Results in Journal Ophthalmology in Russia: 396
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Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-811-816
Purpose: tо evaluate effectiveness of cataractogenesis prophylaxis in patients with epiretinal membrane (ERM) after vitrectomy based on the pirenoxin use.Patients and мethods. The study included 72 patients (64.5 ± 6.4 years old; 31 men, 41 women) with ERM before and after 25G microinvasive vitrectomy with removal of ERM. The 1-st group patients (36 eyes) received pirenoxin instillation (Catalin®; 3 times a day, 6 months) in addition to the standard pharmacological support. The 2-nd group patients received only standard therapy. All patients underwent: standard ophthalmologic examination; lens state photoregistration with an assessment of lens opacities intensity (LOCS-III classification) with the calculation of the cataract development index (CDI). These were control points: examination before vitrectomy and 5 months after surgery. At control points, the incidence of lens opacities in the observation groups was also evaluated. Statistical analysis included: calculation of the mean and its standard deviation (M ± s); assessment of the significance of differences in control points with each group (Wilcoxon's T-test) and between groups (Mann—Whitney U-test); Pearson xi-square test.Results: In the 1-st group (pirenoxin instillation), 6 months after vitrectomy and ERM removal, the following indicators were noted: the initial cataract incidence was 5.6 %; CDI — 0.36 ± 0.03 points, increasing the maximum corrected visual acuity (MCVA) from 0.31 ± 0.03 to 0.6 ± 0.05. In the 2-nd group similar indicators significantly differed from the 1-st group data: the initial cataract incidence was 36.1 % (Pearson xi-square test > 3; p < 0.05); CDI — 3.1 ± 0.3 points (p < 0.01); the MCVA increase from 0.3 ± 0.05 to 0.43 ± 0.1 (p < 0.05).Conclusion. Pirenoxin (Catalin®) has demonstrated quite high efficacy in the cataract prevention in patients after vitrectomy with ERM removal.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-719-724
Purpose. Comparative analysis of the wavefront aberrations and ophthalmoergonomic parameters after excimer laser and orthokeratological correction of myopia in patients aged over 35 years.Patients and methods. The study included 21 patients: 12 (24 eyes) after excimer laser correction of myopia (group 1) and 9 (18 eyes) after orthokeratology (group 2). The average age of patients after excimer laser surgery was 38.5 years, after orthokeratological correction 46.1 years. Special studies included ophthalmoergonomical tests: far and near distance visual acuity, capacity of the visual analyzer, visual productivity, reading velocity, mesopic vision, relative accommodation reserves, objective accommodative response, pseudo-accommodation volume. Wavefront aberrations were conducted on the OPD-scan 3.Results. The spherical equivalent of residual refraction was –0.625 ± 0.08D in the excimer group, and –1.58 ± 0.24D in orthokeratological group. Despite the difference in refraction, values of distance binocular and monocular visual acuity were the same in both groups: in group 1 monocular visual acuity was 0.74 ± 0.03, binocular 0.85 ± 0.03; in group 2 — 0.71 ± 0.06 and 0.89 ± 0.05 respectively. The parameters of both monocular and binocular accommodative response measured on Grand Seiko were 50 % higher in the excimer group compared to those in the orthokeratological group. Relative accommodation reserves appeared to be two times more in the excimer group. The volume of pseudo-accommodation was 2.375 ± 0.12D in group 1, which appeared to be 20 % more than in the group 2 (p = 0.0414). The level of wavefront aberrations was significantly higher in orthokeratological group with the exception of vertical aberrations and, especially horizontal coma, which were significantly higher after excimer laser surgery. Generally, the dynamics of aberrations in both groups correlates with changes of the corneal topography.Conclusion. Excimer laser surgery with hypocorrection is more recommended for patients aged 35–40, and orthokeratological correction for patients over 45 years old.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-705-710
Тhe main treatment for angle-closure glaucoma is laser iridectomy. Somatic comorbidity (autoimmune, allergic, chronic infectious diseases) affects the results of laser iridectomy.Purpose: to evaluate in practice the algorithm for applying the method of laser iridectomy in compliance with preventive measures, including medical support before and after surgery, both in patients with concomitant somatic pathology and without it.Patients and methods. The analysis of combined laser iridectomy’s results in 61 patients (94 eyes) was carried out. A method was used to determine the tactics of management the patients with latent stage of angle-closure glaucoma and pigment dispersion syndrome (Patent RU N 2726404), including an assessment of the general immune status based on information about somatic diseases and medications taken. Combined laser iridectomy was performed in two stages in one visit. The first stage is coagulation in the projection of the lacunae at the periphery of the iris; at the second stage, two through holes were formed. All patients received medication in accordance with the algorithm. The level of reactive hypertension was assessed in 1 hour after surgery, on the first and seventh days after the intervention.Results. In case of standard medical support for laser iridectomy, the level of reactive hypertension is higher in the group of patients with concomitant somatic pathology than without it. Adding additions to the standard drug regimen in a group of patients with impaired general immune status ensures that the target intraocular pressure is achieved. The use of an algorithm for performing laser iridectomy in patients with angle-closure glaucoma and concomitant somatic pathology makes it possible to achieve the target intraocular pressure early after surgery and to avoid complications.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-739-745
The combination of such refractive errors as high and medium astigmatism with anisometropia and presbyopia considerably reduces patients’ standard of living, first of all because methods of the correction stated are very limited. Spectacle correction is, as a rule, extremely uncomfortable or impossible in case of an anisometropia of more than 2.0 dioptres and a high degree of astigmatism; opportunities of contact lenses correction are limited in case of an astigmatism of more than 2.5 dioptres. Therefore these patients are often deprived of adequate visual rehabilitation and prefer not to use means of optical vision correction at all which considerably lowers their quality of life and can be the reason of asthenopia, violation of binocular vision and decrease in fusional reserves. This problem is aggravated with the development of a presbyopia when patients get older. The first manifestations of it reveal themselves in such patients earlier than in emmetrops, their age-mates. Excimer laser technology development has made it possible to help a large number of patients with the most severe refractive disorders, but these techniques still have significant limitations in patients with presbyopia, especially in case of a patient’s strong need for keen eyesight at a close distance. In addition, these patients require a particularly careful examination and preliminary modeling of target refraction at the planning stage of a surgical intervention, for which we use soft contact lenses in our practice. Target refraction modeling with spectacle lenses does not always allow to adequately predict the patient satisfaction with the results of correction. We consider the method of target refraction modeling using soft contact lenses to be the most accurate for this objective; it is widely used in our clinic. This technique is especially effective in patients with presbyopia, who are planning excimer laser correction of the most common types of refractive errors. The article presents a clinical case of binocular excimer laser correction of a high and medium degree compound myopic astigmatism in a patient with anisometropia and presbyopia, which was performed in two stages using LASIK (Custom Q) technology after the preliminary target refraction modeling with the use of soft contact lenses.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-771-778
