Elena Naumovna Iomdina

The purpose of the work was to study the effect of bandage scleroplasty (BSP) on the level of dopamine (DA) in the tear fluid and choroidal thickness (CT) in patients with high progressive myopia. Material and methods . Fifty patients (50 eyes) aged 13.1 ± 1.7 years were examined and divided into 3 groups: Group 1 — children with congenital myopia (spherical equivalent (SE) = 14.5 ± 3.4 D), Group 2 — with acquired myopia (SE = 8.3 ± 1.5 D); Group 3 (control) — with emmetropia and low hyperopia (SE = +0.25 ± 0.7 D). In addition to the routine examination, the children’s eye axial length (AL), choroidal thickness (CT) using the SLO/OCT Mirante multimodal platform (Nidek, Japan), and retinal light sensitivity (RLS) in the macular area using the MP-3 microperimeter (Nidek, Japan) were determined. Biochemical studies of tear fluid were also performed to determine the DA concentration before and 1 month after BSP. Results. In congenital myopia, DA after BSP decreases (by an average of 77 pg/mg protein), while in acquired myopia, it tends to increase (by an average of 20 pg/mg protein) with an increase in CT (by 13.0–20.3 %) in both groups. In patients with congenital myopia and initially low DA values, no normalization of hormone concentrations was observed after BSP, despite improved choroidal blood filling. However, with initially elevated DA levels, its concentration in tears decreased after BSP, accompanied by an increase in CT. Conclusion . BSP promotes an increase in CT in both acquired and congenital myopia. In congenital myopia, DA decreases after BSP, while in acquired myopia, it increases, which may be due to the preservation of retinal dopaminergic cells capable of synthesizing DA.

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in older adults. An important challenge is the recognition of its early asymptomatic stages and the monitoring of its progression, which requires reliable biomarkers. Growing evidence indicates that AMD-related biochemical changes are reflected in the proteome of tear fluid (TF). Although TF is a non-invasive and easily collectable diagnostic material, its proteomic analysis is complex and costly and therefore has limited clinical value. Methods: In this pilot single-center retrospective cross-sectional study, we developed a new method for dry AMD screening based on analysis of nano-differential scanning fluorimetry (nanoDSF) tear protein denaturation profiles (TDPs) within 15 min. The TDPs were recorded in representative groups of dry AMD patients (37% early, 48% intermediate, 15% geographic atrophy), and in control groups, including patients with refractive abnormalities (basic control), other retinal degenerative diseases (diabetic retinopathy, peripheral retinal dystrophy), or TF-affecting conditions (dry eye syndrome). High-dimensional TDP data were processed using unsupervised machine learning followed by k-means cluster analysis. Results: The presented pipeline distinguished AMD from the basic control with 74% accuracy and a sensitivity of 0.81 without relying on prior labels. The specificity of AMD detection was confirmed by its effective differentiation from diabetic retinopathy (72%; 0.74), peripheral retinal dystrophy (79%; 0.76) and dry eye disease (76%; 0.81). Classifying the AMD group from the entire population of other patients yielded an accuracy of 71% and a sensitivity of 85%, with a false-negative rate of only 15%. Conclusions: This study is a proof of concept for the nanoDSF-based approach, which can be considered a fast, cost-effective, and convenient tool for population screening for dry AMD, suitable for use in preventive medicine and public health.

Purpose: to experimentally develop a method for preparing an allograft with optimized properties for scleroplasty (SP) in progressive myopia. Material and methods. The experiment was performed on 40 eyes of 20 Chinchilla rabbits, which were divided into four groups depending on the method of processing the scleral allograft for SP: Group 1 (control) — 5 rabbits (10 eyes) with an intact graft; Group 2 — 5 rabbits (10 eyes) with a graft after ultraviolet (UVA) crosslinking with riboflavin; Group 3 — 5 rabbits (10 eyes) with a graft after UVA crosslinking with riboflavin and with additional treatment with 0.1 % riboflavin solution; Group 4 — 5 rabbits (10 eyes) with a graft after UVA crosslinking with riboflavin with an additional 1.5 % actovegin solution treatment. Comparative evaluation of biomechanical parameters of the graft before and after UVA crosslinking with riboflavin was carried out in vitro using biomechanical testing (AUTOGRAPH device, Japan). Acoustic density of the sclera (ADS) before and after SP was assessed in vivo using an ultrasound diagnostic device VOLUSON 730 (Kretz), and choroidal thickness (CT) using Mirante SLO / OCT (Nidek). One month after SP, a morphological study of the enucleated experimental eyes was performed. Results. The study of the biomechanical properties of the graft, ADS, CT and the morphological picture of the scleragraft complex showed the advantages of using for SP a graft treated with UVA crosslinking in combination with additional treatment with 0.1 % riboflavin solution (group 3). The elastic modulus as a result of UVA crosslinking increased by 1.2 times. The increase in ADS after SP in the 1st (control) group was on average 14 units, in the 2nd — 17 units, in the 3rd — 23 units, in the 4th — 17 units, i. e. the greatest increase in ADS was noted in group 3. The increase in CT was also the greatest in group 3 — 14.4 ± 0.3 μm, against 6.0 ± 0.3 μm in group 2 and 12.1 ± 0.2 μm in group 4. Morphological study showed better engraftment and ordered structure of the graft in the experimental eyes of group 3. Conclusion. UVA crosslinking, as the first stage of the graft preparation, allowed increasing its biomechanical stability and preservation of structure during engraftment, and additional treatment with riboflavin contributed to the improvement of blood supply to the choroid. Preparation of alloscleral graftt for scleroplasty in progressive myopia, including two stages — UVA crosslinking and subsequent treatment with 0.1 % riboflavin solution, is the most effective way to optimize its properties.

