S. I. Ponomareva

Visual impairments are an important medical and social issue affecting the life quality and healthcare economy. Cataracts, glaucoma, myopia and age-related macular degeneration are the leading ophthalmologic conditions. Modifiable behavioral factors and environmental influences play a crucial role in these conditions development. The purpose of this work is to systematically analyze and synthesize current scientific data on how lifestyle affects the prevalence and pathophysiology of ophthalmologic diseases. Modifiable lifestyles correlate with increased risk for major ophthalmologic disorders, such as glaucoma. Physical inactivity, obesity, prolonged use of digital screens, and lack of exposure to natural light all contribute to glaucoma development through vascular and metabolic disturbances. Myopia is also linked to prolonged screen time and a lack of outdoor activity, particularly in children. Unbalanced diets with antioxidant deficiencies accelerate degenerative changes in ocular structures. Smoking increases the risk of cataract and age-related eye disease through oxidative stress. Lifestyle modification is a promising approach to primary prevention of eye disorders. Integrating risk factor information and implementing personalized programs tailored to genetic predispositions and behavioral patterns into clinical care and public health initiatives can significantly reduce eye disease prevalence and improve patient life quality.

PURPOSE. To develop a method for individualized prediction of the rate of progression in moderate and advanced primary open-angle glaucoma (POAG). METHODS. The study included patients with confirmed moderate and advanced POAG who had been under observation for at least 36 months. Prediction of the rate of visual function loss was performed using modern machine learning methods, specifically Ranked PLS-DA, which is highly resistant to multicollinearity and allows for the ordered nature of classes to be taken into account. Two sets of input data were considered: a complete set of 34 variables and an optimized set of 20 variables, including demographic, functional, structural, and vascular indicators. For model optimization and validation, a test dataset was artificially generated using Procrustes Cross-Validation (PCV) method. Model performance was evaluated using specific metrics: sensitivity, specificity, total efficiency (TEFF), and area under the ROC curve (AUC). RESULTS. The optimized set of variables improved model sensitivity (0.93 vs 0.78) while maintaining high specificity (0.78). Total efficiency on the test dataset was 0.77 for the reduced set, with an AUC of 0.9. The model not only distinguished patients with fast, moderate, and slow progression rates but also identified «borderline» cases requiring closer monitoring. Analysis of individual variable contributions revealed key predictors influencing prognostic accuracy: age, retinal nerve fiber layer thickness and ganglion cell complex thickness, peripapillary vessel density, and parafoveal retinal thickness. These findings underscore the importance of a comprehensive approach to assessing the risk of irreversible changes in visual functions. CONCLUSION. The developed Ranked PLS-DA model demonstrated high effectiveness in stratifying patients with moderate and advanced glaucoma according to progression rate. The model may serve as a reliable basis for individualized monitoring and therapy in routine clinical practice.

This literature review is devoted to one of the most challenging problems of ophthalmology — neuroprotective and neuroregenerative treatment of glaucoma and consists of two parts. The second part of the review deals with the role of glia, inflammation and autoimmunization in the pathogenesis of neuroretinal degeneration in glaucoma optic neuropathy (GON), new treatment strategies based on modern achievements of gene and immunotherapy. Special attention is paid to promising therapeutic approaches based on artificial intelligence application, usage of peptide bioregulators, immunomodulators and mixed-action drugs. Alternative methods of axonal regeneration, including gene therapy and stem cell therapy, are discussed.

Glaucoma, one of the leading causes of blindness, often develops asymptomatically, necessitating early diagnosis and prediction of the progression rate of glaucomatous optic neuropathy (GON). Purpose. To develop a classification model using machine learning methods for predicting the rate of GON progression, and to identify the most significant predictors of progression in patients with newly diagnosed early primary open-angle glaucoma (POAG). Material and methods. The study included 59 patients (59 eyes) with early POAG, categorized into three groups based on the expert assessment of GON progression rate over a 36-month follow-up using dynamic morphofunctional evaluation. A classification model incorporating 35 clinical parameters, including optical coherence tomography (OCT) and OCT-angiography (OCT-A) data, was developed using partial least squares discriminant analysis (PLS-DA). Results. Over the 36-month follow-up, slow GON progression was recorded in 21 patients, moderate in 18, and rapid in 20. The mean progression rates were −0.77±1.27%/year for visual field area, −1.21±1.48 µm/year for retinal nerve fiber layer (RNFL) thickness, and −1.23±1.77 µm/year for ganglion cell complex (GCC) thickness. The model demonstrated sensitivity of 90%, specificity of 95%, and efficiency of 92%. The most significant predictors of GON progression were mean vessel density in the deep vascular plexus of the macular region (wiVD_Deep), choriocapillaris dropout in the inferior-nasal peripapillary region, choroidal thickness in the fovea, and lamina cribrosa thickness. Conclusion. The developed model effectively classifies patients based on the predicted progression rate of GON, which is important for individualized approach to glaucoma treatment planning.