Diabetic retinopathy (DR) is becoming more and more widespread disease. Investigation of local changes of metabolic pathways in the eye improves our knowledge about diabetic retinopathy pathogenesis and provide perspective for the development of new pathogenetically based and individually focused therapy of this disease.Purpose of the study was to determine the concentrations of angiotensin II (AII), angiotensin-converting enzyme (ACE) and matrix metalloprotease-9 (MMP-9) in tears and serum of patients with diabetic retinopathy, estimate their significance for the evaluation of diabetic retinopathy severity and choice of treatment.Patients and methods. Tear and serum samples from 31 patients with diabetic retinopathy were analysed. Control group consisted of healthy volunteers of the same sex and age. Concentrations of angiotensin II, angiotensin-converting enzyme and matrix metalloprotease-9 were measured using the ELISA kits.Results: in controls angiotensin II concentration was 9.8 ± 5.5 pg/ml, in tears — 11.8 ± 6.6 pg/ml, angiotensin-converting enzyme concentration in serum was 82.6 ± 10.9 ng/ml, in tears it was 40 times lower: 2.5 ± 0.5 ng/ml, matrix metalloprotease-9 concentration in serum was 186.3 ± 8.9 ng/ml while in tears it was 100 times lower: 2.0 ± 0.9 ng/ml. In tears of patients with diabetic retinopathy levels of all 3 substances were significantly higher than in controls. Concentration of angiotensin II was 8 times higher, angiotensin-converting enzyme concentration 5 times higher and matrix metalloprotease-9 level 3 times higher. In serum angiotensin II concentration was increased 9 times, angiotensin-converting enzyme — 2 times. No difference in serum matrix metalloprotease-9 levels was observed. Thus diabetic retinopathy cause a significant activation of local and systemic rennin-angiotensin system. Local changes are more marked than systemic. Estimation of angiotensin II, angiotensin-converting enzyme and matrix metalloprotease-9 concentrations in tears can serve as an objective test for the diabetic retinopathy diagnostic and a pathogenetic rationale for the development of a new method of therapy — topical use of angiotensin-converting enzyme inhibitors.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-796-803
Purpose: Objective: to evaluate the effect of treatment of bacterial corneal ulcers of varying severity using a combination of antibacterial and corticosteroid drugs.Material and methods. 63 patients with bacterial corneal ulcers of varying severity were treated. The study used a quantitative scale to assess the severity of corneal ulcers. Group 1 — patients with mild corneal ulcers (18 patients); Group 2 — patients with moderate corneal ulcer (17 patients); group 3 — severe corneal ulcer (11 patients); control group — patients with mild corneal ulcer (17 patients). Patients of groups 1, 2 and 3, in addition to the conventional treatment, received Dexamethasone 0.1 % — 0.3 ml in parabulbar injections from the first day of treatment for the entire treatment period. Kr). In addition to the standard ophthalmological examination, all patients were assessed for the ulcer defect using measurements on OCT-POG accessing the parameters of the diameter of the corneal ulcer (d) and the depth coefficient (Kr).Results. The patients in the 1st group received antibacterial treatment and the addition of parabulbar injections of a corticosteroid drug (Dexamethasone). It allowed to decrease the treatment time and the period of hospitalization, promoted faster epithelialization and a reduction in the depth of the ulcer, less coarse scarring of the cornea, allowed to increase the functional results of treatment. The proposed treatment for severe corneal ulcers in 55 % of cases allows to use only conservative treatment. It is possible to obtain moderate opacity with vascularization in 60 % cases, which contributes to the preservation and/or improvement of visual acuity, despite the severity of the inflammatory process without the use of surgical intervention.Conclusion. The proposed treatment, involving the use of the corticosteroid drug Dexamethasone 0.1 % in parabulbar injections of 0.3 ml once daily for a bacterial corneal ulcer of mild severity for, average, 15.0 ± 1.4 days, a bacterial corneal ulcer of moderate severity — 18.0 ± 1.3 days, severe bacterial corneal ulcer — 25.0 ± 4.4 days, seems to be effective if the proposed parameters of the diameter and depth of the corneal ulcer are controlled.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-733-738
Purpose: The development and clinical study of improved femtosecond laser-assisted phacoemulsification (PE) technology of hard nucleus cataract.Patients and methods. Improved femtosecond laser-assisted PE of hard nucleus cataract performed in 83 patients (93 eyes) (1st group), known femtosecond laser-assisted PE technique performed in 72 patients (78 eyes) (2nd group), torsional PE performed in 81 patients (89 eyes) (3rd group). The degree of intraoperative myosis, effective ultrasound time, corneal endothelial cell loss were evaluated in all groups.Results. Femtosecond laser-assisted PE is an effective technique for hard nucleus cataract removal, which can significantly reduce the energy ultrasonic load on the eye tissue. The proposed method for the instillation of prostaglandin synthesis inhibitors and the observance of the minimum possible interval between the first and second stages of the operation can prevent significant intraoperative narrowing of the pupil. A significant narrowing of the pupil by more than 2 mm after the femtolaser stage was noted in 7 (7.5 %) cases in the 1st group of patients, in 15 (16.9 %) cases in the 2nd group, in 5 (6.4 %) cases in the 3rd group. The results of the study has shown a significant decrease in the effective ultrasound time for a femtosecond laser-assisted PE compared with a torsional PE. The effective ultrasound time was in the 1st group (improved technology of femtosecond laser-assisted PE) — 3.81 ± 0.75, in the 2nd group (known technology of the femtosecond laser-assisted PE) — 5.23 ± 1.07 s (p < 0.05), in the 3rd group (OZil technology) — 8.67 ± 1.83 s (p < 0.05). The decrease in the effective ultrasound time has become a determining factor in reducing the loss of corneal endothelial cells in both femtosecond laser-assisted PE technologies compared to torsional PE. The average loss of corneal endothelial cells 3 months after surgery was 8.7 ± 1.8 % in the 1st group, 10.3 ± 2.1% in the 2nd group, 13.5 ± 2.7 % (p < 0.05) in the 3rd group of patients.Conclusion. The proposed improved technology contributes to the solution of some problems that characterize femtosecond laser-assisted PE, and also helps to reduce the effective ultrasound time and the loss of corneal endothelial cells.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-676-682
Topical and systemic carbonic anhydrase inhibitors (CAIs) are widely used in the treatment of glaucoma for reducing intraocular pressure. This part of the review describes the characteristics of systemic CAIs, their side effects and the ways to overcome them, as well as contraindications. The use of CAIs during pregnancy is considered. Particular attention is paid to the antioxidant activity of CAIs and the promising development of hybrid forms based on the existing CAIs as a part of a multipurpose glaucoma treatment strategy.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-761-770
Purpose: to study the antioxidant system and lipid status of serum and evaluate the effect of Cytoflavin on these characteristics in patients with progressive and stable primary open angle glaucoma (POAG).Patients and methods. 67 patients with advanced stage POAG were observed. The average age was 66.3 ± 1.5 years. According to the course of the glaucoma process all patients were randomized into 2 groups: the 1st group with the stable glaucoma (31 patients) and the 2nd group with rapidly progressive glaucoma (36 patients). The progression criteria of POAG were global ganglion cell loss volume (GLV) and perimetric index (mean deviation-MD). For assessment of the reactivity of the vascular endothelium, a test with reactive hyperemia was performed using ultrasound method. The assessment of oxidative stress (OS) including peroxides, malonyldialdehyde (MDA) and the total antioxidant capacity of serum (AOS) were evaluated. The investigations of lipid metabolism included the level of cholesterol total (CT), cholesterol of low-density lipoproteins cholesterol (LDL-C), high-density lipoproteins cholesterol (HDL-C), triglycerides (TG) and atherogenic index (AI).Results. In the 2nd group there was the significant decrease of the mean GLV indices compared to those in the 1st group (7.16 ± 2.5 и 1.06 ± 0.2, respectively, р < 0.001). The mild degree of endothelial dysfunction (ED) predominantly was detected in patients of the 1st group (69 % of cases). The moderate and marked ED were found in patients with progressive POAG (68 and 25 %, respectively). The high level of OS in serum was determined in 43 % of patients of the 1st group and in 69 % of patients of the 2nd group (significant increase of peroxides and MDA). In patients with progressive POAG the mean indices of lipid metabolism (CT, LDL-C, HDL-C, TG, AI) were significantly higher than in healthy subjects (р < 0.001). Cytoflavin had a positive effect on the vascular endothelium function, normalization of lipid metabolism and decrease of OS in serum with increasing AOS in patients with progressive POAG.Conclusion. The assessment of the indices of OS, AOS and lipid metabolism enable us to determine the risk of progression of POAG and evaluate of the effectiveness of treatment.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-683-691
