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№ 12š(187),š2015
Medical sciences
Aznabaev R.A., Shavaleeva K.R. PREVENTION OF DEHYDRATION CORNEAL FLAP DURING THE PROCEDURE LASIKLASIK procedure in patients with high myopia is related with a long period and increasing depth of ablation. These featuresmay cause postoperative complications such as epithelial ingrowth under the flap, aseptic inflammation,flap dystrophy syndrome, thereby reducing patient satisfaction and lengthening the period of rehabilitation after surgery, as well as the development of dry eye disease. 1 month after surgery average score of lacrimal functional complex assessment in the study group was 3.1±0.7. In 8špatients (33š%) state of lacrimal functional complex was in the normal range (0špoints), 16š(64š%)š— borderline (1što 10špoints). Average score in comparison group was higher than in the study (5.2š±š1.3, pš<š0.05). Lacrimal functional complex was within normal limits in 3špatients (15š%), 17š(85š%)š— in a boundary condition. At 3-month follow-average score was 1.9š±š1.1) and 3.6š±š0.8) (pš<š0.05), lacrimal functional complex within the normal range inš14 and 6špatients, respectively. Application of the proposed method of protection of corneal flap from dehydration during LASIK in a limited surgical field, prevents the flap shrinkage, thus contributing the full adaptation of the flap edges to avoid postoperative complications and to achieve maximum optical effects, as well as reduce the risk of dry eye in patients with high myopia.Key words: LASIK, dry eyesyndrome, protection flap.
Babushkin A.E., Orenburkina O.I., Matyukhina E.N. MONITORING OF PRIMARY OPEN ANGLE GLAUCOMA PROGRESSION ON THE BACKGROUND OF MONO- AND COMBINED ANTIHYPERTENSIVE THERAPYPurpose of the study is to assess comparatively the frequency of primary open angle glaucoma (POAG) progression along with prolonged mono- and combined antihypertensive therapy at regular medical check-up of patients. It was performed a retrospective analysis of out-patient medical records in 85 patients (165 eyes) with POAG stage I–III compensated within average rate of intraocular pressure (IOP), which were followed for 5–7šyears. Of these, 64špatients (124šeyes) received topical antihypertensive treatment in the form of instillations with only non-selective beta-blocker timolol 0.5š% and 21špatients (41šeyes)š— non-fixed combination therapy (20šeyesš— timolol in combination with cholinomimetic pilocarpine and in 21šeyesš— timolol with prostaglandins, mainly xalatan). Progression of the disease was defined by the state of vision fields (kinetic perimetry) and optic disc (ophthalmoscopy). The analysis showed that the POAG progression against the IOP compensated within average rate in patients treated with non-selective beta-blocker timolol was observed in 1.3štimes more frequently than in patients treated with non-fixed combination therapyš— β-blockers with prostaglandin drugs or cholinomimetics (62.1š% vs 46.3š%). Thus destabilization of the disease while using a combination of timolol with drugs of prostaglandin series was marked by almost 2štimes less than at combination with pilocarpine (33.3š% vs 60.0š%). The combination therapy using prostaglandin drugs that can reduce the incidence of POAG progression must be much more widely and actively used as the initial treatment of primary open angle glaucoma.Key words: primary open-angle glaucoma, disease progression, mono- and combined hypotensive therapy, prostaglandins, cholinomimetics, β-adrenoreceptor blocking agents.
Balalin S.V., Fokin V.P. THE USE OF TRAVOPROST IN THE TREATMENT OF PRIMARY OPEN-ANGLE GLAUCOMAThe results of the use of travoprost in the treatment of 186špatients with primary open-angle glaucoma (224šeyes). The selection of patients for medical treatment carried out on the basis of achieving the target intraocular pressure after instillation of 0.004š% solution of Travatan. 24šhours after instillation of the drug in patients performed repeated measurements of IOP investigated field of view, the ocular pulse is determined and the target tolerant intraocular pressure. Reducing elevated intraocular pressure to tolerance was assessed by improving hemodynamic parameters of the study eye ocular pulse: increasing the value of the elasticity index of intraocular vessels (IEIV) over 1.3šmm3/mmšHg and an index of the adequacy of blood supply to the eye, which should be less than 12šmmšHg/mm3. Intraocular pressure amid instillation Travatan decreased from (22,6š±š0,1)šmmšHg up to (14,5š±š0.1)šmmšHgš— 8.1šmmšHg (35.8š%) and it was 2.0šmmšHg below the average pressure tolerant (16,5šmmšHgš± 0.1šmmšHg). Tackling drug treatment using travatanovoy samples and identify tolerant IOP allowed to stabilize glaucomatous process against the background of medical treatment during the year in 96.8š% of cases (217šeyes). The results confirm the practical value travatanovoy sample and determine the clinical significance of a tolerant and target pressure in patients with primary open angle glaucoma. In order to achieve the stabilization of visual functions needed to fluctuations in intraocular pressure against the background of medical treatment did not exceed the tolerance pressure. Key words: open-angle glaucoma, medication, travoprost.
Bachinin E.A., Utkin S.I., Stolyarov M.V. THE PREVENTION AND THERAPY OF INTRAOPERATIVE VIOLATIONS OF THE CARDIAC RHYTHM IN THE OPHTHALMOSURGERYIn ophthalmosurgery during operation under anesthesia possibly emergence of life-threatening arrhythmias, in connection with impact on a myocardium of narcosis preparations and the oculocardiac reflex. In the conditions of purpose-built ophthalmic surgery centre, prophylaxis and well-timed perioperative therapy of cardiac rhythm disturbances are especially actual, because in the round-the-clock working hours of clinic there are no cardiologists and resuscitators. 48 patients with initial cardiac rhythm disturbances were analyzed regarding emergence the life-threatening arrhythmias during ophthalmic surgery under local and general anesthesia. In most cases the combination of local anesthesia with sedation or general anesthesia for patients with initial cardiac arrhythmias, depending on volume and duration of the ophthalmic surgery intervention demanded by it, didn't lead to development of the arrhythmias menacing to life. It is reached thanks to adequate selection of preparations for anesthesia and in due time held medical events. The methods of anesthesiology applied by us to ophthalmic surgery patients with initial cardiac rhythm disturbances taking into account its clinical form, extent of compensation, duration and volume of operation, age of the patient allow in all cases to execute operation and anesthesia quite safely, without life-threatening complications and with sufficient extent of protection of the patient. Obligatory introduction of preoperative screening electrocardiogram; the analysis of the accompanying somatic pathology; reception cancellation of beta-blockers and antagonists of calcium channels (in particular Verapamilum) and a cardiac glycosides (in particular Digoxin) in one day prior to operation allow to significantly reduce risk of development of serious and hemodynamic-significant arrhythmias and cases of sudden death in the perioperative period.Key words: anesthesia in the ophthalmic surgery, arrhythmia, cardiac rhythm disturbances.
Belyi Y.A., Tereshchenko A.V., Novikov S.V., Shatskikh A.V., Kolesnik S.V., Kolesnik A.I. CLINICAL AND MORPHOLOGICAL INVESTIGATION OF INTRAOCULAR SAFETY OF NEW BIODEGRADABLE IMPLANTThe purpose of researcher is clinical and morphological substantiation of biodegradable implant safety during it's anterior chamber and intravitreal injection. The research was performed onš60 (120šeyes) rabbits chinchilla. Clinical examination, electroretinography and histology with light microscopy were performed after 1, 3, 7, 14, 21, 30šdays. To assess the status of intraocular structures prior to implantation and in the dynamics underwent ophthalmic examination: biomicroscopy, photographic registration of fundus images, electroretinography. The results of the study indicates the safety of the intraocular injection of unsaturated and saturated dexamethasone implants.Key words: implant, drug delivery, biodegradable polymer, dexametasone.
Berdnikova E.V., Solyanikova O.V., Ekgardt V.F., Dmitrienko V.N. PREDICTION COMPENSATION OF INTRAOCULAR PRESSURE IN PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA DEPENDING ON THE STAGE OF THE DISEASEGlaucoma occupies the third place in the world in the structure of causes of blindness after cataract and diabetes mellitus. Primary open-angle glaucoma (POAG) is considered as a multifactorial disease, the most important risk factor for the development and progression of which is elevated intraocular pressure (IOP). Prediction of compensation IOP in patients with POAG is important. Factors of IOP stability were determined and method for the prediction of IOP compensation depending on the stage of the disease in patients with POAG was developed on the basis of the dynamic observation for one year 150 patients with POAG using discriminant analysis. Observation included a comprehensive assessment of central and peripheral vision, eye and orbital hemodynamics, parameters of general hemodynamic, state of the system "lipid peroxidationš— antioxidant protection", lipid profile and the affective-cognitive status of patient. The method presented in the article allows predicting a highly specific forecast (more then 90š%) about maintaining of intraocular pressure target level during 12šmonths of follow-up.Key words: primary open-angle glaucoma, forecast, intraocular pressure, follow-up.
Bikbov M.M., Khusnitdinov I.I. CANALOPLASTY IN PATIENTS WITH PRIMARY OPEN ANGLE GLAUCOMAGlaucoma is the leading cause of irreversible blindness in the world. Advanced techniques in primary open angle glaucoma surgery tend to minimize the incisions and restore the natural outflow pathways of intraocular aqueous humour. The article presents the results of canaloplasty with the Glaucolight system in 31špatients (35šeyes) with primary open angle glaucoma (POAG). The average age of patients was 57.1š±š6.3šyears. There was an initial stage of POAG in 22šcases, developedš— in 8šcases, far-advancedš— in 5šcases. None of the patients underwent antiglaucomatous operations previously. Postoperatively, increased intraocular pressure (IOP) in all patients was managed. The field of view had no changes. Visual acuity was corresponded to preoperative visual acuity. Two cases (5.7š%) showed IOP increase in 1šmonth after the surgery. Laser descemetogoniopuncture was performed and IOP normalized. Increased up-to 27šmmšHg. IOP was noticed in 4šcases (11.4š%) after 12šmonths after the surgery. Antihypertensive drugs were prescribed for 2šeyes; 2špatients underwent reoperationš— sinus trabeculectomy with implantation of drainage. Canaloplasty helps to restore the natural outflow pathways of intraocular aqueous humour without the creation of the filtering bleb by increasing the permeability of the trabecular meshwork, preventing re-collapse of Schlemm's canal and occlusion of the mouth of the collector channels. óanaloplasty efficiency in patients with POAG in follow-up period up to 18šmonths in absolute terms amounted to 83š% and with an additional treatmentš— 94š%.Key words: canaloplasty, Glaucolight, primary open-angle glaucoma, Schlemm's canal.
Bikbulatova A.A., Pasikova N.V. IATROGENIC KERATECTASIA AS A LONG-TERM COMPLICATION OF ANTERIOR KERATOTOMYIatrogenic corneal ectasia is a serious complication of anterior keratotomy, leading to the decreasing of visual acuity and certain difficulties in further surgical rehabilitation. The urgency of the problem is no doubt due to the massive performance of anterior keratotomy for the correction of myopia and myopic astigmatism at the end of the last century and the increasing number repeat visits of the patients operated more than twenty years ago. Clinical signs of postkeratotomy corneal ectasia does not cover enough in the available literature. According to the results of our study, keratectasia may occur late after radial-tangential and radial keratotomy. Perforations during surgery, repeated keratotomy, crossing the radial by tangential cuts are risk factors for the development of iatrogenic ectasia. The clinical picture of secondary ectasia after keratotomy is characterized by severe refractive disorders in the form of hyperopic complex and mixed astigmatism, including a high degrees. Flattening and thickening of the central area of the cornea is accompanying by increased refraction in the peripheral regions and the emergence of irregular astigmatism. Protrusion of the peripheral parts of the cornea is combining with divergence of keratotomy scars, their differences and the formation of clear epithelial plugs between the edges of scars. In the area of protrusion the corneal stroma is thinning. Iatrogenic keratectasia, which developed in the late period after the anterior keratotomy, has specific refractive, keratometric, keratotopographic, pachimetric and biomicroscopic features. We study patients without family history of ectasia, eye injury, concomitant somatic pathology. This allows us to assume that the anterior keratotomy had become the reason of iatrogenic ectasia.Key words: iatrogenic keratectasia, anterior keratotomy, irregular astigmatism, the divergence keratotomy scars.
Bykova E., Sogolovskaya E., Sotnikova T., Gabriel T. ANALYSIS OF CHANGES IN THE FACTORS OF NONSPECIFIC PROTECTION OF BIOLOGICAL FLUIDS IN VIRAL LESIONS OF THE EYES SURFACEIt is known that in adenoviral conjunctivitis, herpes and other infectious diseases in the human body increases the production of specific and nonspecific protection factors. Nonspecific factors include lysozyme (muramidase) and ceruloplasmin, which form together with other factors, antibacterial, antiviral and antiradical body protection (ABP, AVP, ARP). Adenoviral infection first develops in the nasopharynx, and then raises along tear duct, and involves in the pathological process the conjunctiva and lacrimal apparatus of the eye. The virus of herpes resides in the human body in a latent state and, periodically sharpening, causes ophthalmic herpes. Individual drugs used in ophthalmology for the treatment of viral infections (adenoviral keratoconjunctivitis and ophthalmic herpes), have the ability to inhibit the lysozyme activity (e.g., cycloferon, interferon and poludan). The enzyme activity of ceruloplasmin depends on the chemical structure of a drug and additionally introduced ingredients.Key words: adenoviral keratoconjunctivitis, ophthalmic herpes, ceruloplasmin, lysozyme, lacrimal fluid.
Volkova N.V., Iureva T.N. RESEARCH OF CYTOKINES BALANCE IN PATIENTS AFTER FISTULIZING ANTIGLAUCOMATOUS SURGERYEffect of fistulazing surgery in glaucoma is reduced in every third case in 1–3 years after the intervention. Prevention of inappropriate inflammatory reaction and an attempt to "control" the healing process allow to prolong the hypotensive effect and increase the effectiveness of these interventions. Understanding of the course of postoperative regenerative-reparative process and knowledge of the factors that determine the duration and sequence of its phases at both the local and systemic levels, these approaches do pathogenetically justified. The study of the lacrimal fluid by enzyme immunoassay with determination of the level of interleukin-8 (IL-8), interleukin-6 (IL-6), and isoforms ofš121 andš165 of family of vascular endothelial growth factor VEGF-A. The patients (nš=š42) with uncompensated glaucoma were examined. The control group included healthy subjects (nš=š18). The dynamics of pro-inflammatory and pro-angiogenic cytokines in terms of the day before, on the 3rd day and after 2šmonths after surgery was examined. The level of interleukin-8 was (656,8š±š205,7)š/ (656,8š±š205,7)š/ (175š±š89,3)špg/ml. Interleukin-6š— (23,28š±š9,03)š/ (47,7š±š25)š/ (33,0š±š92)špg/ml. Level of 121 and 165 isoforms of the VEGF family Aš— (703,8š±š379,4)š/ (364,4š±š150)š/ (590š±š230,7)špg/ml (quantitative values are in the order of timeline). In the group of patients receiving prolonged scheme of anti-inflammatory therapy, with the inclusion Restasis ®, the final level of IOP was significantly lower (pš<š0.05), as well as the number of patients with a successful outcome of the surgery. Dynamics of proinflammatory cytokines IL-8 and IL-6 indicates the initial changed local tissue reactivity and confirms the course of inflammatory response during for at least 2šmonths of the postoperative period. Dynamics of isoformsš121 and 165 of the VEGF family confirms long-term nature of processes of fibroplasy and vasculogenesis and justifies the possible inclusion of angiogenesis inhibitors in postoperative rehabilitation of patients. Determination of cytokine balance of lacrimal fluid justifies the schema of postoperative rehabilitation of patients after fistulizing antiglaucomatous surgery. The dynamics of pro-inflammatory IL-8 and IL-6 interleukins indicates the initial changes in local tissue reactivity and confirmed the inflammatory response during for at least 2šmonths of the postoperative period. Dynamics of isoformsš121 and 165 of the VEGF family confirms long-term nature of processes of fibroplasy and vasculogenesis and justifies the possible inclusion of angiogenesis inhibitors in postoperative rehabilitation of patients.Key words: cytokines of lacrimal fluid, scarring, fistulizing antiglaucomatous surgery, CyclosporinšA (Restasis).
