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Ophthalmology in Russia

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Vol 18, No 1 (2021)
View or download the full issue PDF (Russian)
https://doi.org/10.18008/1816-5095-2021-1

REVIEWS

5-11 1001
Abstract

Data from sources of domestic and foreign literature for 2016–2019 is presented in the review of literature. This data concerned of applying the method of optical coherent tomography-angiography in pediatric ophthalmic practice. OCT-A is a non-invasive research method, without the use of fluorescent dyes. The procedure is performed relatively quickly, with the possibility of additional repetition. The method allows to conduct visualization of the vascular network of the retina layer-by-layer, perform its quantitative analysis: to evaluate the density of the microvascular bed and measure the area of non-perfusion zones. Having appeared as a result of a qualitative modernization of OCT, a new method of visualization of vessels OCT-A is actively used in the diagnosis of pathologies such as glaucoma, diabetic retinopathy, post-thrombotic retinopathy, age-related macular degeneration, central serous chorioretinopathy, etc. In present time OCT-A being performed in adult medicine, it is actively used in various areas of pediatric ophthalmology. Presently, pediatric patients with diabetes mellitus, sickle cell anemia, amblyopia, retinal artery occlusion, and coats disease have been performed with OCT-A studies. Retinopathy of prematurity (ROP) is required a special attention among children’s eye diseases. However, mentioning about OCT angiographic studies in patients with ROP are quite rare in the literature. Nevertheless, the available data indicate the enormous diagnostic potential of OCT-A in this severe vasoproliferative disease. The method give possibility for fully control the pathological process, to evaluate the effectiveness of the treatment and timely prevent the development of severe stages of ROP. Due to the information and diagnostic potential, it is necessary to continue research on the possibilities of the OCT-A method in the diagnosis, analysis of treatment results and prediction of ROP.

12-19 1595
Abstract

In this review we presented the information about pathogenesis of mycotic keratitis and the most characteristic clinical signs that can help ophthalmologists to suspect mycotic etiology. In conditions of poor accessibility and informativeness of laboratory and instrumental diagnostic tests, the analysis of the anamnesis and the clinical signs remain the only information that can be used by a physician while making a diagnosis and choosing treating strategies. This review contains the results of a number of studies. In the review we show the progression phases of cornea mycotic infection, among them adherence, invasion, morphogenesis and toxigenicity. We also reveal that the most characteristic clinical signs of mycotic keratitis are scalloped rough edge of stromal defect, prominent dry crumby or caseous structured view of infiltrates and necrotic masses, satellite infiltrates, certain changes of color of the defected area. Heaviness of mycotic keratitis ulcer defect has a correlation with an unfavourable prognosis for disease. Mycotic keratitis during contagion can be complicated by mycotic glaucoma with a malignant disease course and endophthalmitis. There can be cases with mixed infection. While Almost No clinical sign is pathognomonic for keratomycoses, summing up all the signs can verify the diagnosis. Ophthalmologists need training in the recognition the clinical signs of infectious keratitis. Also new methods of fast diagnostics of infectious keratitis etiology and implementation on a large scale are needed.

20-29 1321
Abstract

Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases, which are often accompanied by inflammation of other organs. This article presents modern data on etiology, pathogenesis and clinical course of inflammatory bowel diseases, as well as information on extraintestinal eye manifestations of nonspecific ulcerative colitis and Crohn’s disease. The role of microbiota, genetic factors, immune system defects in pathogenesis of intestinal inflammation and extraintestinal eye manifestations is considered. The possibility the development of ophthalmopathology not only against the background of intestinal inflammation, but also as a consequence of therapeutic and surgical methods of treatment of ulcerative colitis and Crohn’s disease is noted. The peculiarities of the course of episcleritis/scleritis, keratitis, uveitis, chorioretinitis, optical neuritis for patients with inflammatory bowel diseases are considered. The presence of these complications may reflect the activity of the underlying disease, which in some cases requires correction of therapy. Anterior uveitis and episcleritis/scleritis are the most common extraintestinal manifestations of inflammatory bowel disease. Inflammation of tissues of the posterior segment of the eye and optic nerve against the background of ulcerative colitis and Crohn’s disease are less common, but are of clinical importance, as they can catastrophically damage the structures of the eye and, as a consequence, lead to complete blindness. Considering the possibility of mild clinical symptoms and asymptomatic course of inflammation in the eye envelopes, the importance of ophthalmological examination of all patients with ulcerative colitis and Crohn’s disease is emphasized. Aspects of modern therapy of ophthalmopathology and background intestinal inflammation are highlighted. Biological preparations — antagonists of pro-inflammatory cytokines — have been identified as the most promising in the treatment of inflammatory intestinal diseases and extraintestinal manifestations. The important role of proper nutrition and biologically active supplements containing omega-3 fatty acids, vitamin D, microelements, was noted as auxiliary therapy of both intestinal and extraintestinal inflammation.