To date, the problem of interaction between humans and the surrounding microbiome continues to grow in the human population, which is expressed in the so-called crisis of antibiotic resistance. Microorganisms, being pathogens of infectious diseases, no longer have guaranteed pharmacological barriers that can stop their reproduction, which means that they continue to claim thousands of lives every year. This phenomenon is associated with many reasons, such as the presence of mobile genetic elements in bacteria that perform the function of horizontal gene transfer, responsible for their resistance to antibiotics. Mutational microevolution changes in the genotype of a bacterial cell can lead to the development of uncontrolled polyresistance. Also, the combination of micro-and macroevolutionary changes in the external signs of the pathogen determines the system of factors of aggression, invasion, protection and adaptation. Other factors causing antibioticoresistance include overuse of antibiotics and self-nominations during periods of self-medication, antibiotics and medical staff in subclinical doses, too short treatment courses, and sometimes their function in the absence of indications for therapy, the extensive use of antibiotics in agriculture. A number of preventive measures that could significantly affect the crisis of antibiotic resistance are being actively worked out at the state level and include programs to reduce the free circulation of antibiotics, optimize therapeutic regimes, improve diagnostic measures for the verification of pathogens, prevent the spread of infections, optimize interaction between pharmaceutical companies and registration organizations, stimulate investment and public-private partnership, and of course the international initiative on systemic interaction. This paper examines the cause-and-effect relationships that can have a direct impact on the resolution of the crisis of antibiotic resistance, which can be traced in the historical context and up to the present time, as well as describes modern promising scientific and technical directions that can give humanity a new «Golden bullet» against pathogens, in particular the use of artificial fluorophores-quantum dots.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-784-788
Objective. Our study was to examine the degree of the light sensitivity impairment of the retina in patients with chronic cerebral ischemia, as well as to reveal the dynamics of these disorders on the background of the neuropeptide, depending on the stage of vascular encephalopathy.Patients and methods. Comparative analysis of visual function was conducted in 70 persons (140 eyes). Patients were divided into 2 groups, each group is divided into two subgroups. To study the light sensitivity of the retina used automatic computer perimeter Hamphrey Field Analyzer HFA II — I Series (model 610, ZEISS, Germany).Results. As a result of quantifying visual field defects in patients with chronic cerebral ischemia at 2 and 3 tbsp. vascular encephalopathy before treatment received preferential reduction of the light sensitivity of the retina in the temporal halves When comparing manual data with chronic cerebral ischemia patients 2 and 3 stadies vascular encephalopathy control group no significant differences before and after treatment have been identified. However, it is important to note that after 6 months treatment in the same group showed a slight increase in absolute numbers of cattle. In the control group using Cortexin observed reduction in the amount of absolute cattle.Conclusions. The light sensitivity of the retina in patients with chronic cerebral ischemia decreases as the disease progresses, with a primary lesion of the temporal halves of the visual fields. The improvement in the computer perimetry during the treatment, especially in combination with cortexin can be attributed to the normalization of the retina cellular structures, improving the transfer of information and the partial restoration of the disturbed functions, which indicates the relative ischemia is reversible processes, which is effective in patients with stage 2 or 3 vascular encephalopathy.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-817-823
Purpose. To develop the automated expert support system for optic nerve head morphological description in normal conditions and in pathology.Methods. The proposed expert support system is based on the integration algorithm of luminance samples along the diagonal, it allows to detect the optic nerve head border. On the basis of this algorithm the method for solving the following tasks of fundus image processing have been proposed: detecting of the optic nerve head border, method of the morphological description of the optic nerve head boundary, method of the determining the value of the disk excavation. An experimental study of the parameters effect on the effectiveness of the optic nerve head detecting method was made.Results. The effectiveness assessment of the proposed border detection algorithm on the optic nerve head model has showed that the amount of overlap averaged 0.985, which indicates high quality. It was found that the algorithm for estimating the diameter of the single-sided optic nerve head image is sufficiently resistant to changes in such parameters as the influence of the noise level in the scene and the offset of the strobe center coordinates of the samples accumulation from the image center coordinates. Evaluation of the efficiency of the optic nerve head borders morphological description has showed that the value of the first-order derivative of the result of accumulation of luminance readings diagonally for images of optic nerve head with blurred boundaries is 2 times smaller than for images of optic nerve head with clear boundaries. The effectiveness of the method of selecting the border for assessment the disk excavation size was examined. It was obtained that the error in estimating the magnitude of excavation amounted to an average of 8.43 %.Conclusions. Тhe presented expert support system allows to automate the process of optic disk morphological description, in particular, such parameters as the state of the border and the size of the disc excavation. This method can be used to create medical expert systems and software for fundus images processing.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-725-732
Purpose: to study the combined Photo-Activated Chromophore for Keratitis — Corneal Cross-Linking (PACK-CXL) in combination with fulguration of the infiltration zone in the treatment of medically refractive acanthamoebic keratitis.Patients and methods. The study included 9 patients (10 eyes) with medically refractive acanthamoebic keratitis. The diagnosis was confirmed by confocal microscopy data from a microbiological study of scraping of corneal tissue from the lesion site with Romanovsky-Giemsa stain. All patients underwent combined surgical treatment of PACK-CXL with pre-fulguration. Optical coherence tomography (OCT) of the anterior segment of the eye was also performed using an RTVue-100 apparatus (Optovue USA), determination of visual acuity, photographing before and after surgery.Results. In 6 cases (60 %), a positive effect was noted, relief of the symptoms of the disease and the formation of turbidity within a month after the procedure, as well as an increase in the maximum corrected visual acuity. According in vivo confocal microscopy, 6 months after the intervention, no signs of infection were detected. In 4 cases, the therapeutic effect was absent. Subsequently, 3 patients (3 eyes) underwent therapeutic keratoplasty. In one eye, the infectious process was stopped medically for 6 months.Conclusion. The combined PACK-CXL method together with fulguration can be effective and safe in the treatment of medically refractive acanthamoebic keratitis, allowing keratoplasty to be performed with an optical goal if necessary, after stopping the infection process in a distant period.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-789-795
Long-term conjunctival infections are challenging for the outpatient ophthalmologist. This is due to significant changes in microflora towards resistant gram-negative bacteria. Long-term conjunctival infections are challenging for the outpatient ophthalmologist. This is due to a significant change in microflora towards resistant gram-negative bacteria. The above studies are based on microbial associations, which are the causes of inflammatory processes, conjunctiva and cornea.Purpose: to increase the effectiveness of the diagnosis and treatment of chronic specific inflammatory diseases of the organs of vision.Patients and methods. The study was conducted in patients with chlamydial infection (n = 589) and included chronic conjunctival infections lasting more than 4 weeks, follow-up of patients with partners, family members for 3 or more years. Results. The study was carried out in patients with chlamydial infection (n = 589) and with chronic infectious diseases that lasted more than 4 weeks, following patients and family members for 3 or more years. During this period, we performed more than 3 studies for each patient — for diagnostic laboratory studies and 2 consecutive controls 1 and 2 months after treatment, mixed infection was detected in 256 people (10 %), the proportion of women was 20–30 years is 67 %, men — 51 %. In 27 % of cases, communities of Ch. trachomatis and Ureaplasma parvum as leading causative agents of the eye infections.Conclusions. Chlamydia is most often found together with Ureaplasma parvum (27 % of cases among mixed infections). Treatment of various forms of chlаmidia infection is carried out with the help of “Floxal” (0.3 % ofloxacin — drops and ointment).
