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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E. V. Samkovich, I. E. Panova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-172-180

Choroidal melanoma is the most common and life-threatening intraocular malignant neoplasm affecting the eye choroid in about 90 % of cases. The incidence varies from 0.7 to 1.1 per 100,000 of the population. This category of malignant neoplasms is highly aggressive in terms of local distribution, the occurrence of loco-regional and distant metastases. According to various authors, the frequency of metastasis reaches up to 50 %, the risks of metastatic disease depend on the size of the tumor, the duration of observation, clinical and pathomorphological characteristics of the choroidal melanoma and genetic factors. This article provides a detailed literature review on the developmental aspects and growth dynamics of choroidal melanoma from the point of view of neoangiogenesis and the phenomenon of vasculogenic mimicry, and the possibilities of instrumental diagnostics for determining the malignant vasculature of a tumor. The relevance of studying this issue is determined by the peculiarities of the origin of choroidal melanoma, which can occur both de novo and due to malignant transformation from nevus cells and the critical point for it is a tumor thickness of more than 2 mm, at in which the the process of neoangiogenesis starts. This review details the role of various methods of instrumental diagnostics, such as doppler ultrasound imaging to determine the presence or absence of blood flow in the tumor and its blood flow characteristics, angiography using contrasts: fluorescein and indocyanine green angiography, and optical coherent tomography—angiography to identify the malignant vasculature and evaluation of tumor angioarchitectonics. It has been shown that in the diagnosis of especially small choroid melanomas, which are of significant diagnostic complexity, a multimodal approach using the above research methods is important. There is no doubt that these instrumental technologies aimed to identify the malignant vasculature of choroidal melanoma play a large role not only in diagnosis, but also are of considerable practical interest in planning treatment, in assessing its effectiveness, and also in predicting the risks of metastatic process development.
V. V. Volkov, I. L. Simakova, I. A. Tikhonovskaya
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-229-237

Purpose: To evaluate the effectiveness of a new modification of the vacuum-perimeter test (VPT) by V.V. Volkov in the early diagnosis of glaucoma in comparison with the results of the original test and its known modification — vacuum-compression automated test (VCAT) in an open comparative clinical research. Patients and Methods. The study involved 26 patients (47 eyes) (average age 52.9 ± 8.5 years) with suspected open-angle glaucoma (OAG). Patients were divided into three groups: 1-st — 19 eyes with preglaucoma, 2-nd — 18 eyes with the early stage of OAG, 3-rd — 10 eyes of five patients with unconfirmed glaucoma. The control group (4-th) included 20 eyes of 10 healthy people (average age 56.4 ± 4.4 years). Along with the standard ophthalmological examination, all patients underwent perimetry on Humphrey Visual Field Analyzer II 745i (Germany-USA), our modification of Frequency Doubling Technology (FDT) perimetry, evaluation of the optic nerve head (ONH) on Heidelberg Retina Tomograph (HRT 3, Germany) and three stress tests: VPT, VCAT and our modification — vacuum-contrast-frequency test (VCFT). VCFT was created on the base of FDT perimetry with the aim of increasing the sensitivity of the original test (VPT) for detection of preglaucoma through the use of non-standard stimulus and increasing the number of investigated points of central visual field. Results. According to the National classification (1975) the diagnosis of preglaucoma was determined on the basis of a positive result of at least one of three stress tests, taking into account the risk factors for the development of glaucoma in patients. The early stage of OAG was established on the base of International standards for structural and functional assessment of the ONH (2003). The specificity of all three compared stress tests was 100 %, which confirmed their negative results in all patients (10 eyes) from the 3-rd group. However, the sensitivity of VCFT (75 %) was significantly higher than VPT (21.05 %) and VCAT (21.05 %), which is due, we believe, to the specific nature of VCFT stimulus. Conclusion. According to the obtained data, the developed new modification of VPT — VCFT on the specificity of the results was not worse, and the sensitivity was better than the original VPT and VCAT in the diagnosis of preglaucoma. VCFT is quickly performed and comfortable for patients.
E. S. Milyudin, O. Yu. Smorodinova, K. E. Kuchuk
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-269-273

