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The leading place in the structure of blindness and low vision is occupied by two diseases: primary open-angle glaucoma and diabetic retinopathy. The combination of two diseases in one eye gives an even more severe prognosis for vision. Modern diagnostic equipment helps in accurate and early diagnosis of the disease by analyzing digital data of the optic nerve head and macular area of the retina according to the results of an optical coherence tomograph. A mathematical model for predicting the development of diabetic retinopathy and primary open-angle glaucoma according to the proposed mathematical criteria has been developed. The criteria represent the ratio of the integral area of the neuroretinal rim to the integral volume of the neuroretinal rim; the retinal thickness criterion and criterion of the primary open-angle glaucoma and diabetic retinopathy are calculated. A computer program has been developed. The algorithm of the program, which includes windows for entering digital data of the macular zone and parameters of the optic nerve head, is presented. The result of the program is the statement of the risk of developing combined pathology of the fundus in a particular patient.

Aim: to study ophthalmological clinical functional parameters in patients with hypertension and coronary heart disease (CHD) with coronary artery stenosis. Patients and Methods: 30 patients (58 eyes) with hypertension and CHD with coronary artery stenosis (group A) and 30 healthy controls (60 eyes, group B) were examined. Best-corrected visual acuity (BCVA), macular sensitivity (MS) assessed by MAIA microperimetry, central macular thickness (CMT), foveal avascular zone (FAZ) area, vessel density of superficial capillary plexus (SCP VD) and deep capillary plexus (DCP VD) and choriocapillaris measured by optical coherence tomography angiography (OCTA) were evaluated. Results: FAZ area was 0.42±0.03 mm2 in group A and 0.28±0.03 mm2 in group B (p<0.05). SCP VD was 11.4±3.1% in group A and 25.4±2.5% in group B (p<0.05). DCP VD was 22.3±1.1% in group A and 39.2±3.5% in group B (p<0.05). Choriocapillaris VD was 51.2±1.1% in group A and 63.1±1.2% in group B (p<0.05). Correlations between ocular parameters and ejection fraction (EF) were revealed (BCVA: r=0.61, p<0.05; MS: r=0.68, p<0.05; CMT: r=-0.72, p<0.05; FAZ: r=-0.73, p<0.05; SCP VD: r=0.82, p<0.05; DCP VD: r=0.81, p<0.05; choriocapillaris VD: r=0.76, p<0.05). Conclusions: in patients with hypertension and CHD with coronary artery stenosis, significant (p<0.05) reduction in BCVA, MS, SCP VD, DCP VD, and choriocapillaris VD and increase in CMT and FAZ area were detected compared to healthy individuals. Additionally, strong correlations between ocular parameters (FAZ, SCP VD, DCP VD, and choriocapillaris VD) and EF (p<0.05) were identified. OCTA may be recommended to monitor fundus vessels in hypertension and CHD as an effective noninvasive valuable diagnostic tool to verify hypertension and CHD. Keywords: hypertension, coronary heart disease, coronary artery stenosis, hypertensive retinopathy, foveal avascular zone, vessel density, optical coherence tomography angiography. For citation: Moshetova L.K., Vorobyeva I.V., Dgebuadze A. et al. Ophthalmological monitoring in patients with hypertension and coronary heart disease. Russian Journal of Clinical Ophthalmology. 2021;21(2):51–57. DOI: 10.32364/2311-7729-2021-21-2-51-57.

The problem of diabetic retinopathy causes loss of the vision. In nowadays, modern equipment is used to diagnose this disease: an optical coherent tomograph and a fundus microperimeter. For even more accurate diagnosis, biomarker levels in the lacrimal fluid and blood serum are being researched. The mathematical model for predicting the developing of the course of the disease is proposed. The mathematical model is based on four mathematical criteria. The first two criteria analyze the data of digital equipment: the thickness of the retina in 9 zones and the photosensitivity of the macula. The third and the fourth mathematical criteria analyze the levels of pathogenetic biomarkers in the lacrimal fluid (vascular endothelial growth factor VEGF-A) and the blood serum (glycated hemoglobin). The program based on the proposed mathematical formulas combines the objective data from the digital equipment and the biomarkers. The program gives the possibility for the automatic prediction of developing the diabetic retinopathy. The prognosis of development of the course of the disease according to the program coincides with a clinical prognosis of a doctor. It was shown that the application of the proposed complex approach gives more opportunities in comparison with separate studies of the biomarkers, morphology and retinal function.

