Saratov JOURNAL of Medical and Scientific Research

Kamenskikh T.G.

Saratov State Medical University n.a. V. I. Razumovsky, Head of Department of Eye Diseases, Doctor of Medical Science

Assessment of possibilities of transmission polarization mapping for the characterization of sclera macrostructure

Year: 2017, volume 13 Issue: №2 Pages: 435-441
Heading: Ophtalmology Article type: Original article
Authors: Shvachkina M.E., Pravdin А.В., Tikhonov D.A., Kamenskikh T.G., Yakovlev D.D., Yakovlev D.A.
Organization: Saratov state university, Saratov State Medical University
Summary:

The purpose of the study is to assess possibilities of applying the method of transmission polarization mapping for characterization of sclera structure. Material and methods. In the work, samples of rat, rabbit, porcine, and human sclera were examined. Samples of the human sclera were taken (enucleation of the eyeball) from patients with diagnoses: terminal painful glaucoma, subatrophy of the eyeball. From the enucleated eyes, sclera samples were taken from the posterior pole of the eye and from the equator. The sample transparency required for carrying out transmission polarization mapping in thick samples was achieved using immersion optical clearing, 85% and 50% aqueous glycerol solutions and 40% aqueous glucose solution being used as immersion agents. The polarization mapping system used in this work was assembled on the basis of a polarization microscope equipped with a measuring video camera. Re-sults. It is shown that the method of transmission polarization mapping can be used to measure the parameters of the orientational order of scleral collagen fibers, mapping of human sclera samples requiring conduction of the polarization measurements under optical clearing conditions. Since the disorganization of collagen structures of eye connective tissue can be considered as the initial stage of glaucoma process, the technique of transmission polarization mapping can be used as a basis for in vitro studies of the pathogenesis of primary open-angle glaucoma. Conclusion. The potential and limitations of polarization mapping in studying sclera structure in vitro have been established.

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The effectiveness of The Atlas of Ophthalmic Instruments (an application for smartphones) in optimization of the educational process of students, residents, and ophthalmologists

Year: 2017, volume 13 Issue: №2 Pages: 420-421
Heading: Ophtalmology Article type: Short message
Authors: Moiseev R.V., Kryuchkov Yu.A., Kamenskikh T.G.
Organization: Saratov State Medical University
Summary:

Objective: to determine the effectiveness of the Atlas of Ophthalmic Instruments for Smartphones (the application for smartphones) in optimization of the educational process of students, residents, and ophthalmologists. Material and methods. On the Android platform there had been created and placed in the Google Play an application "Ophthalmic Instruments" with illustrations and description of ophthalmic surgical instruments. Next, a survey had been conducted of users of the application (1005 respondents). To this was applied a specially designed questionnaire in English. Results. According to the survey, the average score among students (652 users) is 4.9; among residents (281) 4.7 and doctors (72) and 4.6. Conclusion. Obtained data allow to conclude that the use of interactive mobile applications positively influences the optimization of the educational process and can be considered as a new and effective form of tutorials.

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Development of ophthalmic training simulator for cataract surgery

Year: 2017, volume 13 Issue: №2 Pages: 417-420
Heading: Ophtalmology Article type: Original article
Authors: Kumova S.V., Lunev I.A., Gasparyan E.A., Virsta A.M., Batishcheva Yu.S., Kamenskikh T.G., Dolinina O.N.
Organization: Saratov State Medical University, Saratov state university, Yuri Gagarin State Technical University of Saratov
Summary:

Purpose: development of interactive simulator for the development of phacoemulsification. Material and Methods. Material and methods: the Software developed by the authors ophthalmic virtual simulator has several modules that can also be complemented by depending on put before the students the task. Testing the virtual simulator "Phacoemulsification" held at the Department of ophthalmology with the participation of 20 interns and 18 residents. Results. The development of residents and interns of ophthalmological profile of the theoretical foundations of cataract surgery using developed by the authors of the publication virtual interactive simulator demonstrated the effectiveness of this technique in comparison with passive viewing of video recording operations and the familiarity with the course of phacoemulsification in the operating room. Conclusion. The application of the developed simulator with the purpose of optimization of educational process of residents and interns of ophthalmic profile is a very effective tool in the world today.

