performed operation worldwide. Although the lens belongs to the optical system of the eye, its opacification, with subsequent distortion of incoming sensory signals and impairment of light transmission, has neurophysiological consequences that, together with psychogenic stress and the resulting functional limitations, may lead to mental disorders. The review showed that the presence of cataract increases the risk of cognitive, depressive, and anxiety disorders. Cataract extraction reduces this risk, improves quality of life and sleep, and promotes favorable structural and functional changes in the cerebral cortex. Intraocular lenses implanted to replace the extracted cataract lens require visual neuroadaptation, which may be difficult at an older age because of reduced neuroplasticity. In the case of multifocal intraocular lenses, this process may prove unsuccessful and require lens replacement because of persistent subjective complaints regarding visual quality. In addition, the scientific data showed that the use of blue-light–filtering intraocular lenses does not increase the risk of sleep disturbances. At the same time, the influence of cataract and individual types of intraocular lenses on the development of different types of mental disorders remains insufficiently studied. Ophthalmologists have contributed greatly to the investigation into this problem; however, its complex neurophysiological and interdisciplinary aspects require the active participation of psychiatrists, neurologists, and neuro-ophthalmologists in further research. Given the growing attention of healthcare systems to the protection of individual and public mental health, the influence of cataract and the outcomes of its surgical treatment on mental manifestations requires further study.

This article presents a 6-year follow-up of a patient who first presented at the age of 15 and underwent orthokeratology as a method of myopia control. Baseline visual acuity: OD = 0.1 with sph –2.5D = 1.0; OS = 0.3 with sph –1.25D = 1.0. After five years of wearing individually designed orthokeratology lenses (OK lenses) by OK Vision, a decrease in axial length (AL) was recorded: 0.39 mm in the right eye and 0.28 mm in the left eye. The reduction in AL was accompanied by a 1.0D decrease in myopic refraction in both eyes. The observed change in AL cannot be explained by an increase in choroidal thickness and/or a decrease in central corneal thickness and therefore requires further investigation. The impact of myopia control and accommodation management methods on axial length change remains insufficiently studied. Future research should include evaluation of accommodative function and choroidal thickness as part of standard clinical protocols for patients undergoing myopia control therapy.

BACKGROUND: The analysis of modern studies shows a high prevalence of non-psychotic psychiatric disorders in individuals with ophthalmic pathology. AIM: To evaluate the characteristics of psychological maladjustment in patients with posterior segment eye pathology. METHODS: This study is a single-center observational study using consecutive sampling of patients with confirmed diagnoses of “age-related macular degeneration” and “glaucoma”. The study was conducted from April 1 to December 31, 2024, at the Cheboksary branch of the S. Fyodorov Eye Microsurgery Complex – National Medical Research Center of the Ministry of Health of the Russian Federation. A clinical survey using psychometric scales, including the Spielberg–Hanin test, Yakhin–Mendelevich clinical questionnaire, and SF–36 health survey questionnaire, was performed. RESULTS: A total of 79 individuals were examined (47% male, 53% female), with a median age of 69.5 (60–75) years. The participants were divided into two groups: group 1 — patients with age-related macular degeneration; group 2 — patients with glaucoma. For the sample as a whole, the prevalence of anxiety symptoms (27%) and depression (32%) was characteristic. The severity of anxiety symptoms in group 2 was 72.7%, which is statistically significantly higher compared to group 1 (50.0%, p = 0.035). Symptoms of asthenia were more common in patients from group 2 (63.6%), compared to patients with age-related macular degeneration (41.3%, р = 0.041). Obsessive-phobic and autonomic dysfunction symptoms were more characteristic of patients with glaucoma (39.1% and 47.8%, respectively), compared to patients with age-related macular degeneration (12.1% and 24.2%, respectively). The level of statistical significance for obsessive-phobic and autonomic dysfunction symptoms was р = 0.007 and p = 0.028, respectively. The analysis of the quality of life assessment revealed a more significant physical activity limitation, a more pessimistic outlook on treatment prognosis, and a lower mental well-being in patients with glaucoma. CONCLUSION: The study revealed a high level of psychological maladjustment among patients with posterior segment eye pathology. The obtained data can be used to develop personalized treatment plans that consider both the ophthalmic diagnosis and the mental status of patients.