The purpose of our study was to substantiate and evaluate the effectiveness of the conservative method of treating keratoconus in the early stages of the development of the disease. Patients and methods. The study of the effectiveness of the proposed method for the conservative treatment of keratoconus was performed on clinical material obtained by monitoring 39 patients (75 eyes) with a diagnosis of keratoconus stage I–III for at least 10 years. Every 4–6 months, all patients underwent an ophthalmological examination — visometry, autorefractometry, keratometry, keratotopography, pachymetry, biomicroscopy. Along with the study of the ophthalmic status of the patients, cardiointervalography was performed before starting conservative treatment. The assessment of vegetative homeostasis was performed using the Mustang-Diagnost device of the Technika company (Russia). Results. All patients observed by us were matched with corneal or corneoscleral gas-permeable contact lenses of various models and manufacturers. According to cardiointervalography, in 97 % of our patients vegetative dysfunction was determined, while in 85 % and all examined, a significant predominance of sympatheticotonic neurotrophic regulatory processes was determined. At the first stage of the conservative treatment of keratoconus pharmacological agents were selected. They potentiate cholinergic neurotrophic regulatory effects and activate aerobic processes in the tissues of the eyeball. The next step was the potentiation of sympathicotonic (ergotropic) neurotrophic regulatory processes. Treatment was carried out during the entire observation period, alternating complexes of preparations for 60 days. An increase in diopter strength along the steep meridian was noted in patients with keratoconus of all stages. In the group of patients with stage I keratoconus in 4 eyes out of 16, in patients with stage II disease in 7 eyes out of 35, in stage III patients in 7 eyes out of 24. Opposite, a study of the KISA % index in all observed patients showed a decrease in the coefficient values. Conclusions. The combination of therapeutic factors into tonic (trophotropic, anabolic) and phase (ergotropic, catabolic) regulatory blocks, taking into account their mutual neurodynamic synergism and in accordance with the phase nature of biorhythmogenesis of reparative processes, makes it possible to prevent the progression of keratoconus. The use of the treatment complex developed by us, which includes therapeutic treatment and correction with rigid gas-permeable contact lenses, corrects metabolic disorders and stabilizes collagen synthesis, which makes it possible to lay off the surgical treatment of patients with keratoconus.
V. V. Neroev, S. V. Saakyan, А. G. Amiryan, В. В. Вальский, А. Iu. Tsygankov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-195-201

Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.
Е. P. Gurmizov, К. B. Pershin, N. F. Pashinova, А. Iu. Tsygankov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-209-215

Purpose. Evaluation of the visual and refractive results of additional correction using LASIK and PRK methods in patients with residual refractive error after previous cataract surgery. Patients and methods. The prospective open study included 57 patients (79 eyes) who previously underwent cataract phacoemulsification (n = 37) or refractive lensectomy (n = 42) with various IOL models implantation (2012–2017). The average age of patients was 50.8 ± 13.9 (19–79) years. Operations LASIK (91.1 %) and PRK (8.9 %) were carried out according to standard methods. In 6 cases, femtosecond laser supported by laser correction. The target refraction ranged from –0.25 to 0.25 D in most (97.5 %) cases. The follow-up period ranged from 6 to 9 months. Results. The patients were divided into groups according to the type of residual refractive error (Group 1 — myopia, group II — emmetropia and group III — hyperopia). Statistically significant differences were determined for the species of previously implanted IOLs — in group II, the frequency of monofocal IOLs was significantly higher (p < 0.05). In group II, the values of the cylindrical component of refraction were significantly higher compared with groups I and III (p < 0.05). In group I, a significant (p < 0.05) decrease in the spherical component of refraction from –1.36 ± 0.92 to –0.2 ± 0.8 D was observed. In patients of group II, there was a slight increase in the spherical component of refraction from 0 ± 0.20 to 0.25 ± 0.29 D (p > 0.05). In group III, a significant (p < 0.05) decrease was observed in the spherical component of refraction from 1.27 ± 0.69 to 0.43 ± 0.49 D. When analyzing the cylindrical component of refraction in group I, its decline was noted from –0.69 ± 0.5 to –0.38 ± 0.46 D (p > 0.05). In group II, the largest decrease in the cylindrical component was observed from –1.6 ± 1.0 to 0.03 ± 1.10 Dptr (p < 0.01). In all the studied groups, a statistically significant (p < 0.05) increase in UCFVA was revealed in the postoperative period. Indicators K1 and K2 did not significantly change. Conclusion. The high efficiency of the correction using the LASIK, PRK and femtoLASIK methods on pseudophakic eyes with the achievement of the target refraction in most of the studied cases was shown. This method can be used as an alternative to spectacle and contact correction in patients with residual refractive error after cataract phacoemulsification and refractive lensectomy with IOL implantation.
A. N. Pashtaev, B. E. Malyugin, S. B. Izmailova, N. P. Pashtaev, K. N. Kuzmichev, S. S. Alieva, K. I. Katmakov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-216-222