Gurko T.S THE ANALYSIS OF THE PATIENTS WITH RETINAL PHOTO DAMAGE FOLLOWED SOLAR ECLIPSEAfter the solar eclipse, the patients consult the ophthalmological centers about "a spot", blurring, distortion of the objects, visual acuity reduction. 11špatients, mean age 24.7šyears old, diagnosed as "solar maculopathy" consulted our hospital after looking at the solar eclipse without any protective means on the 20th of March 2015. All patients underwent the routine ophthalmological examination including the optical coherence tomography. Pattern-ERG was performed to one patient. When contacting the mean visual acuity wasš0.86. Subjectively all patients complained of the positive microscotoma that was not detected in perimetry but was noted when reading and was fixed on the Amsler's grid. Computed perimetry at 30.20 was not peculiar. The lamellar defect in one eye was observed in all patients using optical coherence tomography. The paper presented the clinical case with pattern-ERG registration in 3šmonths after the solar eclipse. The the P50-N95 amplitude increase of the affected eye was noted, which pointed to the retinal ganglion cells irritation. During the secondary examination in 2.5šmonths, the pattern-ERG values were within normal limits. As a result of the aforesaid it is recommended to avoid the influence of the direct sun rays without any protective means. The basis of the solar maculopathy is optical coherence tomography. The pattern-ERG alterations demand further investigation.Key words: solar maculopathy, retinal photodamage, solar eclipse.
Dashenko K.N. DYNAMICS OF THE FUNCTIONAL PARAMETERS OF THE EYE AND INFLUENCE OF PHENOFIBRATE FOR THEM IN THE EARLY AND LATE PERIODS AFTER COAGULATION OF THE RETINA IN PATIENTS WITH NONPROLIFERATIVE DIABETIC RETINOPATHYThe main treatment for diabetic retinopathy is laser photocoagulation of the retina that allows you to save the vision in more than 80š% of cases. However, the influence of laser treatment on electrophysiological parameters of the eye in the early and late periods after taking of phenofibrate studied enough. We investigated the prospective and retrospective groups. All patients had nonproliferative stage of the DR with the risk of proliferation. He was executed laser coagulation of the retina. Part patients received fenofibrate (tricor), others do not. In the prospective group assessed the volatility nekorregirovannyh and korregirovannoe visual acuity and electrophysiological parameters of the eye. Laser coagulation of the retina in a small volume in patients with nonproliferative DR as soon as possible contributes to the stabilization of visual acuity and even a slight increase. After the laser treatment of all electrophysiological parameters significantly increased the latency of the ERG waves. To a lesser extent, the latency was increased in patients treated with fenofibrate. In the retrospective group explored the dynamics nekorregirovannyh and korregirovannoe visual acuity. In the group of patients not receiving fenofibrate, visual acuity after 3 months after laser treatment gradually decreased by 3–5šyears: 31,4š% nekorregirovannyh and 28š% korregirovannye from initial values. In the group of patients treated with fenofibrate visual acuity gradually decreased from 1šyear to 3–5šyears has decreased by 26,3š% nekorregirovannyh and 11š% korregirovannye. Laser coagulation of the retina in patients with nonproliferative stage of the DR in the coming time causes an increase of the latency of ERG, indicating some inhibition of electrogenesis of the retina. The appointment of fenofibrate (tricor) helps to minimize the negative effects of laser photocoagulation on the retina as in the next, and in the long-term along with the compensation of the general condition.Key words: diabetic retinopathy, laser coagulation of a retina, phenofibrate.
Drozdova E.A., Khokhlova D.Yu. EFFECT OF ANTIHYPERTENSIVE MEDICINES ON THE EFFICACY OF INTRAVITREAL RANIBIZUMAB IN PATIENTS WITH RETINAL VEIN OCCLUSIONThe article is devoted to an actual problem in ophthalmologyš— treatment of macular edema due to retinal vein occlusion (RVO). Systemic hypertension (SH) is one of systemic risk factors of RVO, and treatment of SH is carried out by different groups of medicines. Purpose: to determine the effect of antihypertensive medicines on the efficacy of intravitreal injection (IVI) of ranibizumab in patients with RVO. We investigated 48špatients with RVO, performed standard and modern methods examination, made of (IVI) ranibizumab according to standard. All patients had SH. 25špatients (52š%) had compensation of SH. Of all patients 16špatients (33š%) took for treatment of SH angiotensin converting enzyme inhibitors (ACE inhibitors), 9š(19š%)š— β-blockers and calcium channel blockers. 23špatients (48š%) had decompensation of SH. Mean best-corrected visual acuity increased in patients with compensation blood pressure of ACE inhibitors: 0.5š±š0.1 in group with nonischemic type and 0.12š±š0.1 in group with ischemic type, and decrease of macular edema. ACE inhibitors increases the efficacy of IVI ranibizumab. The decompensation of SH may worsen the prognosis of visual functions, which need to be considered prior to IVI of ranibizumab.Key words: retinal vein occlusion, macular edema, ranibizumab, angiotensin-converting enzyme inhibitors.
Drozdova E.A., Yadykina E.V. SIGNIFICANCE OF INTRLERLEUKIN-17 IN THE DEVELOPMENT OF UVEITIS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA)Uveitis related to JIA account for about 75š% of anterior uveitis in children. Uveitis is hard for the development of complications, which make up 40š% of cases and may lead to a reduction of visual acuity and blindness without treatment. Among the risk factors for uveitis related to JIA an important place is given the role of cytokines. Special attention is now paid as interleukin-17 (IL-17). It is known that the increase in IL-17 is observed in the articular syndrome of JIA, but poorly understood role of IL-17 in the development of uveitis associated with JIA. The study was conducted in the last 7šyears. Observed 143šchildren with a diagnosis of juvenile idiopathic arthritis. Uveitis developed in 63 (44š%). Uveitis developed in 25šboys (39.7š%) and 38šgirls (60,3š%). Inflammation in one eye proceeded in 29špatients (40š%): 19šgirls (65.5š%) and 10šboys (34.5š%). The process was bilateral in 34špatients (60š%): 19šgirls (55.9š%) and 15šboys (44.1š%). To determine the role of IL-17 in children with uveitis associated with JIA in children, we conducted a quantitative analysis of IL-17 in the serum of children suffering from arthritis with no signs of intraocular inflammation, and with diagnosis of "uveitis." A statistically significant increase in levels of IL-17 in patients with uveitis associated with JIA, in relation to the group of patients with JIA without uveitis, and in the control group (pš˜š0.05). Determination of the concentration of IL-17 in the serum of patients with JIA may be a perspective trend of early diagnosis of uveitis in children with JIA and development new treatments.Key words: juvenile idiopathic arthritis, uveitis, intrlerleukin-17.
Solodkova E.G., Ezhova E.A., Melikhova I.A. SYSTEM OF AN OBJECTIVE ASSESSMENT THE GISTOMORFOLOGICHESKIKH OF CHANGES OF A CORNEA AFTER SURGICAL TREATMENTTo investigate and develop criteria for quantitative analysis histomorphological changes in the cornea after different types of effects on the cornea according confocal microscopy. The results of confocal microscopy at 274špatients (487šeyes) after different types of effects on the corneaš— LASIK, PRK, corneal collagen crosslinking, and after contact lens orthokeratology lenses. We studied the morphological changes of the cornea, typical for these types of effects. The study developed a single 4-point system assessment of the general morphological changes of the cornea, allowing objectify assessment of all the structures of the cornea and the effectiveness of the treatment, as well as study the features of reparative and regenerative processes in the cornea. When orthokeratology correction observed thickening of stromal nerve fibers and the formation of so-called "acellular zone" in the follow-up of 1šmonth. After Lasik surgery microjets noted the presence of corneal flap, metallic inclusions in the interface, "fragments" of nerve fibers in the ablation zone. Change innervation to decrease the number of nerve fibers was noted by us and after the PRK and CBC in terms of supervision of up to 1šmonth. Start reinnervation after surgery occurred in a period of about 1 month. After corneal collagen cross-linking in the follow-up of 1šmonth or more in all cases observed the appearance of a linear opacities in the middle and back layers of the stroma.Key words: confocal microscopy, epitheliopathy, cell activation, numerical score.
Zabolotniy A.G., Misakiyan K.S., Bronskaya A.N., Simonova A.N., Khristichenko E.Yu. METHODOLOGICAL ASPECTS AND ANALYSIS OF THE INEFFECTIVENESS OF THE IMPLANT IN THE SOFT DRAIN PRIMARY PENETRATING SURGERY BEFORE OPERATED OPEN ANGLE GLAUCOMA STAGE I–IIIScarring of the newly formed outflow tract for intraocular fluid (IOF)š— the main cause of IOP decompensation after surgery. For S prevention and reduction a slowly absorbable "soft" drainage implant HealaFlow (Anteis, Switzerland) was applied. Analysis of the implant HealaFlow results in the filtering anti-glaucoma operations (FAGO) of non-penetrating type for patients with POAG of I–III stages. Materials and methods. 30špatients (30šeyes), 18šmen, 12šwomen, 54–76šyears. 5špatients with IIIšstage were previously operated on for glaucoma. The follow-up period was more than 3šmonths. Research methods included optical coherence tomography (OCT) of the anterior and posterior eye segment [VisanteTM OCT, RTVue Avanti (Optovue)]. In all cases stabilization of IOPš— 16–18šmm Hg was achieved. There were no surgical complications. At discharge, on the OCT in the operational area in 29špatients was determined diffuse intraconjunctival cavity (ICC). Intrascleral cavity (ISC) was apposed to ICC filled with HealaFlow. 1špatient (IOP of 29šmmšHg) was performed a revision of a surgery area. 1–3šmonths after surgery in all eyes a bleb with height of 0.6–0.8šmm with subconjunctival micro cavities was visualized. ISC in all patients was saved. All patients with POAG of III stage was underwent DGP up to 3šmonths. The purpose IOP was achieved in 86š% of cases. Implant HealaFlow when FAGO of non-penetrating type with POAG of I–IIIšstages, including repeated, prevents the formation of cicatrical processes. Persistent hypotensive effect was achieved. It requires strict technology observance. Key words: innovations in ophthalmology, glaucoma surgery, drainage implants.
Zainullin R.M., Faizrakhmanov R.R., Gilyazova I.I. IS INTO FUNCTIONAL ZONES, THE CENTRAL CHARACTERISTICS OF THE RETINA IN PATIENTS WITH MACULAR-YEAR-OLD DIABETICOne of the most significant manifestations of diabetes mellitus is a form of retinal lesion as diabetic macular edema (DME), leading to the inevitable loss of vision and disability of patients of working age. Currently, one of the main ways of visualization of retinal lesions and DME is optical coherence tomography (OCT). Regular and objective measurement of the optical density of the macular pigment (MPOD) is justified by the research in the pathology department of central area of the retina. Microperimetry used to assess the functional state of the macular area, allowing the light to determine the sensitivity of the macular area, even in patients with low visual acuity. Determination of MPOD and its relationship with functional and morphological parameters of the central area of the retina at the DME can serve as an additional diagnostic criterion of pathological process. The evaluation of morphological and functional changes in the retinal layers and MPOD as a diagnostic criterion of pathological process in patients with DME. Patients with DME amounted Group Iš— 19špatients (20šeyes), in groupšII included 12špatients (20šeyes) without retinal pathology, comparable in age. In the analysis of OCT cartograms in patients of Group II average total retinal thickness was equal to (298.3š±š6.43)šmm, while the patientsšIš— this figure as a result of edema increased by 35š% and amounted to (404.62š±š15.23)šm. Interpreting the results of studies of MPOD, revealed a significant decline in the average optical density, maximum optical density, the volume of macular pigment in patients of Group I in comparison with the control group (pš<š0.05). Based on the microperimetry data of central zone of the retina, patients of group I remained central locking and stable, and the size of the field of fixation did not exceed 4œ. Indicators light sensitivity were reduced by an average of 9šdB and amounted to (9.85š±š0.09)šdB. Revealed a sharp decline of the optical density of the macular pigment, light sensitivity in patients with DME. Established correlation between quantitative data of MPOD and of area of macular edema according to OCT.Key words: diabetic macular edema, macular pigment optical density, optical coherence tomography.
Zainutdinova G.H., Aznabaeva L.F., Faizullin A.S. EXTRACELLULAR PEROXIDASE ACTIVITY OF BLOOD IN NEWBORN INFANTS WITH RISK OF RETINOPATHY OF PREMATURITYThe problem of early diagnosis of retinopathy of prematurity (ROP) at the present stage remains very relevant due to the increasing number of children with this pathology. The important point in the pathogenesis of ROP is the development of oxidative stress associated with increased production of free radicals and their destructive effects on various organs, including the retina. Several studies proved that the development of ROP occurs on the background of reducing the activity of antioxidant enzymes superoxide dismutase, glutathione peroxidase. In antioxidant protection has also participated peroxidase system, in particular, the enzyme peroxidase introduced into the extracellular space during phagocytosis, the cellular damage of the organs, tissues and catalyzes the oxidation of various substances with hydrogen peroxide. One of the indicators to assess the state of the peroxidase system is the determination of blood of activity extracellular peroxidase. However, data on the participation of the extracellular peroxidase activity (åPA) in blood development and character of the clinical course of ROP in the available scientific literature, the authors found. In this work results of investigations of indicator oxidant-antioxidant protectionš— extracellular peroxidase activity of the blood in 3-4 week 63špreterm infants. Conducted research indicator of extracellular peroxidase activity in serum in preterm infants showed that 48.8š% of infants with reduced values was the development of some clinical forms of retinopathy of prematurity. The majority (61.9š%) of them developed stage I, almost a third (28,6š%) showed progression to stage II–III, in fewer cases diagnosed (9.5š%) of posterior aggressive form of the disease. Research conducted by the authors found that the risk of developing ROP rises upon detection of concomitant somatic pathology of organs of breathing and circulation with reduced activity of extracellular peroxidases of the blood serum in preterm infants at 3–4 weeks of age.Key words: retinopathy of prematurity, extracellular peroxidase activity of blood.
Zelentsov K.S., Ioileva E.E., Zelentsov S.N. USE OF POLARIZING MIXTURE IN TREATMENT OF CLOSED EYE INJURYClosed eye injury ranks second in frequency among all eye contusions. 40.7–46.5š% of patients have ophthalmoscopically visible changes ofretina. 0.5–23.7š% of patients suffer from traumatic optic neuropathy. Nowadays a wide variety of conservative methods of treatment of retina and ophthalmic nerve contusion changes is used. Nevertheless most of them are not efficient enough due to the fact that they don't produce an ethiopathogenetic effect. To study a neuroprotective effect of polarizing mixture (glucose-insulin-potassium) on retina and ophthalmic nerve neuron metabolism in case of eye injury, for 1–3 days after trauma there was examined functional status of retina and ophthalmic nerve of 20 patients with eyeball injury and transparent optical media. There were used objective methods: registration of general electroretinogram (ERG) and visually evoked potentials (VEP) by a diagnostic suite "Electroretinograph" (produced by MBN, Russia). Eye stimulation was held monocularly, with diffusive flashes of white light, flash energy was 0,3šJ, frequence was 1šHz. The acquired data was statistically analyzed. The research has found that according to the electroretinogram data one hour after injection of polarizing mixture wave "Á" is registered to increase by 135š% and wave "b"š— by 164š%. The amplitude of the wave P-100 VEP increases by 161š%. Thus, on the basis of the received data, we believe that using of polarizing mixture produces a neuroprotective effect on retina and ophthalmic nerve in case of closed eye injury.Key words: eye contusion, electroretinogram, visual evoked potentials, polarizing mixture.
