Saratov JOURNAL of Medical and Scientific Research

Ophtalmology

Evaluation of the functional efect of surgical treatment of rhegmatogenous detachment in the late postoperative period

Year: 2019, volume 15 Issue: №2 Pages: 470-473
Heading: Ophtalmology Article type: Original article
Authors: Zaika V.A., Yakimov A.P., Yuryeva T.N.
Organization: The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to identify the key factors determining the functional outcome of surgical treatment of rhegmatogenous retinal detachment. Material and Methods. The study group included 39 patients operated for rhegmatogenous retinal detachment, which 6 months after surgery were divided into 2 groups depending on visual acuity obtained. All patients underwent standard ophthalmologic examination and color computed perimetry, electrophysiological studies, electro-retinography and registration of visual evoked potentials, optical coherent tomography, color Doppler mapping of posterior pole vessels. Results. 6 months after the surgical treatment of retinal detachment in the 1st group, best corrected monocular visual acuity increased by 4 times in comparison with the 2nd group. When analyzing color-opponent perim-etry results in patients of the frst group, a threefold improvement in medium sensitivity and reliability factor indices for both red and blue stimuli was detected in comparison with the 2nd group. Patients in the 2nd group showed an increase in the phosphene index. In patients of this group in late postoperative period there was an increase in peripheral resistance of vascular wall in both arterial and venous parts of the blood fow, which was probably one of important reasons for non- recovery of vision in patients of this group. Conclusion. Full restoration of regional blood fow and receptor channels of organ of vision, as well as restoration of local and general electrical sensitivity of retina and visual pathway conductivity, is a necessary component of successful restoration of visual functions.

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Clinical and etiological and hemostasiological features of isolated optic disk vasculitis

Year: 2019, volume 15 Issue: №2 Pages: 465-469
Heading: Ophtalmology Article type: Original article
Authors: Emanova L.P., Egorov V.V., Smoliakova G.P., Danilova L.P., Povalyaeva D.A., Zhajvoronok N.S.
Organization: Postgraduate Institute for Public Health Workers, The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution
Summary:

 Purpose: the study clinical, etiological and intravascular hemostasiological features of isolated optic disk vasculitis (IODV). Material and Methods. 27 patients with IODV. Duration of the disease at the time of initial appeal ranged from 5–7 days to 12 weeks. The criterion for inclusion in the study was the absence in patients systemic vasculitis, severe cardio and cerebrovascular diseases and systemic immunopathological diseases. One of the main places in the study was devoted to laboratory diagnosticmethods — enzyme-linked immunosorbent assay using set of reagents (test system «Bioservice», Russia) for detection of specifc antibodies to various infections in blood serum. The average period of study patients was 12 months. Results. The exudative type of infammation (67 %), moderate hemorrhagic activity and high risk of macular lesions are typical for IODV; in etiological structure of IODV prevail herpes viral infection and foci of chronic bacterial infections. High average infectious index (2.0±0.1) indicates predominance of mixed infections in patients. The results of laboratory studies have established that pathogenetic mechanisms of development of IODV are associated with activation of the vascular-platelet and coagulation hemostasis and depression of fbrinolysis. Conclusion. Close relationship established between changes in intravascular hemostasis and the clinical activity of disease, which necessitates inclusion in program of complex treatment patients with IODV, along with basic corticosteroid therapy and sanitation of infection foci, medications that normalize hemostasis.

