Vol 37, No 2 (2018)

Articles
OPHTHALMOTRAUMATOLOGY IN THE ARMED FORCES (to the 200th anniversary of the Ophthalmology Department of the Military Medical Academy)
Volkov V.V., Kulikov A.N., Reytuzov V.A., Churashov S.V.
Abstract
The Article is devoted to the development of military ophthalmology in our country. It is shown that the development of military ophthalmology is inextricably linked with the history of the first Russian Department of ophthalmology, founded in the military medical Academy 200 years ago. The main milestones in the history of military field ophthalmology are reflected (1 table, bibliography: 29 refs).
Russian Military Medical Academy Reports. 2018;37(2):4-12
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MEDICAL ECONOMIC EFFECTIVENESS OF EARLY VITREORETINAL SURGERY IN THE SYSTEM OF SPECIALTY AND HIGH-TECHNOLOGY MEDICAL CARE IN PATIENTS WITH EYE TRAUMA IN THE CHUVASH REPUBLIC
Arsiutov D.G., Victorov V.N.
Abstract
Objective: to assess the clinical and medical effectiveness of early or early delayed combined microinvasive vitreoretinal interventions using 23-27 G technologies during primary hospitalization of patients with severe eye trauma. Materials and methods. Since 2012, the clinic has developed a concept for early and early delayed combined phaco-vitreo surgery as part of the initial hospitalization of patients with penetrating and contusion eye injuries, including injuries with the presence of various foreign bodies. Results of the study. The clinical component of early combined phaco-vitreo surgery was determined by significantly higher anatomical and functional results. In the complex treatment of patients using the techniques of early and early delayed vitreoretinal 23-27 G and combined phaco-vitreo surgery during one hospitalization, the cost of direct and indirect costs per patient was 63,000 rubles and included 1.6 hospitalizations. Conclusion. Tactics of early and early delayed high-technology combined minimally invasive phaco-vitreo 23-27 G surgery of severe traumatic eye injuries during primary hospitalization allows to obtain significantly higher functional and anatomical results of treatment, to reduce the risk of post-traumatic complications, to reduce by 30% the total number of hospitalizations and by 30% the total cost of treatment in comparison with the tactics of minimal primary surgery and the implementation of vitreoretinal and combined phaco-vitreo operations in the long term (bibliography: 4 refs).
Russian Military Medical Academy Reports. 2018;37(2):12-15
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MODERN APPROACHES TO THE TREATMENT OF CORNEAL ASEPTIC ULCERS
Brzheskaya I.V., Somov E.E.
Abstract
Introduction. Aseptic ulcers of the cornea are among severe, torpid diseases. The aim is to study the etiology and pathogenesis of the corneal aseptic ulcer and determine the tactics of their treatment. Materials and methods. 84 patients (98 eyes) with an aseptic ulcer of the cornea were examined. All patients, in addition to traditional methods of examination, performed optical coherence tomography, determined the area and depth of the ulcer, as well as the lysis activity of the conjunctival fluid. Patients with superficial corneal ulcer defects were treated conservatively in combination with obturation of lacrimal ducts. Patients with deep corneal ulcers performed the closure of the defect with biological tissues (an amniotic membrane, an auto- or allogenic sclera, an autoconjunctival flap “on the pedicle”). The operation was terminated with blepharorraphy or flap coating with a soft contact lens. Results. In all patients with superficial corneal ulcers, it was possible to avoid further progression of the ulcer process and achieve complete epithelialization of the corneal defect. All patients with deep ulcers of the cornea underwent surgical treatment with the closure of a ulcerative defect with a biological tissue. Primarily performed operations were successful at 60 eyes out of 77 (77.9%). In the remaining 17 cases (22.1%), repeated interventions were required. Conclusion. In the treatment of superficial aseptic corneal ulcers, it is useful to combine conservative therapy with the obstruction of lacrimal ducts. All patients with a progressive aseptic ulcer of the cornea need surgical treatment in the form of its coverage with a biological tissue of allo- or autogenous nature. Anterior stromal ulcers should preferably be closed with a free amniotic flap, and the posterior stromal ulcers should be closed with an autoconjunctival flap “on a pedicle” or with a free flap of the sclera. High lytic activity of the tear is the main cause of lysis of biological tissue and a criterion for prescribing local anti-enzyme therapy (bibliography: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):15-18
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CLINICAL-EPIDEMIOLOGICAL ASPECTS OF PSEUDOEXFOLIATION GLAUCOMA IN UDMURTIA
Grigor’eva E.A., Demina A.D., Zaytsev A.L., Zenin A.A., Plotnikova E.K.
