Saratov JOURNAL of Medical and Scientific Research

Original article

Clinical and functional results of surgical treatment of regmatogenous retinal detachment by ultrasonic vitrectomy 25G

Year: 2018, volume 14 Issue: №4 Pages: 841-845
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.M., Dibaev T.I., Mukhamadeev T.R., Shatunova A.S.
Organization: Bashkir State Medical University of the Russian Health Care, ZAO Optimedservis
Summary:

Objective: to analyze clinical and functional outcomes of surgical treatment regmatogenic retinal detachment by ultrasound vitrectomy. Material and methods. Clinical and functional results of treatment of 70 patients (70 eyes) with regmatogenous retinal detachment (ROS) who received surgical care in the clinic OPTIMIZED from 2015 to 2018 In the main group (n=33) operations were performed by ultrasound vitrectomy 25G, in the control group (n=37) — by traditional guillotine pneumatic vitrectomy using the tools of the same caliber. During surgery, were analyzed: time of vitrectomy stage (sec), total duration of operation (min), achievement planned anatomical result (%). In the postoperative period (up to 12 months) analyzed: stability of anatomical result (%), maximum corrected visual acuity, intraocular pressure, morphometric criteria retinal conditions (OCT, OCT-angiography), incidence of complicated cataract (%). Results. Average value of vitrectomy stage time in the main group (378.3±125.2 sec) lower than in the control (490.9±175.5 sec), p<0.05. Total duration operations in both groups did not differ, but on average was somewhat shorter in the main group. group (53.6±9.4 and 64.2±23.5 min, respectively). Planned anatomical result in retinal adhesion in all sectors was achieved at the end of the operation in 100% of cases in both groups. No intraoperative complications were recorded in any of the cases. Ultrasonic vitrectomy permits the use of smaller values of the vacuum as on the stage initiation of posterior vitreous detachment (333.3±40.1 mm Hg).St) and at the stage of peripheral vitrectomy (203.2±51.5 mm Hg.art.) compared with traditional vitrectomy, where high vacuum was required: 600 mm Hg.art. at the stage of initiation of ZOST, 305,4±66,4 mm Hg.article on stage of peripheral vitrectomy. The anatomical result remained stable in all terms of the postoperative period in the main group in 100% of cases. In control group relapses of retinal detachment were registered in 8.1% of patients and successfully eliminated conducting an audit of the vitreous cavity. In the late postoperative period the most frequent complication was the development of complicated cataracts (27.1 % in the main group, 40.5% in the control). In both groups, by the 12th month of follow-up, high maximum corrected visual acuity (0.5 and higher in 66.6% of patients and in the main 47.3% of patients in the control group). Conclusion. Comparative study conducted the method of ultrasonic vitrectomy in the surgical treatment of rhegmatogenous detachment the retina has shown that this technique is an effective method that provides and stable anatomical and functional result.

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Effect of cataract phacoemulsification on the dynamics of intraocular pressure in patients with primary open-angle glaucoma

Year: 2018, volume 14 Issue: №4 Pages: 837-841
Heading: Ophtalmology Article type: Original article
Authors: Kolesnikov A.V., Kolesnikova M.A., Mironenko L.V., Baranova O.V., Tarasova N.S.
Organization: Ryazan State Medical University n.a. I.L.Pavlov, Regional Clinical Hospital n.a. N.A. Semashko
Summary:

Purpose: to assess the dynamics of intraocular pressure (IOP) after cataract phacoemulsification (CFE) with intraocular lens (IOL) implantation in patients with cataract in combination with primary open-angle glaucoma (POAG). Material and Methods. The subject of this study was the analysis of IOP after CFE in 65 patients (89 eyes) with cataract in combination with POAG. Among the examined patients, the initial stage of glaucoma was noted in 14.6% cases; developed stage in 55.1 % cases, far-reaching stage in 30.3% cases. IOP was compensated in 84.5% cases, and sub-compensated in hypotensive mode in 15.5% cases. The observation period was from 1 month up to 2 years. Results. In dependence of IOP after surgery, patients were divided into three groups: IOP exactly like in preoperative level, below and above the initial IOP In most cases, at all times IOP corresponded to the preoperative level and after 2 years it was noted in 77.4%. The number of patients with ophthalmotonus below the baseline (1-8 mm) decreased from 63.2% in 1-3 months after surgery to 16.1 % in two years. An increase in ophthalmotonus (by 3-4 mm) was noted in 27% of cases, however, a persistent increase in IOP, which required correction, was 7.9% at stage III of glaucoma, and in the rest of the eyes IOP normalized by itself. Conclusion. According to the results of the study, it can be concluded that there is an ambiguous effect of CFE with IOL implantation on IOP in patients with cataract in combination with POAG, which necessitates further study.