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Evaluation of the efcacy of neuroprotective therapy after endovitreal surgery for rhegmatogenous retinal detachment

Year: 2019, volume 15 Issue: №2 Pages: 460-464
Heading: Ophtalmology Article type: Original article
Authors: Egorov A.V., Egorov V.V., Smoliakova G.P.
Organization: The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution
Summary:

 Purpose: to develop optimal approaches to the use of cytofavin for neuroprotection and to evaluate their efective-ness in patients after endovitreal surgery for rhegmatogenous retinal detachment (RRD) with anatomically complete retinal attachment. Material and Methods. 68 people (68 eyes) with primary RRD. Three-port vitrectomy with silicone oil tamponade in the vitreous cavity and its subsequent removal were performed. The patients were divided into 2 groups: the main group (38 people who received cytofavin added to standard therapy), and the control group (30 people with standard therapy only). Depending on visual prognosis calculated before surgery, the main and control groups consisted of patients with tolerable and low levels of visual prognosis. We used laser doppler fowmetry (to register microcirculation index (MI) and microcirculation efciency index (MEI)). Morphological signs of macular ischaemia were recorded by optical coherence tomography angiography (OCT-angiography). Results. Regardless of visual prognosis, the response dynamics of the chorioretinal microcirculation in patients was unidirectional. In patients of the main group 6 months after the surgery, more signifcant positive changes in growth of amplitude of MI and MEI, as well as positive dynamics of OCT-angiography were observed. Conclusion. Including cytofavin neuroprotection in postoperative treatment in patients after

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Wide-feld retinal optical coherence tomography for imaging of peripheral vitreoretinal interface and stratifcation of risk for rhegmatogenous retinal detachment recurrence

Year: 2019, volume 15 Issue: №2 Pages: 456-459
Heading: Ophtalmology Article type:
Authors: Doga A.V., Shkvorchenko D.O., Kryl L.A., Buryakov D.A., Bayzulaeva M.R.
Organization: The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to evaluate the peripheral vitreoretinal interface changes after combined laser-surgical treatment of local rhegmatogenous retinal detachments revealed by wide-feld OCT. Material and Methods. 21 patients (21 eyes) with local rhegmatogenous retinal detachment localized in the upper half of the fundus were enrolled in this study. All patients underwent a combined laser-surgical treatment, which included 3 steps: 1) Nd: YAG laser excision of the vitreoretinal adhesion zone, determined by wide-feld OCT; 2) pneumatic retinopexy; 3) barrier laser photocoagulation at the edge of the tear after retinal reattachment. All patients underwent OCT of the peripheral vitreoretinal interface to identify areas of pathological vitreoretinal adhesions in the post-operative period. Results. OCT analysis of 21 patients has demonstrated the complete elimination of the traction component in the treatment area. However, vitreoretinal adhesions near the tear area were found in 4 patients. These patients underwent additional barrier laser photocoagulation at zones of pathological vitreoretinal traction. Conclusion. Visualization of

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Revisiting the question on the role of trabeculocleaning in surgical treatment of glaucoma with concomitant cataract and pseudoexfoliation syndrome

Year: 2019, volume 15 Issue: №2 Pages: 451-456
Heading: Ophtalmology Article type: Original article
Authors: Dzhashi B.G., Balalin S.V.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, the Volgograd Branch
Summary:

Trabeculocleaning (TC) in the cataract extraction process is the procedure of debris aspiration from the drainage angle, one of the components inducing hypotensive efect after phacosurgery. When being preceded with selective laser trabeculoplasty (SLT) at suprathreshold values which provides a pigment granules' splatter, the described procedure makes it possible to clean the anterior chamber angle (ACA) of the released trabecular debris including pseudo-exfoliation material and pigment granules. Purpose: to study the efciency of trabeculocleaning performed in course of femto-laser assisted cataract surgery (FLACS), with a preliminary suprathreshold SLT. Material and Methods. The study included 26 patients (32 eyes) with a complicated cataract and primary open angle glaucoma with concomitant pseudoexfoliation syndrome. All patients underwent a suprathreshold SLT preceding FLACS and hydrodynamic tra-beculocleaning, in course of which trabecular debris were removed with the help of aspiration-irrigation tips. Results. One month postoperatively mean IOP value decreased by 9.5 mm Hg from initial values (40.95 %), the outfow facility coefcient improved to 0.21±0.002 mm3 / mm Hg*min (t=14.3; p<0.001). In 24 cases (77 %) IOP was compensated without application of antihypertensive drugs, in 7 cases (22.4 %) it reduced under medication. Conclusion. Hydrodynamic trabeculocleaning in course of FLACS with preliminary suprathreshold SLT ensures ACA detersion from trabecular debris: pseudoexfoliation material and pigment granules, therefore aiding to preserve and activate natural pathways to the outfow of intraocular fuid.