30-35 634
Abstract

This literature review analyzed the possible mechanisms of the influence of the design features and optical characteristics of monofocal intraocular lenses (IOLs) on the characteristics of sensorineural adaptation and visual rehabilitation in patients after cataract phacoemulsification. Bibliographic research of scientific publications was carried out in the following databases: Medline, Pubmed, Cochrane, eLibrary. Languages of publications: Russian and English. The literature review reflects research data on the physicochemical properties, optical surface and color of the IOL filter, spatial contrast sensitivity and wavefront aberrations. Analysis of domestic and foreign literature has demonstrated the absence of a systematic approach to the study of sensorineural adaptation in patients after implantation of monofocal IOLs, which would make it possible to reasonably develop requirements for qualitative and constructive characteristics in the production of intraocular lenses to improve the quantitative and qualitative indicators of their visual functions in order to reduce the terms of rehabilitation and improvement of quality of life indicators in patients with pseudophakia. At the same time, there is an obvious need for research on the influence of the design and quality characteristics of optical intraocular implants on the subjective “quality of vision” of patients with pseudophakia, which is, ultimately, the target indicator of cataract surgery at the present stage. Also, the key mechanisms of neurosensory rehabilitation and adaptation of patients who underwent cataract surgery need to be studied and clarified in order to develop recommendations for the production of intraocular implants.

OPHTHALMOSURGERY

36-45 787
Abstract

Purpose: to assess the efficacy and safety of needling performed by the new scleroconjunctival dissector according to our specific technique.

Patients and methods. The study included 60 patients diagnosed with operated subcompensated or decompensated glaucoma. Thirty patients underwent microinvasive reoperation with the help of a sclero-conjunctival dissector. The control group consisted of 30 patients; they underwent repeated sinustrabeculectomy with iridectomy. A standard ophthalmological examination and ultrasound biomicroscopy were performed before the operation and in dynamics (after 1, 3, 6, 9 months).

Results: 76.7 % of the experimental group had IOP less than or equal to 15 mm Hg six months after microinvasive reoperation. In the control group, the same mark was 70 %. Hyphema occurred in 23.3 % of the main group, it was stopped by conservative treatment. 10 % of patient developed choroid detachment, it did not require surgical treatment. Hyphema was formed in 36.7 % in the control group and choroid detachment — in 53.3 % of patients. The complications were more manifested and required surgical treatment in the control group. According to the data of ultrasound biomicroscopy, the acoustic density in the control group steadily increased, while the height of the filtration bleb first increased and then decreased. This may indicate significant tissue induration, probably as a result of fibrosis after an operating injury. The intrascleral «lake» height does not differ between the groups when comparing dynamic observations, and the volume of the intrascleral cavity is significantly greater in the main group than in the control group (p < 0.0001) at admission and during dynamic observation. The text of the article describes a clinical case of a patient who underwent microinvasive reoperation.

Conclusion. When there are indications for re-surgery, an adequate and thorough diagnosis of the preservation of the surgically created outflow tract, namely gonioscopy and ultrasound biomicroscopy, is important. In patients with intact internal fistula and without pronounced fibrosis of the intrascleral drainage pathways, it is possible to carry out microinvasive reoperation according to our technique using a scleroconjunctival dissector, this allows to reduce the risk of postoperative complications and achieve hypotensive efficacy comparable to repeated filtering surgery.

46-53 843
Abstract

Purpose: to evaluate the clinical and functional results of the operation the FemtoLASIK by excimer lasers with frequency more 1000 Hz in patients with low to moderate myopia.

Patients and methods. The 84 eyes of 84 patients with low to moderate myopia who had undergone FemtoLASIK procedure using with excimer lasers: Schwind Amaris 1050 Hz (Germany) and Microscan Visum 1100 Hz (Russia) were included in the study. The “Schwind Amaris 1050 Hz” and “Microscan Visum 1100 Hz” groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central thickness of the cornea, sphere, cylinder, SE) (p > 0.05). All patients underwent complete ophthalmological examination before refractive laser surgery, and also patients were examined on the 1st day and 1 month after FemtoLASIK.

Results. One month postoperatively, in the “Schwind Amaris 1050 Hz” group the UDVA 1.0 or better (20/20 or better by Snellen) was achieved in 100 %, in the “Microscan Visum 1100 Hz” group — in 100 % (p > 0.05). There wasn’t observed a loss of the CDVA lines in both groups. In the “Schwind Amaris 1050 Hz” group gain of one or more lines of the CDVA was 14 %, in the “Microscan Visum 1100 Hz” group — in 12.2 % (p > 0.05). In the “Schwind Amaris 1050 Hz” group the predictability of targeted refraction within ±0.5 D was in 90.7, within ± 1.0 D — in 100 %, in the “Microscan Visum 1100 Hz” group — in 90.2 % and 100 %, respectively (p > 0.05).

Conclusions. The FemtoLASIK procedure using with different high-frequency excimer lasers is an effective, safe and predictable method for correcting low to moderate myopia.

 

54-60 1146
Abstract

Purpose: To evaluate the clinical results of a combined approach to the treatment of pellucid marginal degeneration, that includes femtolaser-assisted keratotomy, intrastromal lamellar keratoplasty with a use of refractive lenticule and a simultaneous intracorneal ring segment implantation, followed by a local collagen cross-linking.