The article is dedicated to the 100th anniversary of the famous Russian ophthalmologist Yuri Z. Rosenblum, his life path and main scientific achievements.

In patients with progressive myopia, there is an imbalance between the processes of lipid peroxidation and antioxidant protection, which is confirmed by changes in the level of hypoxia markers and the activity of the antioxidant enzyme superoxide dismutase (SOD) in the tear fluid (TF). Purpose: to study the SOD activity in the TF of patients with moderate and high progressive myopia after sclera-strengthening treatment. Material and methods. We examined 82 patients (82 eyes) aged 8 to 17 years with progressive myopia (ave 9.1 ± 0.3 D), divided into two main groups: in the 1st group (47 patients), minimally invasive scleroplasty (MIS) was performed using a biologically active graft, in the 2nd group (35 patients) — bandaging scleroplasty (BSP) according to the Snyder-Thompson technique using homoscleral graft. The control group consisted of 12 unoperated patients aged 7–13 years with low hyperopia (0.25 D to 1 D). At various times after MIS and BSP, SOD activity (by inhibition of quercetin autoxidation) and total protein concentration according to Lowry were determined. Results. SOD activity in the TF before surgery in patients of group 1 (32.0 ± 5.3 U/mg protein) and group 2 (24.7 ± 6.4 U/mg protein) was in generally significantly higher than in the control group (20.0 ± 3.2 U/mg protein). At the same time, in some patients with initially low SOD values, enzyme activity significantly increased 1 month after surgery (p < 0.01) and exceeded the control level by 4.3–5.2 times. In case of initially elevated SOD activity, on the contrary, the enzyme concentration significantly decreased (p < 0.01) — 3.5 times with BSP and 1.9 times with MIS. After 6 months, in patients of the MIS group with the initial level of SOD activity below the norm, the enzyme activity remained 2 times higher than normal values (p < 0.01). All other patients showed a decrease in SOD values to the control level, and in some cases below it. Conclusion. Sclero-strengthening treatment has a normalizing effect on SOD activity in the TF, which contributes to the correction of metabolic disorders caused by progressive myopia and confirms the importance of scleroplasty as a method activating bioregulation and normalizing oxidation-reduction processes in the eye tissues.

Limbal-scleral staphylomas in children are a serious problem in pediatric ophthalmology, as they lead to severe consequences, including anatomical death of the eye.The purpose of the work is to evaluate the results of a new combined method for treating limbal-scleral staphylomas in children using and local ultraviolet (UVA) crosslinking of scleral collagen (CSC) and transscleral diode laser cyclophotocoagulation (TDLC).Material and methods. CSC was performed for 2 children aged 12 and 15 with limbal-scleral staphylomas after TDLC. Biomicroscopy, optical coherence tomography of the anterior segment of the eye and determination of the acoustic density of the sclera were used for dynamic observation of patients. The procedure of local UVA crosslinking of limbal staphylomas of the sclera was carried out using a new device for local ultraviolet crosslinking based on the permission of the Ethics Committee of the Helmholtz National Medical Research Center of Eye Diseases. The CSC procedure time was 5 min with an exposure power of 2.5 mW/cm.Results. The use of TDLC and five local CLSC procedures combined with instillations of 0.1% riboflavin solution provided an increase in the thickness and acoustic density of the sclera, as well as a decrease in the area and height of the limbal staphyloma.Conclusion. The first results of treating scleral staphylomas in children using a new device for local UVA crosslinking showed its high therapeutic efficacy and the feasibility of further research to advance this method into clinical practice.

Purpose: a comparative study of the effect of various optical correction methods on the dynamics of refraction in children with progressive myopia after minimally invasive scleroplasty (MIS). Material and methods. A total of 58 patients (58 eyes) aged 8 to 14 years (mean 12.0 ± 0.2 years) with moderate and high progressive myopia — from 4 to 11.5 D (mean 7.7 ± 0.3 D) with the year progression gradient (YPG) from 0.5 to 1.75 D (mean 1.25 ± 0.06 D) were operated on. In all patients, visual acuity, clinical refraction, axial length of the eye and the state of the fundus were determined. For MIS, the biologically active transplant (BAT) Hitex-HG was used. Patients were divided into groups depending on the optical correction prescribed after the operation. In group 1 (17 patients), monofocal (MF) glasses used before the operation were replaced with perifocal (Perifocal-MS, PMS) or progressive glasses. In group 2 (18 patients), children used PMS or progressive glasses before and after MSP. In group 3 (16 patients), MF or soft contact lenses were used before and after the operation. In group 4 (7 patients), MF, PMS or progressive glasses used before the operation were replaced with orthokeratology lenses. The follow-up period was 1 year. Results. Comparative analysis of YPG in groups with different optical correction showed different decrease of this parameter in the postoperative period: in group 1 — 4.7 times; in group 2 — 4 times; in group 3 — 2.3 times; in group 4 — 5 times. Conclusion. The most effective treatment is a combination of MIS and optical correction with accommodation support and/or impact on peripheral retinal defocus. This approach to managing pediatric patients with progressive myopia should be a priority.