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The effect of intraoperative application of Cyclisporin A on the regeneration of the tissues of the anterior segment of the eye in experimentally induced glaucoma

Year: 2018, volume 14 Issue: №4 Pages: 833-837
Heading: Ophtalmology Article type: Original article
Authors: Zhigalskaya Т.А., Krivosheina O.I., Dzyman A.N.
Organization: Siberian State Medical University
Summary:

Purpose: to study in vivo the features of regeneration of a conjunctiva and sclera after surgery with application of a 0.05% Cyclosporin A against the background of experimentally induced glaucoma. Material and Methods. The experiment was performed in 29 rabbits. At the first stage, the animals were induced with a steroid model of glaucoma by subconjunctival injections of 0.5 ml 0.4% Dexamethasone 1 time per week for 3 months. At the second stage rabbits (24 animals) were subjected to a through incision of the conjunctiva and an incision of the surface layers of the sclera of one of the eyes. Depending on the course of the operation, the animals were divided into the main group and the comparison group. Rabbits of the main group (16 animals) were subjected to local application of a 0.05% Cyclosporin A fora duration of 3 minutes in subgroup "a" (8 animals) and 6 minutes in subgroup "b" (8 animals). In rabbits of the comparison group (8 animals), wasn't used cytostatic. Results. In animals of the comparison group, the inflammatory and reparative reaction, despite the presence of dystrophic changes due to an increase in intraocular pressure, proceeds with the stereotypic dynamics of the change of cellular phases. Using a 0.05% Cyclosporin A suppresses the migration of cells from different populations to the surgical zone, increasing the duration of the macrophage reaction phase and slowing down the transition to the regeneration phase. Conclusion. Using of 0.05% Cyclosporin A during surgical intervention slows down the repair of the tissues of the conjunctiva and sclera, preventing pronounced fibroblation in the area of surgical trauma, which can be an effective way to prevent scarring during antiglaucoma operations.

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Modifications of trabeculectomy in glaucoma treatment

Year: 2018, volume 14 Issue: №4 Pages: 831-833
Heading: Ophtalmology Article type: Original article
Authors: Kiseleva О.А., Bessmertny A.M., Suleiman Е.А., Lugovkina K.V.
Organization: Moscow Helmholtz Research Institute of Eye Diseases
Summary:

Purpose: to study efficacy of new trabeculectomy modifications for surgical treatment of primary open- angle glaucoma (POAG). Material and Methods. 49 patients with POAG (49 eyes) aged 51-73 years underwent modified surgery. The main technique of first new modification includes preparation of scleral flap, excision of trabecular tissue along the scleral spur, torsion of scleral flap for 180° and reposition of scleral flap in its original bed secured with interrupted nylon sutures (group 1). The main technique of second new modification includes preparation of scleral flap, excision of trabecular tissue, sewing of scleral flap in the middle with resorbable thread and tightening it into folds. Reposition and fixation of scleral flap and conjunctival flap closure completes the operation (group 2). The efficacy of new modifications of trabeculectomy was assessed during 12 months using complete ocular examination, optical coherence tomography of the anterior segment of the eye (ASOCT) in the early postoperative period and ultrasound biomicroscopy (UBM) subsequently. Results. One month after the surgery average intraocular pressure (ave. IOP) was 10.1±1,9 mmHg in group 1 and 11.2± 1.8 mmHg in group 2 (M±a). At 6 months this parameter was 12.6±3.0 mmHg (group 1) and 13,3±2,7 mmHg (group 2). At 12 months ave. IOP was 15.9±4.1 mmHg (group 1)and 17.3±2.7 mmHg (group 2). Conclusions. The newly developed modifications of trabeculectomy allow to obtain a prolonged hypotensive effect after surgical treatment of POAG.