This literature review is devoted to one of the most complex ophthalmology problems — neuroprotective and neuroregenerative treatment of glaucoma and consists of two parts. The first part considers the main mechanisms of neurodegeneration and the main aspects of therapeutic control related to these mechanisms (excitotoxicity, mitochondrial dysfunction, oxidative stress). The main aim of the conducted literature analysis is to provide a comprehensive overview of both existing neuroprotective strategies and promising areas of therapy based on neuroprotective agents in the potential treatment of glaucoma. A wide range of approaches to neuroprotection demonstrates the great potential for effective treatment of neurodegeneration in order to preserve visual functions in patients with glaucoma.

In 1908, George Coats published a paper about a rare form of outer retinopathy with massive exudation. Until today, the causes of the Coats’ disease (CD) has not been revealed and there is no generally accepted model of its pathogenesis. It was hypothesized that the condition could be caused by an infectious process or an inflammatory reaction, but there is no consensus about that. Genetic determinants of CD have not been identified, either. A histological examination of CD revealed “cholesterol fissures”, subretinal exudate, massive gliosis, retinal disorganization, vasodilation and hyalinization, diffuse thickening of retinal capillaries and areas of complete absence of pericytes and vascular endothelium, as well as inflammatory infiltrates. The main component of subretinal exudate is intense cell reaction of the macrophages. A study of the cytokine profile showed an increased concentration of VEGF in the subretinal fluid, the level of IL-6 was significantly higher in adult patients and correlated with the degree of exudative retinal detachment. In the eye fundus of CD patients, vascular telangiectasias followed by exudate deposition in these areas have been revealed. Complications of CD include vasoproliferative tumors, neovascular glaucoma, intraretinal and intraocular hemorrhages, vitreous fibrosis, traction retinal detachment, anterior chamber cholesterolosis. CD treatment includes laser coagulation, cryotherapy, intravitreal administration of glucocorticosteroids and angiogenesis inhibitors. In severe forms and advanced stages of CD, vitreoretinal surgery is resorted to. Enucleation may be necessary in some cases.

Background. Pseudosarcomas of soft tissues can cause diagnostic and treatment challenges. On the one hand, it is difficult to make a nosological diagnosis based on a biopsy specimen of a tumor; on the other hand, it is difficult to determine the most appropriate treatment strategy based on a histological pattern.The purpose of the study was to analyze available literature data and systematize the histological characteristics of the chondroid lipoma and pseudosarcoma.Case description. We present the case of chondroid lipoma in a 57-year-old female patient with atypical clinical symptoms. This case shows the difficulties of differential diagnosis of soft tissue sarcomas. Using a clinical example of chondroid lipoma, a rare soft tissue tumor, and an analysis of literature data, the authors showed the importance of a detailed study of the obtained material, a qualified description of the morphological picture, in those cases when the diagnostic conclusion cannot be unambiguous about the malignancy of the tumor process. Additional biopsy is not always possible to clarify the histotype of the tumor. The presented observation shows the difficulties of differential diagnosis of soft tissue sarcomas. Minimally invasive biopsy provides no a full appreciation of histological structure; therefore, if there is a suspicion for chondroid lipoma, it is necessary to perform total surgical biopsy followed by a morphological study using the immunohistochemical method.

Thymolipoma is a rare benign pathological tumor of the anterior mediastinum and accounts for about 2–9 % of thymus tumors. Tumor is usually represented as soft tissue consisting of adipose and thymic tissues. Because of the asymptomatic presentation, patients are often diagnosed with a large tumor. Gigantism of the tumor due to long-term and progressive compression of adjacent organs and anatomical structures of this region can lead to dysfunction, and in some cases, to a complete block of their activity, which is fraught with a fatal outcome. Preoperative diagnosis is always a difficult task due to the lower sensitivity of CT scans and biopsies. The main method of treatment is radical surgical excision. The article presents a clinical case of a 51-year-old patient with a giant tumor of the left hemithorax with a long-term asymptomatic presentation, who was diagnosed with thymolipoma after surgical excision and final histopathological examination.