Abstract
Pseudoexfoliation glaucoma is one of the most severe forms of glaucoma. We studied clinical features and course of pseudoexfoliation glaucoma in patients residing in Udmurtia, comparing with primary open-angle glaucoma. There were 135 patients under observation, who were divided into two groups. All patients underwent various studies, analysis and comparison of obtained data. Our study allowed us to establish the following: in Udmurtia pseudoexfoliation glaucoma has a high prevalence, there are early and more pronounced degenerative changes in anterior chamber angle, the optic nerve disk, and the cornea with pseudoexfoliation glaucoma. Pseudoexfoliation glaucoma is characterized by rapid progression of glaucoma process and early transition to surgical treatment (bibliography: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):18-21
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COMPARATIVE EVALUATION OF EFFICIENCY OF USE OF INTRAVITREAL DRUGS IN THERAPY OF POSTTHROMBOTIC RETINOPATHY
Kabardina E.V., Shurygina I.P.
Abstract
Objective: conduct a comparative evaluation of the effectiveness of treatment of postthrombotic retinopathy with the use of drugs for intravitreal treatment - anti-VEGF drugs and biodegradable implant “Ozurdex”. Materials and methods. 40 patients (27 women, 13 men) with postthrombotic macular edema who underwent thrombosis of the upper-temporal branch of the central vein of the retina were observed. The age from the onset of the disease was from 1 to 3 months. Two groups were formed: the first group included 20 patients (20 eyes) who received intravitreal administration of an anti-VEGF preparation (ranibizumab); the second group consisted of 20 patients (20 eyes) who received an intravitreal injection of a biodegradable implant containing 0.7 mg of dexamethasone. We selected patients with non-ischemic type of thrombosis of the upper temporal branch of the central vein of the retina for two clinical groups. Results. After the treatment, after 1 month, both groups showed positive dynamics: an increase in the best corrected visual acuity, a decrease in the height and area of spread of the macular edema. In the first group of patients studied, a slight increase in the best corrected visual acuity was observed in 75% of patients a month later, in 60% of patients a slight decrease in the height of postthrombotic macular edema and in 55% of patients a significant decrease in the area of spread of macular edema. In the second group of patients, a significant increase in the bestcorrected visual acuity was observed in 60% of the patients in a month of observation, a significant significant decrease in the height of the macular edema in 70% of patients, and a moderate decrease in the area of the macular edema in 55% of the patients. Conclusion. In the course of the studies it was found that at the beginning of the treatment of postthrombotic retinopathy, it is necessary to approach the choice of the drug for intravitreal therapy individually (bibliography: 4 refs).
Russian Military Medical Academy Reports. 2018;37(2):21-24
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PECULIARITIES OF ANATOMO-FUNCTIONAL STATE OF CHILDREN’S VISION ORGAN WITH MONOLATERAL CONCOMITANT STRABISMUS
Kononova N.E., Somov E.E.
Abstract
Objective: the purpose of our work is to evaluate the initial anatomical and functional status of the visual analyzer of children with monolateral concomitant strabismus. Materials and methods. 35 preschool children with this pathology were examined. Results of the study. It has been established that the visual acuity of the squinting eye for distance is always significantly lower than this indicator on the “leading” eye, and for the near is higher than for distance; the nature of vision is always monocular; possible noncentral or unstable central visual fixation; the parameters of CSFM are naturally lower than on the «leading» eye; OCT of the retina of the eye with incorrect visual fixation in a number of cases revealed changes in the macular zone. Conclusion. The study showed that children with monolateral strabismus are characterized by deep oppression of the visual functions of the squinting eye, so the first efforts should be aimed at combating amblyopia and noncentral visual fixation (2 figs, 3 tables, bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):24-28
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SPECIFIC FEATURES OF LENS CHANGES IN ADULT VICTIMS WITH «PLASTIC BULLET» SYNDROME
Kutukov A.Y., Kutukova2 1 Saint Petersburg State Pediatric Medical University N.V.
Abstract
Objective: to study the changes in the crystalline lens, caused by contusion with plastic bullets, and their further dynamics. Materials and methods. The study group consisted of 22 patients with the syndrome of “plastic bullet”, with the detected changes in the lens, observed in the dynamics from the moment of trauma for 2 to 6 years. Results of the study. The majority of victims received satisfactory results of treatment, which in most cases allowed to avoid surgical treatment of injuries. However, in the future, most patients developed lens opacities that required surgical treatment. Conclusion. Damage to the lens with “plastic bullet syndrome in adults requires close observation, since they often lead to a gradual decrease in visual function in the long term (bibliography: 5 refs).