Purpose. To evaluate the quality of the surface of an ultra-thin donor transplant prepared from the endothelial surface of the cornea using a femtosecond laser and to demonstrate the preliminary clinical results. Patients and Methods. 4 eyes were operated: 3 with Fuch`s endothelial dystrophy and 1 with pseudophakic bullous keratopathy. All patients were treated with DSEK with an ultrathin graft prepared by Alcon Wavelight FS 200 femtosecond laser (Germany). Before and after surgery UCVA, BSCVA, astigmatism, ECD were measured. EC death, graft thickness and CCT were evaluated at 12 months` observation. Atomic force microscopy was used for examination of 10 samples. Control group was 5 corneal flaps obtained by mechanical microkeratome (Moria SLK-2, France). Main group — 5 corneal flaps, obtained by femtosecond laser. Nonparametric Mann-Whitney test was used for statistical analysis. Coefficient of reliability p < 0.05 was considered to be significant. Results. RMS value of femto-laser group samples was 18.6 ± 7.8 um. RMS of microkeratome group samples was 22.3 ± 18.3 um. Statistical analysis did not reveal significant differences between the values of the studied parameter in these groups (p > 0.05). Transparent engraftment was observed in all cases, no corneal edema was identified. BSCVA ranged from 0.2 to 0.6, which was associated with the presence of concomitant pathology. Astigmatism was 1.35 ± 1.0 D. ECD = 1526 ± 434 cells/mm2. EC loss = 48.0 ± 12.8 %. Graft thickness in the central zone was 78.0 ± 18.1 µm. Center-Edge Index — 0.84 ± 0.12. CCT = 600 ± 31 um. No postoperative complications were found. Conclusion. The developed settings allowed to obtain high-quality ultra-thin graft with a sufficiently uniform surface without a risk of perforation. Preliminary clinical results showed the method potential for restoration of corneal transparency. ECD loss corresponded to the one achievable by DSAEK.
M. H. Durzhinskaya, M. V. Budzinskaya
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-165-171

Oxidative stress due to the imbalance in the production and detoxification of reactive oxygen species in antioxidant defence system of the body, as well as subsequent chronic inflammation, is believed to be associated with age-related eye diseases. Prevention of chronic degenerative diseases such as age-related macular degeneration (AMD) and primary open-angle glaucoma are of particular interest. In the last decade, tremendous success has been achieved in the treatment of age-related retinal pathology. However, these treatments are expensive and require frequent monitoring and, in some cases, injections, which place a huge burden on both the healthcare system and patients. Consequently, considerable interest remains in preventing or slowing the progression of these diseases. Epidemiological studies have shown that diet is a modifiable risk factor for AMD, and nutritional modification with food antioxidant supplements is a particularly attractive method of prevention because of its potential benefits and relatively low cost. A large number of experimental studies, including clinical studies in animals and humans, have provided supporting evidence that antioxidant food additives inhibit the oxidation of macromolecules, as well as an inflammatory response that occurs in the pathogenesis of involutional retinal pathology, which ultimately inhibits its development and progression. This review discusses the role of antioxidant dietary supplements in the prevention of age-related retinal pathology.
D. A. Borisov, E. I. Saidasheva, Z. A. Dautova, N. V. Fomina, S. V. Buynovskaya
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-223-228