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Comparative analysis of biochemical, immunological status in patients with different stages of diabetic retinopathy.

Year: 2017, volume 13 Issue: №2 Pages: 412-416
Heading: Ophtalmology Article type: Original article
Authors: Kozorezova O.V., Kamenskikh T.G., Kolbenev I.О., Zakharova N.B., Kozletsov A.P., Stepanova T.V.
Organization: Saratov State Medical University
Summary:

Objective: comparative analysis of biochemical, immunological status in patients with different stages of diabetic retinopathy. Material and methods. The study group included 137 patients with diabetic retinopathy. A control group consisted of 30 patients with myopia average. Results. The increase of indicators such as glycated hemoglobin, glucose, cholesterol, LDL cholesterol, IL-8, IL-6, TNF-alpha in patients with diabetic retinopathy compared to normal values. The content of IFN -y in both groups significantly below the normal level. Conclusion. The final peroxidation products, reactive oxygen species generate new antigens and trigger an immune response that is expressed in the form of increased concentration of IL-6 (acute phase of immune inflammation), and then TNF-alpha and IL-8; these cytokines activate angiogenic growth factors TGF 131 and VEGF. Increasing the concentration of angiogenic factors triggers neovascularization and proliferation.

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Efficiency analysis of laser magnetic stimulation of an eye drainage system in the treatment of patients with different stages of primary open angle glaucoma based on developments of functional indicators and biochemistry factors

Year: 2017, volume 13 Issue: №2 Pages: 406-411
Heading: Ophtalmology Article type: Original article
Authors: Filatova V.S., Kamenskikh T.G., Zaharova N.B.
Organization: Saratov State Medical University
Summary:

The purpose of study is to develop efficiency analysis of laser magnetic stimulation of an eye drainage system in the treatment of patients with primary open angle glaucoma (POAG). Material and Methods. The study included 197 patients with established diagnosis of POAG. The first group included 104 patients treated with drug treatment and laser magnetic stimulation of the drainage system of the eye using the «AMO-ATOS-ICL». The second group included 93 patients who received only drug therapy. Patient underwent visometry, oftalmobiomicroscopy, threshold perimetry electrophysiological study, the study of intraocular blood flow, level of VEGF and MCP-1. Results. A comparative analysis showed that the use of laser magnetic stimulation eye's drainage system in the treatment of patients with different stages of POAG to an activation of intraocular blood flow, but it was more significant in patients of the main group who were diagnosed with I and II stages of POAG. The decrease in intraocular blood flow resulted in ischemia while the level of VEGF increased. Conclusion. Analysis of clinical, electrophysiological and hemodynamic parameters in treatment of patients with POAG before and after laser magnetic stimulation improved of the state of the visual system in comparison with those in control group.

Keywords: MCP-1, VEGF
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ОСТ investigation of influence of cement kiln dust and keratoprotectoral medication on the cornea structure.

Year: 2017, volume 13 Issue: №2 Pages: 400-406
Heading: Ophtalmology Article type: Original article
Authors: Kalmykov R.V., Popova D.V., Kamenskikh T.G., Genina E.A., Tuchin V.V., Bashkatov A.N.
Organization: National Research Tomsk State University, Saratov State Medical University, Saratov state university
Summary:

The research goal: in vitro study of cornea permeability at the action of cement kiln dust and keratoprotectoral medication. Materials and Methods. Experimental studies were carried out with twenty eyes often rabbits. The measurements were performed using ОСТ system OCP930SR 022 (Thorlabs, USA). Results. ОСТ tomography was used to monitor the attenuation coefficient of the cornea in vitro during the permeability of cement kiln dust and keratoprotector Systein Ultra. The permeability coefficients of the cornea for water, cement dust and keratoprotector were measured. A computer model was developed that allowed one to analyze the diffusion of these substances in the eye cornea. Conclusion. It is shown: 1) cement dust falling on the eye cornea caused pronounced dehydration of the tissue (thickness decreasing) and led to the increase in the coefficient of light attenuation, which in the conditions of cement production could affect the deterioration of the eyesight of workers; 2) the application of the keratoprotector on the eye cornea when exposed by cement dust, slowed significantly the dehydration process and did not cause the increase in the light attenuation coefficient, which characterized the stabilization of visual functions in cement production workers. In this case, the keratoprotector itself did not cause dehydration and led to the decrease in the light attenuation coefficient, which could allow it to be used for a long time in the order to protect the organ of vision from the negative effects of cement dust.