Patients and methods. An analysis of the outcomes of the surgical treatment performed in 20 eyes of 15 patients from 36 to 57 years old who were diagnosed with pellucid marginal degeneration in both of their eyes. During the first stage of the treatment patients underwent a femtolaser-assisted keratotomy in a steep meridian, intrastromal lamellar keratoplasty in the zone of corneal thinning and a simultaneous implantation of intracorneal ring segments with an arc-length of 80 to 160 degrees, followed by a local corneal cross-linking during the second stage. Refractive lenticules obtained during the ReLEx® SMILE procedure were used as a lamellar graft.

Results. By the end of the follow-up period of 12 months the UCVA had improved from 0.1 ± 0.07 to 0.33 ± 0.23 and the BCVA from 0.4 ± 0.25 to 0.7 ± 0.28 (p < 0.05). The corneal topography demonstrated a decrease in maximum simulated keratometry values from 49.28 ± 2.57 D to 46.15 ± 1.73 D and an astigmatism reduction from 7.4 ± 3,9 D to 2.1 ± 0,53 D. The corneal thickness increased from 508.0 ± 31.0 μm to 606.0 ± 36.0 μm in the zone of the thinning.

Conclusions. The analysis of the clinical outcomes has demonstrated the high efficacy of the combined approach to the treatment of pellucid marginal degeneration. The ICRS implantation allowed for a significant cylinder reduction and an improvement of visual acuity. The lamellar keratoplasty allowed for a reinforcement of the thinned cornea, and the subsequent local collagen cross-linking ensured corneal stability.

61-69 814
Abstract

Purpose. To assess safety and effectiveness of calibrated cyclodialysis ab interno involving implantation of a non-absorbable collagen implant in the suprauveal space in decreasing IOP in glaucoma patients.

Methods. Forty-three patients (43 eyes; 16 male and 27 females; average age — 70.4 ± 10.0 years) were included in this pilot study. A 6 mm long and 2.0 mm wide cyclodialysis cleft was created ab interno in one of the lower quadrants of the eye using a specially designed spatula followed by insertion of a strip of implant in the cleft. In 19 eyes (44.3 %) the procedure was performed as standalone procedure and in 24 eyes (55.7 %) along with cataract surgery. Outcome measures were IOP change, use of hypotensive medication(s), complications, and need for a second surgery. Decrease in IOP by >20 % and IOP between 6 and 21 mmHg without hypotensive medication(s) constituted complete success; similar changes in IOP with medication(s) constituted partial success. Need for second surgery constituted failure.

Results. At 6 months, baseline IOP decreased from 20.6 ± 7.4 mmHg to 12.9 ± 4.9 mmHg (a decrease by 37.4 %; р < 0.001) and hypotensive medication use reduced from 2.6 ± 0.8 to 1.0 ± 1.1 (a reduction by 57.7 %; р < 0.001). Complete success was achieved in 19 eyes (44.2 %), partial in — 15 eyes (34.9 %). Nine eyes had unsuccessful outcomes (20.9 %); among these, seven eyes (78 %) had severe glaucoma and five eyes (55 %) had undergone previously glaucoma surgeries. Hemorrhaging at the cleft site was the most common intraoperative complication — 18 eyes (41.9 %). Postoperative complications included hyphema, which was completely resorbed within one week.

Conclusion. Calibrated cyclodialysis ab interno procedure involving implantation of a non-absorbable collagen implant in the suprauveal is safe and easy to perform. It effectively decreases IOP in patients with moderate glaucoma but is less effective in patients with severe glaucoma and in patients with previously failed glaucoma surgeries. Complications were found to be minimal.

70-76 546
Abstract

Purpose: to evaluate outcomes and to expose possible specific complications of two-piece mushroom keratoplasty.

Patients and methods. A total of 9 patients (9 eyes) with corneal perforations and deep stromal opacities involving the Descemet membrane were undergone surgery. In all cases, preserved hypothermic corneoscleral buttons (in Borzenok– Moroz medium) for up to 5 days were used as donor material. The two-piece mushroom keratoplasty was performed using a microkeratome and vacuum trephines set in the variant proposed by M. Busin.

Results. Success survival was obtained in 78 % of patients (7 out of 9 cases). Best spectaclecorrected visual acuity (BSCVA) 1 year after surgery averaged 0.54 ± 0.20. The average of corneal astigmatism was 3.41 ± 1.89 D. Endothelial cell density in 6 months after surgery was on average 2364 ± 236/mm2, and in 1 year — 2082 ± 228/mm2. A false chamber formation between separate parts of the graft as a specific complication was detected in 2 patients on 1 day after surgery. In one case it was eliminated by air re-injecting into the ocular anterior chamber. The second patient underwent conventional PKP due to the lack of graft adaptation. In addition, 1 patient also underwent conventional PKP as a result of postoperative crystalline infectious keratopathy, which is the non-specific complication of mushroom keratoplasty.

Conclusion. The two-piece microkeratome-assisted mushroom keratoplasty is an effective method of surgical treatment of corneal perforations and deep stromal opacities involving the Descemet membrane.

