Kazakh Eye Research Institute

Objective. To assess the level of awareness of retinoblastoma among primary health care (PHC) physicians, identify areas of insufficient knowledge, compare the awareness of general practitioners (GPs) and pediatricians, and determine strategies to improve awareness. Materials and methods. A cross-sectional online survey was conducted from January to February 2025. The study involved 90 PHC physicians (49 GPs and 41 pediatricians). The questionnaire included 18 questions on clinical suspicion, diagnosis, referral pathways, and treatment of retinoblastoma. Statistical analysis was performed using SPSS software. Results. Most respondents were aware of retinoblastoma (81.6% of GPs and 92.7% of pediatricians). However, clinical experience with the disease was limited (20.4% of GPs and 31.7% of pediatricians). Pediatricians were more likely to encounter suspected retinoblastoma cases (51.2% vs. 26.5%, p=0.024) and refer children with a family history of the disease to an ophthalmologist (87.8% vs. 69.4%, p=0.032). The "white pupil" reflex was known to 90.2% of pediatricians and 63.3% of GPs (p=0.003). Only 14.3% of GPs and 34.7% of pediatricians were aware of modern organ-sparing treatments (p=0.027). Conclusions. The study revealed an insufficient level of awareness of retinoblastoma among PHC physicians, particularly among GPs. To improve early diagnosis of retinoblastoma, it is recommended to implement mandatory continuing medical education courses for physicians, with an emphasis on rare pediatric oncological diseases. Additionally, public awareness campaigns and media outreach are recommended to increase clinical suspicion. These measures also contribute to achieving Sustainable Development Goal 3 (SDG 3), which aims to reduce child mortality and ensure universal health. Цель. Оценить уровень информированности врачей ПМСП о ретинобластоме, выявить области недостаточной осведомленности, сравнить осведомленность врачей общей практики (ВОП) и педиатров, а также определить стратегии повышения осведомленности. Материалы и методы. Проведено поперечное исследование в форме онлайн-опроса с января по февраль 2025 года. Участвовали 90 врачей ПМСП (49 ВОП и 41 педиатр). Опросник включал 18 вопросов по клинической настороженности, диагностике, маршрутизации и лечению ретинобластомы. Статистическая обработка осуществлялась в программе SPSS. Результаты. Большинство респондентов знали о ретинобластоме (81,6% ВОП и 92,7% педиатров). Однако клинический опыт был ограничен (20,4% ВОП и 31,7% педиатров). Педиатры чаще сталкивались с подозрениями на ретинобластому (51,2% против 26,5%, р=0,024) и направляли детей с отягощенным анамнезом к офтальмологу (87,8% против 69,4%, р-0,032). Симптом «белого свечения» зрачка был известен 90,2% педиатров и 63,3% ВОП (р=0,003). Только 14,3% ВОП и 34,7% педиатров знали о современных органосохраняющих методах лечения (р=0,027). Выводы. Выявлен недостаточный уровень информированности о ретинобластоме среди врачей ПМСП, особенно среди ВОП. В целях улучшения ранней диагностики ретинобластомы рекомендуется внедрить обязательные курсы повышения квалификации для врачей с акцентом на редкие онкологические заболевания у детей. Дополнительно рекомендуется усилить информационную работу через просветительские кампании и медиа для повышения настороженности. Эти меры также способствуют достижению Цели устойчивого развития 3 (ЦУР 3), направленной на снижение детской смертности и обеспечение всеобщего здоровья. Кіріспе: Қазіргі тамырлы хирургияда қолқа-мықын сегментінің (ҚМС) окклюзиялық зақымдануы ең өзекті мәселелердің бірі. ҚМС окклюзиясын анықтау атеросклеротикалық процестің ауырлығы мен таралуын, демек, басқа артериялық бассейндерде біріктірілген окклюзиялық зақымданулардың үлкен ықтималдығын көрсетеді деген жалпы қабылданған пікір. Осыған байланысты өмірлік маңызды мүшелердін – жүрек пен мидың артериялық арнасының зақымдануы ерекше маңызды. Зерттеудің мақсаты. Өмірлік маңызды мүшелер тарапынан асқынулардың болжаушыларын түзетумен және түзетусіз ҚМС окклюзиялық зақымдануларын жедел емдеу нәтижелеріне салыстырмалы талдау жүргізу, олардың тиімділігін бағалау. Материалдар мен Әдістері: Зерттеу дизайны-проспективті рандомизацияланбаған клиникалық бақылау. Талдауға 2018-2024 жылдары "СМУ КеАҚ " университеттік госпиталінің жүрек-қан тамырлары хирургиясы бөлімінде ота жасалған қолқа-мықын сегментінің (ҚМС) окклюзиялық зақымдануы бар 143 пациент енгізілді. Қолданылатын тактикаға байланысты науқастар екі топқа бөлінеді: 1-ші топ (N = 64) — коронарлық және каротид артерияларының зақымдануын алдын ала түзетусіз, жамбас бассейнінің реваскуляризациясынсыз және бүйрек жеткіліксіздігін емдеусіз ҚМС-не шұғыл реконструктивтік араласулар жасалған науқастар. 2-ші топ (N = 79) — көрсетілімдер болған кезде алдын ала жүрек және цереброваскулярлық патологияны түзету, жамбас артерияларын реваскуляризациялау және негізгі ота алдында бүйрек қызметін тұрақтандыру орындалған науқастар. Нәтижелер: ерте операциядан кейінгі (30 күндік) кезеңде асқынулар бірінші топтағы пациенттердің 43,8%- тіркелген және 10,1 % — екіншісінде (p = 0,0002) тіркелді. Жүйелік асқынулар (миокард инфарктісі, ми қан айнылымының жедел бұзылысы, көп мүшелік жеткіліксіздік) бірінші топта жиі байқалды (p < 0,01). 30 күндік өлім бірінші топтағы 12% - дан екінші топтағы 2,5% - ға дейін төмендеді. 5 жылдық кезеңде асқынулардың жалпы жиілігі 11,5% - ға қарсы 40,7 % құрады (p = 0,0003). Каплан-Майердің жиынтық өмір сүру деңгейі бірінші топта 80%-ға, ал екінші топта 95% - ға жетті, айырмашылықтар статистикалық маңызды (Log-Rank p = 0,029). Қорытынды: бұл тактиканы енгізу емдеудің тікелей нәтижелерін жақсартып қана қоймай, науқастардың қашықтықтан өмір сүруін едәуір арттырды. Өмірлік маңызды органдардың функционалдық бұзылыстарын түзетуге және тамырлы араласулардың кезеңділігін оңтайландыруға бағытталған кешенді операция алдындағы дайындық тиімділігі дәлелденді және ауыр қатар жүретін патологиясы бар науқастарда қолқа-мықын сегментінің окклюзиясын емдеудің қауіпсіз және клиникалық негізделген әдісі ретінде ұсынылуы мүмкін.