The problem of digital medicine in ophthalmology arose in connection with the increase in the incidence of diabetes mellitus in the world. The issue of preventing blindness and early diagnosis in diabetic retinopathy with a forecast of its course using mathematical modeling is especially acute. A system for assessing the prognosis of the risk of developing diabetic retinopathy was created based on interdisciplinary research in three areas: ophthalmology, biochemistry and mathematics. The studies were conducted in ophthalmology with the analysis of the condition of the retina in the macular area using digital ophthalmic equipment (optical coherence tomograph, fundus microperimeter). Biochemical studies consisted in the analysis of tear fluid with the determination of the level of the pathogenetic biomarker VEGF-A and the analysis of blood serum with the determination of the level of glycated hemoglobin HbA1c. Mathematical research consisted in the presentation of digital material in the form of mathematical criteria based on the method of standardizing the indicator under study. The result of the research was a computer program based on the developed mathematical formulas. The program gives the opportunity to automatically enter the data of a specific patient with diabetic retinopathy and give a prognosis of the disease.

In recent years, in the study of diabetic retinopathy the methods of medical engineering and mathematical modeling with the forecast of the course of diseases and given pathogenetic biomarkers in the lacrimal fluid have been widely used. The theoretical aspects of the research are the developed mathematical criteria. The criteria are the mathematical formulas describing objective data of digital ophthalmological equipment and levels of pathogenetic biomarkers in lacrimal fluid and blood serum. The proposed approach allows to create a decision support sys-tem for predicting the development of diabetic retinopathy and diabetic macular edema. The practical application of the mathematical model is reflected in the developed computer program that enables the ophthalmologist to work with the patient’s data in automatic mode. The use of the program for the diagnosis and prognosis of a patient with diabetic retinopathy is demonstrated. The work on the proposed method gives the opportunity to reduce the time for assessing the patient’s condition and give a timely forecast of the course of the disease, which makes it possible to approach each patient in a personalized way.

BACKGROUND: Very few studies have focused on the state of the fundus and visual functions before and after simultaneous transplantation of the pancreas and kidney. In addition, the results and conclusions of authors on this topic are contradictory. AIMS: To evaluate the ophthalmological status of patients with diabetic retinopathy before and after kidney and pancreas transplantation. MATERIALS AND METHODS: The patients were divided into three groups: group 1 included patients on the transplant waiting list receiving hemodialysis, group 2 were kidney transplant recipients, and group 3 included patients who had undergone simultaneous pancreas and kidney transplantation. The ophthalmological status of patients was assessed through standard ophthalmic diagnostic methods and measurements of photosensitivity, central retinal thickness, choroid thickness, density perfusion of the superficial and deep retinal capillary plexus, choriocapillary layer, and deep choroidal layer in the foveal and parafoveal zones of the macular region. RESULTS: The study involved 76 patients (152 eyes) (group 1, n=30 patients undergoing dialysis; group 2, n=24 kidney transplant recipients; group 3, n=22 kidney and pancreaticoduodenal post-transplant recipients). Signs of the active phase of the proliferative stage of diabetic retinopathy (group 1, 54.1%; group 2, 53.3%; and group 3, 25.9%, p 0.05) and diabetic macular edema (group 1, 26.4%; group 2, 31.8%; and group 3, 12.8%, p 0.05) were more common in groups 1 and 2 than in group 3. Moreover, group 3 needed laser therapy (group 1, 45.3%; group 2, 43.2%; and group 3, 20.5%, p 0.05) and antiangiogenic therapy to a lesser extent (group 1, 18.9%; group 2, 25.0%; and group 3, 5.1%, p 0.05) than patients undergoing dialysis and kidney recipients. The eyes of patients after simultaneous pancreas and kidney transplantation were characterized by the smallest retinal thickness, highest retinal and choroidal perfusion, and highest visual acuity and photosensitivity (p 0.05). CONCLUSIONS: A surgical method for restoring euglycemia through transplantation of physiologically active pancreatic tissue favorably affects the morphological and histological state of the retina and retinal and choroidal hemoperfusion and reduces the frequency of the active phase of proliferative diabetic retinopathy and diabetic macular edema.

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