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-779-783
Phenylephrine test is one of the main factors determining the possibility of performing superior tarsal muscle resection. However, the influence of various factors on its result remains unexplored.Aim. To evaluate the effect of patient age, degree of ptosis, and levator muscle function on the result of the phenylephrine test.Patients and methods. 45 patients were examined (64 eyelids). The following examinations were performed for all patients: assessment of the degree of ptosis, levator muscle function and the phenylephrine test.Results. Age and the degree of ptosis do not affect the results of the phenylephrine test. Reduced levator muscle function leads to a decrease of the phenylephrine test results.Conclusion. The phenylephrine test remains an important criteria for patient selection for the planning superior tarsal muscle resection. Levator muscle function does affect the phenylephrine test result.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-692-698
As known, there are changes in the biomechanical properties of the fibrous tunic in glaucoma. This is also due to the imbalance between the formation and loss of collagen fibers. The cornea is a highly sensitive tunic of the eyeball, endothelium is one of the target organs in the formation of pathological changes in primary open-angle glaucoma, and endothelial dysfunction, according to many authors, plays a significant role in its pathogenesis. The unintended consequences of glaucoma surgery lead to a progressive loss of corneal endothelial cells, which can lead to corneal decompensation. In the proposed literature review, we analyzed more than 30 publications by authors representing the results of multicenter studies of the pathological effects of antiglaucoma operations on the corneal endothelium in patients with various types of uncompensated glaucoma. The analysis of both classic fistulizing type operations and modern, so-called micro-invasive techniques (MIGS), including the use of various drains and devices, is presented. Thus, the smallest decrease in the density of endothelial cells was noted during deep sclerectomy and trabeculectomy. The use of mitomycin C in glaucoma surgery significantly improving the prognosis, but increases the loss of endothelial cells in both high and low concentrations. The highest rates of loss of corneal endothelial cells are noted during using valves and shunts. Ex-PRESS shunt implantation is associated with a significant loss of corneal endothelial cell density in the immediate area to the drainage tube, and therefore, shunt implantation should not be considered as an option for eyes with corneal dysfunction. In addition, the authors prove that the drainage device changes its position in the anterior chamber, especially when performing massage and self-massage of filtration bleb, which leads to a greater loss of density of corneal endothelial cells.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-752-760
Some Russian cosmonauts in space flight have revealed swelling of the optic nerve head of varying severity. Four clinical cases presented in this article. A quantitative method for the analysis of OCT images of the optic nerve head and the retina has been developed for the diagnosis and monitoring of the optic nerve’s state. This method is quite informative, regardless of the opinion of each specific medical consultant; diagnosis of optic nerve head edema can be performed according to the generally accepted Frisen’s grading, and thus objectify its diagnostic capabilities. In cases when changes in the optic nerve head are not visualized during ophthalmoscopy, quantitative analysis of OCT images allows one to quantify the presence of optic nerve head edema at the subclinical stage. This objective diagnostic method allows us to establish and quantify the amount of industrial activity, which, with edema of the optic nerve because of intracranial hypertension, mostly pronounced on the nasal side of the nerve disc. Determining the thickness of the retina and head of the optic nerve in the nasal side are paramount for monitoring changes in papilledema in dynamics, especially in the subclinical and 0 stage according to Frisen. Quantitative measurements of the optic nerve head in the temporal side are necessary for the diagnosis, developed papilledema and differential diagnosis of 1-2 stages on the Frisen scale. The use of this diagnostic method has the great importance in assessing the influence of various factors of the space flight on the optic nerve head.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-711-718
The purpose: prospective study of the long-term refractive and visual results of ReLEx® SMILE, depending on the degree of corrected myopia.Material and methods. The three study groups included 71 patients; the mean age was 26.48 ± 5.5 years. Group I consisted of 20 patients (39 eyes) mean SE –2.62 ± 0.87 D, group II — 26 patients (51 eyes), mean SE 4.68 ± 0.74 D, Group III — 25 patients (47 eyes), mean SE 6.88 ± 0.72 D. All patients underwent femtolaser correction of myopia using the ReLEx® SMILE method with the VisuMax™ laser system (Carl Zeiss Meditec AG).Results. Uncorrected visual acuity of 09 — 1.0 was noted in 34 eyes (87.2 %) in group I, in II — in 43 eyes (84.3 %), in 37 eyes (78.7 %) in group III. The efficiency coefficient was 1.0 in groups I — II and 0.89 in group III. There was no decrease in corrected visual acuity (CVA) during the correction of mild and moderate myopia, in group III it was recorded by 0.1 in two cases (4 %), by 0.2 in one case (2 %), the safety factor in I — II groups 1.0, in III 0,89. Two years after ReLEx® SMILE, refraction of ± 0.5 D from planned in the study groups was achieved, respectively, in 94.9, 88.2, 76.6 % of cases, ± 1.0 D in 100 % of cases in I, II groups, in 97 % of cases in III group. The predictability coefficient was 0.95 in group I, 0.88 in group II, and 0.77 in group III. Refractive regression compared with the results 1 month postoperatively was 0.08 D in group I, 0.1 D in group II, and 0.16 D in group III. Analysis of the long-term results of ReLEx® SMILE allows us to conclude: the method is safe and effective, provides high predictability of refractive results in correcting various degrees of myopia. Further study of the long-term results of the operation, the creation and use of nomograms, taking into account the individual characteristics of the cornea, will improve the predictability and stability of refractive results in the correction of high myopia.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-824-829
Fungi implicated in mycotic keratitis include different species. Conventional methods for the diagnosis of fungal keratitis include staining of corneal scarpings, culture medium (Sabouraud agar) for isolating fungi.Purpose. To evaluate the effectiveness of polymerase chain reaction (PCR) for the detection of fungal etiology in comparison with the conventional diagnostic methods in cases with suspected fungal corneal ulcer.Patients and methods. Seven patients with severe corneal ulcers with more than 3 weeks duration. Corneal scarpings and corneal buttons from seven patients who had undergone therapeutic keratoplasty were used for microbiological and PCR analysis. PCR diagnostic kits for the differential detection of Candida albicans DNA and total fungi DNA (DNA Fungi), which allows to identify most pathogenic fungi without determining their species were used. Microbiological methods: microscopy of gramstained smears, culture techniques, including selective for fungi agar Saburo with chloramphenicol.Results. PCR: Fragments of all corneas removed from keratoplasty (6 patients) revealed fungal-common DNA (Fungi DNA) and did not detect Candida albicans DNA, which correlated with sowing results on Saburo medium (mold fungi found in 5 of 6 corneas). Fungi DNA was also detected in the corneal scraps taken prior to surgery; however, growth of fungi during sowing on various nutrient media was not found.Conclusion. Corneal fungal ulcers are a serious disease, often leading to visual disability. The rapid determination of etiology and the correct choice of therapy determines the outcomes of the disease. The advantage of PCR over the culture method: the speed of obtaining results (4 hours instead of 3–7 days); high sensitivity, which allows detecting fungi not only in the tissue of the removed cornea, but also in scrapes from the cornea ulcer of patients who previously received antifungal therapy. The presence of commercial kits for differential detection of fungal-common DNA and DNA of Candida albicans extends the possibilities of PCR in the screening diagnosis of fungal keratitis and the selection of drugs before determining the type of pathogen.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-699-704
