Aleksandr V. Trubilin

Postoperative follow-up is an important element of the system for ensuring the safety and satisfaction of cataract patients. Existing approaches to the regulation of follow-up time do not allow to fully implement the strategy of early detection of postoperative complications, which requires the search for new solutions and complex evaluation of their effectiveness. Purpose : to improve the safety of cataract surgery by optimizing the postoperative follow-up. Materials and methods. A comparative cohort study in 2 groups of patients undergoing cataract surgery included 1951 patients in the main group and 2436 patients in the control group. In the control group of patients, the examination was scheduled within the terms regulated by the clinical recommendations on the 1st, 7rd, 28th day after the intervention. In the main group of patients, the second visit was scheduled on the 3rd day after surgery. The main outcome for assessing the efficacy of the follow-up regimens was the early detection of postoperative complications. Additional efficacy criteria were the visual acuity values after cataract phacoemulsification compared to the control group. Results. Clinical and functional outcomes in both groups did not differ with respect to visual acuity and intraocular pressure parameters before and after surgery (p > 0.05), demonstrating the achievement of a best corrected visual acuity (BCVA) of 0.9 ± 0.2 at 7 days after surgery. A visit at 3 days postoperatively significantly increased the probability of early detection of acute postoperative endophthalmitis (p = 0.018). As a result of endophthalmitis treatment, patients in the main group had an BCVA ³ 0.3, patients in the control group £ 0.2. Conclusions . Optimization of the monitoring regime of patients after surgery includes shifting the examination period from 7 to 3 days after the procedure, which provides a statistically significant reduction of the risks of late diagnosis (more than 1 day after manifestation) and improves the results of acute postoperative endophthalmitis treatment, thus increasing the safety of cataract surgery.

Modern notions of beauty, dominant in the media and online, persistently promote the idea of “eternal youth”, including the need for a slim figure. Consequently, medications originally developed for the treatment of various systemic diseases are often used without medical indications and without physician supervision for the purpose of weight loss and/or rejuvenation. A striking example is the widespread use of human glucagon-like peptide-1 (HGLP-1) analogs (“Ozempic”, “Munjaro”, etc.), which were developed for the treatment of type 2 diabetes and associated obesity. This has led to the use of these drugs not only for the treatment of the aforementioned condition but also for weight loss in otherwise healthy individuals. An analysis of scientific literature and our clinical observations indicate a high risk of a wide range of side effects with this group of medications. The most common complaints include nausea, diarrhea, vomiting, and constipation, occurring in 39–42 % of patients. Additionally, cases of pancreatitis have been described, as well as an increased risk of gallstones, renal failure, anesthesia-related risks such as aspiration of gastric contents into the respiratory tract, and carcinogenic effects such as thyroid and pancreatic cancer. A significant number of studies have documented the development of ophthalmic pathology associated with the use of “Ozempic” and its analogs, including non-arteritic anterior ischemic optic neuropathy — an acute condition characterized by sudden, painless, and irreversible vision loss. Other studies have documented cases of macular edema and progression of diabetic retinopathy. The “Ozempic face” effect — a change in facial appearance (wrinkles, a sunken appearance) due to the rapid loss of subcutaneous fat — is mentioned in the literature. It prompts patients to seek dermal filler injections from cosmetologists, which, consequently, increases the risk of ophthalmological complications, particularly central retinal artery occlusion. It should be noted that decreased appetite associated with this class of drugs is largely due to their mechanism of action on the central nervous system and is accompanied by changes in taste preferences (a decrease in intense taste sensations), as well as increased depression, anxiety, and, in some cases, suicidal ideation. Although the effectiveness of therapy with human glucagon-like peptide-1 analogues has been proven, further research is needed to assess the risk of severe side effects associated with their use, as well as to inform physicians and patients about potential complications to ensure timely medical care, including in ophthalmology.