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Glaucoma incidence analysis and prognosis in adult population of Bashkortostan Republic

Year: 2018, volume 14 Issue: №4 Pages: 825-828
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Zagidullina A.Sh., Fakhretdinova E.V.
Organization: Bashkir State Medical University of the Russian Health Care
Summary:

Purpose: to analyze the general and primary incidence of glaucoma in the adult population in the Republic of Bashkortostan over the 2010-2017 period; make a medium-term forecast for five years. Material and Methods. The analyzed data was based on official statistics of the Ministry of Health of the Russian Federation over the 2010-2017 period. The level of general and primary incidence per 100 thousand population was estimated; the five-year forecast for glaucoma incidence was simulated using mathematical modeling. Results. The Republic of Bashkortostan had the highest rate of general and primary glaucoma incidence in the adult population as compared with the incidence rate in the Russian Federation. The Republic of Bashkortostan ranks first in the absolute number of patient with glaucoma and fourth ranks in general incidence per 100 thousand comparing with Volga Federal District data. The level of general glaucoma incidence in the adult population increased by 23.0% over the 2010-2017 period and primary incidence — by 47.0%. The five-year simulated forecast predicts possible further growth of general and primary glaucoma incidence in the republic by 2022. Conclusion. The performed analysis and simulated forecast of general and primary glaucoma incidence for the adult population in the Republic of Bashkortostan show growth trends.

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Experimental analysis of destructive ability of vacuum pulsation in cataract phacoemulsification

Year: 2018, volume 14 Issue: №4 Pages: 817-820
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Dibaev T.l., Mukhametov R.G.
Organization: Bashkir State Medical University of the Russian Health Care, ZAO Optimedservis
Summary:

 The purpose of the work. To evaluate the destructive ability of vacuum pulsation in cataract phacoemulsification. Materials and Methods. The experiments were performed on 40 separate pig eyes, in which cataract was induced in 3 stages of density according to the WetLab method. In the study group (n=20), phacoemulsification was carried out using a vacuum pulsation generation unit, in the control group (n=20) by the method of traditional ultrasonic phacoemulsification. For comparison of the two methods in both groups, the time of complete destruction of the lens fragment in seconds was recorded. Results. The average time of destruction of a 5x5 mm fragment of the lens, using vacuum pulsation was 23.6±4.9 seconds, for traditional ultrasonic phacoemulsification 17.7±8.9 seconds (p<0.05). Vacuum pulsation has a destructive power, but at the same time requires further refinements to increase the efficiency of phacoemulsification. Conclusions. Phacoemulsification based on vacuum pulsation is promising for further study, since it has a destructive ability. This method does not imply the use of high-energy effects, due to which there are no prerequisites for heating the tunnel incision and negative effects on the corneal endothelium.

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Lens densitometry in ultrasonic cataract phacoemulsification

Year: 2018, volume 14 Issue: №4 Pages: 815-817
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Dibaev T.l., Munasypova V/V., Khamidov U.B., Mukhamadeeva O.R.
Organization: Bashkir State Medical University of the Russian Health Care
Summary:

Purpose: to evaluate the effectiveness of using Pentacam HR sheimpflug camera for objective determination of cataract density. Material and Methods. The subject of the study was the method of determining the density of the lens (densitometry) by the Pentacam HR sheimpflug-camera. The object of the study were patients with age-related cataracts (147 eyes). All patients underwent ultrasound phacoemulsification with implantation of various types of intraocular lenses (IOL). Before treatment, the density of the lens was determined by non-contact method using PNS (Pentacam Nucleus Staging). During the surgery, the density of the lens was determined by the surgeon on a set of factors: the color of the nucleus, the mechanical density, the emulsification easiness. The equivalent ultrasound time and the fact of compliance or discrepancy in the degree of density of the lens with two methods of its determination were recorded for each patient. Results. It was found that the density of the lens recorded by the Pentacam HR is in a direct strong correlation with the equivalent ultrasound time. It was shown that the discrepancy between the PNS method and the contact method performed by the surgeon significantly lengthens the surgery time. Conclusion. The Pentacam HR sheimpflug-camera is an accurate method of determining the density of the cataract before the surgery. The advantage of this method is that it is non-contact, quick and relatively easy-to-perform with the possibility of objective assessment.