The article discusses the effectiveness of accelerated collagen crosslinking in the treatment of patients with corneal diseases, a common basic pathogenetic link of which is endothelial corneal decompensation. This method was used to treat patients with bullous keratopathy and endothelial dystrophy of Fuchs’ cornea with a long postoperative follow-up. In connection with the controversial results of researchers, reflecting the positive dynamics of the postoperative period, the question of the expediency of accelerated collagen cross-linking in patients with this pathology as a monotherapy is discussed.The study included 25 patients (26 eyes) with mean age 69.10 ± 10.61 years (40 to 82 years). There was Fuchs corneal endothelial dystrophy in 16 patients (17 eyes), in 9 patients (10 eyes) — stage II, in 7 patients (7 eyes) — stage III. Bullous keratopathy was present in 9 patients (9 eyes). All patients underwent treatment according to the method of accelerated collagen corneal crosslinking. In patients with bullous keratopathy (9 eyes), the data on the central thickness of the cornea and the maximum corrected visual acuity did not differ from the initial data at any of the postoperative visits, and did not differ from each other (p > 0.83). On the contrary, in some patients the dystrophic process progressed in the form of the appearance of fibrotic changes in the stroma of the cornea. Corneal transplantation was recommended to all patients under observation after treatment at different periods of observation. In patients with Fuchs endothelial dystrophy, a significant difference in the maximum corrected visual acuity from the initial data was observed only 6 months after surgery.The expediency of accelerated collagen cross-linking in the treatment of patients with corneal diseases accompanied by endothelial decompensation as monotherapy is very doubtful. The study of combined surgical methods for treating this complex corneal pathology using cross-linking as an auxiliary method seems promising.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-830-837
High prevalence of blepharitis, multifactorial etiology and chronic course with the possibility of serious complications, including conjunctivitis, multiple chalazions, keratitis, dry eye syndrome — cause significant difficulties in the treatment of this disease. Prescribing treatment of the process only in case of exacerbation with the use of even modern antimicrobial and anti-inflammatory drugs gives only a short-term effect.The aim is to present the clinical features of the blepharitis of different localization and the choice of the optimal treatment algorithm on the example of specific clinical cases. The article presents current data on the classification, etiology and mechanism of blepharitis development. Based on a detailed description of two clinical cases of blepharitis, the features of the clinical course, the range of necessary examinations and consultations of specialists are presented. The first case describes blepharitis associated with the severe rosacea in a teenager with a typical complication in the form of rosacea — keratitis. The second case is devoted to the features of the posterior blepharitis clinical course with meibomian gland dysfunction, complicated by multiple chalazions. The article explains in detail the stages of prescribing various medications, including eyelid hygiene, antibacterial, anti-inflammatory therapy and artificial tears, discusses possible side effects of the therapy and ways to restore the eye surface.Conclusion. The basis of blepharitis treatment is regular three-component eyelid hygiene. In case of exacerbation it is advisable to prescribe antibacterial and anti-inflammatory drugs, taking into account the sensitivity and ability to destroy microbial biofilms. In order to increase patient adherence to treatment, the choice of hygiene products and moisturizing drops should take into account the tolerability of the drug and the convenience of its use.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-746-751
The multifactorial nature of the retinopathy of prematurity (ROP) pathogenesis, makes the thorough study of the mechanism of pathological retinal neovascularization actual. However recently the attention of scientists has been attracted by the participation of renin-angiotensin system (RAS) in the development of retinal vasoproliferative diseases. Purpose: to study the role of AT-II in the pathogenesis of experimental ROP (EROP) in the original model of the disease. Material and methods. To reproduce EROP Wistar rats (n = 15) were exposed to the oxygen concentration varying from 60 to 15% every 12 hours for 14 days from the first day after birth followed by room air for 7 days. Throughout the experiment, the room maintained a constant temperature (+26 °C) and light regime (12 hours a day, 12 hours a night) modes. Control rats (n = 12) were born and kept under normal oxygen content (21 %). Batches of EROP (n = 5) and control (n = 4) rats were sacrificed on 7, 14 and 21 days. All rats underwent binocular enucleation, after which every eyeball was opened on the limb, the cornea and lens were removed with the remains of a persistent vascular bag and a hyaloid artery. Retinas were isolated, homogenized and stored at -20 °C. Angiotensin-II (AT-II) in homogenates was measured using the IFA kit. Results. On the 7th day of the experiment, the level of AT-II in the retina of the experimental group rats was 0.19 ± 0.02 pg/mg protein that was significantly higher than in controls (0.12 ± 0.01 pg/mg protein). On the 14th and 21st days concentrations of AT-II in EROP and control groups had no significant difference. Conclusion. On the 7th day of the experiment, i.e. at the period corresponding to the existence of avascular retinal zones in both groups concentration of AT-II in the retinas of rats with EROP was significantly higher than in controls. This fact indicate the role of this proangiogenic factor in the induction of pathological neovascularization in ROP. Possible prognostic function of this parameter during the period before ROP manifestation has undoubted practical significance.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-669-675
Electrophysiological research today remains an important method for the objective assessment of the functional state of the components of the visual analyzer.There are methods, for example, OCT, that can objectively assess the structural and anatomical integrity of the retina, however, only indirectly shows functional activity. The undoubted advantage of EFR is the ability, excluding the subjectivity of the subject, to perform a functional topographic assessment of the malfunction of all systems of the visual analyzer. Private electrophysiology of the vision organ is represented by a variety of methods for recording the electrobiological activity of the cells of the visual analyzer: ERG, EOG, VEP, mfERG (multifocal electroretinography), and each option is directed to a separate part of it, therefore, to complete the picture, in particular in research works on animal models may use several techniques. In general, the limitation of EFR is its complexity and many confounding factors that can affect the result, ranging from stimulation parameters to the state of the patient himself. At the same time, the main area of prospective use of electrophysiological research is differential diagnosis, preclinical toxicology and scientific and experimental models. However, in recent decades, the active introduction of registration methods, including the appearance of multifocal electroretinography, as well as changes in the conditions of electrophysiological studies, open up new possibilities for the future evolution of the method. Classical methods for evaluating EFR data, taking into account the growth of data flow, do not provide detailed qualitative and quantitative information about the state of the visual analyzer. This leaves the possibility and the need for the study, optimization and algorithmization of the assessment data of the differentiated criteria inherent for a particular ocular pathology. EFRs require simpler and more adapted protocols for clinical practice, allowing a strictly differentiated approach to the smallest anatomical and functional changes, based on open databases and modern adaptation based on artificial intelligence.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-4-804-810
