Ophthalmology in Russia
ISSN / EISSN : 1816-5095 / 2500-0845
Current Publisher: PE Polunina Elizareta Gennadievna (10.18008)
Total articles ≅ 405
Latest articles in this journal
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-61-69
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-36-45
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-157-164
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-143-151
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-117-122
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-12-19
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-129-135
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-70-76
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-171-173
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.
Ophthalmology in Russia, Volume 18; doi:10.18008/1816-5095-2021-1-46-53
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.