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Clinical performance of system for ultrasonic cortex aspiration during phacoemulsification

Year: 2018, volume 14 Issue: №4 Pages: 811-815
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Dibaev T.I., Mukhamadeev T.R., Idrisova G.M.
Organization: Bashkir State Medical University of the Russian Health Care, ZAO Optimedservis
Summary:

Purpose: to study the performance and safety of the use of system for cortex aspiration with the possibility of additional dosed low power ultrasound during phacoemulsification. Material and Methods. The comparative evaluation of developed system for cortex aspiration with the possibility of additional dosed low power ultrasound (main group, n=36, ophthalmological surgical platform Optimed Profi) and the traditional system for cortex aspiration (control group, n=40, ophthalmological surgical platform Centurion Vision System) were performed. Results. Using the system for cortex aspiration decreases mean time of cortex aspiration. In the main group the mean time of cortex aspiration was 72.6±24.3 s, in the control group 93.9±48.0 s (p<0.05). Intraoperative complications were not observed in the main group. Posterior capsule rupture was detected during the cortex aspiration in 1 patient (2.5%) in the control group. Conclusion. The system for cortex aspiration with the possibility of additional dosed low power ultrasound allows decrease the time of cortex aspiration, to create conditions for a safer removal of cortex, compared with traditional technology.

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Clinical efficacy of using autocytokines in surgery for bullous keratopathy

Year: 2018, volume 14 Issue: №4 Pages: 805-808
Heading: Ophtalmology Article type: Original article
Authors: Denisko M.S., Krivosheina O.I.
Organization: Grand Retina LTD, Siberian State Medical University
Summary:

Purpose: to study clinical efficacy of a surgical modality of treatment for bullous keratopathy (BK), which is based on cell technology and involves intrastromal injection of autologous mononuclear leukocytes suspension, in comparison with medical therapy. Material and Methods. All patients with BK in this study were divided into two groups: treatment group, which consisted of 14 subjects who underwent intrastromal injection of autologous mononuclear leukocyte suspension; and control group, which included 13 subjects who received conservative treatment. Results. In treatment group corneal edema significantly subsided 1 month after treatment, which was accompanied by a decrease in corneal thickness by 24% and a 3.4-fold increase in visual acuity. After 6 months pachymetry index decreased by 32.8% from the initial value, visual acuity increased 10-fold from the initial value as well, and these parameters remained stable for 8 months. In control group, biomicroscopic pattern and pachymetry index had unstable dynamics, which was accompanied by only a 2.7-fold maximum increase in visometry after 1 month with a gradual decrease observed later on. Conclusion. Our method of surgical treatment for BK which involves injection of suspension of autologous mononuclear leukocytes into a posterior third of corneal stroma leads to a faster relief of corneal syndrome symptoms, restoration of normal corneal thickness within reference values and to a significant and stable increase in visual acuity when compared to a course of medical treatment.

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Correction of the dry eye syndrome of professional etiology using a complex of mitochondrial substrates and co-factors

Year: 2018, volume 14 Issue: №4 Pages: 799-804
Heading: Ophtalmology Article type: Original article
Authors: Anisimova S.G., Mazina N.K., Abramova T.V.
Organization: Kirov Regional Clinical Hospital, Kirov State Medical University
Summary:

Aim: to evaluate the effect of the drug Cytoflavin (CFL), containing mitochondrial substrates and co- factors, on tear production in arc welders, gas welders and office workers with dry eye syndrome (DES). Material and Methods. 124 patients (248 eyes) with DES of professional etiology were enrolled in this study. Patients of the experimental group (CFL) took three 25-day courses of cytoflavin separated by 1 month intervals, while the control group received placebo. Results. Reception of CFL over 3-month cycles with intervals of 30 days contributed to an increase in visual acuity (VA) by 29,0-34,0%, Schirmer's test (ST) by 27.0-51.0%, and Norn's test (NT) by 7.5-11.0%, meniscus measurements (MM) by 32.0-37.0% and lower indices of intraocular pressure (IOP) by 3-5% in both occupational groups. Conclusion. The resulting increase in values of parameters characterizing the functional activity of the lacrimal gland under the action of the CFL suggest that pharmacological energy protection contributes to the improvement of tear production and eye hydrodynamics in welders and office workers.

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