Ophthalmology in Russia

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ISSN / EISSN : 18165095 / 25000845
Current Publisher: PE Polunina Elizareta Gennadievna (10.18008)
Total articles ≅ 310
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S. I. Rychkova, V. G. Likhvantseva
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.
S. I. Rychkova, V. G. Likhvantseva
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.
V. V. Neroev, M. V. Zueva, A. N. Zhuravleva, I. V. Tsapenko
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.
A. N. Zhuravleva, M. V. Zueva, E. B. Shustov
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.
R. R. Faizrakhmanov, E. A. Larina, O. A. Pavlovskii
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.
G. A. Gamidov, I. A. Mushkova, S. V. Kostenev
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.
D. V. Cherepov, S. J. Goziev
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.
D. V. Angelova, E. E. Kazaryan, N. Yu. Shkolyarenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-508-512

There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.
A. V. Tereshchenko, I. G. Trifanenkova, E. V. Yerokhina
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-451-458

Purpose: to study the features of the anatomical and topographic relationships of the eye’s anterior segment structures in children with stage 5 ROP in the cicatricial period with the method of ultrasound biomicroscopy and optical coherent tomography of the anterior segment and to evaluate the possibility of using the data to optimize the surgical treatment of ROP.Patients and methods. For the period 2015–2018 in the Kaluga branch of the Fyodorov Eye Microsurgery, 68 children (118 eyes) with 5 cicatricial ROP stages were examined and treated. Gestational age at birth varied from 24 to 31 weeks, body weight at birth — from 630 to 1600 grams. Age at the time of the survey ranged from 5 to 15 months. All children underwent the complex diagnostic examination, which included biometrics, tonometry, ultrasound ophthalmoscanning in B-mode, as well as UBM and OCT of the anterior segment of the eyeball. The extent of fixation of retrolental opacities to the posterior lens capsule, the presence of cystic cavities and retinal folds at the periphery, traction detachment of the ciliary body were determined. OCT of the eye anterior segment was performed in the presence of iridocorneal contact in order to clarify its length. As a result, a comprehensive detailed assessment made it possible to clarify or reject the characteristics identified by UBM, as well as determine the phasing and develop an individual plan of the operation in each case.Conclusion. The use of complex diagnostic examinations, including UBM and OCT of the eye anterior segment in patients with 5 cicatricial PH stages, allows to optimize the tactics of surgical treatment in the advanced stages of the disease.
L. K. Moshetova, O. I. Abramova, K. I. Turkina, M. K. Nurbekov, O. P. Dmitrenko, I. N. Saburina, S. A. Kochergin
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-330-335

Visual impairment in elderly people is a serious problem that significantly affects the quality of life of millions people around the world. The magnitude of this problem is becoming increasingly apparent as the population ages and the number of older people increases. Age-related macular degeneration (AMD) is the third leading cause of blindness worldwide and the main cause of vision loss in people over 60 years. It is expected that AMD will affect about 288 million people by 2040. AMD is a multifactorial disease with a progressive course. The arised dystrophic changes in the retina cannot be reversed by any of the known treatment methods. A lot of research and effort has already been invested in identifying various biomarkers for predicting the incidence rate, identifying people at risk, finding out the pathogenetic mechanisms of this disease, and finding effective methods of treatment and prevention.Aging is the basis of pathological changes that occur during AMD. Aging biomarkers are measurable vital signs that qualitatively and quantitatively change with the age of the body. DNA methylation is a molecular mechanism that is a potential biomarker of aging. Sirtuins indirectly participate in this process, regulating the activity of the DNMT1 enzyme. The article discusses current knowledge of the mechanisms underlying the action of sirtuins (Sirtuins / SIRT), with an emphasis on SIRT1. Analysis of the pathophysiological action of sirtuins can affect the prevention and treatment of pathological eye changes associated with AMD. The article provides literature sources containing the results of studies of the effect of SIRT1 as a marker of aging in body tissues. SIRT1 is an attractive candidate for developing therapeutic strategies preventing early eye aging, in particular, age-associated diseases such as AMD The impact on the genetic mechanisms of this disease is a promising direction in treatment.
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