The purpose: to study to evaluate the effect of ortokeratology lenses (OK-lenses) on the state of the ocular surface, depending on the duration of their wearing by adolescents with myopia. Patients and methods. Under control were 212 patients with myopia aged 12 to 16 years, who used OK-lenses “Paragon CRT100” (USA) for a long time (3–5 years). Examination, in addition to standard ophthalmological methods, included evaluation of complaints using the OSDI questionnaire/scale, Schirmer, Norn tests and biomicroscopy with staining of the cornea with fluorescein before and during wearing OK-lenses. Patients with keratopathy additionally underwent scanning confocal microscopy of the cornea using ConfoSkan-4 (Nidek, Japan); bacteriological examination of scraping from the cornea. Results. Clinical and functional signs of dry eye syndrome (SDE) in patients before and after prolonged use of OK therapy are not diagnosed. In 12 (5.6 %) teenagers with non-standard values of corneal curvature, signs of late epitheliopathy were revealed against the background of the absence of complaints. Patients were divided into 2 subgroups depending on the choice of antimicrobial eye drops in addition to keratoprotectors. The results of treatment in both subgroups were the same, but the use of fluoroquinolones was accompanied by an adverse development of SDE. Conclusion. In general, long-term OK therapy of myopia in adolescents is safe. The compulsory condition is an adequate prescription and observance of the wearing and lens care rules. It does not have a significant adverse effect on the clinical and functional state of the ocular surface, including the cornea. The frequency of late epitheliopathies with long-term (3–5 years) wearing OK lenses is 5.6 %, and the severity of the manifestation is characterized mainly by a mild degree. Patients with extreme corneal curvature are in a high-risk group for the development of late corneal complications during the use of OK therapy. If late epitheliopathies are detected while wearing OK lenses, it is necessary to cancel their use and to prevent the development of infectious keratitis, in addition to keratoprotectors, you can add the modern antimicrobial drug with antiseptic effect, for example, Vitabact, as the original, without a preservative, approved medicine for use in children. The use of fluoroquinolone drugs with virtually aseptic inflammation of the cornea is unjustified.
N. V. Maychuk, I. A. Mushkova, A. M. Mayorova, A. A. Shpak
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-295-299

Introduction. Reduced corneal transparency leads to dissipation of energy of the femtosecond laser (FSL), which may complicate the formation of the intrastromal incision and limits the use of FSL in eyes with corneal opacities and scars. The purpose of this work is to demonstrate the possibility of successful ReLEx SMILE in a patient with superficial corneal opacity located in the paracentral zone. Case report. Patient R., 29 years old, complained of decreased vision in both eyes since childhood. Visual acuity OD = 0.1 sph –2.75D = 1.0; OS = 0.1 sph –3.50 D cyl –0.75D ax 165° = 1.0. Biomicroscopy of the right eye visualized a superficial semi-transparent corneal opacity of 5 x 3 mm located at 5.30–6 hours at a distance of 1.3 mm from the optical center. According to the anterior segment optical coherence tomography (AS-OCT) the depth of the opacity was 73–78 microns and was limited by the Bowman’s membrane. ReLEx SMILE for myopia correction was performed on both eyes with 6.7 mm lenticule diameter at a depth of 120 µm, which covered the opacity area by 1.1 mm. The surgery was standard and uncomplicated. Seven days postoperatively the patient did not complain. Uncorrected visual acuity (UCVA) was 1.0 for both eyes (and binocularly it was 1.2). According to the AS-OCT data, a hyperreflective line of the interface zone was visualized on the right eye at the depth of 141–147 µm; the opacified superficial corneal layers were detected in the lower paracental zone over the interface line. In one month after the surgery the visual acuity did not change: UCVA = 1.0 in both eyes (binocularly 1.2). Conclusion. ReLEx SMILE technology can be considered as one of the options for myopia correction in patients with superficial corneal opacity located in the paracental zone. More observations are required to evaluate the effectiveness of this technology on corneas with paracentral opacities different in sizes and located at different depths.
E. A. Sozurakova, E. V. Gromakina, V. G. Mozes
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-181-187

Eye injury is one of the actual problems in modern ophthalmology. Penetrating wounds of the cornea are the most significant among all eye injuries. New data on the course of inflammation in corneal injury will allow us to predict the course of the post-traumatic period and improve treatment outcomes. The corneal immune privilege is a unique system of protecting one’s own tissues from damage caused by systemic immunity reactions, which is realized through several mechanisms. Modern research shows that healing from corneal injury is a complex cascade of cellular reactions, the understanding of which is still far from consummation. It was described the regenerative potential of cell populations of the cornea when it was damaged. Contravention of barrier properties in injuries of the cornea deprives the organ of vision of immune privilege. This violation initiates the launch of the messenger pools of angiogenesis, remodeling and inflammation. Besides studying the interaction of cellular messengers in cornea trauma and inflammation, researchers pay great attention to cellular reactions. Recruitment of immune cells during corneal injury is mediated by pro-inflammatory cytokines released during damage from epithelial cells and keratocytes.
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