77-82 839
Abstract

Purpose: to analysis the results of microimpulse transscleral diode laser cyclophotocoagulation (DCPC) technique as a method of choice in patients with open-angle subcompensated glaucoma (OAG) with toxic allergic syndrome of the ocular surface (TASOS).

Methods. The retrospective analysis of patients’ case reports with subcompensated open-angle glaucoma and TASOS was performed. Transscleral diode laser cyclophotocoagulation (DCPC) in a microimpulse mode was used in their treatment. A total of 19 patients’ case reports were analyzed.

Results. In the postoperative period, its course, patient’s complaints, ophthalmological status, visual acuity indicators were determined. The level of intraocular pressure was measured. Almost all patients (84.2 %) reached the target level of IOP. The frequency of side effects was low. In 36.84 % of patients, symptoms of TASOS decreased in response to hypotensive treatment due to reduction of instillation frequency.

Conclusion. The use of micro-pulse cyclophotocoagulation in patients with subcompensation form of OAG and toxic-allergic ocular surface syndrome (TASOS) reduces the intensity of the drop regime of antihypertensive drugs. As a result, the manifestations of TASOS are reduced, which increases the patients’ quality of life in the postoperative period. In addition, the use of DCPC in microimpulse mode leads to stabilization of functional and structural indicators, helps to prevent a decrease in visual functions. Thus, the described method is characterized by safety, high efficiency and a wide range of indications for its performance. It allows to compensate the IOP with a minimum percentage of complications and stable postoperative results.

CLINICAL & EXPERIMENTAL RESEARCH

83-89 579
Abstract

Purpose: to study the subpopulation composition of peripheral blood lymphocytes in patients with long — term chronic post-traumatic uveitis (CPT).

Patients and Methods. There were 131 people aged 17 to 87 years, who received the surgical treatment in the Department of plastic surgery and eye prosthetics in NMITS eye diseases Helmholtz of the Ministry of health, Russia, where the removal of the eyeball by evisceration was carried out in 101 patients (70.3 %), 30 patients (29.7 % of cases) were enucleated. The study identified two groups: the Ist group– with the outcome of the injury, including non-penetrating (n = 46) and penetrating wounds (n = 51) of the eyes, were 97 patients; group II included 34 patients with complications due to single (n = 8) or repeated (n = 26) ophthalmic surgery (development of glaucoma and retinal detachment).

Results. When analyzing the mean values, we found a decrease in the relative number of CD3+ CD4+ helpers/inducers in the blood of patients of both groups (up to 43.5 ± 0.81 and 42.19 ± 1.29 % versus 45.7 ± 1.19 % in the control), statistically confirmed for the 2nd group. Individual analysis revealed multidirectional shifts from the norm of cellular immune status of patients with PU in both groups. The most interesting, in our opinion, results were obtained by analyzing the relative number of effector cytotoxic cells of adaptive and nonspecific immunity. The increase in the relative content of t-cytotoxic lymphocytes CD3+ /CD8+ and NK-lymphocytes CD16+ /CD56+ was revealed with the same frequency, approximately in 18.5 and 19.5 % of cases in the PU group at the outcome of injury, in the 2nd group the increased number of these subpopulations was observed more often, amounting to 23.5 and 20.5 %, respectively.

Conclusions. The results of the study on a large clinical material indicate that in long-term CPTU there is a pronounced systemic imbalance in the immunoregulatory subpopulations of lymphocytes, revealed by individual analysis in groups of patients.

90-95 714
Abstract

Purpose: to assess the role of microperimetry in dynamic observation and treatment of patients with macular holes.

Patients and Methods. Retrospective study of the microinvasive vitrectomy results using 25G or 27G technologies in 29 patients (29 eyes) with idiopathic macular holes (IMH). The examination included the determination of the best corrected visual acuity (BCVA), tonometry, perimetry, ultrasound biometry, optical coherence tomography, fundus photography, microperimetry.

Results. After surgical treatment all patients have shown a significant improvement in BCVA and retinal photosensitivity (p < 0.05). A formula was derived for the dependence of BCVA after treatment on the initial retinal photosensitivity and the minimum IMH size, which can be applied to predict the results of surgical treatment.

Conclusion. Microperimetry is a modern non-invasive examination method that allows with a higher density and resolution to localize central defects of the visual field and to carry out thorough monitoring before and after surgical treatment. The study of the retinal photosensitivity in the macular region and the minimum IMH size before treatment allow to predict BCVA in the postoperative period.

96-102 597
Abstract

Purpose. To reveal predictors of small choroidal melanoma transpupillary thermotherapy efficiency using optical coherence tomography-angiography.

Patients and methods. 34 patients with small choroidal melanoma at an average age of 55.0 ± 2.9 years were examined. Optical coherence tomography-angiography was performed on an OCT-Angiography Software for RS-3000 Advance Optical Coherent Tomograph, Nidek, Japan, before and 4 months after 1 session of transpupillary thermotherapy. Transpupillary thermotherapy (TTT) was performed with a Nidec DC 3300 diode laser.