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Evaluation of the effectiveness of antiglaucomic operations with the use of the Ex-Press mini glaucoma shunt and Repegel-1 drainage in patients wi

Year: 2017, volume 13 Issue: №2 Pages: 394-400
Heading: Ophtalmology Article type: Original article
Authors: Kamenskikh T.G., Veselova E.V., Filatova V.S., Lyakhovich V.V., Golub' L.K., Karpenko A.A., Alekseyeva E.l., Kamenskikh I.D.
Organization: Saratov State Medical University
Summary:

The purpose of study is to evaluate the effectiveness of antiglaucomic operations with the use of the Ex-Press mini glaucoma shunt and Repegel-1 drainage in patients with primary open-angle glaucoma. Material and Methods. 65 patients (65 eyes) with an established diagnosis of uncompensated primary open-angle glaucoma of Stage III were observed. All patients underwent anti-glaucoma surgery. Patients of group 1 (15 patients, 15 eyes) underwent penetrating deep sclerectomy with implantation of the Ex-Press mini shunt under the scleral flap. Patients of group 2 (25 patients, 25 eyes) — penetrating deep sclerectomy with Repegel 1 drainage. Patients of group 3 (25 patients, 25 eyes) underwent sinus trabeculectomy without drainage. Results. In the early postoperative period, a good hypotensive effect was obtained in patients of all three groups. The most persistent antihypertensive effect was obtained in patients who underwent anti-glaucoma surgery with Repegel-1 drainage implantation. In patients who were implanted with the Ex-Press mini shunt, there was a significant decrease in the perimetrical MD index for 3 months. Conclusions. 1. Improvement of the photosensitivity of the retina in patients who underwent an antiglaucoma operation with Ex-Press shunt implantation, possibly due to the low invasiveness of the intervention and the absence of a sharp drop in IOP level. 2. Preliminary results (analysis 3 months after the operation) indicate a lower number of postoperative complications in the implantation of Repegel-1 drainage and a persistent hypotensive effect. 3. Patients who underwent antiglaucoma operations with implantation of drainage systems showed improvement of hemodynamic parameters in the pool of posterior short ciliary arteries in the postoperative period.

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Experience of antiangiogenic and corticosteroid therapy of a diabetic macular edema

Year: 2017, volume 13 Issue: №2 Pages: 383-388
Heading: Ophtalmology Article type: Original article
Authors: Kamenskikh T.G., Batishcheva Yu.S., Kolbenev I.O., Tsipyashchyk A.F., Andreychenko O.A., Gileva E.M., Vasil'yeva T.V., Zakharova N.B.
Organization: Saratov State Medical University
Summary:

Diabetic macular edema (DME) is a leading cause of blindness in patients with diabetes. The purpose of the research is to evaluate the effectiveness of treatment of patients with DMOs resistant to the administration of ranibi-zumab, using the intrauritreal implant "Ozurdex". Material and Methods. 66 patients (98 eyes) are examined. All of the patients were divided, into three groups, depending on a stage of a diabetic retinopathy. The patients underwent a complex of examinations: along with traditional methods, optical coherence tomography, fluorescence angiography of the fundus, multifocal electroretinography, determination of the content of VEGF-Aand cytokines in serum were used. Results. According to ОСТ of a retina and a visometry there are differences in efficiency of treatment depending on a condition balance of cytokine. Conclusion. The use of the intrauretic implant "Ozurdex" was more effective in patients with DMO in the stage of p re-pro I iterative diabetic retinopathy and in patients resistant to anti-VEGF therapy.