Russian Military Medical Academy Reports. 2018;37(2):28-31
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FEATURES OF POST-CONTUSION CATARACTS IN ADULTS ABLE-BODIED AGES
Kutukova N.V., Kutukov A.Y.
Abstract
Objective: to study the characteristic features of cataracts in the outcome of severe eyeball contusions, in adults under 60 years of age. Materials and methods. The study group consisted of 32 patients, operated on for post-traumatic cataracts, which appeared at different times after a severe eye contusion. Resats ofthe study. Most patients noted the occurrence of cataract symptoms as early as 1-1.5 years after the injury. The older the patients, the faster the turbidity progressed. Subluxation of the lens was revealed in a significant proportion of them. As a result of surgical treatment, it was possible to practically restore visual functions in all patients. Conclusion. Patients with severe eye contusions need systematic and long-term follow-up, surgical treatment of postcontractive cataracts is often complicated by the presence of subluxation of the lens. In the examined group of patients, there is a tendency to shorten the progression of post-traumatic cataracts with increasing age, however, this issue requires further study (bibliography: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):31-34
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COMBINATION FOR TREATMENT FOR UVEITIS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS
Nikitina T.N., Serogodskaya E.D., Kostik M.M., Gaydar E.V.
Abstract
Objective: to evaluate the efficacy of combination therapy of children with uveitis associated with juvenile idiopathic arthritis, resistant to standard local and systemic therapy with corticosteroids and methotrexate. Materials and methods. We examined 36 children with juvenile idiopathic arthritis, treated in the pediatric and ophthalmology departments of the clinic of Saint-Petersburg state pediatric medical University in 2009-2016 Age of the patients ranged from 4 to 14 years. Before monitoring begins, all patients received regular therapy regarding arthritis with the use of methotrexate for at least two years. When joining the uveitis treatment was added gradually at first, local corticosteroids by injection and instillation of dexamethasone. With no effect or in case of severe course of uveitis added systematically adalimumab. Evaluated the effectiveness of combination therapy for duration of remission, the frequency of exacerbations and severity of uveitis. Results. Using only locally dexamethasone remission of active uveitis occurred an average of 4 weeks, and on the background of adalimumab treatment was achieved after an average of 2 weeks from the start of treatment. The duration of remission of uveitis also increased when using adalimumab in an average of 28 weeks. Marked reduction in the frequency of exacerbations of uveitis: 4 cases per patient in the year before the appointment of adalimumab to 0 on the background of its application. Conclusions. The staged treatment of uveitis associated with Jia, from the local instillation of dexamethasone to the use of adalimumab, may be used to achieve long-term remission and prevent complications (bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):34-37
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EXPERIENCE OF OPTICAL COHERENCE TOMOGRAPHY-ANGIOGRAPHY IN CHILDREN WITH ACTIVE STAGES OF RETINOPATHY OF PREMATURITY
Tereshchenko A.V., Trifanenkova I.G., Erokhina E.V., Tereshchenkova M.S.
Abstract
Objective: to assess diagnostic value of optical coherence tomography angiography in children with active retinopathy of prematurity. Materials and methods. 5 patients (8 eyes) with different stages of active ROP (birth weight 680-1630 g, 25-32 weeks of gestational age) were included into this study. Stage 3 of classic course of retinopathy of prematurity in zone I was revealed in 1 patient, in zone II - in 1 patient, 4A stage in the zone II - in 1 patient. Aggressive posterior retinopathy of prematurity was diagnosed in 2 children, in 1 - at the stage of early clinical manifestations, in 1 - at the stage of manifestation. In addition to the standard examination, patients were undergoing spectral optical coherence tomography and optical coherence tomography angiography. Results of the study. In children with 3 and 4A stages of active retinopathy of prematurity in the zone II, optical coherence tomography angiography revealed no pathological changes in the capillary bed within the central zone of the retina. In patients with 3 stage of active retinopathy of prematurity in the zone I, epiretinal neovascularization was found within the foveal region. At the stage of early clinical manifestations of aggressive posterior retinopathy of prematurity, intraretinal neovascular complexes and multiple arterio-venous anastomoses were found in the superficial capillary plexus in all segments within the perifovea. At the stage of manifestation of aggressive posterior retinopathy of prematurity we found significant alteration of superficial and deep capillary plexuses, dilated and tortuous vessels of the upper temporal vascular arcade associated with multiple intra- and epiretinal neovascular complexes. Conclusion. Optical coherence tomography angiography is a valuable method in diagnosis of active stages of retinopathy of prematurity in infants. The pathological changes identified in this study require further investigation (bibliography: 8 refs)
Russian Military Medical Academy Reports. 2018;37(2):37-40
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APPLICATION OF SECTIONAL MODIFICATION OF THE IRIS-LENS DIAPHRAGM IN OPTICAL-RECONSTRACTIVE SURGERY
Khodzhaev N.S., Sobolev N.P., Shkandina Y.V.