Results. Prior to TTT — a loop-shaped, cranked-convoluted with an uneven lumen heterogeneous nature of the vasculature of the tumor with numerous bends and interlacing, located under the vessels of the retina in the central zone; the area of neovascular vasculature is 32.82 mm2, the density is 12.42 %. The limiting avascular zone is on the periphery. Around melanoma is a homogeneous hyperreflective rim of dilated choriocapillaries. 4 months after 1 session of TTT in 24 (70.6 %) of 34 cases — occlusion of the choriocapillaries in the central and peripheral zone of the tumor (avascular regions), expansion of the large and medium vessels of the choroid around the focus — predictors of complete tumor devitalization (chorioretinal scar). In 6 (17.6 %) of 34 patients, occlusion of the choriocapillaries in the central zone, expansion of large and medium vessels of the choroid around the tumor, along its periphery and in the paracentral region, retinochoroidal anastamoses along the periphery and in the paracentral zone, heterogeneous neovascularization of the choriocapillaries around; decrease in the area of vasculature — 12.44 mm2, density — 6.15 %, (p < 0.05) — predictors of partial devitalization of small choroidal melanoma (residual tumor). In 4 (11.8 %) of 34 cases, tumor vessels in the tumor area, large and medium vessels of the choroid around, along its periphery and in the central zone, occlusion of the choriocapillaries in the central zone, retinochoroidal anastamoses in the periphery and in the central zone, heterogeneous neovascularization choriocapillaries around; vascular network area — 29.13 mm2, density — 10.17 %, (p > 0.05), lack of devitalization (continued growth).

Conclusion. The introduction of optical coherence tomography-angiography revealed the predictors of the effectiveness of transpupillary thermotherapy of the initial melanoma of the choroid, which are various types of tumor vascularization, indicating its about complete, partial or absence devitalization after treatment.

103-109 944
Abstract

Dislocation of intraocular lens is a serious complication of phacoemulsification with implantation of intraocular lens. Among the causes of early dislocation of intraocular lens intraoperative complications predominate, as well as various form of their mixed fixation. In the late postoperative period, dislocation of the capsular bag-intraocular lens complex mainly occurs, the main reasons for which are the zonular weakness and the failure of the capsular bag support or its fibrosis.

Purpose: to assess the influence of various factors on the development of late IOL dislocation (both in the capsular bag and without it) requiring surgical correction.

Patientes and methods. The study included 78 patients (78 eyes) who were underwent surgical treatment of varying degree of IOL dislocation from October 2018 to April 2020. The control group consisted of 62 patients recruited for surgical treatment of cataract at the same period. The main factors for assessment were the following: axial myopia (≥26 mm), previous vitreoretinal surgery, recurrent uveitis, primary glaucoma, retinitis pigmentosa, and the use of the capsular tension ring during phacoemulsification.

Results. Among the factors studied, the following risk factors of late IOL dislocation were revealed: age, gender, the presence of pseudoexfoliation syndrome, axial myopia, primary glaucoma, implantation of the capsular tension ring. Conclusion. Phacoemulsification is the standard surgical treatment of cataract. However, in patients with potential risk factors of developing IOL dislocation, surgeons should consider the use of additional IOL fixation.

110-116 874
Abstract

Purpose: to investigate local functional changes in the rabbit retina by multifocal electroretinography under pulsed laser radiation.

Materials and methods. Transpupillary applications by single laser pulses (Nd:YAG laser, 532 nm, 50 ms) with the diameter of the laser beam spot on the retina surface of 132 µm (15 eyes) and 200 µm (15 eyes) were performed on 30 eyes of 15 rabbits. In each eye were applied 6 applications of different laser pulse power (15, 30, 50, 100, 150 and 200 mW). The diameter of the injury zone was assessed ophthalmoscopically and histologically. Multifocal electroretinography was performed before and 30 minutes after exposure using a module for multifocal electroretinography Neuro-ERG (Neurosoft, Russia), topographically comparing a pattern of 61 hexagons with an ophthalmoscopic fundus picture. The amplitude (µV) of the P1 peak and the implicit times (ms) of the P1 and N1 peaks were estimated in the first-order response in the hexagons corresponding to the laser damage zones.

Results. When using a laser spot on the retina of 132 microns and 200 microns, the threshold level of laser radiation power for the development of significant local changes in the bioelectric activity of the retina was 50 and 30 mW, respectively (p < 0.05). The minimal diameter of the laser damage at which significant functional changes are recorded by multifocal electroretinography with a pattern stimulator consisting of 61 hexagons was 127.2 ± 6.4 µm (spot 132 µm, energy 50 mW), while a significant relationship was found between changes in the peak amplitude P1 and ophthalmoscopic and histological dimensions of the damage zone (r = 0.73 and r = 0.71, respectively, p < 0.01).

Conclusion. The use of multifocal electroretinography can be used to quantify functional changes in local laser damage to the retina in experimental studies on rabbits.

117-122 920
Abstract

Purpose: to study the clinical and functional state of the visual analyzer of patients after surgery for the epiretinal membrane (ERM) from the standpoint of the relevance of postoperative rehabilitation.