Izmailov A.S., Kotsur T.V. ANALYSIS OF THE EFFECTIVENESS OF THE DIODE LASER (0.8šμ M) IN THE MODES OF COAGULATION AND MICROPATHOLOGICAL WHEN RUNANALYSIS THE PARAMETERS OF THE EFFECT IN THE TREATMENT OF DIABETIC MACULAR EDEMADiabetic retinopathy (DR) is the leading position among other causes of blindness in the population of economically developed countries, however, the main cause of disability in diabetes is diabetic it may (DM). The effectiveness of laser photocoagulation in the treatment of DM was confirmed during a multicenter randomized study Early Treatment Diabetic Retinopathy Study (ETDRS) and currently, laser photocoagulation is the standard treatment of diabetic macular edema. However, the application of coagulation is associated with postcompletion atrophy membranes of the ocular fundus and a decrease in the sensitivity of the retina. The current standard for treatment of diabetic macular edema is laser photocoagulation in the macula, the effectiveness of which was confirmed during a multicenter study. Sub-threshold (MicroPulse) leads to the appearance of badly visible or invisible burns of the retina and is also proven effective in the treatment of diabetic macular edema if there is no Wii side effects inherent in the ETDRS method (atrophy of the pigmention of the epithelium and choroid, reducing the sensitivity of the retina). The effectiveness of micropathological may be increased when a more dense application of laser applications, however, in the modern literature is devoted to this question a few publications.Key words: diabetic maculopathy, diabetic retinopathy, diabetes of IIštype, microphotocoagulation, subthreshold laser coagulation.
Ioyleva E.E., Krivosheeva M.S. FEATURES OF VISUAL IMPAIRMENT IN FAMILIAL FORMS OF MULTIPLE SCLEROSISIt is known that the risk of developing MS in the immediate family is 10-15štimes higher than in the general population. According to the researchers, when the family form at the onset of the disease is dominated by visual, oculomotor and sensory disorders. With regard to visual impairment in familial forms of MS are no reliable confirmation of concordance. To study visual impairment in familial forms of MS. 2šfamilies in which two relatives diagnosed MS cerebrospinal form. In both cases, the manifesto of multiple sclerosis began with visual impairment. Onset of the disease was accompanied by visual disturbances with a sharp decrease in central vision, and pain. In one family at the sister (43šyears), optic neuritis was observed at the age ofš21, with multiple recurrences at intervals ofš1 to 3šyears. She noted the growth of neurological symptoms, despite treatment. The progressive course of MS led to disability at 6šyears after the onset of the disease. There was a pronounced neurological deficit, reduced visual function in connection with the development of optic nerve atrophy. Brother disease is diagnosed for the first time. Both have the same clinical manifestation in the form of visual impairment prior to the neurological clinic, had the same age range debut. Also confirmed is the same form of the diseaseš— cerebrospinal. In FGBU "Eye Microsurgery Complex" named S.N.šFedorov over the past 5šyears found 2šfamilies with MS, which amounted to 2š% of all patients with visual impairment due to MS. Revealed concordance form of the disease, the age range and the first manifesto in the immediate family. When the family form PC optic neuritis preceded by neurological symptoms.Key words: optic neuritis, visual impairment, multiple sclerosis, familial forms of multiple sclerosis.
Kagan I.I., Kanyukov V.N., Bazhitova E.A. CORRECTION OF PALPEBRAL FISSURE PARAMETERS IN PATIENTS WITH ACQUIRED PATHOLOGY One of actual problems of modern plastic ophthalmosurgery is the correction of the form and parameters of the palpebral fissure. Anatomic facial indicators of a healthy person and, in particular, the geometric dimensions of the palpebral fissure, acquired great importance due to the increasing tendency to change some features of the face. In this work we studied variant anatomy of palpebral fissure in middle age patients with emmetropia, conducted anatomical and variational substantiation of the partial measured canthotomy. The obtained data were treated using the program STATISTICAš10.0. Surgical repair of palpebral fissure was performed according to the method of partial constant measured canthotomy with local plasty (patent №š2003310, V.N.šKanyukov, 1991), which preserved the conjunctiva intact, preventing the formation of rough scarring in the canthus area in the postoperative period. We developed and applied in clinical practice a set of tools for canthotomy (patent №š121153 "A tool for measured canthotomy", V.N.šKanyukov, 20.10.2012; patent №š110267 "Cannula holder for canthoplasty", V.N.šKanyukov, 27.11.2011). The developed surgery technology for increasing the length of palpebral fissure is the best method, in which it is possible to conduct an adequate audit of the surgical field, the necessary individual correction of palpebral fissure parameters for each patient.Key words: canthotomy, palpebral fissure.
ëaiotkina å.V., Chistyakova S.V., ëuvyrkova O.I. THE RESULTS OF COMPLEX TREATMENT OF OCULAR ISCHEMIC SYNDROMEOcular ischemic syndrome is one of the most difficult to treat pathological conditions of the eye with steadily progressive vision loss and a significant decline in the life quality of patients, especially in the elderly, leading to permanent disability. Often the main background of the disease with ocular ischemic syndrome is a chronic cerebrovascular pathology. In recent years there has been growth in ischemic diseases of the eye, which is associated with the spread of atherosclerosis, hypertension, coronary heart disease, diabetes, and cervical osteochondrosis. The article analyzes the results of complex treatment of patients with ocular ischemic syndrome. Among them were patients with open-angle compensated glaucoma, retinal degeneration, subatrophy of the optic nerve, age-related macular degeneration, nonproliferative diabetic retinopathy. Most patients were chronic cerebrovascular, cardiovascular, bronchopulmonary pathology. The control group received the standard neuroprotectors and angioprotectors, antioxidants and trophic preparations. In the main group in addition to standard treatment was prescribed nasal drops Semax 0,1š% (3štimes a day for 20šdays). The duration of treatment was 20šdays. Treatment courses were repeated every 3–6šmonths. Comparative evaluation of treatment efficiency was carried out according to visometry and perimetry. In the intranasal use of drops Semax uncorrected visual acuity increased 1.7štimes (fromš0.18 toš0.32), corrected visual acuity increased 3.1štimes (fromš0.19 toš0.59). Field of vision increased by 10–15 degrees. Almost all patients of the main group (96š%) reported subjective improvement of vision, improving overall health, mood, increase concentration, improve memory, reduce irritability.Key words: ocular ischemic syndrome, complex treatment.
Kanyukov V.N., Saneeva Zh.Kh. CLINICAL APPLICATION OF "ALLOPLANT" FOR REVASCULARIZATION OF CILIARY BODY AT PHTHISIS BULBIThe main factor in the development of phthisis bulbi is a traumatic detachment of ciliary body and disorder of its trophic function, due to mechanical damages of choroid and post-traumatic inflammation in it, as well as paresis and vasodilation of vessels resulting in extravasation and swelling of the surrounding tissues, which leads to the development of hypotension. Phthisis bulbi has typical clinical symptoms: post-traumatic uveitis, hypotension, scarring changes of fibrous eye capsule, deformation and shortening of eyeball sizes, lowering of visual functions up to their complete absence. The main purpose in the treatment of phthisis bulbi is the relief of inflammation and restoration of ciliary body trophism. The analysis of the conducted investigation showed that the clinical effect developed best of all for 6 months indicating the positive impact of "Alloplant" on phthisis bulbi process. We proposed a sparing method of revascularization of ciliary body by "Alloplant" allowing to improve ciliary body trophism, minimize the time of surgical intervention, and reduce trauma and additional scarring of tissues of phthisis bulbi by means of biomaterial rebuilding and the development of newly formed blood vessels in it.Key words: phthisis bulbi, Alloplant, revascularization, eyeball, ciliary body.
Kanyukova Yu.V., Kadnikova O.V. SELECTIVE LASER TRABECULOPLASTY AS A TREATMENT MODE FOR PRIMARY OPEN-ANGLE GLAUCOMA (THE RESULTS OF 6šMONTHS FOLLOW UP)Glaucoma is one of the most common eye diseases, often resulting in low vision, blindness and disability. Among the clinical forms of the disease the primary open angle glaucoma (POAG) accounts for 72š% of all glaucoma cases. According to some researchers, selective laser trabeculoplasty (SLT) is a safe alternative for anti-glaucoma medications in the treatment of POAG. SLT was performed in 90špatients (125šeyes) aged 18što 85šyears (48šmales and 52šfemales). The first stage of glaucoma was registered on 49 eyes (39.2š%), the second stageš— 46šeyes (36.8š%) and the third oneš— 30šeyes (24.0š%). IOP was 20što 35šmmšHg. The patients underwent surgery had the following comorbidities: cataractš— 34šeyes (27.2š%), myopiaš— 35šeyes (28.0š%), hyperopiaš— 23šeyes (18.4š%), pseudophakiaš— 9šeyes (7.2š%), presbyopiaš— 11šeyes (8.8š%), pseudoexfoliation syndromeš— 13šeyes (10.4š%). The laser parameters were adapted for the selective impact on the trabecular pigmented cells, without coagulate damage of structure of trabecular meshwork or non-pigmented cells. All patients were examined at 1šday, 1, 3 and 6šmonths after surgery. SLT is an effective and safe laser surgery in patients with early stage of POAG. Using SLT the target pressure has been achieved in 88š% of cases. IOP compensation was noticed by the end of the first day after surgery and was stable, while maintaining therapeutic regimen or its weakening during follow up period (6šmonths). An important indicator of SLT efficacy is improvement of visual acuity and widening of limits of field of view. Selective laser trabeculoplasty may be inappropriate for patients with previously operated far-advanced glaucoma and on the background of diabetic retinopathy due to the presence of goniosynechia, neovascularization and high proliferative activity. Key words: laser treatment, selective laser trabeculoplasty, primary open-angle glaucoma, intraocular pressure, hypotensive therapy.
Klokova O.A., Sakhnov S.N., Zabolotniy A.G., Klokov A.V. TO THE QUESTION OF PRIORITY OF REFRACTIVE ERRORS EXCIMER LASER CORRECTION IN COMPLEX TREATMENT OF REFRACTIVE AND ANISOMETROPIC AMBLYOPIA IN CHILDREN AND ADOLESCENTSAmblyopia on the background of refractive errors, especially anisometropic, responds poorly to conservative treatment, is often accompanied by severe disorder of binocular functions and is one of the causes of visual disability. The study group included 19špatients (24šeyes) aged fromš9 toš16šyears (mean was 13.8š±š0.85 years) with mixed astigmatism from 4.25 to 6.5šdiopters (mean was 5.13šdioptersš± 0.46šdiopters). During the surgery and in the postoperative period the complications were not observed. As a result of laser correction in patients were achieved following refractive indices: decrease of astigmatism degree by 4.11šDš± 0.41šD (80.1š% of the initial value) and anisometropia degreeš— 4.0šDš± 0.53šD (88.1š% of the initial value). As a result of LASIK and FemtoLASIK the average UCVA of patients was statistically significantly higher than the average BCVA before surgery: 0.56š±š0.15 and 0.44š±š0.13 (Pš<š0.01) respectively. After the laser correction patients underwent laser stimulation and computer treatment courses. In 20.8š% of cases the increase in BCVA by 0.1–0.2 was observed, whereas preoperative conservative treatment was not given any effect. The efficacy and safety of laser correction determines its priority in complex treatment of refractive and anisometropic amblyopia in children and adolescents with mixed astigmatism. Decrease of amblyopia and anisometropia degree by LASIK and FemtoLASIK techniques improves the quality of vision and provides optimum social adaptation of children and adolescents.Key words: anisometropiÁ, amblyopia, mixed astigmatism, laser correction, LASIK, FemtoLASIK.
Kopayev S.Yu., Askerova S.M., Kopayeva V.G., Shafiev A.Ch. COMBINED USAGE OF NEODYMIUM YAG 1.44šΜM AND HELIUM-NEON LASERS IN LACRIMAL APPARATUS SURGERYA novel technique based on simultaneous action of two types of laser radiation conducted with the same optical fiber for surgical treatment of lacrimal apparatus was proposed. The laser endodissector (neodymium YAG 1.44šμm) unblocks lacrimal outflow pathways. Helium-neon laser operates in continuous mode, activates the regeneration process of damaged tissues, has anti-inflammatory (phototherapeutic) effect on the inside of mucosa lining lacrimal apparatus, serves as an optical fiber, besides that, it's a marker for operating in the pulsed mode of colorless, destroying energy of Nd-YAG laser. We operated 60 patients with the diagnosis of obliteration of nasolacrimal canal, dacryocystitis, chronic rhinitis in remission stage. The patency of lacrimal passages was restored. Complications during the surgery and in the postoperative period were not observed. In the long-term period (6–18šmonths) in 53šcases (88š%) lasting positive effect took place. In two cases lacrimation was noticed at forward flexion of head due to atony of the lower eyelid. Relapse of inflammation was observed in 7špatients with both rhinitis and conjunctivitis. The combined application of two types of laser energy of different target impact, performed by one optical fiber for photodisruption (Nd-YAG 1.44šμm) and phototherapeutic effect using low-intensity helium-neon laser can reduce postoperative recovery period due to the leveling of concomitant inflammatory pathology and the activation of regenerative processes.Key words: lacrimal apparatus, Nd-YAG laser 1.44šμm, helium-neon laser.
Korepanov A.V., Demina A.D., Lyalin A.N. THE OPTICAL EFFICIENCY KINESIOTHERAPY AS A METHOD OF PREVENTION OF ACQUIRED MYOPIA IN CHILDRENThe problem of acquired myopia remains relevant today. It is no exaggeration to say that myopia is an epidemic of our time. Despite intensive methods of treatment and prevention of myopia, the number of myopic people is steadily increasing every year, it is especially pronounced among students. It is known that among high school graduates, the incidence of myopia up to 26š%, gymnasiums and lyceumsš— 50š%. Myopia limits the ability of a person in school and choosing profession is one of the most common causes of low vision (35.1–40.3š%) and disability (14.6–44,8š%) impaired. Consequently, there is now a need to develop an effective method of prevention of acquired myopia. In the study, we examined two groups of first graders. In one group the children received two courses of optical kinesiotherapy to study this method as a way of preventing myopia. In both groups by the end of the school year there was a significant increase in inventory relative accommodative. In the group, the course of the last optical kinesiotherapy, there has been a significant significant increase in reserves of adaptation of the visual system, and the results achieved have been preserved and even improved by the end of the school year. In the second group was significantly lower data rates in the course of the school year. Optical kinesiotherapyš— is an effective method of recovery and further improvement of the system of visual perception, creates conditions for increasing the stability of the system of visual perception to visual stress, as well as to the hyperopic defocus. This method of improving the visual system is easy to use, good for personal use and also for mass preventive measures.Key words: emmetropia, myopia, retinal defocus, reserves adaptation of the visual system.