The development of biological therapeutic agents has provided new opportunities for treating neovascular age-related macular degeneration (nAMD) using humanized monoclonal antibodies (mAbs) targeting vascular endothelial growth factor A (VEGF-A). The emergence of biosimilars of anti-VEGF agents can significantly improve treatment accessibility and its effectiveness by increasing patient adherence. The development of biosimilars involves comparative studies with the original drug to establish equivalence in physicochemical and biological properties, efficacy, and safety. Biosimilar development programs include extensive analytical and preclinical studies to compare structural and functional components with the original bioproduct, and clinical trials are conducted to prove bioequivalence and therapeutic equivalence. The process of development and registration of the biosimilars is strictly regulated and has no significant differences in Russia, the EU and the US. Currently, more than 10 biosimilars of ranibizumab have been approved worldwide, in Russia it is the drug Laxolan (AO GENERIUM). The introduction of a domestic biosimilar of ranibizumab into clinical practice allows reduction of the costs of retinal disease treatment while maintaining the efficacy and safety of antiangiogenic therapy.

Relevance. The use of scleral contact lenses (SCLs) is currently indicated for patients with complex ametropia and irregular corneal surfaces resulting from various causes. SCLs are effective in cases of intolerance to other vision correction methods or when glasses or standard contact lenses fail to provide satisfactory visual function and optical rehabilitation. A critical factor in SCL design is ensuring sufficient oxygen transmission for safe wear, which can be enhanced by fenestration. The study aims to demonstrate the possibility of optical rehabilitation in a post-keratitis patient using fenestrated scleral lenses made of Optimum Infinite material. Objective: to demonstrate the possibility of optical rehabilitation in a post-keratitis patient using fenestrated scleral lenses made of Optimum Infinite material. Materials and methods. A patient born in 2013 presented with complaints of low visual acuity. The patient’s history included keratitis, leading to ametropia uncorrectable with glasses. In addition to standard examinations, corneal topography, pachymetry, and morphological evaluation via scanning confocal microscopy were performed. Results. A scleral contact lens (OKVision SMARTFIT®) made of high-oxygen-permeable Contamac Optimum Infinite material with fenestration (1 × 0.3 mm) was fitted. The patient’s visual acuity improved from 0.08 to 0.9 after lens fitting. No complications associated with lens wear were observed during the follow-up period. Conclusions. Scleral contact lenses made from the high-oxygen-permeable material Contamac Optimum Infinite with fenestration can be recommended for optical correction in patients with ametropia induced by keratitis.

Introduction. The use of invasive methods for diagnosing primary diffuse large B-cell lymphoma of the central nervous system (PDLBCL CNS) and primary vitreoretinal lymphoma (PVRL) is often associated with the development of severe neurological deficits and disability of patients. A promising direction in the diagnosis of PDLBCL CNS and PVRL is the use of non-invasive approaches based on molecular genetic methods for the determination of mutations in the MYD88 gene in the cerebrospinal fluid (CSF), vitreous fluid (VF) and free circulating tumor DNA (cfDNA) in blood serum.Aim: to present the potential of non-invasive diagnosis of PDLBCL CNS and PVRL.Main findings. The study included 6 patients (4 — PDLBCL CNS, 2 — PVRL). The average age was 64 (54–75) years. Despite increased cytosis in the CSF in all 4 patients with PDLBCL CNS, the tumor population was determined by flow cytometry in only half of the cases. According to a molecular genetic study, mutations in the MYD88 gene with an allelic load from 2.5% to 15% were detected in the genomic DNA of the CSF of all patients. In 2 patients with PVRL, mutations in the MYD88 gene were detected in VF with an allelic load of 4.2% and 6.6%, which was the only confirmation of the diagnosis. Currently, 5 patients have completed the treatment program and 1 is undergoing therapy. All 5 patients are in complete remission (CR) of the disease with follow-up periods from 1 to 8 months.