Corneal disorders are among the leading causes of visual impairment worldwide, with corneal transplantation historically serving as the cornerstone of surgical treatment. However, the global shortage of donor tissue, risk of immune rejection, and variable long-term graft survival underscore the urgent need for alternative approaches, particularly in the setting of ocular surface diseases such as inflammation or dry eye that can compromise graft survival. Regenerative medicine has emerged as a transformative paradigm, offering strategies to restore corneal architecture and function through cell-based therapies, tissue engineering, and gene modulation. These strategies are promising, addressing structural repair and modulating wound-healing responses. In the corneal epithelium, cultivated limbal epithelial transplantation, simple limbal epithelial transplantation, and cultivated oral mucosal epithelial transplantation have expanded therapeutic options for limbal stem cell deficiency, with clinical trials demonstrating long-term ocular surface stability. Regulatory approval of commercial products, such as Holoclar and Nepic, confirms the potential of standardized regenerative products. Stromal regeneration with stromal and mesenchymal stem cells has shown promise in preclinical and early phase clinical trials, with intrastromal stem cell injection improving corneal transparency and biomechanics and potentially stabilizing progressive disorders such as keratoconus. For endothelial dysfunction, intracameral injection of cultured corneal endothelial cells supplemented with Rho-associated protein kinase (ROCK) inhibitors has yielded sustained corneal clarity and visual restoration at 5–10 years, marking a paradigm shift from transplantation to minimally invasive, donor-independent therapies. Tissue engineering innovations, including matrices, hydrogels, and three-dimensional bioprinting, are advancing toward translation, while gene therapy approaches using viral vectors and Clustered Regularly Interspaced Short Palindromic Repeats -Cas9 are being explored to modulate angiogenesis, fibrosis, and inherited dystrophies. Overall, regenerative medicine is reshaping corneal therapeutics, offering effective alternatives to conventional transplantation with reduced donor dependence and improved safety. Future work must focus on long-term safety, cost-effectiveness, and equitable global access to realize its full clinical potential.

