Children with congenital achromatopsia possess an interesting paradoxical pupillary constriction to darkness that has not been previously described. This paper describes three children in whom this paradoxical pupillary reaction was documented with infrared pupillometry. The literature on the pupil in achromatopsia is reviewed and a tentative testable model of the reaction is hypothesized.
Purpose:to study the relationship between the optic nerve structural changes and the electrophysiological parameters of visual analyzer in the early diagnosis of primary open-angle glaucoma (POAG).Patients and methods.68 people took part in the study. 48 patients (56 eyes) were diagnosed with ophthalmic hypertension, suspected glaucoma (age ranged from 35 to 67 years, the average age was 51 years) and 20 healthy subjects (40 eyes) who entered the control group (age 32 up to 63 years, the average age is 47 years). All patients underwent standard ophthalmologic examination, multifocal electroretinography (mEPHRG), confocal scanning laser ophthalmoscopy (KSLO), electrophosphhenes and CFCs. For all types of analysis of mEPHR indices (by rings, quadrants and 3D), normal topography and density of the biopotential of the central region of the retina were recorded in patients with suspected glaucoma. The indices of the electrosensitivity of the inner layers of the retina, the conductivity of the axial fasciculus of the optic nerve, and CFSC also corresponded to normal values. Analysis of CCEA results showed a significant decrease of NRF volume of and the thickness of the retinal layer of nerve fibers compared to the control group, while in the group of patients with suspected glaucoma in 71 % of cases, the decrease of indicators correlated with the abnormalities in the static perimetry that was carried out earlier. Conducted morphometric studies confirm the fact that the decrease in the volume of IUU and SNV begins at the early, preclinical stage of glaucoma, and this in patients with ophthalmic hypertension can provide valuable information on the early diagnosis of POAG.
The screening method for determination of individual norm of IOP proved the efficiency for early glaucoma diagnosis and for the treatment and monitoring of a disease. Purpose: definition of compliance of IOP to individual norm or tolerant IOP (TIOP) in different age groups Patients and methods. 4212 women (65.6%) and 2205 men (34.4%) aged from 22 up to 80 years participated in a research. In total 12820 examinations were analyzed. At each patient the result of compliance of settlement TIOP to the available real oftalmotonus was estimated. Patients with excess of an oftalmotonus concerning TVGD up to 15% were carried to group with low risk of disease developing, with excess from 15 to 25% — with average risk, by more than 25% — with high risk of glaucoma development. All patients were divided into 3 groups depending on age: younger 40 years, with average age of 35 years (620 eyes); from 40 to 60 years, with middle age 54 years (2724 eyes); 60 years, with middle age are more senior 73 years. Results. The regularity consisting in decrease in an indicator of lack of risk of glaucoma with age and in increase in high risk of a disease in the senior age groups was revealed. For patients who entered into risk group, morfofunctional monitoring for the glaucoma exception, dynamic observation with the subsequent analysis of the received results through certain time was recommended. The obtained data confirm decrease in hemodynamic parameters of eyes with increase in age, and assessment of indicators of microcirculation of an eye with calculation of TIOP can be one of important diagnostic criteria for glaucoma diagnostics and monitoring.
Purpose.To assess the state of blood flow in retrobulbar vessels using the method of color Doppler imaging in thrombotic microangiopathy (TMA) associated with atypical hemolytic uremic syndrome (aHUS), malignant hypertension (MH) and catastrophic antiphospholipid syndrome (CAPS).Methods. The study involved 16 patients aged from 18 to 43 years with TMA associated with aHUS (13 patients), MH (2 patients) and CAPS (1 patient). All patients underwent a study of the state of blood flow in the vessels of the retrobulbar space by color Doppler imaging using a multifunctional ultrasonic diagnostic device Voluson 730 Pro and Voluson E8. The spectrum of blood flow in the ophthalmic artery (OA), central retinal artery (CRA), central retinal vein (CRV), in the medial and lateral short posterior ciliary arteries (SPCA) was recorded and the following parameters were determined: maximum systolic velocity (Vsyst), final diastolic velocity (Vdiast), peripheral resistance index (RI), pulsation index (PI).Results. The analysis of the Doppler blood flow spectrum in all patients with TMA syndrome revealed a decrease in Vsyst in the vessels of the retrobulbar space, more pronounced in the CRA, with an increase in the venous component of the Doppler spectrum. In patients with TMA associated with aHUS and MH Vdiast in the studied vessels were in normal limits or increased, RI and PI were reduced. In aHUS a statistically significant correlation was found between Vdiast in OA and the level of haptoglobin in blood serum, which is a classic marker of intravascular hemolysis.Conclusion. Color Doppler imaging of retrobulbar vessels is an important method for the diagnosis of ocular hemodynamics disorders in the syndrome of TMA. All patients with TMA syndrome are characterized with a decrease in the systolic component of the Doppler spectrum of blood flow in the vessels of the retrobulbar space, especially in the CRA, with an increase in the venous component. With aHUS and MH diastolic blood flow in the retrobulbar vessels corresponds to the norm or increases, RI and PI decrease. In TMA associated with aHUS, the final diastolic velocity of blood flow in OA depends on the level of microvascular hemolysis.
There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.
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