Kuznetsova O.S., Fokin V.P. THE ANALYSIS OF RESULTS OF EKSIMERLAZERNY SURGERY AFTER APPLICATION THE ORTOKERATOLOGICHESKIKH OF CONTACT LENSESAnalysis of results of LASIK patients who applied to the operation orthokeratology lens. The results of LASIK in 50špatients (100šeyes). In the first group there were 20špatients (40šeyes) which are used to LASIK orthokeratology lenses (CPR). Experience carrying 6 months up to 1.5šyears. Patients using hard contact lenses reverse geometry "Emerald" company "Euclid Systems Corporation" (USA) of gas permeable material Opticon A with a range from –1.0 to –5,5šDptr refraction and indicators ophthalmometres from 41.0 to 45.5šdiopters. The second group consisted of 30špatients (60šeyes), which had LASIK surgery was used only spectacle correction (control group). The average thickness of the corneal flap was (118.2š±š4.3)šmm. After 1šweek after LASIK in the first group SE averaged (0.35š±š0.26)šdiopters, 1šmonthš— (0.4š±š0.18)šdiopters, 6šmonthsš— (0.4š±š0.12)šdiopters. After 1šweek of ELS in the second group SE was equal toš— (0.47š±š0.21)šdiopters, 1šmonthš— (0.41š±š0.13)šdiopters, 6šmonthsš— (0.35š±š0.12)šdiopters. BCVA at all follow-up of both study groups wasš1.0. Use of OKL in patients with myopic refraction does not adversely affect the course of LASIK surgery and has no effect on the results of excimer laser surgery.Key words: orthokeratology lenses, night lenses, LASIK, refraction, myopia.
Lyalin A.N., Korepanov A.V., Chernykh N.A., Chermak S.B. RESULTS OF PREVENTION AND TREATMENT OF THE ACQUIRED MYOPIA USING SIMULATORS "ZENICA" AT THE SCHOOLThe onset and progression of school myopia is an acute social problem. Myopia affects about 35š% of the world population, have high myopia observed in 7š%. Causes of myopia in school age are intense visual loads at close range, wide spread of gadgets schoolchildren from 1šclass. According to inspection of schoolchildren 2nd and 3rd classes of a comprehensive school of Izhevsk it was found 29.8š% of those with a myopic refraction. Visual acuity at myopes before treatment wasš0.41 and after treatment had risen toš0.42. Moreover, full recovery of visual acuity to 1.0šmentioned in 6.25š% of cases (3šeyes). In emmetropia at the beginning of observation, visual acuity wasš0.98, and in the endš—š0.96. After the course with TDO "Zenica" noted a significant increase in reserves accommodation 0.6šdiopters. Increase of resistance to defocusing for a distanceš— expansion of a focal zone with the resolution of 40š% in emmetropia –7,0šD and miopyš— 5.75šD. The use of TDO "Zenica" marked improvement of visual acuity in children with myopic refraction. In both groups resistance of visual acuity to defocusing for a distance with negative lenses increased. Therefore, resistance to a gipermetropichesky defocus which accelerates growth of an eyeball increased. Possibility of passive adaptation process refractogenesis exist throughout the "period of risk of formation of myopia". Therefore the courses of trainings directed on preservation of balance of visual loadings we recommend to carry out on a constant basis in an age interval from 6–7 to 18–25 years 2štimes within a year.Key words: school miopiya, TDO "Zenica", optiko-reflex trainings, results of treatment.
Malov V.M., Eroshevskaya E.B., Malov I.V., Gorbunov A.E., Banzykina Y.V. FRAGMENTATION OF THE NUCLEUS OF THE CRYSTALLINE LENS BY PHACOEMULSIFICATION IN PATIENTS WITH PSEUDOEXFOLIATION SYNDROME In patients with pseudoexfoliation syndrome marked difficulty in performing phacoemulsification at the stage of fragmentation of the nucleus, associated with weak Zinovich ligaments, possible subluxation of the lens, the presence of a dense core, rigid narrow pupil. For prevention of possible complications there is a need to develop methods of crushing of the core lens, avoid or reduce the tension and tear Zinovich ligaments and hydrodynamic effects on the capsule of the lens. To that end, phacofragmentation, the use of which reduces strain on ligaments and posterior capsule of the lens; to minimize the influence of ultrasound on the tissues, to reduce the number of intra- and postoperative complications and to improve the quality of surgical treatment in these patients. A comparative analysis of the results of phacoemulsification cataract surgery in 56špatients with pseudoexfoliation syndrome by traditional and proposed technology of crushing of the core lens. During the operation, two patients of the control group was observed prolapse of the vitreous body. Postoperative corneal edema was observed in one patient the primary and in two patients of the control group, ocular hypertensionš— two patients of the main and three in the control group. High functional results of the patients in both groups (pš>š0.05): the maximum correctable visual acuity in the first days after surgery was 0,678š±š0,32; 12šmonthsš— 0,91š±š0,35. The magnitude of the induced postoperative astigmatism at discharge ranged fromš0.75 toš2.0šD, an average of (1.28š±š0.43)šD; 12šmonthsš— (0.45š±š0.42)šD. Visual results of surgery, as well as the magnitude of induced astigmatism did not differ significantly between patients of both groups. The technology of phacofragmentation allows to obtain good results of surgical treatment of patients without the risk of serious complications.Key words: phacoemulsification, pseudoexfoliation syndrome, chopper.
Machekhin V.A. CLINICAL FEATURES OF GLAUCOMA IN HIGH MYOPIAHigh myopia is one of the risk factors for glaucoma development. The difficulties of glaucoma detection in such patients are connected with the fact that high myopia itself may be accompanied by the significant visual acuity reduction especially in normal-tension glaucoma. Straining and thinning of the exterior ocular membrane often leads to the incorrect IOP assessment and severe glaucoma development. The purpose of our work is to detect the main reasons, which lead to the advanced stages of glaucoma in high myopia. There was made a retrospective analysis of the case histories of 97špatients (188šeyes) with high myopia and glaucoma, examined in 2006-2015. Among the primary patients such a combination was detected in 0.8–0.9š%. All examined patients had progressive myopia because detected in the early age and on account of the different individual factors it led to the eyeball growth and ocular refraction increaseš— a condition that may be accompanied by such complications as chorioretinal dystrophy, hemorrhages into the vitreous body, retinal detachment and others.All these besides glaucoma may become the reason for the significant reduction of the corrected visual acuity. Though according to our data such a combination occurred only in 0.9š% of patients with high myopia, it demanded the proper attention to predict the glaucoma blindness. It was noted, that the appearance and manifestation degree of glaucoma process in patients with high myopia was connected neither with the age, nor with the myopia degree and axial length of the eye. The main reason was the false assessment of the true intraocular pressure value. All patients with high myopia should undergo the examination for glaucoma notlater than at the age of 30 using computed perimetry and treatment approach determined not by the standard true IOP limits (up to 21šmmšHg) but by the individual tolerant pressure value.Key words: glaucoma, high myopia, tolerant intraocular pressure.
Milyudin E.S., Nikolaeva G.A., Milyudin A.E. CLINICAL AND MORPHOLOGICAL CHARACTERISTICS RETROKORNEAL MEMBRANESA frequent cause of intra operative complications in repeat Keratoplasty is a need for reconstruction of the anterior chamber and excision retrokorneal fibrous growths. In this connection it is essential determining the type and nature of retrokorneal membranes. The goal of this studyš— to study the morphological structure retrokorneal growths in patients operated again on the pathological changes of the cornea. Observed 30špatients with vascular leukomas 4–5šcategory by classification Filatovš— Bushmich who underwent re-keratoplasty. From remote systems during operation of the corneal disk retrokorneal membrane prepared histological sections that were stained by the method of Van Gieson and examined using a light microscope. In all patients during surgery removed retrokorneal membrane. Fibrotic growths in the anterior chamber or limited imperforate of the pupilš— 4špatients (13š%) or were tougher membranesš— in 26špatients (87š%). As a result of the morphological study excised corneas from membranes retrokorneal we identified three types. The first type retrokorneal membrane was represented as exfoliated Descemet's membrane, with a small number of endothelial cells. The second type retrokorneal membranes, characterized by a corneal epithelial ingrowth of scar or proliferation of endothelial. For the third type retrokorneal membrane characterized by loose connective tissue fibers, welded either iris or cornea, excessive growth of newly formed blood vessels, lymphocytic infiltration. Traumatic and long-existing inflammatory processes are the main causes of retrokorneal fibrin formations. The degree of severity and duration of inflammation are the determining factors for the development of one of three types retrokorneal membran.Key words: re-keratoplasty, retrokorneal membrane morphological study.
Musina L.A., Nuraeva A.B. BURN WOUND HEALING WHEN USING ALLOGENIC BIOMATERIALS (EXPERIMENTAL STUDY)Prevention of eyelid cicatricial deformity secondary to trauma or burn is the unmet need in ophthalmosurgery. In order to understand the mechanisms of tissue regeneration after eyelid surgical repair using allogenic biomaterials it is interesting to compare burn wound healing process without treatment, using conventional medications (Actovegin) and with the use of allogenic biomaterials in experiment. In the experiment was conducted on 84šwhite Wistar male-rats. Heat injury was modeled. In control group without treatment the healing process was accompanied by prolonged eschar presence, late epithelisation and slowdown of newly formed connective tissue maturation due to marked inflammation process. Reparation was incomplete and accompanied by coarse scarring. In the second control group treated with Actovegin the epithelisation was faster, nevertheless slowdown of reparation process in dermal layer was noticed. Inflammatory processes prevailed over reparative ones, granulation tissue stayed immature for a long time and eventually underwent scarring. In treatment group where animals underwent subcutaneous injection of disperse biomaterials (made from derma and tendon) rapid proliferation of epithelium was noted as long as necrotic mass demarcation and fast eschar desquamation. As granulation tissue matured it formed proper connective tissue plate of skin. It was found that the use of allogenic biomaterials in skin burns accelerated epithelisation and leaded to complete defect closure. Biomaterials inhibit coarse scarring during healing process. Key words: thermal injury of the skin modeling, allogenic biomaterials, regeneration, scar inhibitor.
Mukhamadeev R.A. RETINAL THICKNESS IN THE MACULAR REGION IN NORM AT A YOUNG AGEThe purpose of the study was to obtain normative parameters retinal thickness in the macular region. The thickness of the retina was measured at 76šophthalmological healthy volunteers using an optical coherence tomograph Cirrus HD-OCT 5000. Used a standard protocol Macula Cube 512šÈš128. For the center of the macula (within 1šmm) average thickness of the retina was 249.41šμmš± 15.50šμm (220–284šμm). Macula (within 1što 3šmm): upperš— 324.16šμmš± 11.72šμm (296–347šμμm), nasalš— 323.03šμmš± 11.90šμm (296–348šμm), lowerš— 320.31šμmš± 10.78šμm (293–339šμm), temporalš— 310.41šμ mš± 13.57šμm (265–344šμ m). For a perimacular region (within 3–6šmm): upper — 279.79šμmš± 10.97šμm (250–305šμm), nasalš— 295.49šμmš± 10.97šμm (273–319šμm), lower — 269.20šμmš± 9.86šμm (248–295šμm), temporalš— 263.99šμmš± 10.24šμm (242–287šμm). The average thickness of the retina was 281.66šμmš± 9.34šμm (259–298šμm), the average volume of the retina within the investigated regionš— 10.14šmm3š± 0.34šmm3 (9.3–10.7šmm3). There were significant differences between the thickness of the retina in the central sectors and in nasal and temporal sectorsperimacular region between men and women: women have lower value. These indicators can be used as reference values to assess the reduction in the thickness of the retina as a result of various degenerative processes, or to determine the degree of increase in retinal thickness at its swelling.Key words: optical coherence tomography, norm, retinal thickness, macula.
Mushkova I.A., Borsenok S.A., Karimova A.N., Shkandina Y.V. HISTOMORPHOLOGICAL CHANGES IN THE RABBIT CORNEA AFTER IMPLANTATION INTRACORNEAL LENSES AND ELECTRON MICROSCOPIC JUSTIFICATION OF THE RESULTSToday on the international market is approved and available for clinical use different models of intracorneal lenses for surgical correction of presbyopia. Using the technical capabilities and production capacity of domestic manufacturers were modeled and manufactured lenses with geometric parameters, calculated using mathematical modeling taking into account characteristics of the cornea, made of modern polymeric materials. To study the biocompatibility of intracorneal lenses it is necessary to conduct preclinical studies of reactivity of cornea in response to the implantation of the developed products hydroxyethylmethacrylate (HEMA) and olygourethanmethacrylate (OUMA) in an experimental study in vivo and conduction electron-microscopic examination of intact "inlays". When carrying out scanning electron microscopy the surface and edges of intact lenses is rendered smooth surface with no visible chipping. In the study of the shape of the edge surface of intracorneal lenses from HEMA visualized jagged, irregular edge, and lenses from OUMAš— smooth, with no visible chipping. When conducting in vivo confocal microscopy in the experimental groups was visualized single collagen fibers, activation of keratocytes, was determined hyperreflexivity and hypocellularity in the area of the lens, pseudokeratinization of the surface epithelium. In the group with the use of GEMA's lenses noted decrease of transparency of the extracellular matrix around the implant. During the light microscope in the experimental groups was visualized bed of inlay. Around bed in both groups was detected activation of cells, presumably native keratocytes. The epithelium and endotheliumš— no visible changes in the area of inlay and outside this zone. In the control groupš— no significant changes in all layers of the cornea. Thus, in the course of the study it was found that the developed products do not cause pronounced cellular and tissue response of the cornea of the rabbit, the rendered methods of in vivo confocal microscopy and the light microscopy. However, jagged, irregular shape of the edge surface of GEMA's lenses caused, apparently, more technically complicated manufacturing technology ("turning") can cause greater activation of cells around the bed of the cornea and a moderate seal of stroma around the lens, in comparison with OUMA's lenses.Key words: inlay, light microscopy, in vivo confocal microscopy, electron scanning microscopy, presbyopia.
Naumenko V.V., Balashevich L.I., Kladko M.A., Pravosudova M.M. SURGICAL TREATMENT OF PATIENTS WITH REFRACTORY FORMS OF OPEN-ANGLE GLAUCOMA WITH ONE COMPONENT DRAINAGE DEVICESToday the problem of surgical treatment of refractory forms of open-angle glaucoma remains unresolved. A distinctive feature of these forms of glaucoma is fast scarring produced during traditional surgery ways outflow of fluid, that leads to recurrence of elevated intraocular pressure. The most perspective direction in this problem is using in glaucoma surgery various drainage devices. There are suggested a great number of implants and drainage devices of different designs and materials used in their manufacture. The aim of the present review article is to analyze the data of foreign and national literature on the results of refractory forms of open-angle glaucoma treatment with one component drainage devices: Ex-PRESS shunt, Gold micro-shunt, IStent, acrylic shunt, leucosapphire explantodgainage. The search and improvement of the optimal one-component drainage device, provided the safe and effective treatment of patients with refractory open-angle glaucoma, remain still actually.Key words: refractory open-angle glaucoma, glaucoma drainage devices.
