Vol 15, No 4 (2018)

30 years activity of the Volgograd branch of FSAI NMRC ISTC «Eye Microsurgery named after academician S.N. Fedorov» of Public Health Ministry of the Russian Federation is constantly aimed at improving the efficiency and safety of treating eye diseases which is possible only if innovative technologies are developed and introduced into the practical work of the regional ophthalmological service. The period 1988-2018 of the ophthalmic care provision was analyzed. There were performed more than 610000 laser and surgical operations during this period. Fulfillment of work on the territorial state guarantees program for compulsory medical insurance, application of modern diagnostics methods, monitoring and treatment made it possible to increase the efficiency and availability of primary, specialized, high-tech ophthalmic care.

The authors points of views on the clinical classification, diagnostics with of Goldman lens, and tactics in patients with peripheral vitreochoriretnal degenerations are delivered.

84 patients (150 eyes) with different studies of glaucoma, glaucoma suspects and healthy eyes were examined. Using HRT and OCT similar parameters of the optic disc, peripapillary retina and macula area were studied. Optical coherence tomography (RTVe-100 OCT) and Heidelberg laser retinal tomography (HRT-3) have almost the same opportunities for early diagnosis of glaucoma.

The clinical study involved 55 people aged from 17 to 36 years old with acute optic neuritis (ON) associated with HVI. Data analysis showed that more significant positive dynamics was noted in patients, who received additional muscle injections of Cycloferon. The method of etiotropic therapy at ON, associated with HVI, developed by us, allows to shorten recovery time and improve functional results of treatment.

Frequency of recurrences of increase of intraocular pressure (IOP) in postoperative period of phacoemulsification (PE) using our own surgical techniques at combination of primary open-angle glaucoma (POAG) and age-related cataracts was studied. The clinical material consisted of 83 patients (83 eyes) with developed or far-advanced stages of glaucoma, a rigid pupil, a dense nucleus, a lens subluxation of the 1st degree, which had antiglaucomatous operations. The use of our own methods of performing some stages of PE helped to reduced intraoperative trauma and frequency of recurrence of increase of IOP in period of observation to 3 years.

The development of new diagnostic technologies and modern capabilities of high-tech surgery help determine the optimal tactics for treating patients with cataracts complicated by severe defects of the ligamentous apparatus.

There was performed a study of 36 patients with myopia after scleroplasty (36 eyes). The patients' age is from 5 to 17 years old, average age is (13,4 ± 2,5) years. The combination of accommodation weakness, constantly redundant tension of accommodation (CRTA) and intraocular pressure values in the range of 18 to 23 mm Hg indicates the presence of ophthalmic-hypertensive syndrome of overstretching accommodation and the progression of myopia. The use of 0,005 % solution of Latanoprost (Prolatan) in the complex treatment of patients with myopia leads to normalization of intraocular pressure, increase of corneal hysteresis and rigidity index of corneoscleral tunic, as well as increase in the coefficient of accommodative response and decrease in the coefficient of the ciliary body microfluctuations.

A study of the concentration of stress hormones was conducted in 16 patients with acute and in 18 patients with the chronic form of central serous chorioretinopathy. In patients with central serous chorioretinopathy, there is an increase in blood concentrations of cortisol and 17-OH-oxyprogesterone, a 25-32 % reduction in the concentration of thyroid stimulating hormone with a constant content of thyroxin was detected, а decrease in testosterone concentration and the concentration of melatonin in the urine was significantly reduced. Thus, the obtained data prove the validity of the idea of a close connection and interdependence of the revealed changes in the hormonal regulation in the pathogenesis of central serous chorioretinopathy.

An actual problem in modern ophthalmology is the large number of infected traumatic lesions of the cornea. The study was carried out on 90 mature rabbits of the chinchilla breed, of which experimental groups were formed, included 30 animals (60 eyes) in each group. In order to study the structural changes in the eyes, a morphological study was performed in rabbits. According to the results of the study it was found that the use of antibacterial polymer membranes when used after an infected trauma can be achieved by rapid restoration (on day 5) of the morphological parameters of the cornea to normal values. With the use of standard antibiotic regimens, complete restoration of the cornea occurs on day 7.

This article discusses a clinical case intrachiasmal hemorrhage. Patient V., 51 yo. entered the hospital with complaints of a lack of vision in the right eye, a severe deterioration in the vision in the left eye and a diffuse headache. The examination revealed optic nerve chiasm change having the features of hemorrhage in the subacute phase. During the operation, pay attention significantly increased and gray-blue color optic chiasm and the initial sections of the right optic tract. When dissecting the pial membrane of the chiasm at a depth of 1 mm, a dense cystic formation was found. The masses corresponding to the hematoma in the organization stage are removed from the cavity of the cystic formation. In the early postoperative period, the patient noted an improvement in vision in the left eye. The described clinical case demonstrates the possibility of early decompression of optic and the importance of radical removal of chiasmatic hematomas without significant deterioration of the neurological and visual deficit in the postoperative period.

