H. M. Plieva

The purpose: a comprehensive assessment of hypertension as a comorbid disease and a potential risk factor for an adverse response to anti-VEGF therapy in MNV. Materials and Methods. This prospective cohort study included 321 patients with MNV (321 eyes), aged 50–93 years, including 210 women and 111 men. All types of refractive error, ranging from +6.0 to -16.0 diopters, were represented. The diagnosis was established according to the International Classification of Diseases, 10th Revision (ICD-10; H35.3). Best-corrected visual acuity (BCVA) was assessed. Intraocular pressure (IOP) was measured, and slit-lamp biomicroscopy of the anterior and posterior segments of the eye, optical coherence tomography (OCT), and OCT angiography (OCTA) were performed. Patients with active MNV were treated with intravitreal aflibercept injections administered according to a fixed regimen in compliance with the Russian federal clinical guidelines. Results. Hypertension (AH) was assessed as a comorbid disease that worsens the clinical course of MNV and a risk factor for an adverse response to antiangiogenic therapy. Hypertension was found in the cohort of MNV (321 people, 321 eyes) in 35 % of cases. It was found that patients with MNV with AH + were about 2 years older than patients without AH, 51% of them were over 75 years old, 50.9 % had atherosclerosis, 30.4 % suffered from diabetes mellitus; and 38.2 % had grade 1–2 obesity. In 93.8 % of cases, their SBP exceeded 140 mmHg, in 36 % of their DBP exceeded 90 mmHg. The marker of AH + had signs of background vascular retinopathy (in 72 % of cases, the symptom of Guist was present). The effectiveness of antiangiogenic therapy was comparable: 43.5 % of non-responders were present with MNV without AH, compared to 51% in the MNV group with AH+ (n/a; p = 0.22), despite the fact that patients with MNV with AH+ had to be transferred to another drug twice as often. In AH, subretinal fluid (SRF) and intraretinal fluid (IRF) were less well resorbed. By the beginning of treatment, the frequency of SRF in MNV without AH was 53.3 % versus 66.1 % in the AH+ group (n/a), during treatment it decreased to 47.0 % in the group without AH, and 63.0 % in the group with AH+. Intergroup differences in the frequency of SRF at the end of the loading course were regarded as a strong tendency ( p = 0.08) to decrease the therapeutic effect in AH+. Conclusions. Thus, hypertension is the most common comorbid disease in the cohort of patients with MNV: it occurs in 35 % of cases. Despite the fact that, in general, the frequency of non-compliance in response to antiangiogenic therapy in patients with comorbidity of MNV and AH is comparable to that of patients with MNV without AH (51.0 % vs. 43.5 %, n/a), nevertheless, the probability of transfer to another drug for various clinical indications increases 2 times more often.

Obesity is an established risk factor for cardiovascular disease, arterial hypertension, and lipid metabolism disorders leading to atherosclerosis and drusen formation. An association between obesity and age-related macular degeneration (AMD) has been demonstrated. Obesity may be associated with AMD either directly or indirectly through diabetes mellitus, hypertension, dyslipidemia, or disturbances of metabolic processes in ocular tissues. Purpose. To evaluate the role of obesity as a comorbid condition and a risk factor for a suboptimal response to anti-VEGF therapy. Patients and Methods. This prospective cohort study included 318 patients with macular neovascularization (MNV; 318 eyes), aged 50–93 years, including 210 women and 108 men. All types of refractive error, ranging from+6.0 to -16.0 diopters, were represented. The diagnosis was established according to the International Classification of Diseases, 10th Revision (ICD-10; H35.3). Best-corrected visual acuity (BCVA) was assessed using the Snellen chart. Intraocular pressure (IOP) was measured, and slit-lamp biomicroscopy of the anterior and posterior segments of the eye, ophthalmoscopy, optical coherence tomography (OCT), and OCT angiography (OCTA) were performed. Patients with active MNV were treated with intravitreal aflibercept injections administered according to a fixed regimen in compliance with the Russian federal clinical guidelines. Results. Of the 318 patients with MNV, 97 (30.4 %) had class I–II obesity, while 141 patients were overweight. Nearly one in three patients with MNV was overweight. Despite successful resolution of subretinal exudation and a reduction in pigment epithelial detachment (PED) in both groups of patients with MNV, the therapeutic response was less pronounced in patients with obesity. OCT demonstrated delayed regression of the intraretinal fluid (IRF) area, which began only after the fourth injection. During the first three intravitreal injections, exudation continued to increase slowly and accumulate. The differences became increasingly evident and reached statistical significance by the final injection of the loading phase ( p < 0.05). Overall, fluid resolution was less effective in patients with obesity. This was reflected in the final BCVA outcome. Conclusions. Obesity aggravates the clinical course of MNV and adversely affects the outcome of anti-VEGF therapy. Disease progression despite courses of intravitreal injections occurred twice as frequently in patients with obesity (10.3 % vs 5.0 %; p = 0.09). During treatment, intraretinal fluid resolved more slowly, which affected the functional outcomes.