Patients and methods. There were 158 patients under observation (158 eyes, main group, MG), among whom 66 % were men, 34 % were women aged 45–74 years (the average age of patients was 62.4 ± 1.5 years) with a diagnosis of ERM. At the same time, the leading form of ERM was idiopathic (122 patients, 77.2 %). As a control group (CG), were examined 32 patients of equal age and gender, who did not have visual organ pathology. In order to remove ERM, all patients underwent subtotal posterior vitrectomy with intraoperative administration of antioxidants, in particular glutathione contained in a balanced salt solution “BSS-PLUS” (Bausch + Lomb, USA). A comprehensive examination of the clinical and functional state of the visual analyzer was performed one month after surgery.

Results. The data obtained indicate that almost all the studied parameters revealed a significant deterioration in the MG compared to the CG with a fairly good anatomical effect (the thickness of the central retinal zone after the operation was 287.1 ± 11.6 μm). In particular, a decrease in the subjective indicator “Quality of life” (by 53.1 %), as well as a deterioration in the objective indicators of the critical frequency of flicker fusion, the magnitude of the electrical lability of the retina and the threshold of electrical sensitivity of the retina (by 36.2; 38.2 and 45, 5 % respectively).

Conclusions. A fairly good anatomical effect of vitreoretinal surgical intervention for ERM is accompanied (one month after the operation) by a significant decrease in the functional state of the visual analyzer. In order to restore vision more quickly, it seems advisable to conduct early postoperative rehabilitation (based on the complex use of physiotherapeutic effects and combined drug therapy) aimed at correcting functional disorders of the retina, which will lead to a decrease in the severity of characteristic complaints and an increase in the “Quality of life” of the patient.

123-128 791
Abstract

An increased share of the elderly in the structure of modern society, along with other causes and risk factors, is accompanied by the growing the incidence of glaucoma. According to international research in the world by 2020 it is predicted that glaucoma patients will increase to 80 million. Among the elderly, glaucoma is a common pathology, the development of which is associated with local disorders of the interleukin profile. However, the features of the latter in patients with primary closed-angle glaucoma in the elderly have not been studied. The purpose of this work is to identify the features and informativeness of local interleukin profile indicators in elderly patients with primary angle — closure glaucoma. The study included 58 patients with primary angle-closure glaucoma of stage II, who made up the main group, aged 60–74 years with a median of 70.1 ± 2.5 years. All patients underwent a comprehensive ophthalmological examination. The diagnosis of primary angle-closure glaucoma was established in accordance with the requirements of the National glaucoma guidelines. The control group consisted of 27 elderly people aged 60 to 74 years with a median of 68.7 ± 2.1 years without signs and manifestations of primary angle-closure glaucoma, who also underwent a comprehensive ophthalmological examination. Changes in proinflammatory interleukins at the local level in the development of primary angle-closure glaucoma are accompanied by a significant increase in their content in all cases. On the contrary, changes in anti-inflammatory interleukins in the lacrimal fluid in patients with the considered ophthalmological pathology are characterized by a significant inhibition of their production. IL-10 are characterized by the most significant decrease at the local level and it is less related to IL-4. Local interlacing profile of patients with primary angle-closure glaucoma elderly are characterized by increased level in the tear fluid of anti-inflammatory IL-2, IL-17, IL-8 and lower production of anti-inflammatory IL-10. These local interleukins have the greatest informative value, which is of scientific and practical significance for identifying new mechanisms of development, diagnostics and justification of selective immunotropic therapy of the pathology in question.

PHARMACOLOGY

129-135 3296
Abstract

The aim of the study was to evaluate the effectiveness of the preparations Optinol® Express Moisture (0.21 %) and Optinol® Deep Moisture (0.4 %) in the treatment of children with dry eye syndrome (DES) and to determine the indications for prescribing these drugs for various etiologies and clinical course of the disease.

Patients and methods. The study involved 56 children aged 4–17 years with DES, which were divided into 3 groups, depending on its pathogenetic type. The first consisted of 24 children with DES, which developed on the basis of chronic blepharitis, the second — 12 children with neuroparalytic keratitis, and the third — 18 children with chronic uveitis, in whom DES was caused by prolonged instillations of eye drops with benzalkonium chloride. Each group was divided into 2 more equal subgroups, the first of which was prescribed the drug Optinol® Express Moisture, and the second — Optinol® Deep Moisture with a frequency of 4 times a day.

Results. In all children, from the very first days of instillation of the studied drugs, a decrease in the severity of subjective signs of DES (OSDI) was noted, as well as a gradual decrease in the degree of xerotic changes in the ocular surface (severity of its staining with vital dyes) and an increase in the stability of the tear film (M.Norn). At the same time, the positive dynamics of the controlled parameters increased with the continuation of therapy, reaching a maximum by the 30th day of treatment. Moreover, the effectiveness of therapy depended on the severity of xerosis of the ocular surface: it was maximal in children with mild, and minimal in children with an extremely severe form of xerosis (with neuroparalytic keratitis). Moreover, the drug Optinol® Express Moisture was more effective in the treatment of children with mild and extremely severe forms of DES, and Optinol® Deep Moisture — with moderate and severe xerosis.

