BACKGROUND: Multiple sclerosis is a chronic autoimmune demyelinating disease of the central nervous system. Early diagnosis of the disease is extremely important for the just-in-time start of specific therapy. Optical coherence tomography (OCT) of the optic nerve head and retina can become an early marker of the neurodegenerative process in multiple sclerosis. AIM: To determine OCT-changes in the retinal nerve fiber layer (RNFL) thickness and retinal thickness in the macular area being most specific for multiple sclerosis. MATERIALS AND METHODS: 197 patients were examined, the study group consisted of 136 patients (274 eyes) with an established diagnosis of multiple sclerosis and the disease duration of at least 6 months. The control group included 61 healthy people (122 eyes). All patients underwent a standard ophthalmological examination, OCT was performed on Spectralis OCT (Heidelberg Engineering, Germany) using 2 scanning protocols: ONH-RC-Scan (Optic Nerve Head-Radial Circle Scan) and PPAA (Posterior Pole Asymmetry Analysis) RESULTS: Only 11 patients (8.1%) had a history of retrobulbar neuritis, the best corrected visual acuity was 0.7 and higher in 83 (81%) patients with multiple sclerosis, while the optic nerve head and retinal nerve fiber layer OCT-changes typical for multiple sclerosis were found in 118 patients (87%). The most prominent thinning of the retinal nerve fiber layer in group with multiple sclerosis was revealed in the temporal part of the optic nerve head (59.9 14.8 in the study group versus 76.6 12.0 in the control group; p 0.001), the least thinning was in the nasal half (66.6 14.3 in the study group versus 69.3 12.4 in the control group; p = 0.013). The retina in the macular area in multiple sclerosis patients was thinned over the entire area, the most significant changes were in the Outer Nasal 7 zone (303.3 20.4 in the study group versus 324.3 10.0 in the control group; p 0.001). Cluster analysis found 6 new retinal zones for mapping the macular area using the scanning protocol PPAA. In order to determine the prognostic value of the obtained zones, a logistic regression model was constructed, which with a sensitivity of 87.1% and a specificity of 81.6% allows concluding on the probability of having multiple sclerosis. CONCLUSION: OCT data using the proposed mapping of the macular area with the mathematical model analysis could be used to diagnose specific optic nerve atrophy, to reveal typical thinning of the retinal nerve fiber layer associated with multiple sclerosis, and in the long run, to become an additional criterion for establishing the diagnosis of multiple sclerosis.
The emergence of targeted therapy has become a significant breakthrough in the management of cancer patients, but even it is not without drawbacks. The article describes a clinical case of the development choroidal neovascularization in a 42-year-old patient with stage IV skin melanoma during 15 months of therapy with MEK and BRAF inhibitors. Clinicians need to remember that such patients may have not only MEK-associated retinopathy, but also other pathological changes in the retina, in particular choroidal neovascularization, which may be associated with both the chemotherapy they receive and the paraneoplastic syndrome itself against the background of the course of the underlying disease. Timely diagnosis and adequate management tactics allow such patients to preserve visual functions.
Purpose to estimate the efficacy of “artificial tear” preparation on the trehalose base in dry eye syndrome treatment in cataract patients after phacoemulsification.Materials and methods: in 40 patients with incipient cataract phacoemulsification with IOL implantation was performed. During 1 week, all patients received eye gel with dexpanthenol in addition to postoperative therapy. Then, all patients were divided into two groups (randomization using envelopes): in the main group, the gel was replaced by Thealoz®, in the control group, the gel was discontinued. Special investigation tests (OSDI score, TBUT test, conjunctival hyperemia, corneal confocal tomography) were performed before surgery, in one week and one month after it. Statistical analysis was performed using SAS 9.4 program.Results: all investigated parameters had significant differences with time and between groups (р < 0.001). TBUT test result decreased in one week after surgery from 7.4 ± 2.1 to 4.6 ± 1.9 sec in the main group and from 7.5 ± 2.3 to 4.4 ± 2 sec in the control group. Return to baseline results in the control group was slowed down and made 6.4 ± 2.8 sec (compared with 7.9 ± 2.4 sec in the main one). In the trehalose group, OSDI score ameliorated from 35.1 ± 8.7 (in one week) to 14.2 ± 5.3 (in one month), in the control group, from 40.1 ± 11.5 to 24.8 ± 9. Conjunctival hyperemia was also less pronounced in the main group in one month after surgery: 0.45 ± 0.6 (1.6 ± 0.7 in one week), in the control group, these indices were equal to 1.7 ± 0.5 (in one week) and 1.3 ± 0.7 (in one month).Conclusions: Thealoz® use as a part of combined postoperative therapy helps to effectively fight against dry eye syndrome main signs and enhances treatment tolerance.
Received: 15.01.201615.01. Accepted: 18.03.2016 G Over the past 15 years, the negative role of toxic preservatives in the IOP-lowering eye drops solutions used in the treatment of primary open angle glaucoma (POAG) patients has been convincingly proven by many national and foreign experts. Therefore, there is a worldwide tendency to prescribe preferably preservative-free IOP-lowering eye drops nowadays. Taflotan is the world's first preservative-free prostaglandin F2a analogue. In our study of POAG patients switched to Taflotan from the benzalkonium chloride-preserved latanoprost eye drops, we observed a marked decrease in corneal staining and severity of conjunctival hyperemia, as well as increase of the tear breakup time and corneal epithelium morphology improvement evaluated by confocal tomography. Thus, the drug not only effectively lowers IOP but also produces less negative effect on the tear film and eyeball surface, improving treatment tolerability.G
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