Nikiforova E.B. THE CLINICAL EPIDEMIOLOGICAL ANALYSIS OF DYNAMICS OF EYE INCIDENCE, DISABILITY AND THE STATIONARY OPHTHALMOLOGICAL HELP TO THE POPULATION OF THE SAMARA REGION DURING 2010–2014 YEARSStatistical information of ocular morbidity, disability and prevalence determines the needs of the population in the eye care, which in turn is the basis of a network of ophthalmic offices, divisions, centers. The efficiency of use of hospital beds, the analysis of the organization of eye care in the outpatient level, the research of state of ophthalmologists allow you to adjust and optimize the organization of ophthalmic services in order to increase the availability of and satisfaction with public provision of eye care. There is the growth of ocular morbidity annually In the Samara region on during the reporting period, the growth was 9.8š%. The main role in this process was played by diseases such as cataract, glaucoma, retinal disease, disorders of refraction. In accordance with national trends in the structure of eye disability leading positions belong to glaucoma, degenerative myopia and diseases of the retina. At the same time the number of ophthalmologists of polyclinic decreased, accordingly the number of visits of ophthalmologist decreased also. Such discrepancy between the needs of the population in ophthalmological help and the actual delivery may cause a decrease the availability of ophthalmological help and, therefore, the growth of social tension in society. The clinical epidemiological analysis of dynamics of eye incidence during 2010-2014 years allowed to identify growth ophthalmological pathology of the population of the Samara region, primarily due to cataract, glaucoma, retinal diseases. The statistical indicators of stationary ophthalmological help in the Samara region improve annually. From year to year the number of patients treated in specialized ophthalmologic hospitals, in 5šyears the number has increased by 32.5š%. The number of eye operations increased of 44.6š% at the same time. Modern technologies of surgical treatment of ophthalmological patients allow most of these patients to treat of hospital-replacement technology, which leads to significant reduction in bed-days and turnover of ophthalmological beds. Clinical and epidemiological analysis helped to develop a regional target program on improvement of ophthalmologic aid to the population of the Samara region and to identify the main activities to optimize the organization of the ophthalmological help to the population of the Samara region in order to improve its accessibility and quality.Key words: ophthalmological incidence, eye disablement, stationary ophthalmological help, cataract surgery rate, cataract, glaucoma, eye operation, middle duration of treatment, middle bed occupancy, middle bed turnover.
Nuraeva A.B. SURGICAL REPAIR OF EYELID CICATRICAL ENTROPION AND TRICHIASISIn this study the results of surgical treatment of eyelid cicatrical entropion and trichiasis with Alloplant biomaterial for eyelid plasty as an adjuct to autological transplantation of labial mucous membrane. Cicatricial entropion could be secondary to chemical burn or trauma, as long as chronical allergic or infectious process in conjunctiva, Stivens-Johnes disease, Layell syndrome and Sjogren's syndrome. Scarring process starting from conjunctiva involves tarsus and changes eyelid position into entropion. This is usually accompanied by trichiasis which promotes chronical inflammation of conjunctiva and may lead to secondary keratitis, corneal ulcer and corneal opacification. Patients usually experience discomfort from eyeball rubbing by eyelashes, excessive tearing and photophobia due to corneal syndrome. 32 patients with cicatricial entropion of upper eyelid and 29špatients with cicatricial entropion of lower eyelid were followed up in reconstructive and plastic surgery department of our clinic. Eyelid deformities were caused by burn, trauma, Layell syndrome and Stivens-Johnes disease. All patients underwent eyelid entropion surgical repair using know-how surgical technique with the use of Alloplant biomaterial for eyelid plasty and autological labial mucous membrane. During follow up of three years complete entropion and trichiasis repair was observed in all patients. All patients experienced symptoms improvement marked as relief in corneal irritation symptoms, excessive tearing and photophobia disappearance. Special regenerative properties of Alloplant for eyelid plasty provided good transplant survival. Newly formed adequate eyelid frame with anatomically correct position of eyelashes prevented from entropion and trichiasis recurrence.Key words: eyelid cicatrical entropion, trichiasis, eyelid plasty, labial mucous membrane.
Panova I.E., Zhiliaeva ï.V., Shaimov T.B., Abdulaeva E.A. COURSE OF CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH NEOVASCULAR STAGE AGE-MACULAR DEGENERATION AND AXIAL MYOPIA ON THE BACKGROUND OF ANTI-VEGF THERAPYThe current age-related macular degeneration (AMD) and axial myopia (OM) may be accompanied by development of choroidal neovascularization (CNV), which leads to in permanent decrease of visual functions in patients. The combination of AMD and OM in clinical practice not uncommon which complicates the disease. Anti-VEGF therapy is a drug therapy CNV resolution in the Russian Federation. Comparative analysis of the parameters of optical coherence tomography (OCT) and data visometry in 37špatients (40šeyes) with neovascular stage age-related macular degeneration (AMD), and 23špatients (26šeyes) with AMD, occurring against the backdrop of axial myopia who received treatment intravitreal injections ranibizumab to clinical stabilization process in the study conducted. Mostly occult choroidal neovascularization occurred in both treatment groups. Positive results were obtained in both groups: the maximum increase in visual acuity occurred after the fourth injection, improvements in OCTš— after the first injection. The best therapeutic response in a fit of the retinal pigment epithelium detachment in patients diagnosed with AMD, while the best performance in the treatment of comorbidity achieved a reduction of neuroepithelial detachment and cystoid changes of retinal.Key words: age-related macular degeneration, myopia, ranibizumab, choroidal neovascularization.
Unishkova L.I., Pashtaev N.P., Pozdeeva N.A. ANALYSIS OF CHANGES IN THE ABERRATIONS OF THE OPTICAL SYSTEM OF THE EYE AFTER FEMTOSECOND INTRASTROMAL RING IMPLANTATION OF THE MYORING IN PATIENTS WITH HIGH MYOPIA IN COMBINATION WITH A THIN THICKNESS OF THE CORNEAAnalysis of changes in the aberrations of the optical system of the eye after femtosecond intrastromal Myoring implantation in patients with high myopia in combination with a thin thickness of the cornea. Femtosecond intrastromal Myoring implantation was performed in 43šeyes (of 24špatients) with an age fromš24 to 45šyears (mean of 34.5š±š3šyears) with high myopia in combination with a thin cornea thickness. Corneal aberrometry was studied on aberrometer (Visionix L80 WAVE+, Israel) before and 3šmonths after femtosecond intrastromal Myoring implantation. The value of the spherical component of the refraction was fromš–9.25 toš–17.5šdiopters (average 13.4š±š1.4šdiopters), cylindrical fromš–1.0 toš–4.0šdiopters (average 2.5š±š1.2šd). The minimum value of pachymetry in the centre ranged fromš430 to 498šμm (average of 464šμmš± 20šμm). The average keratometry valueš— 44.50šdiopters. The level of higher-order and lower-order aberrations were evaluated. Spherical aberration and Coma aberrations have analyzed from higher-order aberrations. There is analysis of changes in the aberrations of the optical system of the eye after femtosecond intrastromal ring implantation of the MyoRing in patients with high myopia in combination with a thin thickness of the cornea. Uncorrected distance visual acuity (UDVA) has increased in 8štimes after MyoRing implantation, corrected distance visual acuity (CDVA) — in 1.5štimes, spherical component decreased in 8.5štimes, cylindrical — in 2štimes immediately after surgery. UDVA improved from 0.13š±š0.01 3šmonths after surgery, CDVA has not changed. Analysis of the results indicates a high refractive efficiency of this method, the reduction of lower-order aberrations and increasing higher-order aberrations. So, analysis of changes in the aberrations of the optical system of the eye after femtosecond intrastromal Myoring implantation in patients with thin cornea during 3šmonths observation showed a reduction of lower-order aberrations and an increase in higher-order aberrations.Key words: myopia, corneal intrastromal Myoring implant, femtosecond laser,aberrations higher and lower-order.
Perevozchikov P.A., Vasilyev Yu.G., Karban O.V. REACTION OF MESODERMAL TISSUE OF EYEBALL AT IMPLANTATION OF THE MECHANOACTIVATED BIOLOGICAL MATERIALDespite of state-of-the-art-technology, the mechanisms of reparative regeneration of connective tissue, in particular, of an eyeball are still not studied well. Understanding of such mechanisms is important due to wide-spread use of implantation of various bio-materials. The main reaction in recipient's tissue to the bio-material injection is the reaction of mesodermal tissue cells which must be evaluated when studying the process of reparative regeneration, including application of the specific markers. Authors researched experimentally the reaction of the cells of mesenchymal origin of a rabbit eyeball connective tissue in response to implantation of biomaterial of various size, using the specific marker of vimentin. It was shown that during implantation of bio-container with mechanically activated biomaterial of human placenta, at the implantation zone there was observed mesenchymal cell reaction, more intense in comparison with coarse-ground analogue and macroscopic implant. However, it was noticed the activation of elements of fibroplastic and endothelial cell, that means significant bio-response of recipient's mesenchymal tissue. Application of specific marker of vimentin reveals the reaction of the connective tissue cells of mesenchymal origin. This is important for understanding the process of reparative regeneration of recipient's tissue in response to implantation, also when using mechanically activated implants not studied before.Key words: vimentin, cells of a mesenchymal origin, biological material, human placenta, a reparative regeneration.
Pilyagina A.A. THE OPPORTUNITIES OF THE DIFFERENT BIOMETRY METHODS IN OCULAR AXIAL LENGTH ASSESSMENTThe question about intraocular correction improvement remains open. The latest diagnostic techniques introduction of measuring biometric eye parameters aims at improving the calculation accuracy of the intraocular lens optical power and at refractive error reduction in postoperative period.The accuracy of the intraocular lens power calculation suffers because the accurate biometry methods are not widely used and are not applied in the absolute majority of patients. Errors when measuring the anterior posterioreyeball axis (APA) determine fromš40 to 54š% of mistakes in the postoperative refractive result. The aforesaidtestifies to the urgency of the chosen topic, and identifies the aim of our work: the comparative investigation of the opportunities of different biometry methods in ocular axial length assessment. There were analyzed the results of the anterior posterior ocular axis measurements in 27špatients (46šeyes) using the ultrasound applanation and immersion biometry and optical biometry. The results of our investigation showed that the difference in APA measurements using these methods of biometry is minimum and statistically insignificant.However, when comparing the measurements obtained by optical and applanation ultrasonic biometry, there has been a trend towards reduction of APA indices, because of the possible corneal compression in applanation of the ultrasonic sensor. The results of APA indices, measured by the immersion and optical biometry, are comparable with each other. Thus, immersion method of the ultrasound biometry lacks forapplanationmethod disadvantages, namely corneal compression, is usedin any degree of mature cataract and corneal opacification, according to the biometric measurements accuracy it is not inferior to the optical method and can be an alternative to optical biometry.Key words: ultrasound immersion biometry, ultrasound applanation biometry, optical biometry, anterior posterior ocular axis.
Podoprigora R.N. POSTGRADUATE EDUCATION IN OPHTHALMOLOGYOrenburg branch employees perform postgraduate education of ophthalmologistsš— general improvement (certification cycleš— 144šh., thematic improvementš— 72šh. and improvement in the workplace) according to the license for educational activity (№š0752, Juneš04, 2013.). According to the existing requirements each specialist should undergo improvement 1 time every 5 years. Ophthalmologists from Orenburg region, Kazakhstan, Chelyabinsk, Chechen Republic, Kaliningrad underwent improvement on the base of the Orenburg region. Among our teachers are 6šprofessors, honored scientists, doctors and candidates of medical sciences, high level certificate physicians. Lectures and seminars are held in the conference hall with modern projection equipment, the original form of lectures with synchronous graphic illustration and demonstration of advanced technologies operations are introduced in the process. We pay great attention to the practical part of education: an examination of patients, an analysis of non-standard cases, a visit to the operating room, work out in the training room, where there is a microscope and a set of ophthalmic surgical microinstruments. For the control of students' knowledge computer tests are developed in the research and education center to estimate the initial and the final level of knowledge before the exam. Postgraduate training of nurses is held in cooperation with the Orenburg Regional Medical College, including the use of telecommunication technologies. It is possible to ensure a continuous process of training of specialists in ophthalmology due to the improvement of information technology in the modern system of postgraduate education.Key words: ophthalmology, education, thematic advanced training.
Podtynnykh E.V., Basinskaya L.A., Komarovskikh E.N. MODERN IDEALS ABOUT ETIOPATHOGENESIS AND METHODS OF DIAGNOSIS OF KERATOCONUS (REVIEW)The article presents modern views on etiology and pathogenesis of keratoconus, reflecting the major theories explaining its origins and factors contributing to its emergence. As a chronic, often a hereditary condition typically affects both eyes patients keratoconus had acquired particular relevance during the last few decades. Corneal dystrophy problem causing its thinning and deformation, type of cone exaggeration and dimness in the optical area, is of great social significance in southern Russia because of disability able-bodied young people. The article provides information on contemporary methods of diagnosis of keratoconus, allowing todiagnose the disease at an early stage and early initiation of treatment and rehabilitation of patients. Are the basic theory of the evolution of keratoconus: genetic, endocrine, exchange (due to a change in the exchange of enzymes in the cornea), immunologic, allergic and some others, which confirms the many reasons of this disease. The article mentions this risk factor of keratoconus, how race and ethnicity of the patients. Reliably more often keratoconus evolves among residents of southern and mountainous regions, representatives of the Asian race, Muslims as well as such ancient nationalities, Armenians and Jews. This is due to the long isolated living ethnic groups, and, as a consequence, a high level of closely related links. Early diagnosis of keratoconus is of great value for the timely appointment and stabilizing treatment of keratoconus in preclinical or early stage of the disease. Detection of keratoconus in the preclinical stage determines the safety of surgery for cornea, which has been actively developing in our country.Key words: keratoconus, etiology, pathogenesis, diagnostic methods.
Pozdeeva O.G., Dulyba O.R. SCREENING STUDY OF PERIPHERAL RETINAL DEGENERATIONS AMONG STUDENTS OF HIGHER EDUCATIONAL INSTITUTIONS OF CHELYABINSKPeripheral retinal degenerations (PRD) are a major cause of rhegmatogenous retinal detachment in young, working persons, both in our country and abroad. The need for preventive measures to prevent complications is dictated by the severity of the disease and the difficulty of its diagnosis and treatment, which underlines the relevance of the study. It was conducted screening eye examination of 23š162šuniversity students in Chelyabinsk. The average age was 21šyears old. In 1š992špeople (3š012šeyes) were revealed different clinical forms PRD. The most frequently encountered white frost degeneration, cystoid, lattice and "snail track". Less detected white without depressions and "cobblestones". Lattice degeneration and "snail track" almost equally often met all kinds of clinical refraction of the eye, including emmetropia. There was both unilateral and bilateral retinal damage. In patients with "cobblestones", white with no depressions, cystoid and white frost degenerations in 60–70š% of cases the disease occurred on the background of myopia of high to medium, and often pathological process was bilateral. Thus, by screening younger patients aged 16–25šyears, the risk-shaped peripheral retinal degenerations occurred in 3.2š% of cases in all students and 36.5š% of students with PRD, including lattice degeneration 2.4 and 27.5š% and the "snail track" of 0.8šand 9.0š% respectively. The results determine the high importance of preventive medical examinations with obligatory study of the periphery of the fundus of the eye, regardless of the type of refractive error.Key words: peripheral retinal degeneration, lattice degeneration, "snail track", white frost degeneration, cystoid degeneration, degeneration of the type "cobblestones", white with no depressions.