Gas-liquid chromatography (GLC) is one of the most promising methods of adamantane derivatives analysis due to their sufficiently high volatility and resistance to high temperatures. The purpose of this study was validation of a previously developed technique for assay of gimantan injection by gas-liquid chromatography. Defined validation characteristics were specificity, linearity, limit of detection, limit of quantification, accuracy and precision, also the calculation of technique uncertainty was performed.

The article presents an analysis of regional features of morbidity with temporary disability, disability and mortality of employees of the internal affairs bodies of Russia. The source of the data was medical statistical reports generated by the medical and sanitary units of the Ministry of Internal Affairs of Russia using lexical analysis of medical documentation.

Clinical cases of treating patients with inflammatory genesis of infertility using assisted reproductive technology (ART) techniques with different outcomes are presented. The follicular fluid (VF) was studied in patients with the method of wedgeshaped and marginal dehydration. The outcome of the use of ART technologies was predicted by the structuring of the VF. The introduction of methods into the practice of a reproductive expert will contribute to the ability to determine the readiness of the ovaries to apply the methods of ART, assess the degree of residual metabolic disorders in follicular structures and the organism as a whole, and predict the effectiveness and outcome of ART.

Introduction. Over the past quarter century, revolutionary changes have occurred in the Russian herniology associated with the active introduction of endoprostheses into hernioplasty the use of which reduced the number of relapses to 3-5 %. At the same time, at the site of implantation, a prosthetic-tissue complex is formed, the physicomechanical properties of which determine the number of complications and relapses after surgery. The purpose of this work was to study the physicomechanical properties of the formed prosthetic-tissue complex after implantation of the endoprosthesis. Material and methods. The study of the physicomechanical properties of the prosthesis-fabric complex was carried out on an REM-0.2-1 tensile testing machine on the basis of the research laboratory of the FSBEI HE KSMU of the Ministry of Health of the Russian Federation. The following indicators were calculated: breaking load, relative breaking elongation and tensile strength. Measurements were performed along a looped row and along a looped column. It was taken into account that the indicators of elasticity and relative rupture elongation under load characterized the elastic properties of the endoprosthesis, and the indicator of the ultimate strength - the strength properties of the endoprosthesis. The obtained digital data was processed using the software package Statistica v. 8.0 (StatSoft Inc., USA). Differences were identified at the 0,05 significance level. Results. During the implantation of the endoprosthesis «Gineflex», by the 21st day of the experiment, the prosthesis-tissue complex that was being formed was more elastic under conditions using the PRP technology. The elasticity of the prosthesis «Gineflex» ultralight after implantation was greater, since relative to the initial values, the decrease in elongation of the complex «prosthetic-tissue» with the introduction of autoplasma into the wound, enriched with platelets, ultralight was 7 %. Without the use of PRP technology, the reduction was 10 % along the hinge bar. The study of the strength properties of the emerging prosthetic-tissue complex during the implantation of the Gineflex ultralight revealed large values of the breaking load and, as a result, greater strength along the stitch row and hinge column under the conditions of PRP technology. «Gineflex» ultralight had the greatest strength, the maximum values of the breaking load of which were observed along the stitch column. By the end of the experiment, the breaking load, in comparison with the initial data, increased by 2 times along the hinge bar and 1,6 times along the hinge row. Conclusion. The use of PRP technology in endoprosthesis replacement with the «Gineflex» endoprosthesis ultralight results in a more durable and at the same time elastic prosthetic-tissue complex. Also, when implanted under conditions with the introduction of autoplasma enriched with platelets into the wound under the endoprosthesis, the inflammatory stages change faster and the active regeneration period begins, the morphological substrate of which is the appearance of mature, brightly oxyphilic collagen fibers on the 10th day of the experiment.

The paper presents a comparative analysis and algorithm of clinical and instrumental diagnostics in complex differential cases with pathological changes in the macular area, such as sclerocompression maculopathy (SM) and choroidal hemangioma (CH). It was revealed that the most accessible, non-invasive and highly informative method for the differential diagnosis of SM with GC is high-resolution optical coherence tomography. In difficult diagnostic cases, magnetic resonance imaging of the orbits is recommended. As an additional method for identifying the cause of the development of complicated forms of SM and CH activity, invasive methods such as fluorescent angiography and angiography with indocyanine-green can be used. Differential diagnosis of SM and CH is extremely important for the correct choice of treatment tactics.