Abstract
Objective: to evaluate the clinical and functional results of the implantation of sectional modification of iris-lens diaphragm in patients with severe post-traumatic pathology of the anterior segment of the eye. Materials and methods. 7 patients (7 eyes) with post- traumatic aniridia, aphakia who were presented for reconstructive surgery were under observation. During the operation the artificial iris (The H1 model, «Reper-NN», Nizhny Novgorod) and an optical element have been consistently implanted to all patients. Due to the lack of safe structures of a capsular bag, the artificial iris was fixed by 3 scleral sutures. Standard and special ophthalmological examinations of patients were made before surgery and 3 months later. Results of the study. After the surgery the uncorrected visual acuity and the best-corrected visual acuity were increased compared with preoperative values. IOP remained stable in all patients, with the implant centered throughout the follow-up period. There were no intraoperative complications. Among the postoperative features, it was worth noting the transient edema of the cornea tissue, which was resolved by the 3-7 day of inpatient treatment. Patients noted a significant decrease of photophobia, undesirable visual effects (glare, halo) and were satisfied with the postoperative cosmetic result. Conclusion. Based on the presented clinical research, the possibility of using the sectional modification of iris-lens diaphragm in optical-reconstructive surgery of the anterior segment of the eye was shown. The prospects of development are the potential to replace the optical element, which is especially important in pediatric ophthalmic traumatology, including the need for spherotorical correction. In the case of preservation of the structures of the capsular bag in patients, it is possible to implant sectional modification of iris-lens diaphragm through surgical access to 2.4 mm, which minimizes the value of induced astigmatism (2 figs, bibliography: 11 refs).
Russian Military Medical Academy Reports. 2018;37(2):40-44
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THE ALGORITHM OF RECOVERY OF VISUAL FUNCTIONS IN PATIENTS WITH SEVERE BURNS THE EYES
Chentsova E.V., Makarov P.V., Petrova A.O.
Abstract
Objective: to assess long-term results of keratoprothesis after strengthening corneal leucome set by our technigue together with developed individual plan for long-term management of patients with burn injury. Materials and methods. The first observation group includes patients who were operated keratoprothesisonly in one or two stages (38 patients). The second group observation includes patients who were operated by our fixed algorithm of prior strengthening corneal leukome (24 ceses). In addition to direct keratoprothesis was done a number of operations on individual rehabilitation plan for each patient. Was held the primary (delayed) surgical necrectomy with revascularization on 55 eyes, fornix reconstruction, eyelid reconstructions on 64 eyes, planned lamellar or penetrating keratoplasty on 6 eyes, antiglaucomatous surgery on 49 eyes, preliminary strengthening of corneal leukoma with on 49 eyes, preliminary strengthening of the leukoma with autologous ear cartilage on 44 eyes). Results of the study. The implementation of multi-stage keratoprothesis which was made by our fixed algorithm with conduction of previous operations by the individualplan reduce the frequency of postoperative complications in different percents. There wasn’t cases of aseptic necrosis and protrusion of keratoprothesis. Conclusion. Patient, that suffered from severe eye burns need long-term therapy, success and stability of the result depends on undivided plan treatment and making mylty-stegykeratoprotesis (bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):44-47
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CLINICAL VARIANTS OF VITREOPAPILLARY TRACTION SYNDROME IN PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY
Babaeva D.B., Shishkin M.M.