Non-penetrating deep sclerectomy (NPDS) is one of the safest and most effective surgical treatments for glaucoma. Nd:YAG laser goniopuncture (LGP) as a mandatory adjuvant procedure is associated with a significant risk of delayed complications. Purpose of the study: to evaluate the clinical efficacy and safety of a combined technique of LGP after non-penetrating deep sclerectomy compared to a control group. Materials and methods. A retrospective cohort study was conducted in 2 groups of patients with primary open-angle glaucoma who underwent NPDS followed by LGP between 2016 and 2021. In the main group, a microfistula was formed in the superolateral part of the trabeculodescemet membrane (TDM). In the control group, LGP was performed in the central part of the TDM. The primary endpoint to evaluate the efficacy of the technique was the maintenance of complete surgical success of NPDS at 6, 12, 18, 24 months after LGP compared to the control group. The safety endpoint was the number and outcome of postoperative complications. Results. 71 patients were included in the main group and 63 patients in the control group. At the end of 2 years of follow-up, 55 (77 %) patients in the main group maintained complete surgical success of NPDS, while in the control group — 39 (62 %) patients (χ2 = 3.870, p = 0.049). In the main group, the Kaplan — Meier survival analysis showed statistically significant greater odds of maintaining surgical success of NPDS after LGP (p = 0.032). In the main group, 3 out of 71 patients (4.2 %) developed microfistula blockage by the iris root, in all cases the complications were resolved by laser reconstruction of the surgical field. In the control group, microfistula blockage was described in 11 out of 63 (17.5 %) cases (p = 0.012), in 1 case it was resolved during laser reconstruction of the intervention area, 6 patients were treated with hypotensive eye drops, 4 patients underwent surgical intervention. Conclusions. The combined technique of LGP and risk-oriented approach to patient monitoring significantly reduces the incidence of complications, ensures their early detection and allows to manage their consequences through non-invasive treatment methods. As a result, the probability of maintaining complete surgical success of NPDS during 2-year follow-up is increased, which improves the long-term prognosis for vision preservation in glaucoma patients.

A review of the literature data indicates the need for additional research to improve the effectiveness of barley and chalazion treatment, in particular to determine objective indicators of barley transition to chalazion based on instrumental studies, and to study the relationship of the above pathological processes with concomitant pathologies, in particular, acute respiratory diseases and dry eye syndrome. The conducted study allowed us to develop an algorithm for differential diagnosis of barley and chalazion: barley is an acute inflammatory process of the sebaceous glands of Zeiss (external) and meibomian (internal), in 55.2 % of cases it develops against the background of hypothermia and/or acute respiratory viral infections, is stopped by local use of antibiotics and corticosteroids in 65.5 % of cases during an observation period of 7–14 days, in 34.5 % of cases it passes into the stage of chronic inflammation — secondary chalazion; A secondary chalazion is the transition of an acute inflammatory process to a chronic one over an observation period of 14 to 30 days (capsule formation), accompanied by an increase in its density and blood flow velocity, as determined by ultrasound. A chalazion is detected three times less frequently than a primary chalazion due to a disruption of the secretion of the meibomian glands without signs of acute inflammation. Correlation analysis data showed that the longer the chalazion persists, the denser its capsule becomes and the more severe the impairment of blood circulation in the area. The data obtained during the study can serve as a basis for developing a conceptual understanding of the etiopathogenesis of styes and chalazions in practicing physicians. This, in turn, will facilitate the appointment of timely and adequate treatment methods, including the consistent use of local drug therapy, intracapsular glucocorticoid injections, surgical removal of the chalazion, as well as the appointment of preventive treatment in the form of eyelid hygiene and other physiotherapeutic procedures at the stage of stopping this pathological process.