Conclusion. The preparations Optinol® Express Moisture and Optinol® Deep Moisturization are effective in the treatment of children with DES, which has developed on the basis of pathology of the ocular surface of neurotrophic and artifact genesis, as well as increased volatility of the precorneal tear film against the background of chronic blepharitis.

136-142 810
Abstract

The clinical course of active retinopathy after anti-VEGF therapy, the possibility and timing of recurrence of the disease, anatomical and functional outcomes of treatment are widely discussed in the press, not fully studied and relevant.

Purpose: to study the clinical course of active retinopathy of prematurity after anti-VEGF therapy and clinical and functional outcomes.

Patients and Methods. Children with active retinopathy of prematurity, who turned to the Helmgoltz National Medical Research Centre of Eye Diseases after anti-VEGF therapy, examined by indirect binocular ophthalmoscopy and digital retinal camera (RetcamShuttle). Children were monitored from 1.5 to 6 years (average 2.94 ± 1.47). All children underwent routine examination, 4 children older than 3 years underwent optical coherence tomography.

Results. In all cases, after anti-VEGF therapy, there was a decrease in vascular activity and continued vascularization of the retina. Recurrence of the disease requiring additional treatment, were detected in 11 (42.3 %) eyes within 6–22 weeks (in average 13.33 ± 5.57) after intravitreal anti-VEGF therapy. Laser coagulation of the retina was carried out in 4 children (7 eyes) and repeated administration of anti-VEGF drug — 2 children (4 eyes), which led to regression of the disease. In the long-term period, all 13 (100 %) children had successful outcomes.

Conclusion. Anti-VEGF therapy is effective in plus-zone 1 disease and posterior aggressive retinopathy of prematurity. Its advantages include the ability to treat retinopathy in zone 1 posterior, the absence of “blockade” of the peripheral retina with the possibility of continued growth of blood vessels to the periphery, lower frequency and severity of myopia. The disadvantages include the possibility of recurrence of the disease, which requires long-term regular monitoring.

143-151 2100
Abstract

Purpose: to evaluate the influence on the state of the eye surface and the tear-producing system of decorative cosmetics and cosmetic products with different chemical bases for removing makeup.

Patients and methods. The study included 45 (90 eyes) persons without clinical signs of an acute inflammatory process of the eye surface, they were prescribed the use of one of the Biore products: 15 people — makeup removal wipes, 15-micellar water, 15-makeup removal serum. The results of the objective (biomicroscopy, tests for lacrimal production) and subjective examinations are included in the questionnaires developed and standardized for this study (3 visits after the start of the use of cosmetics, 14, 30 days after the start of their use).

Results. There were no significant differences (p > 0.5) between the groups that used makeup remover products on different bases — makeup remover serum, micellar water, makeup remover wipes — in all the patients included in the study. Patients with signs of a chronic inflammatory process on the eye surface and dry eye syndrome are less tolerant of makeup remover, which is manifested in a lower subjective assessment of these products after their use compared to patients without signs of an inflammatory process (p < 0.5). A correlation was determined at r = 0.3085, p = 0.0392 between the skin type and the Schirmer test parameters, exactly, the more oily the skin, the higher the Schirmer test parameters, it indicates a possible relationship between the skin type and the functional activity of the tear-forming glands, which indicates the need for further research in this area. The absence of a correlation (p > 0.5) between objective and subjective parameters that characterize the state of the eye surface and the tear-producing system, as well as the number of hours per day when decorative cosmetics are used, indicates that prolonged use of this type of exposure does not lead to the development of a pathological process on the eye surface.

152-156 628
Abstract

The study included patients with a verified diagnosis of “Traction retinal detachment” (RD) in pediatric (50 patients, mean age 13.8 ± 1.1 years, age range from 11 to 18 years) and adults (50 patients, mean age 54, 6 ± 2.2 years, age range 19 to 72 years). The control groups included 25 children (mean age 13.1 ± 1.2 years) and 25 adults (mean age 52.8 ± 1.6 years) patients without pathology of the organ of vision. A comprehensive examination of the functional state of the visual analyzer was performed, including the assessment of clinical (maximum corrected distance visual acuity, BCVA), subjective (Quality of Life, QOL), hemodynamic (pulsation index in the central retinal artery, PI), electrophysiological (threshold of electrical sensitivity of the retina (PESR); threshold of electrical lability of the retina; critical frequency of fusion and flashing (presentation of a red object); photostress test) and biochemical (antioxidant activity in the lacrimal fluid, AOA; superoxide dismutase indicator, PS in the lacrimal fluid) indicators of the visual system. The data obtained indicate some differences in the studied parameters in patients with OS in pediatric and adult practice. In particular, a higher level of BCVA in adults was found (by 18.8 %, p < 0.001). Along with this, it was determined that RD in children is accompanied by more pronounced disorders of hemodynamic and antioxidant parameters, which is associated with a more pronounced degree of proliferative vitreoretinopathy and preservation of antioxidant defense mechanisms. The results of stepwise discriminant analysis of the statistical characteristic F, which determines the weighting coefficient of the relationship in the regression equation of the basic AOA parameter with each indicator in the general array, determined the following most informative indicators (F > 3.0) of the visual system of patients with OS associated with antioxidant protection: in an adult practice — BCVA, QOL, PI, PESR, PS; in pediatric practice — BCVA, PI, PESR, PS. The obtained similar results of statistical analysis for children and adults are actualized by research in pediatric practice aimed at increasing the clinical effectiveness of vitrectomy for RD based on antioxidant protection methods tested in adult practice.