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Hormonal and lipid imbalances in the formation of myopic chorioretinal neovascularization in women

Year: 2019, volume 15 Issue: №2 Pages: 447-451
Heading: Ophtalmology Article type: Original article
Authors: Grigorieva A.V., Shchuko A.G., Kursakova Yu.V., Ivanova E.l., Samsonov D.Yu.
Organization: Irkutsk State Medical University, The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to determine the role of hormonal and lipid imbalance in the formation of myopic chorioretinal neovascularization in women. Material and Methods. The frst clinical group includes the results of the study of patients with the active form of myopic chorioretinal neovascularization, the second — the results of the study of their paired eyes. The control groups were formed separately. Ophthalmologic and somatic status of all patients and people in the control groups were thoroughly examined. Results. An increase in the level of prolactin to 501.7±28.2 mlU/ml was established, in the control group to 272.9±33.4 mlU/ml, the level of follicle-stimulating hormone 13±0.1 mlU/ml, the control group 4,6±1.2 mlU/ml. The concentration of estradiol is reduced 35.2±3.1 pg/l, progesterone 2.8±0.1 nmol/l, compared to the control group 66.8±8.1 and 6.2±1.1 nmol/l respectively. An increase in the level of acute-phase proteins was revealed: fibrinogen 3.8 (14.0±0.5) and C-reactive protein 2 times (5.72±2.30) compared with the control group 3.6±0.5 and 2.5±0.7. Increased lipoprotein level (a) 50.2±1.2 g/l and ApoB/ApoA 0.6±0.1 compared with the control group 9.1±1.1 et 0.4±0.1 g/l. Conclusion. The fndings confrm the pathogenetic signifcance of systemic risk factors in the development of choroidal dysfunction and, as a

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Stability of the electric sensitivity threshold of the visual analyzer in case of fve repeated investigations

Year: 2019, volume 15 Issue: №2 Pages: 442-446
Heading: Ophtalmology Article type: Original article
Authors: Galautdinov M.F., Gareev E.M., Koshelev D.I.
Organization: Russian Eye and Plastic Surgery Center
Summary:

Purpose: to evaluate the stability of the electric sensitivity threshold (EST) parameter in a series of fve measurements in patients with the vision pathology. Material and Methods. 66 patients (129 eyes) took part in the investigation with the age ranging from 12 to 82 with diferent ophthalmic pathologies and without them. In each case a series of fve measurements (EST) was performed using ESOM-Komet devise according to the standard program. Results. Five typological groups were revealed which difered reliably as per the tendencies of EST level changes in the course of fve successive measurements. In 80 % of the cases the successive EST values turned out to be practically stable. In 20 % of the cases there was observed a high EST variability with the signifcant trend towards a gradual growth of EST level. The nature interrelation analysis of EST successive charges depending on the diagnosis, age, sex, initial EST level didn»t reveal signifcant relations. Conclusion. The performed series of measurements can be regarded as a highly simplifed model of monitoring the visual system condition in dynamics. The absence of stability / instability interrelation with the clinical data points to the necessity to investigate the criteria and strategy of taking the decision in patients in the course of the diagnostic procedures.