Thus, the study demonstrated that both styes and chalazions are 2.1 times more likely to recur than non-recurring cases. Stye and chalazion were most frequently detected in patients with a history of cosmetic procedures in the periorbital area, followed in descending order by patients with skin diseases and complicated somatic conditions, primarily gastrointestinal diseases. Data analysis is aimed for studying the influence of risk factors on the occurrence of styes revealed clinically significant differences: styes (an acute inflammatory process of the meibomian glands) occur 19.2 % more frequently in patients with a history of cosmetic procedures in the periorbital area, primarily in patients who had eyelash extensions (the difference in rates in this subgroup was 20.3 %). Stye provoked by primary cosmetic procedures is often not recurrent, while skin diseases in patients with stye increase the recurrence rate by 22.4 %, and an aggravated somatic status, in particular gastrointestinal diseases, by 65.2 % at p  < 0.001. The data obtained through the use of artificial intelligence programs in studying the influence of the significance of risk factors for chalazion development showed that, according to the SHAP values in the LightGBM model, the following factors had the greatest influence on the development of recurrent chalazion (in descending order): blepharoplasty (1.23), gastrointestinal diseases (0.89), autoimmune diseases (0.52), botulinum toxin (0.48), and a history of allergic reactions (0.25). The obtained data can allow routing the patient for additional examination and treatment by specialists, which will increase the effectiveness of the therapy.

Modern life is inextricably linked with the latest technologies. Artificial intelligence (AI) poses a new challenge to humanity, the application of which affects all areas of life, including medicine. This article examines the potential application of AI in medical practice, particularly in ophthalmology. It presents an example of how AI can be used to determine risk factors for dry eye syndrome in patients undergoing cosmetic procedures in the periorbital area. It also analyzes the limitations of AI in medicine. An analysis of the literature demonstrates that the use of AI in scientific and medical practice has opened up a wide range of opportunities for conducting research at a new technological level, such as screening examinations, image-based diagnostics, and disease prediction; selection of optimal drug dosages; mitigating the threat of pandemics; and automation and precision of surgical interventions. When integrating AI technologies into medical practice, it’s important to consider a wide range of ethical issues, including potential breaches of confidentiality, transparency, and the reliability of information received. Frequent use of chatbots can lead to errors and the dequalification of physicians, especially those with limited clinical experience, as well as disruption of doctor-patient communication. Furthermore, it’s important to consider legal and forensic issues, primarily the question of who will bear responsibility for making decisions. Given the above, in our view, a personalized approach to treating each individual patient remains a priority in everyday clinical practice. This approach takes into account not only objective indicators but also anamnestic data, the body’s individual responses to treatment, and psycho-emotional aspects, as well as the physician’s fundamental knowledge and experience.

The relevance of studying the development of barley and chalazions is growing, as new high-tech treatments, including various physiotherapeutic procedures, are being developed in addition to standard treatment methods for these conditions. This literature review describes in detail the risk factors for developing these conditions, the mechanism of external and internal styes, primary and secondary chalazions, conservative and invasive treatments for barley and chalazions, and presents studies comparing the effectiveness of these treatments. The literature analysis presented in this review revealed that there are currently no clear indications for various treatment options, including both conservative treatments, which include anti-inflammatory medication and eyelid hygiene, and invasive treatments, which include long-acting corticosteroid injections and surgical chalazion removal. Clear indications for various types of physiotherapy treatments, depending on the time of chalazion development, have not been defined. To improve the effectiveness of barley and chalazions, larger studies are needed. They should include data about the age and gender of subjects, comorbidities, chalazion duration, treatment choice, and a longer post-treatment follow-up period. Further studies with a larger sample size are needed to determine the influence of chalazion size, structure, and duration on the choice of initial treatment.

Purpose: to create a simple and effective complex method of prevention of dry eye syndrome (DYE) during cataract phacoemulsification. Patients and methods. The study was aimed at developing a complex intraoperative algorithm for the prevention of DES after cataract phacoemulsification in the postoperative period. For developing the algorithm, data from Russian and international sources of reviewed scientific literature, as well as clinical guidelines for cataracts were evaluated. The developed algorithm was applied for 291 patients (291 eyes) aged 45 to 75 years. The effectiveness of this intraoperative method of preventing Dry eye syndrome (DES) was evaluated during the early postoperative period, which lasted for 2 weeks. Patients were evaluated for the condition of their tear-producing system using the MediWorks Dixion S 350 slit lamp, and their quality of life was assessed with the SPEED scale. It allowed for the determination of the severity of SHS according to the 2024 classification of DYE severity. The developed algorithm is comprehensive, and all the techniques are interconnected and mutually influencing. The combination of all these techniques provides the effective prevention of DES in the postoperative period of cataract phacoemulsification, which improves the condition of patients by eliminating or reducing the manifestations of DES, which can significantly affect not only the patient’s quality of life but also the final visual acuity and, consequently, the patient’s satisfaction with the surgery.