Abstract
We observed 60 patients with diabetic vitreopapillary traction syndrome. Depending on clinical implications of vitreopapillary traction syndrome patients were divided into 3 groups: I group - 28 patients with the isolatedvitreopapillary traction syndrome; II group - 27 patients with a vitreopapillomacular traction syndrome; III group - 5 patients with a vitreopapilloretinal traction syndrome with involvement of other departments of retina. All patients examined with А-scan, B-scan kinetic ultrasonography, optical coherence tomography, perimetry and underwent 25 G vitrectomy. The preliminary results of our observations demonstrate that diabetic vitreopapillary traction syndrome at patients in the form of three topographical options with not only involvement of the optic nerve, but also other departments of retina. Timely diagnostics, well-timed vitreoretinal surgery to patients with diabetic vitreopapillary traction syndrome can prevent the involvement of other departments of the retina in this pathological process and stop the progression of the proliferative process. Our assumption about the possible reason for the different flow of the VPTS may be due to the different axial length (1 figure, bibliography: 7 refs).
Russian Military Medical Academy Reports. 2018;37(2):47-50
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RETINAL SENSITIVITY AS AN INDICATOR OF THE EFFECTIVENESS OF TREATMENT OF DIABETIC MACULAR EDEMA IN COMBINATION WITH THE EPIRETINAL MEMBRANE
Bikbov M.M., Fayzrakhmanov R.R., Zaynullin R.M., Kalanov M.R.
Abstract
Objective: to assess changes in the photosensitivity of the central zone of the retina in the dynamics of treatment of diabetic macular edema in combination with the epiretinal membrane. Materials and methods. Vitreoretinal intervention in the volume of subtotal vitrectomy with peeling of the epiretinal membrane and internal limiting membrane was performed in 35 patients (35 eyes) with diabetic macular edema in combination with the epiretinal membrane. The analysis of functional changes in the retina was performed according to microperimetry data on the device («MP1 Microperimeter», Nidek , Italy). Results of the study. Vitreoretinal intervention led to an increase in visual acuity of 2.28 times (p = 0.031). The photosensitivity of the central zone of the retina in the examined patients was 8.44 ± 0.12 dB before the operation, 12.55 ± 0.11 dB after surgery (p = 0.036). When evaluating the distribution by zones, a uniform reduction in the light perception from the periphery to the center was established, due to deformation of the retinal interface due to the contractile capacity of the epiretinal membrane. Conclusion. Performing vitrectomy with peeling of the epiretinal and internal border membrane in patients with diabetic macular edema in combination with the epiretinal membrane leads to an increase in visual acuity and light sensitivity, which confirms the importance of the method of microperimetry in the study of the functional status of the macular zone, and also substantiates the appropriateness of the chosen surgical technique (1 figure, bibliography: 5 refs).
Russian Military Medical Academy Reports. 2018;37(2):50-53
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TACTICS OF SURGICAL TREATMENT OF IMPAIRED PASSAGE OF THE NASOLACRIMAL DUCT IN PEOPLE OF DIFFERENT AGES
Brzhesky V.V., Chistyakova M.N., Raykova A.S., Brzheskaya I.V.
Abstract
Objective: to evaluate the effectiveness of different methods of treatment of patients of different ages with the obstruction of the nasolacrimal duct and determine the rational tactics of their treatment. Materials and methods. A total of 327 patients (394 eyes) were examined: 285 children aged 2 weeks to 18 years with atresection of the nasolacrimal duct (346 eyes) and 42 patients 18-85 years old with a nasolacrimal duct obstruction (48 eyes) acquired or in time not eliminated. Taking into account the age, the children were treated with a therapeutic massage of the lacrimal sac, washing (probing) of the lacrimal passages, and with their inefficiency - bougiezing of the tear ducts (including intubation with silicone thread), dacryocystorhinostomy and lacoprosthetics. Adults performed dacryocystorhinostomy, and in the absence of the effect of repeated such interventions, as well as in cases of previous extirpation of the lacrimal sac - lacoprosthetics. Results. The effectiveness of therapeutic massage of the lacrimal sac is maximum in the first weeks of the child’s life, however, it did not exceed 33%. Complete restoration of sludge removal after probing of the nasolacrimal duct was noted in 93.6%, but only in cases when it was carried out during the period from the second to the fourth month of the child’s life, after bougaining - in 46.7%, bougies with intubation with silicone thread - in 58.3%, after dacryocystorhinostomy - in 77.8%% of cases. In adults, the efficiency of dacryocystorhinostomy performed by external access was 82.4%, and endoscopic endonasal 88.9%. Lakoprosthesis (silicone prosthesis with fixation in the nasolacrimal duct) for children and adults is performed in the absence of the effect of previous plastic interventions. Conclusion. Reconstructive surgery of the nasolacrimal duct has age specificity, characterized by phased implementation of lacrimal sac massage, sensing, bougiezing of the nasol- acrimal duct and dacryocystorhinostomy - in children and dacryocystorhinostomy - in adults. Each subsequent intervention is performed in the absence of the result of the previous procedure. Multiple unsuccessful dacryocystorhinostomies serve as an indication for lacoprosthetics (bibliography: 10 refs).