Poylova å.S., Malafeev á.V., Stoyanov Y.N. EXPERIENCE OF SURGICAL TREATMENT OF LARGE AGE-RELATED MACULAR HOLES WITH DIAMETERS GREATER THAN 1000 MICRONSPurposeš— to analyze the efficiency of surgical treatment of large idiopathic macular holes using short-term tamponade with perfluordecalin (PFOC) and its subsequent removal. Materials and methods. Analyzed the results of 30špatients (30šeyes) treatment operated for this disease in 2013–2014. Average corrected visual acuity before surgery wasš0.1. All patients underwent vitrectomy micro-invasive technology 25–27šG to remove the back hyaloid membrane, membranorexis internal limiting membrane, short-term tamponade and vitreous cavity PFOC followed by comparing the edges of the hole. Results of surgical treatment were estimated using spectral optical coherence tomography on the 5thšday, 1.5šmonths, 6šmonths and 1šyear. The results and discussion. Full closure of the holes was observed in 26šeyes (87š%). During the two-year follow-up period of relapse was noted. In all cases for imaging results observed profile of the fovea was formed, the layers of the retina compared anatomically, the photoreceptor layer was rarefied. The increase in visual acuity after treatment, though statistically significant, is not always consistent with the expected results on the part of the patient. The proposed method of surgical treatment of macular holes with diameters greater than 1š000šmicrons is effective. The technique allows to eliminate subjective discomfort that occurs when tamponade with silicone oil or gas-air mixture. However, after the closing of the hole it is not always functional recovery, as reparative processes, probably, safety outer limiting membrane plays a role.Key words: large idiopathic macular hole with diameters greater than 1š000šmicrons, vitrectomy 25–27šG, PFOC tamponade.
Skoybedo I.E., Efimov S.G., Bolotnikov V.N., Korolikhin F.S., Dokashenko D.A. ANESTHESIA METHODS AT INTUBATION OF NASOLACRIMAL DUCT IN CHILDREN Inflammation of the lacrimal sac and nasolacrimal duct (dacryocystitis) is the cause of lacrimal passages disfunction. Constant lacrimation, mucopurulent discharge increase the risk of purulent-septic and inflammatory diseases of the eye and organs surrounding the eye thence intubation of nasolacrimal duct in children with neonatal dacryocystitis should be carried out in the early stages (up to 6 months) and under general inhalation anesthesia. General anesthesia allows avoiding stress reactions in children, eliminates restlessness, avoids trauma and neurological complications of nasolacrimal duct intubation. Ensuring a high level of comfort to the surgeon allows recanalize nasolacrimal duct in complicated and neglected cases without too much emotional stress. High level of general anesthesia security is provided by experience and staff training, the availability of comprehensive monitoring and correct its use, allowing you to carry out the procedure on an outpatient basis with minimal risk of complications.Key words: neonatal dacryocystitis, general inhalation anesthesia in children, laryngeal mask airway.
Soljannikova O.V., Berdnikova E.V., Jekgardt V.F., Tur E.V. FORECASTING OF DYNAMICS OF VISUAL FUNCTIONS IN PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA DEPENDING ON THE STAGE OF THE DISEASEPrimary open-angle glaucoma (POAG) is the most common eye disease with a progressive course even when the intraocular pressure, the main factor of progression of this disease, is compensated a large percentage of patients with glaucoma have deterioration in visual function. Forecast of changing of visual functions in POAG that are the most important component of patient's quality of life is a critical task. Method for the prediction of visual functions changes depending on the stage of the disease in patients with POAG who achieved "target" intraocular pressure was developed on the basis of the dynamic observation for one year 150špatients with POAG using discriminant analysis. Observation included a comprehensive assessment of central and peripheral vision, eye and orbital hemodynamics, parameters of general hemodynamic, state of the system "lipid peroxidationš— antioxidant protection", lipid profile and the affective-cognitive status of patient. The method presented in the article allows predicting a deterioration or stable state of the eye functions in POAG-patients with high (over 90š%) specificity.Key words: primary open-angle glaucoma, forecast, visual functions, follow-up.
Sorokin E.L., Tatanova O.Iu. ASCERTAIN OF PRESENCE OF POTENTIAL RISK OF THE ACUTE SPASM OF PRIMARY CLOSED ANGLE GLAUCOMA IN EYES WITH THE SHORT AXIAL LENGTH A YEAR LATER AFTER LASIKIn recent years more and more people seek to get rid of anomalies of refraction. At performing LASIK in hypermetropic eyes excimer laser influence is carried out on peripheral cornea. It is necessary to investigate, whether this impact on angle of forward chamber (AFC), due to changes of morphological properties of collagen fibers of peripheral cornea can affect. In-depth study of extent of opening of the AFC and risk of development of primary closed angle glaucoma (PCAG) in 24šeyes a one year after LASIK by reason of a hypermetropia of average and high degrees is conducted. All operations was planned, without complications. In all eyes the planned eye refraction was reached. Research was conducted by means of gonioscopy, the projective-scan keratotopography; an ultrasound biomicroscopy of structures of the AFCš— to find out versions of the anatomical provision of ciliary body (CB) regarding scleral spur became clear: forward, average, back. The high risk of PCAG was educed in 4šeyes (clinically significant narrow AFC), in 10šeyesš— increased risk (forward condition CB)š— only 58.3š% of the studied materials. In 2šeyes the flat iris syndrome took place. At selection of patients with hypermetropia of average and high degrees for refractive surgery it is necessary to remember that these eyes are subject to risk of formation of PCAG. At presence of risk factors the phacoemulsification can become good alternative, not only eliminating risk of formation of acute spasm of PCAG, but also acting as a method of correction of hypermetropic refraction. At planning LASIK for patients with short axial length of the eye concerning hypermetropia of average and high degrees need to define extent of opening of the AFC and version of the provision of CB (with use of ultrasound biomicroscopy and keratotopography).Key words: short axial length of the eye, acute spasm of glaucoma, angle of forward chamber, refractive surgery.
Sorokoletov G.V., Zuev V.K., Tumanjan J.R., Veshhikova V.N., Frankovska-Gerlyak M.Z. THE RESULTS OF CORRECTION OF HIGH MYOPIA DOMESTIC PHAKIC INTRAOCULAR LENS Currently it is widely used correction of high myopia (MIF) negative posterior chamber phakic lenses, but the question remains of conformity of the linear size of the PIOL to the diameter of the ciliary sulcus. High myopia correction by posterior chamber IOL implantation is very popular today but disproportion between the PIOL size and the ciliary sulcus diameter could be a reason for some complication at long-term follow-up. Therefore a new model of PIOL with adaptation ability to individual ciliary sulcus diameter was propounded. The PIOL is manufactured from hydrophilic acrylic (Contamac CI26) with water contains 26š% and refractive indexš1.46. In result the new PIOL shows efficacy, safety and high adaptation ability. Key words: high myopia, phakic IOL, ciliary sulcus.
Stanishevskaya O.M., Tonkopii V.O. THE USE OF SUBTHRESHOLD MICROPULSE LASER EXPOSURE USING YELLOW 577îí DIODE LASER ("QUANTEL MEDICAL") IN THE TREATMENT OF POST-THROMBOTIC EDEMA MACULOPATHYEvaluating the effectiveness of subthreshold laser effects using the yellow diode laser 577šnm ("Quantel medical") in the treatment of edema maculopathy in the post-thrombotic retinopathy.It were examined 14šeyes of 13špatients. The exposure radiation and its duty cycle (duty factor) were chosen individually for each patient depending on the height and the degree of swelling of the fundus pigmentation. The findings were evaluated before and after the laser intervention in 1.5šmonths after treatment. Visual acuity before treatment averagedš0.37 with correction, after treatment with an average ofš0.46 with correction, the height of macular edema treatment amounted to an average of 431šnm, after treatment with an average of 310šnm. All patients in the group noted subjective improvement in visual function. The findings suggest that the subthreshold laser effects Micropulse using the yellow diode laser 577šnm ("Quantel medical") a single application is effective and safe procedure in the treatment of cystic non-tractional macular edema at post-thrombotic retinopathy.Key words: sub-threshold microimpulse laser effects, post-thrombotic retinopathy, macular edema in the post-thrombotic maculopathy, micropulses.
Stebnev V.S., Stebnev S.D., Malov V.M. SYMPTOMATIC VITREO-MACULAR ADHESIONCOMPLICATED BY TRACTIONALMACULOPATYVitreomacular adhesion (VMA) may be asymptomatic not causing patients or decrease in visual acuity, nor any complaints. With the development of symptomatic VMA (sVMA) increasing traction from the vitreous leads to anatomical vitreomacular interface disorders. Depending on the length and severity of sVMA, from the direction and power of the vector forces vitreomacular traction, sVMA can lead to the development of different clinical forms of lesions of the macular area, including the traction maculopathy. The role of symptomatic vitreo-macular adhesion in the formation of the traction maculopathy studied. Using optical coherence tomography, the peculiarities of fixation and extent symptomatic of vitreo-macular adhesion, especially changes in the external and internal layers of the retina. In the study of 185špatients with sVMA complicated by traction maculopathy, we studied the nature of fixation and linear extent of adhesion of the vitreous body. In 137špatients (74š%) revealed the length of sVMA less than 500 microns. The linear length of sVMA from 500 to 1500šmicrons was observed in 18špatients. The length of sVMA more than 1š500šmicrons was diagnosed in 30 patients. The analysis of the nature of intraretinal changes in the combination of symptomatic of vitreo-macular adhesion and vitreo-papillary adhesion. Thus, our studies allowed us to identify three groups of vitreo-macular adhesion of different morphological configurations and linear length. The features determined the character of changes in the macular profile, characteristics and timing of the development of changes in the retinal macular area.Key words: vitreo-macular adhesion, symptomatic vitreo-macular adhesion, traction maculopaty, vitreo-papillary adhesion, optical coherence tomography.
Stebnev S.D., Stebnev V.S., Malov V.M. CHROMOVITRECTOMY OF SYMPTOMATIC VITREO-MACULAR ADHESIONCOMPLICATED BY EARLY STAGES OF PRIMARY FULL-THICKNESS MACULAR HOLESChromovitrectomyš— modern section of vitreoretinal surgery involving the use during surgery endovitreal dyes for better visualization of the vitreous, preretinal and retinal structures. This technology involves the selective recruitment endovitreal dyes for staining structures of the posterior segment of the eye, which creates a useful contrast edges of the removed structures, extends the identification of the true boundaries of the pathological membranes, improves the visualization of the underlying internal limiting membrane, allows you to operate on patients at earlier stages of the disease, and with less injuries. Central pathogenetic role in the development of primary full-thickness macular hole is traction symptomatic effects of vitreo-macular adhesion (sVMA) on foveolar region. Studied the clinical efficacy of chromovitrectomy in the surgery of symptomatic vitreo-macular adhesion, complicated by primary full-thickness macular hole in the early stages of its formation in 42špatients. The patients age from 46što 72šyears (average of 64.5šm± 3.2šm). Womenš— 31š(74š%), menš— 11š(26š%). In 23špatients primary full-thickness macular hole was classified as stagešI, 19š— IIšstage. Using technology chromovitrectomy may guaranteed eliminate symptomatic of vitreo-macular adhesion. All 42špatients with this disease who were under surveillance, was able to eliminate symptomatic of vitreo-macular adhesion and to achieve primary closure of full thickness macular holes. The use of technology chromovitrectomy symptomatic of vitreo-macular adhesion, complicated by primary full-thickness macular hole, allows to obtain a high anatomical and functional results that provides a basis to apply active surgical tactics in the early stages of primary full-thickness macular hole.Key words: chromovitrectomy, symptomatic vitreo-macular adhesion, primary full-thickness macular hole.
Stepanov V.K., Marieva I.V., Isaeva O.V. THERAPEUTIC CORNEAL TRANSPLANTATION IN DESTRUCTIVE KERATOPATHY IN PATIENTS WITH RHEUMATOID ARTHRITISAuthors produced results of therapeutic corneal grafting on patients with destructive corneal pathology, which was associated with rheumatoid polyarthritis. There were 27špatients (18šwomen, 9šmen) aged fromš52 toš82. Destructive processes looked like deep clean corneal ulcers. There were 14špatients with uncovered descemet's membrane, 7špatients had perforation of the cornea, 8špatients had destructive corneal processes through 2–3šmonths after cataract extraction with IOL implantation. We have made therapeutic lamellar keratoplasty by own technology in all of cases, because conservative treatment was ineffective. In 15špatients we added to keratoplasty amniotic membrane covering and blepharorrhaphy, it allowed us check out these patients from the hospital on next day. In 23špatients recovery happened after first surgery, in 4špatients we have seen relapse disease in long-term period through 1–2šmonths. In 2špatients recovery happened after repeated surgery and in 1špatient after third surgery. Corneal transplant has regenerated transparent in 12špatients, half-transparent in 11špatients and opacity cornea in 4špatients. All patient's eyes were saved with vision function toš0.1. In this way, the lamellar keratoplasty gave effective result with saving of eyes in all patients with hard destruction of the cornea, which was associated with rheumatoid polyarthritis. Amniotic membrane covering of corneal transplant and blepharorrhaphy allowed to use postoperative treatment outpatient with observing in the Eye hospital, it was comfortable for patients and was cost effective for hospital.Key words: corneal grafting, corneal pathology, rheumatoid polyarthritis.
Surkova V.K., Oganisian K.Kh. EPIDEMIOLOGY OF CORNEAL ECTASIAS. LITERATURE REVIEWData on frequency of corneal ectasias varies significantly. The first epidemiological studies were conducted in 1959 by Hofstetter et al. in the US where the frequency of corneal ectasias was 0.6š%. The growing interest in keratorefractive surgeries, introduction of anterior segment analyzers at the end of the last century marked the beginning of a new era in diagnosis of corneal ectasias for which reason the incidence of corneal ectasias increased. Disease incidence depends on climatic and geographical factors, the level of technical equipment of medical institutions, ethnic background. Hereditary forms of ectasias according to different authors meet in 6–21,74š% of cases. Family forms of keratoconus patients Israel, Saudi Arabia, India can be attributed to inbreedingš— high frequency of closely related marriages. Thus, according to the literature data there is an annual growth of corneal ectasias mainly in young active age population what requires the use of modern diagnostic methods with the aid of high-tech equipment for early diagnosis and treatment.Key words: epidemiology, corneal ectasias, keratoconus, diagnostics.
Tereshchenko A.V., Belyy Yu.A., Takhchidi E.Kh., Novikov S.V., Maychuk N.In., Usanova, G.Yu. EXPERIMENTAL STUDY OF THE EFFECT OF A 0.1š% SOLUTION OF BENZALKONIUM CHLORIDE ON THE CONDITION OF THE CORNEA IN RABBITSIn order to create an experimental model of toxic corneal erosion in rabbits we have studied clinical and functional condition of the cornea (with use of confocal microscopy and quantitative calculation of the area of desquamated epithelium) and comparative assessment of the effect by instillation surface-active 0.1š% solution of benzalkonium chloride (experimental group) four times a day for 7 days, and saline solution (control group) on the rabbit cornea. It was shown that instillation of 0.1š% benzalkonium chloride for 7šdays induced toxic corneal erosion, which is perspective for further development of new methods for treatment and prevention of this nosology.Key words: benzalkonium chloride, corneal erosion, cytotoxicity, confocal microscopy.
Tikhonovich M.V., Iojleva E.Je. THE ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN RETINAL PHYSIOLOGY In this review paper we discuss the role of endothelial vessels growth in normal retina physiology and in pathologies for different organism development stages. We consider various isoforms of the growth factores and the importance of these factors for correct development of the retinal vascular bed. We discuss the existence of VEGF and its receptors in different retinal cells under normal conditions. Much attention has been given to the role of VEGF in angiogenesis: its action on endothelial cells, vascular development in normal eyes and the formation of retinal and subretinal new vessels in ischemic conditions. The factors, that trigger the process of neoangiogenesis are considered in detail. There are interactions between the nervous and cardiovascular systems, that are carried out with the help of the vascular endothelial growth factor. These interactions are considered here. The neuroprotective properties of VEGF in the central nervous system in general and in the eye in particular, which are attracting much interest among the researchers in the last few years, as well as its action on ganglial cells, glial cells of the retina and photoreceptors are also mentioned in the review.Key words: VEGF, retina, angiogenesis, neuroprotection.