Purpose of the work was to study the possibility of using transpalpebral tonometry (TPT) using the Tonotest device in younger children (up to and including 5 years old) for screening control of intraocular pressure (IOP). Material and methods. As part of the screening examination, IOP was determined in 46 children (92 eyes) aged 5 months to 5 years, divided into 2 groups. In the 1st group — 21 children (42 eyes) aged 5 months to 3 years (average 1.5 ± 1.0 years) — only Tonotest was used for tonometry, and in the 2nd group — 25 children (50 eyes) aged 3.5 to 5 years (average 4.5 ± 0.6 years) — IOP measurement was performed sequentially (in random order) by two methods — using Tonotest and a pneumotonometer (Reichert 7 AutoTonometer, USA). Results. In most cases, the children tolerated the TPT procedure well and did not complain of discomfort, pain, or any other unpleasant sensations. However, in 7 children (33 %) of the 1st group and in 5 children (20 %) of the 2nd group, behavioral characteristics did not allow measuring IOP. The IOP level according to TPT in the 1st group was 16.4 ± 2.9 mm Hg. In the 2nd group, the IOP value according to Tonotest was 15.1 ± 2.0 mm Hg, according to the pneumotonometer — 16.0 ± 2.1 mm Hg (p = 0.09). Conclusion. The possibility of using TPT for screening control of IOP in younger children (0–5 years old) is shown. Comparison of the results of IOP determination in the group of children aged 3.5–5.0 years using Tonotest and pneumotonometer showed no statistically significant differences between them. TPT using Tonotest allows to expand the possibilities of IOP monitoring in pediatric practice.

The modern pathogenesis of the neurodegenerative process in glaucoma identifies several key risk factors for its development: ischemia/hypoxia, mitochondrial dysfunction, oxidative stress and neuroinflammation. An analysis of recent studies shows that in glaucomatous optic neuropathy, as in other neurodegenerative diseases, the immune system is involved in the pathological process, and immunoregulation is carried out mainly by retinal glial cells, microglia, astrocytes, Müller cells and the complement system. Chronic activation of glial cells caused by increased intraocular pressure in glaucoma can provoke a pro-inflammatory state at the retinal level, causing disruption of the blood-retinal barrier and death of retinal ganglion cells. The review presents pro-inflammatory markers of glaucoma, immunomodulatory and pro-inflammatory mediators, shows the role of a number of metalloproteinases and their tissue inhibitors, as well as pro-inflammatory cytokines in the development of glaucoma.

Autoimmune uveitis is a relapsing blind-causing ocular condition with complex pathogenesis that is not completely understood. There is a high demand for accurate animal models of experimental autoimmune uveitis (EAU) suitable for elucidating the molecular mechanisms of the disease and testing new therapeutic approaches. Here, we demonstrated that photoreceptor Ca²⁺/Zn²⁺-sensor protein recoverin is a uveoretinal antigen in albino rabbits provoking typical autoimmune chorioretinitis 2–4 weeks after immunization. The pathologic process in recoverin-induced EAU shared features with human disease and included lymphocytic infiltration of the retina, Dalen–Fuchs nodules and foci of subtotal or total retinal atrophy, manifested as a decrease in amplitude of the a-wave of the electroretinogram. In some cases, changes in the retinal vascular pattern and subretinal hemorrhages were also observed. These signs were accompanied by a gradual accumulation of serum antibodies against recoverin. Biochemical examination of the aqueous humor (AH) revealed typical characteristics of inflammation and oxidative stress, including increased levels of TNF-α and IL-6 and decreased levels of IL-10, as well as decreased total antioxidant activity, superoxide dismutase and glutathione peroxidase activities, and increased zinc concentration. Consistently, metabolomic and targeted lipidomic analysis of AH showed high lactate and low ascorbic acid levels in early EAU; increased levels of key pro-inflammatory signaling lipids such as PGE2, TXB2, 11-HETE and Lyso-PAF; and reduced levels of the anti-inflammatory fatty acid DHA in advanced stages of the disease. Uveitic AH became enriched with recoverin, confirming disruption of the blood–ocular barrier and photoreceptor damage. Notably, the application of mitochondria-targeted antioxidant therapy impeded EAU progression by maintaining local antioxidant activity and suppressing TNF-α, IL-6 and PGE2 signaling. Overall, our results demonstrate that recoverin-induced EAU in rabbits represents an accurate model of human autoimmune posterior uveitis and suggest new directions for its therapy that can be trialed using the developed model.