Saratov JOURNAL of Medical and Scientific Research

Original article

Realization of the «Health care» national project in the initial stages: telemedicine consultations conducted with the use of the unifed state health care information system

Year: 2019, volume 15 Issue: №2 Pages: 572-576
Heading: Ophtalmology Article type: Original article
Authors: Chukhrayov A.M., Khodzhaev N.S., Kechin E.V.
Organization: The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to analyze the structure of telemedicine consultations (TMС) implemented using the «Telemedicine con-sultations» component of the subsystem of the federal electronic registry of the unifed state health care information system (component of TMС FER USHIS) for the period from 01.01.2019 to 31.03.2019. Material and Methods. The study was carried out according to the reporting forms of the component of TMС FER USHIS. Results. In total, 490 TMK of the «doctor — doctor» type were carried out, of them: 306 (62.5 %) — ophthalmologist consultations; 158 (32.2 %) — rehabilitologist consultations; consultations of a phthisiatrician, endocrinologist, pediatric surgeon, pediatric oncologist, cardiologist, cardiovascular surgeon, radiotherapist in total 26 (5.3 %). Consultative medical organization was S. Fe-dorov Eye Microsurgery Federal State Institution in all conducted TMC of ophthalmology. In the Russian Federation, in 72.9 % TMC cases of an ophthalmology profle was conducted to determine treatment tactics, 10.5 % to determine the diagnosis, and 10.5 % to agree on conditions and hospitalization in a federal medical organization, the other aim of the consultation were 6.1 % in total. TMC according to the «Ophthalmology» profle was performed with 37 regions of the Russian Federation, with 48 regions were not carried out. Conclusion. The analysis of the TMC structure showed that it is necessary to carry out further work on the implementation of the TMС FER USHIS component in medical organizations of the Russian Federation regions.

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Application of multivariate statistical analysis for evaluation of management of ophthalmological care to the population of the Orenburg region

Year: 2019, volume 15 Issue: №2 Pages: 568-572
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Lositsky A.O., Trubnikov V.A.
Organization: Orenburg branch of S. Fedorov Eye Microsurgery Federal State Institution
Summary:

The purpose of this study was to identify and study clusters (groups) of medical organizations of the Orenburg region with similar parameters, refecting the level of organization of ophthalmic care to the population. Material and Methods. The proposed method of evaluation is based on the use of the method of multivariate statistical analysis of the structure and activity of ophthalmological units of primary health care of the Russian Federation, with the allocation of groups of structures under research with similar evaluation characteristics and graphic representation of the results. Evaluation criteria are: availability of specialized ophthalmological care for the population, stafng level, overall and primary disease incidence, incidence on separate nosological groups, general and primary disability indicators. Results. Based on the data representative of the organization of ophthalmic care 50 medical organizations of the Orenburg region, providing primary health care were divided into 3 clusters. Indicators of the ophthalmic care management for each of the clusters were characterized. Conclusion. The results of the study allow us to identify groups of medical organizations that require diferent approaches in management decision-making in order to improve the ophthalmological service of an individual subject of the Russian Federation.

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Corneal endothelial cells condition after thermokeratocoagulation in a long-term period.

Year: 2019, volume 15 Issue: №2 Pages: 566-568
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Kuznetsov I.V., Pasikova N.V., Kuznetsova V.I.
Organization: Orenburg branch of S. Fedorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the research was to assess the quantitative and qualitative state of the corneal endothelium after thermokeratocoagulation in a long-term period. Material and Methods. The main group consisted of 18 patients (36 eyes) after thermokeratocoagulation, which was performed from 19 to 28 years ago. The control group consisted of 22 patients (44 eyes) aged from 45 to 58 years (middle age 51.3±3.2 years) from refraction and axial hypermetropy various degree without the previous surgical interventions. The research was performed on a non-contact mirror scanning microscope EM-3000 (Tomey, Japan). Results. The endothelial cells density in the main group averaged 2245.4±316.2 cells / mm2, in the control group 2661.7±169.2 cells / mm2 (p<0.05). The coefcient of endothelial cell size variability counted 0.34, in the control group 0.26 (p<0.05). The percentage of hexagonal corneal endothelial cells in patients after thermokeratocoagulation averaged 53.7±14.9 % in patients of the control group 74.3±6.5 % (p<0.05). Conclusion. In the long-term period patients showed a statistically signifcant decrease in the corneal endothelial cells density, a decrease in the percentage of hexagonality and an increase in the coefcient of cell size variability.