Turutina Al.O., Malishev A.S., Turutina An.O., Danielyan L.V. FEATURES OF APPLICATION OF SELECTIVE LASER TRABECULOPLASTY IN THE TREATMENT OF PATIENTS WITH PRIMARY MIXED GLAUCOMAThe article is devoted to features of laser treatment of patients with primary mixed glaucoma. .Results in laser treatment of two groups patients with primary mixed glaucoma were analyzed retrospectively. In the first group were 11špatients (17šeyes); second group had 14špatients (19šeyes). Baseline intraocular pressure amounted to Poš= (24,5š±š1.3)šmm Hg.šPT. in the first and second group. During the gonioscopy, all patients had the anterior chamber angle Iš— II degree of opening, pigmentation of anterior's chamber structures angle was (++)—(+++). All patients in every group were performed YAGš— laser iridotomy, by the same doctor. Through 5šdays, the second group of patients was followed by a second stage of laser irradiationš— selective laser trabeculoplasty. Target pressure was achieved only in two eyes (9.7š%) of the first group. Patients of the second group achieved target pressure in 73.7š% of cases (14šeyes) and it amounted (18.5š±š1.3) mm.šHg., through 1šmonth it was (17.7š±š1.3) mm.šHg.šPT. 3šmonths later Cš=š0.17š±š0.03. Through 3šmonths, there were able to reduce the hypotensive regime in 3šeyes (15.8š%), carbonic anhydrase inhibitors were eliminated. We have repeated SLT In 2šeyes (10.5š%) after having increase of eye pressure through 6 months. After that, was achieved compensation of glaucoma process. Hypotensive effect wasn't achieved in 5šeyes (26.3š%), these patients have had hypotensive surgeries. It was shown that during the observation period of 12šmonths, two-stage laser irradiation in the treatment of patients with primary mixed glaucoma, high performance, and, therefore, should be more widely used in everyday practice.Key words: primary mixed glaucoma; YAG-laser iridotomy; selective laser trabeculoplasty; remote results.
Fabrikantov O.L., Khaleeva D.V., Shutova S.V. THE COMPARATIVE ANALYSIS OF THE ANTERIOR-POSTERIOR OCULAR SEGMENT MEASUREMENT IN CHILDREN AND TEENAGERS WITH REFRACTION ANOMALYAccording to the data of World public health organization in 2014, 12šmillion children had visual impairment caused by the refractive anomaliesš— the conditions that could be easily diagnosed and corrected. On a global scale one of the main reasons of visual impairment in adults (43š%) is non-corrected refractive anomalies (myopia, hypermetropia, astigmatism), conditions reducing the life quality, and often leading to disability. The determination of the ocular axial length accuracy in children and teenagers with refraction anomaly is obligatory in diagnosis, and in myopia it is the only reliably objective method to determine its progression. At present, it is possible to perform the ultrasound (US) and optical biometry. Ultrasound (US) biometry is a contact method of investigation and "golden" standard in ophthalmology. Optical biometry (OBM) is a non-contact method and which is an advantage. The purpose of our study is to determine the accuracy of the ocular axial length values using the ultrasound and optical biometry methods in children and teenagers. The group of patients (54špeople, 108šeyes) were examined using both methods. Also after the investigation, they were asked about the feeling of discomfort and pain. In the examination outcomes we took into account the characteristics of the absolute inter individual and intra individual variations of the examined signs, as well as the reproduction assessment of the echobiometry and optical biometry results. The ocular axial length measurement by the optical biometry provides with the more accurate values in comparison with the results obtained by the ultrasound echobiometry and it is well tolerated by patients.Key words: biometry, ultrasound biometry, optical biometry, anterior-posterior ocular segment.
Faizrakhmanov R.R., Kalanon M.R., Zainullin R.M. VITRECTOMY COMBINED WITH PEELING OF THE INTERNAL LIMITING MEMBRANE IN DIABETIC MACULAR EDEMA (LITERATURE REVIEW)A review of published data to evaluate the effectiveness of vitrectomy combined with internal limiting membrane peeling in the treatment of refractory diabetic macular edema. Most authors agree that this type of surgical treatment contributes to a significant regression of edema, the stabilization of the process and improvement of visual functions. It was found that the most effective treatment for diabetic macular edema, beginning with intravitreal injection of ranibizumab, and then ILM peeling.Key words: diabetic macular edema, vitrectomy, internal limiting membrane posterior hyaloid membrane.
Fokin V.P., Ezhova E.A., Balalin S.V. CONTACT CORRECTION OF AMETROPIA AFTER LASIKWe observed 20 patients who had previously been held excimer laser vision correction. The median age wasš— 26.8š±š0.27šyears. Patients were divided into two groups of 10š(10šeyes). In groupš1 uncorrected visual acuity (UNCA) averaged 0.24š±š0.01, sphere-equivalent (SE) — 1.58š±š0.1šdiopters, best corrected visual acuity (BCVA)š— 0.98š±š0.01. In groupš2 UNCA averaged 0.23š±š0.01, SE — 1.63š±š0.1šdiopters, BCVAš— 0.99š±š0.01. Patients in one group were assigned to the soft contact lens (SCL) ("1-Day Acuvue TruEye") in daily wear. Patients in groupš2 were assigned orthokeratology contact lenses (OKL) ("Emerald"), used during sleep. Research UNCA, BCVA, SE, holding biomicroscopy was performed at 1, 3 and 6šmonths after the appointment of a contact lens (CL). Within 1 month of observation in the appointment of CL was obtained significant (pš<š0.05) increase and decrease UNCA, SE in groupš2. Significant differences in BCVA between the use of OKL and SCL has not been received (pš>š0.05), which indicates a positive effect on the equivalent of both options on the parameters KL BCVA. Using OKL, as well as SCL, allows to obtain high functional results of vision correction, and given a certain congruence of OKL and the profile of the cornea after LASIK, provides an additional opportunity to achieve a stable and comfortable vision for the patient.Key words: LASIK, myopia, soft contact lenses, orthokeratology contact lenses.
Fokin V.P., Kuznetsova O.S. RESULTS OF APPLICATION OF OVAL RINGS AT OPERATIONS LAZIKExplore the possibilities and characteristics of the metal reusable vacuum ring with an oval hole for fixing when LASIK. The results of 426 LASIK with using metal reusable vacuum rings with an oval hole were analyzed. Excimer correction was performed by using excimer laser SCHWIND AMARIS (Germany). Metal reusable vacuum ring with an oval hole is well fixed on the eyes of patients with different diameter of the cornea. In 10š% of cases pointed cutting edge vascular network of the cornea, more pronounced in the upper part, especially in patients long-term use of contact lens. Metal reusable vacuum rings with an oval hole for fixing are easy-to-use and they allow to minimize trauma of marginal glomerulal vasculature, when horizontal corneal diameter ™ 10,5šmm. The nomogram to determine the amount of corneal flap legs optimal size. Recommended manufacture and use of the ring to "0" for the operations in the flat corneas to generate corneal grafts larger diameter.Key words: LASIK, vacuum ring, the corneal flap, mechanical longitudinal microkeratome.
Frantsuzova L.V., Galeeva F.S., Gabdrahmanov L.M., Karlova E.V. FEATURES OF MENTAL AND EMOTIONAL STATE OF PATIENTS WITH PRIMARY OPEN ANGLE GLAUCOMA The article analyzes the results of psycho-emotional state of patients with primary open angle glaucoma treated with laser and surgical treatment. It was found that patients with POAG are in the state of constant psychological stress caused by chronic disease. The findings indicate the need for psychocorrectional events to improve the social adaptation of patients, their quality of life and compliance of treatment.Key words: primary open-angle glaucoma, emotional state.
Khusnitdinov I.I., Bikbov M.M. ONE-STAGE PHACOEMULSIFICATION AND AHMED VALVE IMPLANTATION IN PATIENTS WITH REFRACTORY GLAUCOMACataract complicated with glaucoma is quite often encountered in practice and according to the literature ranges fromš15 to 76š% of cases. The article presents the results of simultaneous phacoemulsification of complicated cataract and Ahmed valve implantation in 19špatients with refractory glaucoma. All patients had in past medical history of fistulizing antiglaucomatous surgery. 10špatients (10šeyes) had complicated cataract after operated primary open angle glaucoma, 6špatientsš— after secondary neovascular glaucoma developed on the background of progressive diabetic retinopathy, 3špatientsš— after a post-traumatic glaucoma. The age of patients ranged fromš56 to 73šyears. Early postoperative period was marked by manageable levels of IOP (14.2šmmšHgš± 2.6šmmšHg.) and the absence of inflammation and bleeding typical for fistulizing combined operations. Visual acuity increased toš0.1 in 6šeyes, fromš0.2 toš0.5š— in 10šeyes, fromš0.6 to 0.7š— in 3šcases. In long-term follow-up period (from 6šmonths to 2šyears) visual acuity decreased in 2šeyes due to progression of diabetic retinopathy. In one case, in 1.5šyears after surgery there was a dislocation of a complex of the capsular bag, intracapsular ring and IOL. After 12šmonths of follow-up there was IOP increase primarily in patients with neovascular glaucoma, the appointment of antihypertensive drugs was requested. Simultaneous phacoemulsification of complicated cataract and Ahmed valve implantation in patients with refractory glaucoma provides improvement of visual function with simultaneous compensation of intraocular pressure for a long-term follow-up period.Key words: phacoemulsification, the Ahmed valve, refractory glaucoma.
Tsurova L.M., Milyudin E.S. , Zelter P.M., Kanivec N.V., Popov N.V. NEW IN CHOOSING OF OPTIMAL SIZE ORBITAL BONE IMPLANTIn the prevention and treatment of anophthalmic syndrome is important to choose the optimal size implant for each individual patient. In our study we used CT scan of the orbits, the BMD of the eyeballs and facial radiography of the skull to calculate the optimal size of orbital bone liner, taking into consider anatomical parameters of the orbit. There are 60špatients without eye pathology, separated on three group depend on method of diagnostic research. Patients aged fromš30 toš75. Analysis results of diagnostic tests have allowed us to develop new optimal size of orbital bone implant. Bone orbital implant is bone block with cylindrical form and porous structure, which had three type sizes. Our studies show, that orbital bone implant, which optimal size have developed in diagnostic researches, help us to create good functional and cosmetic result after enucleation. We offer complex researches of orbit (CT scan of the orbits, eyes ultrasound biometry, facial skull radiography), that is optimal set of researches for calculation of type sizes bone orbital implant.Key words: enucleation, orbital bone implant, computed tomography of the orbits, ultrasound biometry, radiography of the facial scull, musculoskeletal postenukleatsional stump.
Chernykh D.V., Smirnov E.V., Bratko G.V., Gorbenko O.M., Shvayuk A.P., Obukhov O.O., Chernykh V.V., Trunov A.N. THE RELATIONSHIP BETWEEN THE ACTIVITY OF THE LOCAL INFLAMMATORY, IMMUNE AND PROLIFERATIVE PROCESSES IN THE PATHOGENESIS OF PROLIFERATIVE DIABETIC RETINOPATHYCurrently discussed the significance of the activity of the inflammatory process, immune response, imbalance of cytokines and other biologically active substances in the mechanisms of the development of proliferative diabetic retinopathy. However, many aspects of the pathogenesis of proliferative diabetic retinopathy remain insufficiently studied. In addition the relationship between the activity of the inflammatory process, vascular proliferation and disorders of the immune response in the pathogenesis of proliferative diabetic retinopathy are debated and require in-depth study. In the study was established the importance of the local inflammatory and proliferative processes and activation of the immune response in the pathogenesis of proliferative diabetic retinopathy, what is confirmed by the presence in the vitreous significantly higher concentrations of interleukin 4, 6, 8, 17A, vascular endothelial growth factor, monocyte chemotactic protein-1, transforming growth factor-beta 2, growth factor pigment epithelium and sIgA. Statistically analysis found presence correlative relationship between markers the reflecting activity immune inflammatory and proliferative processes [VEGF and TGF-β2 (rš=š0.46, pš<š0.05); VEGF and IL-17A (rš=š0.45, pš<š0.05); VEGF and IL-8 (rš=š0.45, pš<š0.05); PEDF and IL 17A (rš=š0.48, pš<š0.05); PEDF and IL-8 (rš=š0.58, pš<š0.05); IL-17A and IL-8 (rš=š0.59, pš<š0.05); IL-17A and IL-4 (rš=š0.62, pš<š0.05); IL-8 and IL-4 (rš=š0.71, pš<š0.01), and others]. The findings suggest an association between the development of local immuno-inflammatory and proliferative processes in the mechanisms of development of proliferative diabetic retinopathy.Key words: proliferative diabetic retinopathy, cytokines, growth factors.
Chistyakova S.V., ëÁiotkina E.V. MODERN OPHTHALMODIAGNOSIS POSSIBLE EARLY MANIFESTATIONS OF HYPERPROLACTINEMIA IN WOMENIt is generally recognized that a sign of hyperprolactinemia (GPRL), is to increase the levels of the hormone prolactin (PRL). There is a dissonance between the level of PRL in the serum and the severity of ocular manifestations, and significantly complicates early diagnosis and prognosis of the disease. Given the nature of the location of the intracranial optic nerves, crossed them in the chiasm and settling near the pituitary gland, so functional and organic changes may affect the functions of the visual analyzer. A total of 82šwomen (164šeyes) aged fromš16 to 36šyears old, the average age was 26,1±2,3 years. A survey of patients included: clinical, gynecological, ophthalmological examinations. According to the results of computer Humphrey perimetry reduction of the threshold of sensitivity in the upper-nasal areas identified inš10 (12.2š%) women, bitemporal hemianopsia inš71 (86.5š%) cases, unilateral temporal decreaseš— inš1 (1.3š%) case. When Goldmann perimetry no patient showed no limitation of the visual fields. When R-graphy sella retrosellyarnoe calcification was detected inš3 (3.6š%) women. When CTG and MRI of the brain revealedš— prolactinoma inš22 (26.8š%), external hydrocephalusš— inš7 (8.5š%) cases. In 15šwomen were diagnosed with hypothalamic-pituitary syndrome, which inš7 (8.5š%) cases accompanied by changes in thyroid function. Treatment of hormone imbalance to assign the drug Dostinex (intended gynecologist). It was found that patients with hyperprolactinemia most significant findingš— Humphrey perimetry. In 86.4š% of cases it was found to decrease in retinal sensitivity characteristic that has made the highest accuracy of the method compared to the R-graphy sella (13.6š%). The important symptoms of pituitary prolactinomas are the progression of myopia in the ageš> 20šyears (27.3š%), the presence of the syndrome of "dry eye" (100š% of patients). Modern ophthalmologic diagnosis of hyperprolactinemia is the earliest diagnostic criteria to identify and follow-up.Key words: hyperprolactinemia, ophthalmologic symptoms, diagnosis, hyperprolactinemia.