The evaluation the burden of disease is an important aspect of modern medical science, such studies clearly illustrate the need for preventive measures aimed not only at improving the quality of life of patients, but also at the possibility of saving the state budget. It can become a reason for additional investments in the healthcare system from the state. A comprehensive analysis of the preventive treatment’s impact on dry eye syndrome for preparing patients for cataract phacoemulsification in accordance with the developed algorithm, which involves a differentiated approach based on the severity of dry eye syndrome, allowed us to determine the following indicators. In the absence of preventive treatment for dry eye syndrome (DES). Тhe duration of the disease is extended by an average of 35 %. It means that the patient will receive 38.64 % less money than the minimum level for living in Moscow. At the population level, assuming that only 1/3 (33 %) of 14,000 patients with severe dry eye syndrome complications are employed, i.e., 4,620 persons, the loss of wages amounts to up to 46,200,000 rubles from the patient’s perspective. It has been established that from the government’s point of view, financial expenses for temporary disability payments can reach up to 75,679,800 rubles per year. A course of therapy aimed at preventing the development of severe DYS in the postoperative period in patients with cataract phacoemulsification during their preparation for surgical treatment will reduce the total burden of the disease (direct and indirect costs) by 115,416,000 rubles per year. The obtained data indicate the needs of the ophthalmologists’ attention to the importance of timely diagnosis of DYS at the stage of patient rehabilitation for planned ophthalmic surgery, in particular, for cataract phacoemulsification. It’ll reduce the incidence of severe forms of DES, improve the quality of life of patients, and decrease costs for both the patient and the government.

Despite the widespread belief that blepharoplasty is a non-traumatic cosmetic intervention, clinical observations and analysis of scientific literature data indicate that the above-mentioned operation can cause a number of serious side effects, which, among other things, may be associated with impaired blood circulation in the eyelids and periorbital zone.Patients and methods. There were 148 patients (296 eyes) in the study. All patients included underwent color Doppler mapping (CDM) of the right and left eyes to assess geomdignamic indicators in the lacrimal artery bed, the results were averaged and included in the protocol. CDM was performed using the transpalpebral method. All patients included in the study were divided into groups depending on the presence or absence of blepharoplasty in the anamnesis, as well as the time after blepharoplasty: 115 patients — the main group, which was divided into subgroups: 32 patients 1 month after blepharoplasty, 27 patients 3 months after blepharoplasty, 31 patients 6 months after blepharoplasty, 25 patients more than 12 months after blepharoplasty; 33 patients without blepharoplasty — the control group.Results and conclusion. The study allowed us to establish that during the observation periods of patients after blepharoplasty of 1–3 months, there is a reliable increase in the systolic blood flow velocity — Vs according to color Doppler mapping, compared to patients who did not undergo this surgical intervention, which may be associated with the formation of scar tissue and the presence of a postoperative inflammatory process. Stabilization of the Vs index was determined at a 6-month observation period. In the group of patients aged 12 months or more, a reliable decrease in systolic blood flow velocity to a level that corresponds to similar indicators in the age group over 60 years without blepharoplasty is noted. The obtained data should be taken into account when preparing patients for planned ophthalmic surgery, which can be recommended for patients with a history of blepharoplasty no earlier than 6 months later, at the stage of stabilization of hemodynamic parameters. This will reduce the risk of complications in the postoperative period associated with changes in hemodynamic parameters of the eyelids, as well as carry out preventive treatment of dry eye syndrome in patients with a history of blepharoplasty, since trophism, including the meibomian glands, is impaired as a result of blepharoplasty