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The possibilities of optical coherence tomography in En Face mode in planning and conducting computer-assisted laser surgery for central serous chorioretinopathy

Year: 2019, volume 15 Issue: №2 Pages: 433-442
Heading: Ophtalmology Article type: Original article
Authors: Volodin P.L., Ivanova E.V., Fomin A.V., Agafonov S.G., Polyakova E.Yu.
Organization: The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to assess the diagnostic capabilities of optical coherence tomography (OCT) in En Face mode for planning and conducting surgical navigation using Navilas 577s laser system in patients with central serous chorioretinopa-thy (CSC). Material and Methods. 12 patients (12 eyes) with CSC underwent high-resolution OCT in En Face mode showing morphological changes in the retinal pigment epithelium (RPE). The treatment was performed on Navilas 577s laser device with an individual selection of the necessary energy parameters in the micropulse mode. The follow-up was performed at 1, 3 and 6 months. Results. According to the OCT data in the En Face mode, all patients had morphological changes in RPE, which made it possible to plan and perform computer-assisted laser surgery. 1, 3 and 6 months after treatment, positive dynamics was observed in all cases. Conclusion. The OCT method in En Face mode allows detailed study of architectonics and identifes pathological changes in RPE, which play an important role in the manifestation of CSC, as it enables planning and implementation of topographic-oriented treatment using the Navilas 577s navigation laser system in the areas of RPE detachments.

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New approach to amnioplasty in surgical treatment of primary progressing pterygium

Year: 2019, volume 15 Issue: №2 Pages: 428-433
Heading: Ophtalmology Article type: Original article
Authors: Bochkareva A.N., Egorov V.V., Smoliakova G.P., Banshchikov P.A., Belous A.V.
Organization: Postgraduate Institute for Public Health Workers, Regional Clinical Oncological Center, The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to improve the efcacy of surgical treatment of primary progressing pterygium by developing a new method of amnioplasty. Material and Methods. 85 patients were divided into two groups based on topographical features of amnioplasty site. The main group included 42 subjects who underwent amnioplasty using a technique which was proposed by us (after surgical removal of primary progressive pterygium at the initial site); the control group included 43 subjects in whom amnioplasty at the zone of limbus was performed after removing the pterygium. The criteria for evaluating treatment efcacy were time to disappearance of symptoms of postoperative infammation, time to complete corneal epithelialization and vitalization of the amnion, visual acuity in the frst year after surgery, reduction of corneal astigmatism, recurrence rate. Results. Amnioplasty technique proposed by us showed high efcacy: time of postoperative ocular surface infammation decreased, which led to an increase in corneal epithelization rate by 1.7 times and in amnion vitalization rate by 1.2 times; reduction of astigmatism by 3 times and an increase in visual acuity by 3.9 times when compared to the control group. Conclusion.

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Computer analysis of corneal aberrations in relation to the tasks of laser surgery of the anterior segment of the eye

Year: 2019, volume 15 Issue: №2 Pages: 425-428
Heading: Ophtalmology Article type: Original article
Authors: Bakutkin V.V., Bakutkin I.V., Zelenov V.A., Nugaeva N.R.
Organization: International Consulting, Audit and Education Academy, Saratov State Medical University
Summary:

Purpose: development of a method for computer analysis of corneal aberrations as applied to the tasks of laser surgery of the anterior segment of the eye. Material and Methods. As a result of mathematical modeling, an algorithm has been developed that is implemented as a computer program for selecting individual parameters of laser radiation depending on the optical characteristics of the cornea. Results. For astigmatism, it has been proposed to consider the topographic zones of the optical center of the cornea, 3.5 mm in diameter, and peripheral meridional zones. Aberrations at the periphery of the cornea increase by 10 %. At 1 and 2 stages of keratoconus, the rate of aberrations rises 2–3 times. In the third stage of keratoconus, in some cases keratometry and keratotopography is technically impossible. With pterygium 2 and 3 degrees, laser surgery in the peripheral zone of the cornea is impossible. Conclusion. Improving the efciency of laser operations is provided primarily by optimizing the impact parameters on the tissues of the anterior segment of the eye. The data on the types of corneal aberrations for various diseases, which indicate the need to change the parameters of laser exposure. The developed diagnostic algorithms are implemented as a computer program and allow you to optimize the parameters of laser irradiation of eye tissue.

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