Purpose: to assess the possibilities of ophthalmonutraceuticals using in age-related macular degeneration (AND) patients.Patients Methods. The study included 35 patients (68.3 ± 6.3 years old; 15 men, 20 women) with AMD (AREDS-2 and AREDS-3 categories). As an ophthalmic nutraceutical, a biological active supplement was used, included vitamins C and E, zinc, lutein, zeaxantine, cooper, selenium (Retinorm; 3 capsules per day with meals). The observation period was 12 months (6 courses of therapy). There were the main control points: examination at study entry and examination at study completion. All those observed patients were underwent standard ophthalmological examination; fundus state photo registration (Nidek); OCT (Opto-Vue). The significance of a possible increase in the proportion of AREDS-3–4 AMD category patients was assessed using the Pearson γ2 test. An additional criterion was the maximum corrected visual acuity (MCVA) stabilization. The mean and its standard deviation (M ± s) were calculated, the significance of differences was assessed using the Wilcoxon’s t-test.Results. The study was completed in 33 patients. In 2 eyes a transition of AMD from the AREDS-2 to AREDS-3 category was recorded (an increase in the number and size of druses, with the appearance of large druses). The increase in the proportion of patients with the AREDS-3 AMD category was statistically insignificant (γ2 = 0.267; p = 0.606). In no case was there a transition to the AREDS-4 category. In the vast majority of those who completed the study (31 eyes; 93.9 %), the manifestations of AMD were stable, which, taking in account the chosen criterion, allows us to consider nutraceutical support to be affective. MCVA during the observation period also remained stable with a slight, but statistically insignificant tendency to its increase (from 0.72 ± 0.07 to 0.75 ± 0.09; t = 37.5, p > 0.05). One patient was excluded from the study after 6 months of observation due to development of an allergic skin reaction (presumably to the components of a nutraceutical). In the vast majority of patients (97.1%), no significant side effects of therapy were observed, the nutraceutical regimen was comfortable. One more patient was excluded from the study (after 3 months) due to his failure to appear for next follow-up examination.Conclusion. The use of Retinorm ophthalmonutraceutical can stabilize the manifestations of AMD (AREDS-2–3) in 93.9 % of patients with follow-up periods of up to 12 months. Repeated courses of therapy in 97.1 % of patients are not accompanied by significant side effects, and the regimen for taking ophthalmonutraceuticals is characterized by patients as comfortable.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-542-549
Глаукома — главная причина необратимой слепоты в мире. Ингибиторы карбоангидразы (ИКА), применяемые как системно, так и местно, эффективно снижают внутриглазное давление. В отличие от системных ИКА, 2%-ный дорозоламид и 1%-ный бринзоламид, проникая глубоко в ткани глаза, не приводят к системным эффектам, а поэтому эти препараты нашли широкое применение в лечении глаукомы. В обзоре приводится характеристика различных изоформ карбоангидразы, рассмотрены механизмы действия препаратов, направленные на ее блокирование, анализируются результаты различных исследований по эффектам 2%-го дорозоламида и 1%-го бринзоламида, а также их фиксированных комбинаций. Рассмотрены эффекты ИКА как в качестве монотерапии, так и в сочетании с другими антиглаукомными препаратами. Представлен анализ данных о влиянии ИКА на глазной кровоток.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-592-596
Цель: разработка и клиническое изучение оптимизированной методики фемтолазерной факоэмульсификации (ФЭ) у пациентов с перезрелой катарактой. Пациенты и методы. Фемтолазерная ФЭ перезрелой катаракты выполнена у 72 пациентов (72 глаза). В 1-ю группу вошли 45 пациентов (45 глаз), которым был выполнен фемтолазерный капсулорексис с мощностью импульсов 6700 наноджоулей (оптимизированная методика фемтолазерной ФЭ). Во 2-ю группу вошли 27 пациентов (27 глаз), которым был выполнен фемтолазерный капсулорексис с мощностью импульсов 7000 наноджоулей. Результаты. Применение фемтосекундного лазера для выполнения переднего капсулорексиса при ФЭ перезрелой катаракты позволяет получать капсулорексис идеальной круглой формы с высокой точностью диаметра, что невозможно при мануальном капсулорексисе у пациентов с перезрелой катарактой. В 1-й группе во всех случаях получен капсулорексис с ровным краем без радиальных надрывов. Во 2-й группе радиальный надрыв края капсулорексиса отмечен в 2 (7,4 %) случаях. В послеоперационном периоде во всех случаях в 1-й группе периферия оптической части ИОЛ была покрыта ровным краем капсулорексиса правильной круглой формы по всей окружности. Во 2-й группе в 2 (7,4 %) случаях отмечен выход края оптической части ИОЛ из-под края капсулорексиса вследствие его радиального надрыва со смещением оптической части ИОЛ кпереди, что может негативно отражаться на точности рефракционного результата при имплантации ИОЛ. Показатели остроты зрения без коррекции и с максимальной коррекцией не имели существенных различий в обеих группах и зависели от состояния нейрорецепторного аппарата. Средняя потеря клеток эндотелия роговицы составила 5,7 ± 1,4 % в 1-й группе и 8,7 ± 1,8 % во 2-й группе (р < 0,05). Заключение. Использование фемтосекундного лазера для выполнения переднего капсулорексиса при ФЭ перезрелой катаракты является эффективной методикой ее хирургического лечения, что обеспечивает полностью внутрикапсульное положение ИОЛ в послеоперационном периоде. Оптимизация энергетических параметров фемтосекундного лазера способствует предупреждению надрывов края капсулорексиса у больных с перезрелой катарактой.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-566-571
Латентная стадия закрытоугольной глаукомы — функциональный ангулярный блок, приводящий к прогрессированию глаукомы при отсутствии лечения. Цель: определить тактику и оценить результаты персонализированного подхода к хирургическому лечению пациентов с латентной стадией закрытоугольной глаукомы. Пациенты и методы. Был проведен анализ результатов хирургического лечения 35 пациентов (56 глаз) с латентной стадией закрытоугольной глаукомы. Первая группа (I) включала пациентов с аккомодирующим прозрачным хрусталиком, отсутствием либо наличием аметропии не более 1,0 диоптрии, высоким рейтингом качества жизни по опроснику VF14 (Visual Function). Всем пациентам I группы выполнена персонализированная комбинированная лазерная иридэктомия с предварительной коагуляцией радужной оболочки. Вторая группа (II) включала пациентов с мало аккомодирующим по причине пресбиопии, прозрачным либо непрозрачным хрусталиком, отсутствием либо наличием аметропии выше 1,0 D, низким рейтингом качества жизни. Пациенты второй группы были разделены на две подгруппы: II А — всем пациентам выполнена персонализированная комбинированная лазерная иридэктомия с предварительной коагуляцией радужной оболочки, II В — всем пациентам выполнена факоэмульсификация с имплантацией интраокулярной линзы. Результат хирургического лечения оценивали по динамике глубины передней камеры, степени открытия угла передней камеры в соответствии с классификацией Ван-Бойнингена, по данным опросника качества жизни VF14. Результаты. Во всех группах увеличилась степень открытия угла передней камеры глаза и глубина передней камеры, но показатели варьировали. В группе II В результаты были достоверно максимально эффективными. В I группе рейтинг качества жизни после лазерной иридэктомии не изменился и остался стабильно высоким, во II В — значительно повысился, а во II А остался сниженным.Заключение. Персонализированная комбинированная лазерная иридэктомия с предварительной коагуляцией радужной оболочки и факоэмульсификация катаракты с имплантацией ИОЛ являются эффективными методами лечения латентной стадии закрытоугольной глаукомы. В случае сохраненной аккомодации, прозрачного хрусталика, отсутствия аметропии, высокого рейтинга качества жизни по опроснику VF14 достаточно выполнения персонализированной лазерной иридэктомии для лечениялатентной стадии закрытоугольной глаукомы. В случае аметропии, отсутствия или слабой аккомодации по причине пресбиопии, а тем более катарактальных изменений в хрусталике, низкого рейтинга качества жизни необходима факоэмульсификацияс имплантацией интраокулярной линзы.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-610-616
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-604-609
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-556-565
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-640-647
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-577-584
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-533-541
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-550-555
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-653-663
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-625-633
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-634-639
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-597-603
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-648-652
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-572-576
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-585-591
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3s-617-624