Introduction: This study aimed to develop a method for predicting the risk of developing macular degeneration in the early stages by facilitating prompt intervention by medical professionals. Methods: Using a cross-sectional design, 455 age-related macular degeneration (AMD) patients from Kazakhstan were recruited via random sampling. Demographic traits, familial AMD history, medical history, and eye-related characteristics were collected through a systematic questionnaire. The patient cohort comprised 169 Caucasians and 286 Asians, with 160 males and 295 females. Results: Notably, 117 individuals (25.7%) were classified as high AMD risk, 322 (70.8%) as moderate risk, and 16 (3.5%) as low risk. Additionally, eye-related findings revealed high-risk factors, including bright iris colors, increased UV exposure, and cataract surgery, alongside presbyopia and myopia. The study underscores the need for national/regional AMD risk stratification to inform monitoring and screening programs. Recognizing high-risk individuals holds paramount significance from both public health and therapeutic perspectives, offering opportunities for early detection and management to mitigate permanent vision loss. Conclusions: The findings elucidate the interplay between risk factors, shedding light on their collective impact on AMD risk. Overall, this study's predictive model and risk categorization framework have substantial implications for ophthalmological practice, enabling timely preventive measures and potentially revolutionizing AMD management.

Introduction: Cataract is a prevalent eye condition that affects millions of individuals worldwide, leading to visual impairment and reduced quality of life. Cataract surgery is the most effective treatment, but post-surgical complications can arise, impacting the success of the intervention. Optical coherence tomography (OCT) has emerged as a valuable imaging technique for evaluating these complications, but the manual interpretation of OCT images is time-consuming and subjective.Objective: In this study, we aimed to assess the performance of a machine learning (ML) tool specifically developed for detecting post-surgical complications in cataract patients.Methods: We employed a support vector machine (SVM) algorithm to analyze a comprehensive dataset of OCT images. The dataset comprised 700 OCT images obtained post-surgery, including patients with cystoid macular oedema (CMO), retinal detachment (RD), and healthy individuals. The ML tool utilized pre-processed OCT images with annotations provided by expert ophthalmologists, undergoing retinal layer segmentation using intensity-based features.Results: The SVM algorithm demonstrated high sensitivity and specificity in detecting and classifying post-surgical complications. It achieved a sensitivity of 92.5% in detecting CMO and 90.9% in identifying RD. The specificity of the algorithm was 90.9% and 96.2% for these complications, respectively. The overall accuracy of the ML tool in correctly identifying and classifying post-surgical complications was 92%.Conclusions: The integration of ML algorithms in OCT imaging shows promise in enhancing the accuracy and efficiency of assessing post-surgical complications in cataract patients. The ML tool developed in this study provides reliable and objective assessments, reducing the subjectivity and variability associated with the manual interpretation of OCT images

This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation. The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated. All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors. The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.