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Eyesight condition in frst-year pupils

Year: 2019, volume 15 Issue: №2 Pages: 563-565
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Voronina A.E.
Organization: Orenburg branch of S. Fedorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to determine the characteristics of eyesight in frst-year pupils. Material and Methods. Parents were initially interviewed to establish the presence and severity of symptoms of dry eye syndrome in their children. The second stage involved ophthalmologic examination which included non-contact autorefractometry on Plusoptix A09 device and checking visual acuity with and without correction. Results. Autorefractometry revealed emmetropia in the majority of cases (79.16 %), myopia was identifed in 3.34 %, accommodation disturbance — in 11.25 %, hypermetropia — in 3.75 %, astigmatism — in 2.5 %. Visual acuity test in the majority of children revealed the maximum acuity, while visual acuity of less than 0.5 was detected in 5.4 % of frst-year pupils. A survey for symptoms of dry eye syndrome showed minimal manifestations in frst-year pupils from 0 points for the majority, up to 8 points. The most frequent complaint among the respondents was hypersensitivity to light (33.75 %) and frequent eye infammation (23.3 %). Watching TV was the most frequently reported visual workload. Conclusion. The majority of frst-year pupils (78.3 %) had high visual acuity of 1.0; 3.34 % of the children had myopia; 11.25 % had accommodation disturbance.

Efect of FemtoLASIK on the condition of accomodation and vis-coelastic properties of the cornea in patients with myopic refraction

Year: 2019, volume 15 Issue: №2 Pages: 555-559
Heading: Ophtalmology Article type: Original article
Authors: Fokin V.P., Solodkova E.G., Kuznetsova O.S., Balalin S.V.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, the Volgograd Branch
Summary:

The purpose is to study the efect of FemtoLASIK operation on the state of accommodation, intraocular pressure and viscoelastic properties of the cornea in patients with myopic refraction. Material and Methods. Examined 84 patients (84 eyes) with myopia degrees before and after the operation Femtolasik. Results. In patients with mild myopia after Femtolasik, there was a decrease in the coefcient of accommodation microfuctuation (CAM) by 3.6 % and an increase in the coefcient of accommodation response (CAR) by 28.6 %, in patients with moderate myopia there was a decrease in the values of CAM to 11.1 % and an increase in CAR to 30 %, in patients with myopia of high degree of CAM increased by 14.4 %, and CAR 34 %, respectively. The decrease in the values of corneal-compensated intraocular pressure (IОPcc) was statistically signifcant. In the frst group decrease IОPcc amounted to 17.1 % in the second group 17.3 %, in the third of 25.8 %. Conclusion. An improvement in the state of accommodation is observed against the background of a decrease in the indicators of corneal- compensated intraocular pressure after performing the operation FemtoLASIK.

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Long-term results of the combined treatment of severe forms of proliferative diabetic retinopathy

Year: 2019, volume 15 Issue: №2 Pages: 550-555
Heading: Ophtalmology Article type: Original article
Authors: Tereshhenko. A.V., Sidorova Yu.A., Zhukova O.M., Firsova V.V.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, Kaluga Branch
Summary:

Purpose: to evaluate the results of fve-year follow-up of patients with proliferative diabetic retinopathy after combined treatment using intravitreal administration of angiogenesis inhibitors and subtotal panretinal laser coagulation of the retina. Material and Methods. The study included 42 patients (42 eyes) with severe forms of proliferative diabetic retinopathy. In all cases, the frst step was intravitreal administration of an angiogenesis inhibitor (IVV AI) of-label. The second stage was carried out sessions of panretinal laser coagulation (PRLK), with the frst session — no later than two weeks after the IVV AI. Subsequent sessions of laser treatment were carried out with an interval of 1.5–2 months before the completion of subtotal PRLK (3 sessions). In the course of further follow-up, additional treatment was performed as necessary. The observation period was 5 years. Results. By the end of the observation period, complete regression of retinovitreal neovascularization and neovascularization of the optic nerve head was observed on 39 and 32 eyes (92.8 and 76.2 % respectively). During the observation period, all patients underwent subtotal PRLK, additional sessions of laser treatment were required in 19 cases (45.2 %), of which in 12 cases 1 additional session was performed, in 7 cases — 2 sessions of PRLP each. IVV AI was performed once in all cases, in 11 cases (26.2 %) additional injections were required, with the largest number of injections performed during the frst 2 years. Conclusion. The proposed algorithm for the management and treatment of severe forms of proliferative diabetic retinopathy has demonstrated its efectiveness, as evidenced by fve-year observation data.

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Comparison of the efcacy and safety of the elaborated combined laser technology and «grid» laser photocoagulation in patients with the initial stages of the idiopathic epiretinal membrane

Year: 2019, volume 15 Issue: №2 Pages: 546-550
Heading: Ophtalmology Article type: Original article
Authors: Takhchidi K.P., Kachalina G.F., Kasmynina T.A., Tebina E.P.
Organization: Russian State Medical University
Summary:

Purpose: to evaluate the efectiveness and safety of the developed combined laser technology in comparison with «grid» laser photocoagulation in the treatment of patients with the initial stages of the idiopathic epiretinal membrane. Material and Methods. The analysis of two groups of patients was carried out. The frst group (32 patients (32 eyes)) was treated using the developed combined laser technology; the second group (30 patients (30 eyes)) was treated using grid» laser photocoagulation. The assessment uncorrected visual acuity, best corrected visual acuity, central retinal thickness and central retinal sensitivity was performed. The maximum follow-up is 5 years. Results. In the frst group of patients the maximum visual-functional results (UCVA, BCVA, CRS) were obtained from 3 to 12 months, followed by their stabilization until the end of the observation period. The CRT gradually decreasedduring all observation period. In the second group of patients a short-term positive efect was achieved up to 3 months of observation with an increase UCVA, BCVA, CRS. 12 months post op there was increasing of CRT with decreasing UCVA, BCVA, and CRS until the end of study. Conclusion. The technology of combined laser treatment showed high efciency in comparison with «grid» laser photocoagulation with stabilization / increase of UCVA, BCVA, CRS and stabilization / improvement of the morphological parameters of the retina — the decrease of CRT.

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The frst results of combined treatment of central serous chorioretinopathy using subthreshold micropulse laser exposure with 577 nm wavelength and injections of platelet autoplasma

Summary:

Aim: to compare the efects of a combination of subthreshold micropulse laser irradiation (SMPLI) with injections of autologous platelet plasma (PP) in the region of the pterygopal fossa on the afected side with the efect of SMPLI in central serous chorioretinopathy (CSСR). Material and Methods. This study was conducted on 60 patients (60 eyes) with CSCR. Patients were divided into 2 groups: in the comparison group patients received treatment only with SMPLI with a wavelength of 577 nm. In the experimental group patients received SMPLI with TP injections. TP was started after 72 hours, with 3 injections into the area of pterygopalatine fossa in the afected eye, with an interval between injections of 72 hours. Ophthalmologic examination, OCT and fuorescent angiography were carried out before treatment and 1, 3, 6 and 12 months after treatment, and ELISA assessment of IL-4, — 6 and -17A levels in lacrimal fuid was performed. Results. In the experimental group, where SMPLI+TP were performed, visual acuity has signifcantly improved, thickness of central section of macula was noted to have been decreased, and photosensitivity of central zone of retina signifcantly improved when compared to the SMPLI group. In the SMPLI+TP group the levels of IL-4, IL-6 and IL-17A in tear fuid increased. SMPLI was performed using Supra 577 nm laser device (Quantel Medical, France) over the entire area of macular edema. Conclusion. SMPLI+PRP treatment in patients with acute CSCR is efective for restoration of visual function.