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-502-507
The spontaneous change of eyes’ color is a quite rare complain in ophthalmological clinical practice for young and middle-aged patients. We consulted the 18-year-old patient complained that a month ago she noticed a change of the iris’ color. It was symmetrical in both eyes, which had lightened and acquired a “spotty appearance”. Before the appearance of these complaints, the patient had eyes of a rich dark brown color. After a comprehensive examination, the bilateral acute iris depigmentation (BADI) was diagnosed. BADI is bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior segment. It is more common for young and middle-aged women, and is often asymptomatic. BADI has bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior eye segment of the eye, which may affect the trabecular network. A feature of this disease is the absence of transillumination, changes in the shape of the pupil, and an inflammatory reaction. In some cases, repigmentation may occur spontaneously during the next few years. Therefore, from a prognostic point this disease has a favorable prognosis. However, patients with BADI syndrome should undergo regular ophthalmological examinations, including measurement of intraocular pressure to exclude the development of secondary open-angle pigmented glaucoma, and use sunglasses when the sun is bright. BADI syndrome must be differentiated with the following diseases: Fuchs heterochromic iridocyclitis, viral iridocyclitis caused by HSV and CMV, pigment dispersion syndrome and pseudo exfoliative glaucoma, as well as bilateral acute iris transillumination (BAIT) syndrome to make a correct diagnosis and apply adequate treatment tactics.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-429-434
The research is devoted to one of the most urgent problems of modern ophthalmology — the search for new approaches to creating effective methods of functional treatment of refractive amblyopia using computer technologies.The purpose of the work is to evaluate the effectiveness of computer technology with consistent use of alternating and non-alternating modes of presentation of stereostimulars in the functional treatment of refractive amblyopia in children.Patients and methods. 105 patients with refractive amblyopia at the age of 7 to 17 (on average 11.45 ± 0.3) years were observed. Refraction was hypermetropic in 31 (29.5 %) children, myopic in 62 (59 %) and mixed astigmatism was detected in 12 (11.5 %) children. The visual acuity of the best-seeing eye was on average 0.76 ± 0.01, that of the worse-seeing eye was 0.68 ± 0.02, and that of the binocular eye was 0.77 ± 0.01. In the study on synoptophore, all children had normal correspondence of the retina with the fusion reserves, which were significantly reduced. The character of vision was binocular in all children, but the presence of stereo vision on the Fly test was detected in 96 (91.4 %) children, and on the Lang test only in 73 (69.5 %) children. Functional treatment was performed using computer programs with sequential use of modes of alternating and non-alternating presentation of stereo stimuli with certain characteristics.Results. As a result of the course of treatment, the number of children with stereo vision increased from 96 (91.4 %) to 105 (100 %) on the Fly test and from 73 (69.52 %) to 97 (92.4 %) on the Lang test. In addition, there was a significant increase in visual acuity (on average, up to 0.96 ± 0.01 for the best-seeing eye, up to 0.9 ± 0.01 for the worse-seeing eye, and up to 0.97 ± 0.01 binocularly). There was also an increase in positive fusion reserves by 1.5 times and negative reserves by 1.3 times.Conclusion. Visual training with computer programs that provide the consistent use of modes of alternating and non-alternating presentation of stereo stimuli with certain characteristics is an effective way of functional treatment of refractive amblyopia in children, allowing to increase monocular and binocular visual acuity, improve the performance of fusion reserves and improve the state of stereo vision.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-442-450
Conjunctival lymphomas are predominantly extranodal B-cell non-Hodgkin’s lymphomas (NHL), most of them are MALT-lymphomas originating from the mucosa-associated lymphoid tissue. The paper is devoted to the study of the feasibility of using hypercorrection in the functional treatment of children with non-paralytic strabismus.The purpose of this work is evaluation of the effectiveness of hypercorrection in the diagnosis and functional treatment of children with non-paralytic strabismus. Patients and methods. We observed 166 school-age children with friendly strabismus: 140 children with esotropia (134 children with hypermetropic refraction and 6 children with myopic refraction) and 26 children with exotropia (17 children with myopic refraction and 9 children with hypermetropic refraction). The control group of children included 151 school-age children with ametropia without strabismus: 110 children with hypermetropia and 41 children with myopia. Optimal optical correction, accommodation and visual acuity were studied under monocular observation conditions and then under bifixation control using a binarimeter at different distances from the eyes (0.5, 1, and 5 m).Results. In children with esotropia and hypermetropic refraction, the most favorable conditions for the formation of a binocular visual image (BVI) were created using hypercorrection (average values from 2.4 ± 0.06 to 2.8 ± 0.06 D for different distances from the eyes). Children with exotropia and myopic refraction also needed hypercorrection to form BVI (Me = 2.5 [Q1 = 2.0; Q3 = 3.0] D at all distances from the eyes). At the same time, a strong positive correlation was found between the deviation value and the hypercorrection value necessary for the formation of BVI in children with both esotropia and exotropua (r = 0.85, p < 0.001 and r = 0.8, p < 0.001, respectively). In children with “inappropriate” refraction (myopic with esotropia and hypermetropic — with exotropia), BVI was easier to occur and better maintained under hypocorrection by an average of 1.75 ± 0.06 d. In the control group of children, the maximum visual acuity under the control of BVI was observed with the strength of correcting lenses 0.5 D less compared to monocular conditions of the study.Conclusion. The effectiveness of using hypercorrection in children with non-paralytic strabismus and “appropriate” refraction for the formation of BVI on a binarimeter is shown. In this case, the value of hypercorrection has a direct dependence on the value of deviation, which is consistent with the principles of accommodation-convergent synkinesia. In children with non-paralytic strabismus and “inappropriate” refraction, more favorable conditions for the formation of BVI are created when using hypocorrection. The result of functional treatment on a binarimeter with an individual selection of optimal optics for performing exercises is an improvement of accommodation, binocular and stereo vision, an increase of fusion reserves and visual acuity.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-336-343
The review analyzes the capabilities of modern technologies of structural neuroimaging of the retina, standard perimetry, and studies of ocular blood flow in the early diagnosis and management of glaucoma. The relevance of the search for those structural and functional changes that are primary in the development of glaucomatous optical neuropathy (GON) and the diagnostic method that has the greatest clinical significance is discussed. Progress in understanding the pathogenesis of glaucoma and the expansion of scientific understanding of key risk factors for the development and progression of the disease, including genetic factors, can be crucially important to substantiate new strategies for preclinical diagnosis and the development of radically new approaches to personalized and preventive glaucoma therapy. However, the search for what arises most early with in primary open-angle glaucoma — changes in structure or function — will not have clinical relevance unless you take into account the capabilities of specific methods of structural and functional neuroimaging that represent information at various levels of organization of the visual system. The search for a single primary factor in the pathogenesis of GON can lead to an erroneous exaggeration of the close relationship between the variables being studied, which in reality either does not exist as a causal relationship or is significantly less than what is supposed — the phenomenon called “illusory correlation”. The reliable diagnosis of early changes that occur before the clinical manifestation of glaucoma is most likely to be based on a combination of structural, functional, and hemodynamic indicators, aimed not only to increase the sensitivity of diagnosis in detecting the earliest events in the development of GON, but rather to dramatically improve the understanding and quality of interpretation of those markers that we own.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-321-329