The manuscript provides an overview of vitrectomy as the most frequent surgical treatment for vitreous opacities.It also discusses alternative treatments such as YAG laser vitreolysis and the potential use of gold nanoparticle-assisted photoablation.Additionally, the manuscript briefly mentions the surgical management of diabetic retinopathy.Overall, the manuscript covers several studies and research findings related to these topics.However, there are a few points that could be clarified or expanded upon for a more comprehensive review.Here are some specific comments:

Background and Objectives: The aim of our study was to identify risk factors associated with phacomorphic glaucoma (PG) by comparing the biometric parameters of contralateral eyes of patients with PG with the eyes of patients with a mature cataract. Methods: This retrospective case–control study included 71 eyes affected with PG, 311 eyes of control participants, and 71 contralateral eyes of patients with PG. All participants were ethnically Kazakh. Axial lengths (AL), anterior chamber depths (ACD), and lens thicknesses (LT) were measured using A-scan ultrasound biometry. To determine the threshold value of the A-scan parameters associated with PG, we performed ROC analysis. Results: The eyes with PG had smaller AL and ACD values and larger LT values, followed by the fellow eyes with PG and the control eyes. There were no differences in age and sex between patients with PG and mature cataracts. After adjustment for age and other A-scan parameters, continuous measures of ACD and LT were associated with PG (OR 0.57, 95% CI 0.38–0.73, p < 0.001; OR 3.36, 95% CI 1.64–6.912, p = 0.001). When A-scan parameters were dichotomized according to the identified threshold, an ACD of less than 2.5 mm (OR 3.113, 95% CI 1.562–6.204, p = 0.001) and an LT thicker than 4.75 mm (OR 26.368, 95% CI 9.130–76.158, p < 0.001) were found to be related to PG. Conclusions: We found that a thicker lens and, possibly, a shallow ACD are risk factors for PG.

Purpose To investigate the age at recognition and presentation for surgery for congenital and developmental cataract at Kazakh Eye Research Institute in Kazakhstan. Methods A retrospective review of children aged 0–18 years, who presented with congenital and developmental cataract between January 1, 2010 and December 31, 2020. All medical records were reviewed. Gender, age at recognition, age at surgery, laterality, residential location (rural/urban) were recorded. Results The study population included 897 patients of children presented with congenital and developmental cataract over a 10-year study period, 58% of them were boys and 44.6% were from rural areas. Cataract was bilateral in 621 (69.2%) and unilateral in 276 (30.8%) of patients. Median age at recognition for patients with congenital/developmental cataract was 12 months. Median age at surgery for congenital/developmental cataract was 51 months. Only 14.7% of children underwent surgery within first year of life. The urban citizens underwent surgery earlier than patients from rural areas. The median delay in presentation for surgery was 15 months. Conclusion The average age at cataract surgery in the population of Kazakhstan is much older than in developed countries. It is essential to study barriers that associated with delayed presentation to build strategies to overcome them. Key messages It is known that cataract surgery in children early in life provides favourable visual outcome. Children with congenital and developmental cataract in Kazakhstan experience delay in surgical treatment. Children from rural areas undergo cataract surgery later than urban citizens.