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The results of femtolaser scleropuncture in experiments on isolated animal tissue (preliminary report)

Year: 2019, volume 15 Issue: №2 Pages: 536-539
Heading: Ophtalmology Article type: Original article
Authors: Smetankin I.G., Vasilyeva A.E.
Organization: Privolzhskiy Research Medical University
Summary:

The purpose of the study is to evaluate the results of femtolaser sclerotomy in the experiment on isolated eye of animal, as well as the prospects of applying the method of laser transscleral puncture of the sinus canal of sclera. Material and Methods. We performed a series of experiments on fresh scleral tissue of isolated pig eyes using industrial femtosecond laser PH-1SP with a wavelength of 1028 nm, pulse energy of 0.5–1.5 MJ, frequency of 1–20 kHz. Series of 10–15 pulses with duration less than 100 FS were performed. In order to assess the depth of femtosecond laser exposure to scleral tissue, as well as the quality of the obtained punctured holes, histological preparations were made, studied using routine light microscopy with multiplicity of magnifying up to ×400. Serial sagittal and frontal sections 15 µm thick and hematoxilin eosin staining were used. Results. Puncture channels of diferent confgurations with a minimum marginal coagulation of no more than 5 microns were obtained due to the efect of ablation of the scleral tissue. The maximum depth of the formed channels is 500 microns at a power of 1.5 MJ and a frequency of 10 kHz. Since the thickness of the scleral tissue of the human eye in the limbal zone is 600–800 µm, there is prospect of using a femtosecond laser for the laser transscleral puncture of the schlemm channel. Conclusion. The infuence of femtosecond laser on tissue of sclera is characterized by the almost complete absence of heat, the coagulation efect and the pronounced depth of the ablation, thus it is possible to discuss the use of femtosecond laser for the laser transscleral puncture of the sclera sinus channel.

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Comparative analysis of the application of the above- threshold laser coagulation and micropulse laser exposure in central serous chorioretinopathy

Year: 2019, volume 15 Issue: №2 Pages: 532-536
Heading: Ophtalmology Article type: Original article
Authors: Popova N.V., Fabrikantov O.L., Goydin A.P.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

Purpose: to determine the efectiveness of above-threshold (focal) laser coagulation and micropulse laser exposure (MPLV) in patients with central serous chorioretinopathy (CCA). Material and Methods. 91 people with a diagnosis of CCA were examined. The median age was 35.2 years. Patients of the 1st group (n=19) was performed MPLV a wavelength of 810 nm; group 2 (n=31) — about threshold photocoagulation with the wavelength of 810 nm. Control group — 50 people with a natural course of the process. Results. After 1 month after treatment in group 1, visual acuity increased from 0.5±0.08 to 0.8±0.03. According to optical coherence tomography (OCT), the neuroepithelial detachment decreased from 446 to 341.3 MK. With the chronic course of the process after laser treatment, recurrence of the disease was revealed, which required an additional session of MPLV. In group 2, after 1 month, visual acuity increased from 0.6±0.20 to 0.8±0.03, neuroepithelial detachment decreased from 365 to 269 MK. Relapse of the disease in chronic form required an additional session of MPLV. After 3 months, both groups showed complete adhesion of the neurosensory retina and increased visual acuity to 0.9±1.0. Conclusion. Laser coagulation (above- threshold laser coagulation, micropulse laser exposure) is minimally invasive and highly efective in the treatment of central serous chorioretinopathy. The choice of laser treatment method depends on the

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