CASE REPORT

157-164 822
Abstract

The purpose: to describe clinical cases of oculodental-digital dysplasia (ODDD, OMIM #164200) with mutation in GJA1 (OMIM 121014) with molecular genetic verification of the diagnosis.

Methods. The article describes the clinical case of oculodental-digital dysplasia in a 51 years old patient. Patient underwent full ophthalmic examination including autorefractometry, visual acuity testing with full correction, tonometry, biomicroscopy, fundus examination and photo as well as kinetic perimetry, autofluorescence and optical coherence tomography (OCT) of macula and optic disk were performed. Electrophysiological examination included Visual Evoked Potentials (VEP) to flash and pattern stimulation, ISCEV standard electroretinograms (ERG) and macular ERG. For the verification of the diagnosis and pathologic gene molecular genetic examination was performed with family anamnesis previously attained.

Results. The patient was complaining the deterioration of vision, hearing loss and the sense of smell. Visual deterioration was associated with nyctalopia. Natural history revealed glaucoma 2а which was diagnosed when he was 48 years old. Best corrected visual acuity was 1,0. Peripheral visual field defects were revealed bilaterally. High visual acuity correlated with normal foveal structure on OCTs the retinal nerve fiber layer (RNFL) was thinner than normal in temporal half; deep excavation was visualized in both eyes. Normal MERG and bilateral decrease of scotopic, maximal full-field ERG was recorded which correlated with nyctalopia, as well as subnormal photopic responses indicating cone system involvement. The genetics revealed characteristic features of the face: a small nose with hypoplasia of the wings of the nose, unfolded nostrils and a wide bridge of the nose (pseudohypertelorism). On right-wing the ear sink was detected 2 antitraguses. Changes fingers upper extremities — operated syndactyly IV and V on the background of brachydactyly of the fingers. On the legs on both sides — syndactyly III–IV. 10 years the sense of smell has been dereriorated. In the study of DNA in proband in direct Sanger sequencing of all exons 1–2 and regions of exon-intron compounds of gene GJA1, was found the pathogenic variant in second exon c.412G>A (p.Gly138Ser) in heterozygous state. Was established autosomal dominant type of disease.

Conclusion. We are the first to describe rod-cone dystrophy in oculodental-digital dysplasia.

165-170 764
Abstract

Introduction: penetrating keratoplasty (PK) is an effective method for the surgical treatment of corneal failure and its layers and low visual acuity. It is well-known that the graft degrades over time, it is associated with “chronic immune destruction”. Rekeratoplasty is conducted in case of rapid decrease of transplant functions, but even with multiple rekeratoplasty iterations, the result can be unstable.

Patient and methods. Patient D., 42 years old, complaints to low vision of left eye — arm movement 10 cm on face. Both eyes have been previously surgically operated for the last 10 years. Two iterations of an artificial iris transplantation in combination with IOL implantation, and Ahmed drainage implantation and five rekeratoplasty on the left eye were conducted. Corneal graft failure with transplant thickness — 802 μm. The patient suffers from Mediterranean fever and polyarthritis. We conducted a course of conservative therapy, which increased visual acuity to 0.05. Then we performed a surgical procedure for hybrid type of keratotransplantation. The following procedures were gradually conducted: mechanical removal of epithelium, femto-laser formation in a recipient’s replaceable corneal disk formation with 500 μm thick and a diameter of 7.0 mm, removal of disk, femto-laser formation of a central penetrating hole with a diameter of 3 mm opposite the artificial pupil, placing of the hydrogel graft 60 μm thick on the bottom of the bed. Hydrogel graft was covered by a donor corneal graft, which was fixed by interrupted sutures and soft contact lens.

Results: Visual acuity of the left eye after 1 day after keratoplasty — 0.2; after 1 month — 0.3, the transplant was transparent; after 4 months — 0.4 with complex correction — 0.7, the transplant was transparent, the thickness of the donor disc — 275 μm.

Conclusion. After multiple rekeratoplasty iterations the presented method of combined keratotransplantation allows to obtain a non-permanent effective result. At the same time, the polymer metabolism is preserved, since it has a circulation with the front camera. The case requires further observation.

ANNIVERSARY

171-173 579
Abstract

The article presents the main milestones in the creative life of the Hero of Socialist Labor, the USSR State Prize Laureate, Honored Scientist of the RSFSR, Honorary Doctor of the Military Medical Academy Professor V.V. Volkov.

PATENTS

 
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ISSN 1816-5095 (Print)
ISSN 2500-0845 (Online)