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Clinical and immunological parallels in the diagnosis of primary open-angle glaucoma.

Year: 2017, volume 13 Issue: №2 Pages: 378-383
Heading: Ophtalmology Article type: Original article
Authors: Kamenskikh I.D., Kamenskikh T.G., Kolbenev I.O., Zakharova N.B., Kozletsov A.P., Tuchin V.V.
Organization: Saratov State Medical University, Saratov state university, Yuri Gagarin State Technical University of Saratov
Summary:

The purpose of study is an assessment of the informative value of various diagnostic parameters in monitoring and prognosis of the state of the visual organ in patients with primary open-angle glaucoma. Material and methods. 216 patients (216 eyes) were examined. 126 patients (126 eyes) with the diagnosis of primary open-angle glaucoma I, II or III stage were included in the main group (I), and 90 patients (90 eyes) without ophthalmologic pathology were included in the control group (II). All patients underwent complex examination. Laser confocal scanning tomography for the analysis of the optic disc morphology was performed using a Heidelberg Retina Tomograph II from Heidelberg Engineering (Germany). Evaluation of the field of view was carried out using the computer static perimeter Oculus twinfield-2 (Germany). Electrophysiological studies (apparatus Roland Consult, Germany) included: the study of visual cortical potentials on the outbreak, the pattern-electroretinogram, photopic negative response. Neurotrophic brain factor, ciliary neurotrophic growth factor and protein NF-200, S-100 protein, monocyte chemoattractant, vascular endothelial growth factor were determined in the serum. Results. An increase in the concentration of the S-100 protein with progression of POAG testifies to the existence of parallels between apoptosis of retinal ganglion cells and systemic neurodegenera-tion affecting the central nervous system as a whole. The importance of electrophysiological research methods, which give information about the third neuron of the visual pathway, has been confirmed. Pattern-electroretinogram, photopic negative response most reflect abnormalities in the work of ganglion cells of the retina, including before the appearance of structural changes in the optic disc and the retina. Conclusion. The interrelation of dynamics of functional, morphological and immunological criteria of progression of POAG is revealed, which allows to predict the further course of the pathological process. Since the study involved patients with IOP target values, it is important not only to maintain IOP on target values, but also to carry out neuroprotection.

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Efficiency of nistagmus treatment method using videooculography in a long-term observation

Year: 2017, volume 13 Issue: №2 Pages: 364-369
Heading: Ophtalmology Article type: Original article
Authors: Doroshenko А.А., Radevich S.B., Postelga А.Е., Usanova Т.В., Kamenskikh T.G., Usanov D.A.
Organization: Saratov State Medical University, Saratov state university
Summary:

The purpose of the study was to investigate the efficiency of nistagmus treatment method using videooculography in a long-term observation. Material and methods. 288 patients were examined. The nystagmogram had been record-ering at the time of the patient's admission, every day after the treatment and after the entire course of treatment. The video image had been recordering for 1 minute at the sight of the patient directly. Based on the diagnostic results, there had been determining the following parameters: the main nystagmus frequency, the amplitude of the nystagmus (maximum deviation from the central position). The treatment procedure had been carrying out for 7-10 minutes in average, depending on the degree of decrease in the amplitude of the nystagmus. It is necessary to correct the frequency of light stimulus when the main nystagmus frequency changes. Results. Suppression of nystagmus in patients after a single treatment procedure persisted for different times (from several seconds to several minutes), after which the gradual recovery of the nystagmus occurred before the values of the amplitudes less than before the start of the treatment procedure. The result of repeated procedures was a further decrease in nystagmus amplitudes and an increase in the time of preservation of the suppression effect. One course included 7-10 treatment procedures. On average, for 2 courses of treatment per year in 60% of patients the amplitude of nystagmus decreased by 40-85%, in 30% of patients the amplitude of nystagmus did not change more than 8-12%, in 10% of patients there were no significant changes. Conclusion. The developed method using videooculography is effective in the diagnosis and treatment of nystagmus, as it allows to reveal the frequency of nystagmus of each patient with further treatment by light stimulus of the patient at this frequency and the possibility of its correction.

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