This paper presents clinical and pharmacological drug interactions for the treatment of patients with glaucoma combined with concurrent cardiovascular pathology, risks of side effects, and adverse drug reactions. The article discusses the multifactor nature of glaucoma, age factors, and the direction of local and systemic pathogenetic treatment, principles of the personified approach, and its feasibility. It is shown that an essential element of this approach can be a system of questionnaires for glaucoma patients with chronic diseases, the principal place in which is occupied by a questionnaire filled out by the patient himself. Digital processing of individual data and assessments provided by patients allows us to implement the tasks of a personalized approach to the treatment. Analysis of the pharmacological effects of the available and used arsenal of medicinal products allows you to generalize the array of data obtained, to form model algorithms for deciding by an ophthalmologist on the choice of medications. In scheme optimizing of the prescribed medications, it is important to cross-inform between specialists of different profiles (ophthalmologists, therapists, neurologists, cardiologists, endocrinologists, rheumatologists, etc.), create an algorithm for entering the medications of choice and their rational combinations, which reduces the risk of polypragmasia. Possible causes of progression of glaucoma optic neuropathy (GON) against the background of age-related systemic diseases (using the example of the cardiovascular system’s pathology) are considered. Ways of influencing the pathogenetic links of the glaucomatous process are proposed from the standpoint of an optimal combination of medications. Analysis of literature on the problem of structural and functional disorders in GON’s development shows that it is promising to expand our understanding of the fundamental processes underlying these changes, search for clinically significant combinations of contemporary markers of changes in structure and function, and, accordingly, treatment approaches. The possibilities of neuroprotection of glaucoma optical neuropathy, as well as modern methods of electrophysiological research in the monitoring assessment of its effectiveness and the differential diagnosis, approaches to enhance the effectiveness of medications treatment with combined medications are analyzed in the article.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-368-374
Macular holes are the most often pathology leading to reduced vision among persons after 60 years. The macular hole is the acquired disease which is a defect of a foveola part of retina on all thickness from an internal limiting membrane to an external segment of a photoreceptor layer. The standard method of treatment is surgery method: a microinvasive vitrectomy with membrane peeling in macular area. There is a number of the techniques increasing efficiency of operative intervention. Even in case of successful surgical intervention macular holes are not always closed.The purpose: development and assessment of morphological parameters of the central retina with a new surgical method of closing earlier operated macula hole using a free flap.Material and methods. 40 patients (40 eyes, 28 women and 12 men) had participated in this study. All patients were operated about macular hole with negative anatomic result. By technology which were used earlier, patients were divided into 3 studied groups (with PRP mass using, with introverted flap using, with mechanical matching of edges of a hole). The main method of research was the optical coherent tomography. All patients were operated by an original technique. It’s purpose was a closing of earlier operated rigid macular hole using a free flap.Results. The defect of a photoreceptor component was closed with an additional expansion of earlier created macular rexis in patients of the 1st and 3rd groups at reoperation. The earlier created flap of an internal limiting membrane was used in patients of the 2nd group. In the analysis of dependence of change of visual acuity from morphological parameters of a macular hole after primary surgical treatment the inverse correlation relation from diameter of a macular hole on small and big radiuses is revealed. The highest visual acuity after a reoperation was reached at patients of the second group.Conclusions. It is necessary to consider the technique which was used earlier, diameter of a macular hole on small and big radiuses, postoperative edema in a parafovea zone for planning the surgical treatment and a forecast of functional results.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-351-360
Purpose: to develop an effective and safe method of cyclotorsion compensation, to improve the clinical and functional results of the of myopic astigmatism correction with SMILE surgery.Patients and methods: Two equivalent groups of 30 people (30 eyes) were formed with cyclotorsion from ±5 degrees («Standard» and «Verion»). The correction for cyclotorsion was carried out only in the «Verion» group. Before the laser-refraction surgery, all eyes were examined using «Verion» image guided system (Alcon, USA) to determine cyclotorsion. In the «Verion» group, the obtained cyclotorsion data was used to aligement the astigmatism axis by Introducing into the «Visumax» femtolaser system. Further, the operation was carried out according to the standard protocol. At 3 months after SMILE surgery, all patients were examined by a UDVA, CDVA, objective refraction. Furthermore, efficiency and safety, as well as vector analysis of corneal astigmatism according to Alpins were calculated indices at 3 months after surgery.Results: The mean and standard deviation of cyclotorsion of the «Standard» and «Verion» groups was 6.16 ± 1.31 D and 6.30 ± 1.36 degrees, respectively (p > 0.05). The increasement of 1 or more UDVA lines was noted at 20 % and 7 %, respectively after 3 months in the «Standard» and «Verion» groups. The safety index (postoperative UDVA / preoperative UDVA) in both groups was not statistically significantly different (p > 0.05). The predictability of the spherical equivalent within ±0.5 D relative to the target refraction (emmetropia) in the «Standard» and «Verion» groups was 70 % and 100 %, respectively. The predictability of the cylindrical component of refraction within ±0.5 D relative to the target refraction (emmetropia) was 40 % and 90 % for the «Standard» and «Verion» groups, respectively (p < 0.05). Difference vector was 1.01 ± 0.59 D in the group «Standard» and 0.64 ± 0.33 D in the «Verion» group (p < 0.05). Correction index was 0.80 ± 0.43 in the «Standard» group and 0.99 ± 0.04 in the «Verion» group (p < 0.05).Conclusions: Сyclotorsion compensation using the «Verion» image guided system is a safe method. It improves the efficiency and predictability of correction myopic astigmatism in patient undergoing to SMILE surgery. This method recommended for patients with cyclotorsion from ±5 degrees and myopic astigmatism from –0.75 D.
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-513-518
Purpose: presentation of a clinical case of an idiopathic macular hole (IMH) recurrence after its successful closure augmented with platelet-rich plasma (PRP) and the results of repeated surgical treatment.Methods. The patient underwent clinical examination and optical coherence tomography (OCT) of the retina before and after surgical treatment. А 2-stage surgical treatment of the left eye with an interval of 7 days: phacoemulsification (PE) followed by microinvasive vitrectomy with Internal limiting membrane peeling (ILM) and closure with the use of PRP. The patient was discharged with improved visual acuity and closure of the macular hole (MH). After 2 weeks vision deterioration was noted by the patient in the operated eye. Clinical examination revealed macular edema (ME) and recurrence of MH. Topical steroid eye drops were used to no avail, with increase of ME and MH via OCT control. Revision of the vitreal cavity augmented with PRP was performed.Results. In follow-up a complete closure of the MH, resolution of ME and improvement in visual acuity after repeated surgery was confirmed.Conclusions. A case of recurrent MH after primary closure with PRP is described. The case suggests a possibility of clinical improvement after repeated MH closure augmented with PRP. The causes and mechanisms of the recurrence of MH are still not clear. Despite the positive results of surgery subsequent OCT retina examination is necessary.