Shavaleeva K.R., Aznabaev R.A. DRY EYE SYNDROME IN LASIK PLANNING: CAUSES AND METHODS OF DIAGNOSIS (REVIEW)Dry eye symptoms are fairly common in patients prior to LASIK, very often due to dry eye-associated contact lens intolerance leading patients to seek alternate methods of refractive error correction. This review presents the main causes of dry eye syndrome and methods for its diagnosis. The prevalence of dry eye symptoms prior to undergoing LASIK is estimated to be between 38 and 75š%. Post-LASIK, it has been widely shown that a majority of patients complain of dry eye symptoms, especially in the early postoperative period. Immediately after LASIK, 95š% of patients report some dry eye symptoms. Dry eye symptoms are reported in as high as 60š% of patients 1 month after LASIK. Post-LASIK dry eye usually peaks in the first few months after surgery, and then symptoms begin to improve in the vast majority of patients at 6–12šmonths after surgery. Despite this, in some patients dry eye syndrome is retained for a longer period, significantly reducing the quality of life after LASIK. Diagnostics of dry eye syndrome still presents significant challenges for the practicing physician. The heterogeneity of the causes of dry eye syndrome and the absence of "gold standard" diagnostic dictates the need to develop principles of forecasting its occurrence and differentiated pathogenetically oriented prevention dry eye syndrome at LASIK. Identifying preoperative dry eyes, and treatment in the perioperative time period, can lead to enhanced patient satisfaction and more accurate visual outcomes.Key words: LASIK, dry eye syndrome.
Panova I.E., Shaimov T.B., Abdullaeva E.A. CLINICAL ASPECTS OF A POLIPOIDNY HORIOIDALNY VASKULOPATIYA AS ATYPICAL OPTION OF A CURRENT OF A NEOVASCULAR FORM OF AGE MAKULYARNY DYSTROPHYThe problem of a neovascular form of the age makulyarny dystrophy (AMD) has special value in connection with the high frequency of an invalidization from this disease. An atypical form of neovascular process is the polipoidny horioidalny vaskulopatiya (PHV), the etiology and which pathogenesis aren't up to the end studied. The current of PHV is characterized by anevrizmalny expansions on the terminations of the branching network from abnormal the horioidalnykh of vessels, antiangiogenny methods of treatment of this disease not always have desirable efficiency. Therefore it is important to reveal a polipoidny horioidalny vaskulopatiya among patients with "damp" age makulyarny dystrophy. The main oftalmoskopichesky signs of a polipoidny horioidalny vaskulopatiya on the basis of the comparative analysis with the classical and hidden neovaskulyarization forms at VMD are studied. The following differences from typical forms of a neovaskulyarization at age makulyarny dystrophy are revealed: rare presence Druze (54.0š%), parafovealny localization of an otsloyka of a neurotouch retina (56.0š%), perifovealny localization of an otsloyka of a pigmentary epithelium (26.0š%), kistovidny hypostasis of a retina (48.0š%), and also existence of gemorragiya (56.0š%) mainly subretinalnykh (48.0š%) and solid exudate (82š%). Occurrence frequency the subretinalnykh of red-orange small knots as specific sign of PHV made 90š%. The main triad clinical the oftalmoskopicheskikh of signs of a polipoidny horioidalny vaskulopatiya at patients with age makulyarny dystrophy is revealed: rare presence Druze, solid "honey" exudate, red-orange subretinalny small knots. The obtained data should be considered in clinical diagnostics of a polipoidny horioidalny vaskulopatiya at patients with a neovascular form age makulyarny dystrophy.Key words: age-related macular degeneration, AMD, polypoidal choroidal vasculopathy, PCV.
Shaimova T.A., Panova I.E., Ermak E.M. OCT-PARAMETERS OF CHORIORETINAL COMPLEX IN PATIENTS WITH COMBINED PATHOLOGYš— AGE-RELATED MACULAR DEGENERATION AND PRIMARY OPEN ANGLE GLAUCOMAAge-related macular degeneration (AMD), and primary open angle glaucoma (POAG)š— the main reasons for the decrease of visual function and quality of life in older age and advanced age patients. The purpose of this study is to identify the OCT-parameters features of chorioretinal complex in patients with combined pathologyš— the dry form of AMD and POAG. There were 98špatients (192šeyes), we identified three study groups (SG): SG1š— AMD with POAGš— 63šeyes; SG2š— AMD without neuroopticopathyš— 56šeyes, SG3š— POAG without AMDš— 40šeyes; the average ageš— 75.7š±š6.5šyears. Manually measure of the neuro-sensory retina (NSR) thickness, the ganglion cells complex (GCC) thickness and the choroid thickness by optical coherence tomography were performed in two areas: 4šmm lateral (areašI) and 4šmm medial (areašII) to the optic nerve head. Index of GCC thickness (GCCT) was calculated equal to the ratio: GCC thickness/ NSR thickness. It was found that in patients with combined pathologyš— AMD and POAG (SG1) thickness of the NSR, thickness of the GCC, index of GCCT and choroid thickness significantly reduced in the area I and II in comparison with the control group. In the patients of SG1 NSR thickness, GCC thickness, index of GCCT was significantly lower in areašI andšII; choroidal thickness was lower in the areašI and significantly lower in areašII in comparison with patients of SG2. The research results of OCT-parameters of chorioretinal complex in patients with combined pathology (AMD and POAG) determined the severity of progressive course of AMD in patients with POAG predominance of atrophic form.Key words: age-related macular degeneration, primary open-angle glaucoma, optical coherence tomography, retinal ganglion cells, choroid.
Shangina O.R., Musina L.A. ELASTIC-DEFORMATIVE PROPERTIES OF COMBINED ALLOGRAFTS FOR THE RESTORATION OF THE ORBITAL WALLSThe necessity of studying biomechanical properties of allografts stems from the inquiries of practical medicine. Problems of restoration surgery, transplantology and other sciences are solved based on the study of strength and deformative properties of tissues. The aim of physico-mechanical investigations is the evaluation of allograft as the material which temporary or constantly performs mechanical functions following the transplantation. Different methods of manufacture, preservation, lyophilization and sterilization of allografts lead, on frequent occasions, to the changes of biomechanical properties. The conservation of elastic-deformative properties of allografts during the process of their manufacture is an important factor which sets conditions for the effect of their clinical practice. Biomechanical tests were carried out in the tissue bank of the Russian Eye and Plastic Surgery Centre to evaluate strength properties of combined allografts manufactured according to Alloplant technology for the restoration of orbital walls. Combined allografts were modeled from the derma of the foot supporting areas and then were reinforced by the costal cartilage. The carried out tests showed the following resultsš— the parameters of relative elongation, ultimate strength and Young's modulus of elasticity of derma allografts didn't subject to reliable changes (compared with the control groupš— native derma). It allows to make a conclusion that mechanical properties of the given allografts are preserved after the physico-chemical treatment. Ultimate strength and plastic deformation parameters of the allografts reinforced by the costal cartilage treated as per Alloplant technology didn't undergo considerable changes as well, compared with the control group (native derma). It is established that multistage physico-chemical treatment as per Alloplant technology does not have an adverse effect on the strength characteristics of the derma of the foot supporting areas and costal cartilage which are used to manufacture a combined allograft for the restoration of the orbital walls. Such strength properties of allografts as tension and deformation, which in their turn, are of the utmost significance play an important part in reconstructive surgeries. Key words: allografts, biomechanical properties, reconstructive ophthalmosurgery.
Shevchenko M.V., Shugurova N.E., Siradzinova D.R. BIOMETRIC EVALUATION OF THE CORNEA IN PRIMARY OPEN-ANGLE GLAUCOMA IN THE DYNAMICSIn recent years, more attention takes corneal biomechanical parameters and their relationship with the development of glaucoma. Central corneal thickness (CCT) of all parameters currently the most available for use in clinical practice. The aim of the work was to assess the state of the central corneal thickness in patients with primary open angle glaucoma (POAG) in the course of 7šyears depending on the stage of the process and its initial parameters. In 106špatients (147šeyes), corneal thickness was evaluated in dynamics within 7šyears. The control group consisted of 235šhealthy individuals (470šeyes). In the study group the average value of the central corneal thickness was 537.49šμš± 33.83šμ, which was significantly less than in the control 555.48šμš± 39.85šμ (tš=š9.1; pš<š0.01). At 82.3š% of patients with POAG central corneal thickness decreased by an average of 10.51šμš± 11.81šμ, compared with the control group (35š% decrease of 0.29šμš± 10.61šμ). During seven years there was a tendency to a decrease of the central corneal thickness both average and at different initial corneal thickness. This is significantly different from the control group. In addition, the reduction of the central corneal thickness in patients with primary open angle glaucoma increases with increasing time of observation (9.99šμš± 12.47šμ at the observation 1–3šyears, 12.11šμš± 13.22šμ at the observation 4–7šyears). The individual values of dynamic control of the central corneal thickness in patients with POAG for 7 years showed a statistically significant decrease in 82.6š% of cases. Reducing the thickness of the cornea is independent of its initial value and the stage of glaucoma.Key words: open-angle glaucoma, central corneal thickness, pachymetry.
Shevchuk N.E., Babushkin A.E., Orenburkina O.I., Matyukhina E.N. CONCENTRATIONS OF TGF-β2 IN TEAR AND SERUM IN PATIENTS WITH OPEN-ANGLE GLAUCOMA IN THE DYNAMICS OF SURGICAL TREATMENT AND ITS ROLE IN EXCESSIVE SCARRING AFTER ANTI-GLAUCOMA OPERATIONSTo study ôGF-β2 level in lacrimal fluid (LF) and blood serum (BS) in patients with primary open angle glaucoma (POAG) in the course of surgical treatment so as to estimate predictability of antiglaocomatous operations outcome. 23špatients with POAG were analyzed for TGF-β2 concentration in blood serum and lacrimal fluid in the course of surgical treatment. Deep sclerectomy (DS) was applied as an antiglaocomatous operation. TGF-β2 concentration in blood serum and lacrimal fluid was investigated before the operation, one week, 1, 3 and 6šmonths thereafter. An increased level of TGF-β2 in blood serum and lacrimal fluid was detected in operated patients with advanced stages of POAG. An ocular hypertension relapse due to excessive postoperative scarring was accompanied by TGF-β2 level increase with its peak serum concentration 3šmonths after penetrating DS. High local preoperative level of TGF-β2 may be applied as a prognostic marker for early excessive postoperative scarring in newly formed intraocular fluid outflow tracts.Key words: POAG, tear, serum, TGF-β2, scarring.
Shilovskikh O.V., Safonova O.V. PHACOEMULSIFICATION OF UVEAL CATARACT WITH SYNECHIOTOMY, POSTERIOR CAPSULORHEXIS, PARTIAL VITRECTOMY AND ORIGINAL METHOD OF IOL IMPLANTATION: REMOTE RESULTS Cataract is a frequent complication of chronic uveitis. There are literary data concerning the results of surgery in this pathology. Lensectomy, extracapsular extraction, phacoemulsification with or without intraocular lens implantation as well as partial or subtotal vitrectomy have been described. Postoperatively, complications influencing visual outcome such as pupil occlusion, iris bombee, secondary cataract often develop. Working out new methods of surgery minimizing complications frequency is actual. The paper presents the experience of surgery in 111šeyes of 83špatients with uveal cataract. The operations were performed using authors' method including ultrasound cataract phacoemulsification with preliminary synechiotomy, posterior capsulorhexis, partial vitrectomy and intraocular lens implantation. Haptics of the intraocular lens were placed into the capsular bag and optic part was placed behind the posterior capsulorhexis. No intraoperative complications were observed. Visual acuity in 1–2 days after surgery was: above 0.5š— in 43.2š% of cases, 0.2–0.5š— in 34.2š%, below 0.2š— in 22.6š%. Most significant increase of visual acuity after the operation was observed in patients with preoperative visual acuity aboveš0.5 and belowš0.2. Complications included local posterior synechiae without iris bombee in 2 eyes (1.8š%), increase of intraocular pressureš— 7.2š%, uveitis recurrenciesš— 17š%, deposits on IOLš— 11.4š%, pre-existing macular edemaš— 40š%, macular edema in 1š— 6šmonths after surgeryš— 5.4š%. Subtotal vitrectomy with epiretinal membrane removal was performed in 9šeyes (8.1š%). The developed method of uveal cataract surgery is safe, provides good anatomic results and a significant increase of visual acuity. Cases with low postoperative visual acuity are associated with pre-existing macular edema. Epiretinal membrane is a risk factor for cystoids macular edema progression after phacoemulsification of uveal cataract and is an indication for vitrectomy. Key words: uveal cataract, posterior capsulorhexis, chronic uveitis.
Shukhayev S.V., Naumenko V.V., Boiko E.V. PHACOEMULSIFICATION WITH FEMTO-LASER SUPPORT IN EYES WITH ENDOTHELIAL DYSTROPHY OF FUCHSFemtosecond laser assisted cataract surgery (FLACS) is the most important innovation in cataract surgery in recent years. The purpose of the study was to assess the endothelial cell loss after FLACS procedure in the eyes with Fuchs' endothelial dystrophy. 50špatients (50šeyes) with Fuchs' endothelial dystrophy were included into this prospective clinical study. All patients had central cornea guttata with warts and low endothelial cell density at the center of the cornea. 23špatients underwent FLACS procedure and other 27špatients underwent conventional manual surgery. Endothelial cell densities were measured before and 1šday, 1šmonth after the surgery at 7šstandardized points of the cornea. Prior to the surgery, both groups showed no difference in cataract grade, nuclear density and endothelial cell density (pš>š0.05). Postoperatively endothelial cell loss was significantly greater in the manual group (pš<š0.05). For the preservation of the endothelial integrity, FLACS proves to be safer procedure.Key words: Key world: femtosecond laser assisted cataract surgery, phacoemulsification, endothelial cell loss, Fuchs' endothelial dystrophy.
Yablokova N.V. OUR EXPERIENCE OF THE SELECTIVE LASER TRABECULOPLASTY IN THE OPEN-ANGLE GLAUCOMA TREATMENTAccording to the data of World Public Health Organization, glaucoma is one of the principal diseases that leads to the incurable blindness and ocular disability. The problem of glaucoma treatment, search for the known methods of treatment remains one of the most important directions in ophthalmology. One of the methods of IOP reduction in glaucoma treatment is selective laser trabeculoplasty (SLT), which was introduced into practice in 1997. SLT as the main or additional treatment is a rather safe and effective method of primary open-angle glaucoma treatment that allows using it in very different situations often occurring during the cure of such complicated disease as glaucoma. The paper presents the practical experience analysis of the selective laser trabeculoplasty in the open-angle glaucoma treatment in 213špatients (250šeyes) followed up from 1šmonth to 5šyears [at average 15.45š±š1.03 months], among whom there were patients with open-angle glaucoma of I–III stages, with both eyes operated on, with the only sound eye, patients undergone surgical treatment. The preoperative mean IOP in the examined group (250šeyes) was (19.70š±š0.21) mmšHg. The postoperative mean IOP was (16.04š±š0.22) mmšHg by the moment of the last examination [the difference was statistically significant (tš=š11.98, pš=š0.000)]. Analyzing the perimetry data MD index wasn't changed reliably: (6.77š±š0.51)šdB before the SLT and (7.15š±š0.54)šdB after the SLT (the differences were not significant enough (tš=š–0.51, pš=š0.610). Analyzing the hypotensive regimen the tendency towards its reduction was noted during the whole follow-up. SLT gives the additional opportunity to a surgeon to act rather quickly, flexibly and properly in many cases of the open-angle glaucoma including the unusual ones, though as an additional therapy but that does not belittle its significance. SLT is effective, safe and may be successfully used at any stage of the open-angle glaucoma treatment.Key words: open-angle glaucoma, selective laser trabeculoplasty, intraocular pressure, different stages of the open-angle glaucoma.
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Editor-in-chief |
Sergey Aleksandrovich
MIROSHNIKOV |
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