   Background. Macular neovascularization is one of the leading causes of irreversible central vision loss in older adults. However, the pathophysiological mechanisms underlying its development remain insufficiently understood. The effect of baseline refractive status on choroidal structural changes in macular neovascularization is of particular interest because it remains poorly studiedand the available evidence is conflicting. Clarifying these relationships may support personalized approaches to early diagnosis, prognostication, and treatment.    Purpose. To characterize choroidal morphometry in eyes with macular neovascularization according to refractive status.    Materials and methods. Choroidal parameters were analyzed in 126 eyes of 114 patients with macular neovascularization examined between 2017 and 2026. The eyes were stratified into three groups according to refractive status. Group 1 included 71 hyperopic patients (Hm; +0.5 to +4.5 D). Group 2 comprised 24 emmetropic patients (Em; spherical equivalent, –0.5 to +0.5 D inclusive). Group 3 comprised 19 myopic patients (Mh; spherical equivalent, –0.5 to –7.5 D). Macular optical coherence tomography (OCT) was performed with the DRI OCT Triton system (Topcon Healthcare, Japan).    Results. Distinct patterns of choroidal change were identified. Choriocapillaris thinning was observed in hyperopic, myopic, and emmetropic eyes (p = 0.002, p = 0.0001 and p = 0.0001 respectively), while Sattler’s layer was thinner in emmetropic and myopic eyes (p = 0.021 and p = 0.0001 respectively). Haller’s layer thickness in eyes with macular neovascularization was within age-matched reference values in emmetropic eyes and exceeded them in myopic (p < 0.001) and hyperopic eyes (p < 0.001). Reduced vessel density was observed in all choroidal layers. The greatest vessel density deficit in eyes with macular neovascularization occurred in the choriocapillaris, reaching 28.5 % in emmetropic, 21.7 % in hyperopic, and 19.2 % in myopic eyes. The deficit was smaller in Sattler’s layer: 19 % in Hm, 16.7 % in Em, and 10.8 % in Mh. The smallest deficit was found in Haller’s layer: 12 % in Hm and 6.5 % in Mh.    Conclusion. This study demonstrated that macular neovascularization is associated with significant thinning of the choriocapillaris and Sattler’s layer, together with an altered interlayer distribution of choroidal vessel density. The severity of these changes varied according to refractive status. The choriocapillaris vessel density deficit was greatest in emmetropic eyes and smallest in myopic eyes. Thus, choroidal morphometry in macular neovascularization is heterogeneous and should be interpreted in the context of refractive status; these findings may inform risk stratification and the selection of antiangiogenic treatment strategies.

Introduction. Pregnant women are objects of special attention of physicians due to two main reasons. The first one is that the fetal life depends on the health and quality of life of a future mother. The second is associated with increased load on all organs and systems of the female body, including the organ of vision. However, manifestations of dry eye syndrome (DES) in this contingent are often not given due attention and often remain untreated, which has a negative impact on the quality of life of women during this difficult period and can lead to diseases of the anterior segment of the eye. The aim of the study was to evaluate the effectiveness of a drug based on sodium hyaluronate 0.21 % in pregnant women with dry eye syndrome due to dysfunction of the meibomian glands. Рatients and methods. The study included 60 patients (120 eyes) with dry eye syndrome with an average age of 31.45 ± 5.98 years and a follow-up period of 3 months. There were 2 groups of patients: the main group (pregnant women with DES) and the control group (non-pregnant women with DES). Patients of both groups were administered a preservative-free form of 0.21 % sodium hyaluronate three times a day for 3 months. All studied patients underwent standard methods of examination, indicators of DES were assessed along with an objective valuation of tear film parameters and meibomian glands condition by digital biomicroscopy on a MediWorks slit lamp (Precision Instruments Co., Ltd., Shanghai) at the time of first visit and at 1 and 3 months of follow-up. Results and discussion. A comparative analysis of therapy effectiveness in the main and control groups showed that OSDI scores (ocular surface disease index), non-invasive tear breakup time (NITBUT) and meibomian gland function improved after treatment in both groups. Early diagnosis and timely correction of DES manifestations in pregnant women by administration of tear replacement therapy with preservative-free sodium hyaluronate 0.21 %, as well as eyelid hygiene can improve the quality of life of this group of patients and prevent associated with DES complications. Conclusion. The selected preservative-free tear replacement therapy with sodium hyaluronate 0.21 % (Optinol® Express moisturizing) provided a combination of ocular surface moisturizing and reducing the risk of inflammatory lesions with facilitating the release of meibomian gland secretion, contributing to the effectiveness and prolongation of therapy.

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.

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.

The earliest damage in glaucoma starts in the posterior pole of the eye, where the axons of retinal ganglion cells, that form the optic nerve fibers, and retinal vessels pass through the connective tissue network called the lamina cribrosa (LC). Modern diagnostic techniques, such as optical coherence tomography (OCT), enable the visualization of the LC and the assessment of blood flow within it, providing new opportunities for the diagnosis of glaucoma. This review highlights the anatomy and vascularization of the LC, along with the latest research findings obtained via OCT. The article details age-related changes in the LC and the impact of intraocular pressure (IOP) changes on its properties. A novel parameter, the lamina cribrosa curvature index (LCCI), reflecting LC deformation, has been shown to be the most important biomarker of glaucomatous damage.

Insufficient blood supply, vascular dysregulation, perfusion pressure and endothelial dysfunction may account for the pathogenic mechanism. OCT angiography (OCTA) measurements have been reported to be useful for glaucoma diagnostics. OCTA microvasculature could serve as a potential biomarker for glaucoma diagnosis. One of the important criteria for the treatment of NTG is the reduction of IOP, which is achieved by both conservative methods of treatment and laser and surgical interventions. With timely diagnosis, control of IOP and monitoring of morphofunctional changes in the eyes with NTG, it becomes possible to suspend the development of glaucoma optic neuropathy and preserve the patient’s vision for a long time.

In the modern world, glaucoma is one of the main causes of irreversible vision loss. Normal tension glaucoma (NTG) constitutes the major proportion of POAG, which is common in Asian populations. NTG is a disease resulted from the interaction of multiple genetic risk factors. But other factors are also important, such as thinning of the scleral lamina cribrosa and a lesion of the transmembrane pressure gradient. Central visual field defects and disc hemorrhage are characteristics finding that is highly associated with the progression of NTG.