PURPOSE. To assess the hypotensive effectiveness, frequency and nature of intra- and postoperative complications in patients with various clinical manifestations of refractory glaucoma. MATERIALS AND METHODS. The study included 196 patients (196 eyes) with various forms, stages and clinical manifestations of glaucoma. There were 142 patients with primary glaucoma, among them 120 with open-angle glaucoma and 22 with angle-closure glaucoma. Among the patients with primary glaucoma, 85 had pseudophakia (77 with openangle and 8 with angle-closure forms); 57 had a native lens (43 with open-angle and 14 with angle-closure forms of the disease). Secondary glaucoma was presented mainly by patients with neovascular (21) and postuveal (16) glaucoma. The intraocular pressure (IOP) level in the group as a whole ranged from 16 to 50 mm Hg (on average 30.1±2.6 mm Hg). In all presented cases of surgical intervention, the Glautex drainage was used, which is a bioresorbable composite biomaterial based on polylactic acid (polylactide) and polyethylene glycol (manufactured by “HiBiTech”, Russia). Standard methods of patient examination were used. RESULTS.In patients with POAG, the IOP averaged 13.7± 4.7 mm Hg one week after surgery and 16.1±3 mm Hg 12 months after surgery. The absolute success of the operation was noted in 71 patients with POAG (59.2%); the relative hypotensive effect — in 85.8%. In primary angle-closure glaucoma, the same indicators were 47.6 and 61.1%, respectively. In the group of patients with neovascular and postuveal glaucoma, the hypotensive effect was as expected lower and amounted to 42.8 and 50.0%, respectively. The restart of therapy at different periods of observation was done in 78.3%. Complications, their frequency and nature, noted by us in the operated patients, could be attributed to those typical for fistulizing operations in refractory glaucoma. The most common complication was ciliochoroidal detachment, which was seen in all groups, but percentage-wise was more common in patients with PACG, neovascular and postuveal glaucoma. CONCLUSION. Composite drainage based on polylactic acid (polylactide) and polyethylene glycol (glautex) is an effective and safe solution to the issue of surgical treatment of glaucoma. The antihypertensive effectiveness of the Glautex drainage implant depends on the severity of the glaucomatous process and the timeliness of the surgical intervention. The frequency and nature of complications depends on the degree of refractoriness of glaucoma, initial clinical characteristics of the process, and patients' multimorbidity.

Aim: to develop a complex preventive and therapeutic program for refractive errors in school year children. Patients and Methods: 1,760 pupils of elementary, secondary, and high school of eight schools of Almaty (1,302 pupils of gymnasiums and 458 pupils of general education schools and sport boarding school) were examined. The 1st step was a preventive screening. The 2nd step was a distant interactive screening by teachers. The 3rd step was an eye examination of schoolers with low vision. The efficacy of the detection of visual impairments in schoolers during preventive and distant computer screening was compared. In addition, significant indicators for visual impairment monitoring in schoolers were identified. A "Program for the Prevention of the Development and Progression of Refractive Errors in Schoolchildren" was developed. To evaluate its efficacy, 140 pupils of general education schools with refractive errors and 1,302 pupils of gymnasiums with refractive errors or their high risk underwent eye examinations. In addition, to compare the effect of wearing glasses/contact lenses with full correction on the quality of life, 31 schoolers aged 12–17 with refractive errors were selected. Results: the rate of visual impairments was 28.4% among the pupils of general education schools and 31.3% among the pupils of gymnasiums. The most common refractive error was myopia (46.9% and 65.4%, respectively). As children moved through their school carrier, the proportion of myopia tended to increase. Accommodative dysfunction ranked second 48.5% and 29.7%, respectively). Time spent on distant screening was twice less compared to time spent on preventive screening. Visual acuity, cycloplegic refraction, reserves of relative accommodation, and axial length (measured by ultrasound) were indicators of visual impairments in children during monitoring. Poor general health was reported in 33% of children who wear glasses and 15% of children who wear contact lenses. Keywords: refractive errors, myopia, accommodation, schoolchildren, distant screening, prevention, vision correction with contact lenses. For citation: Botabekova T.K., Aldasheva N.A., Abdullina V.R. et al. Complex program for the prevention of the development and progression of refractive errors in school year children. Russian Journal of Clinical Ophthalmology. 2021;21(3):135–142 (in Russ.). DOI: 10.32364/2311- 7729-2021-21-3-135-142.