Russian Military Medical Academy Reports. 2018;37(2):53-57
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ADULT MANIFESTATIONS OF CICATRICIAL PERIOD OF RETINOPATHY OF PREMATURITY
Diskalenko O.V., Konikova O.A., Gaydar M.V., Petrova E.S.
Abstract
Objective: to systematize manifestations, to study the efficacy of treatment of late complications of retinopathy of prematurity. Methods. The analysis of consecutive cases of late vitreoretinal complications of retinopathy of prematurity was carried out according to the requestability in 2013-2017 39 patients (43 eyes). The criteria for inclusion in the studies were a favorable anatomical and functional outcome of the active period of retinopathy of prematurity, stabilization of the disease for a period of not less than 5 years. Results. The main complications of the retinopathy of prematurity in adults were late traction, traction-regmatogenic retinal detachment (69.8%), vitreous hemorrhage (16.3%), recurrent neovascularization, exsudative vitreoretinopathy (13.9%). The anatomical success of surgical treatment of late retinal detachment depended on the stage of retinopathy of prematurity in its active period and amounted to 82.4% in 1-3 stages of retinopathy of prematurity, 53.8% at 4a stage, 23.1% at 4b-5. The reasons of inefficacy resurgery of retinal detachment were severe retinal rigidity, giant breaks in its central sections, and reactivation of fibrovascular proliferation. Conclusion. Late vitreoretinal complications can accompany any stage of the scarring period of retinopathy of prematurity. Their treatment is complex and not always solvable from the perspective of modern possibilities of vitreoretinal surgery (bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):57-61
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THE RESULTS OF SURGICAL TREATMENT OF PTOSIS OF THE UPPER EYELID, ASSOCIATED WITH FATTY DEGENERATION OF THE MÜLLER MUSCLE OF THE UPPER EYELID
Kataev M.G., Dzagurova Z.R., Shatskikh A.V.
Abstract
Objective: to evaluate the results of surgical treatment of ptosis of the upper eyelid caused by a poorly understood cause fatty infiltration of the muscle of Müller of the upper eyelid, confirmed by histopathological method. Materials and methods. The study included 18 patients (18 eyes) with acquired upper eyelid ptosis due to adipose dystrophy of the Müller’s muscle of varying severity. At the preoperative stage, the basic parameters were determined: MRD1, the width of the eye slit, the symmetry of the upper orbitopalpebral fold. Transcutaneous access resection with conjunctival Müller muscle 6-8 mm. For histopathological studies the fragments of the “muscle of Müller-conjunctiva” stained by hematoxylin and eosin, methods of Van-Gieson and of Mallory. Three bioptates of the «muscle of Müller-conjunctiva» complex with unchanged Müller muscle acted as control samples. The percentage of fat and muscle tissue are calculated using morphometric mesh Avtandilov. Statistical analysis: Statistica software, version 10.0. Results. Intraoperatively at the stage of visualization of the complex “Тhe aponeurosis of the levator-muscle of Müller- conjunctiva” was defined dramatic thinning of the levator aponeurosis and thickening layers of tissue in the course of square Müller muscle. Microscopy revealed the morphological pattern of substitution partial fatty degeneration of the smooth muscle tissue. Postoperative MRD1 all patients achieved from +2.5 to +4 mm. The position of the century and remained stable during the whole observation period (11 months). Conclusion. The «muscle of Müller resection of the upper eyelid transcutaneous access to the underlying conjunctiva with ptosis, due to fatty degeneration of the muscle of Müller, giving a stable positive clinical result. The described cause of acquired ptosis is insufficiently studied and requires a differentiated approach to surgical treatment (3 figs, 1 table, bibliography: 10 refs).
Russian Military Medical Academy Reports. 2018;37(2):61-66
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EXPERIENCE IN THE TREATMENT OF ORBITAL COMPLICATIONS OF MAXILLECTOMY
Malinovskaya N.A., Troyanovskiy R.L.
Abstract
Objective: on the example of clinical cases, determine the tactics of managing a patient when orbital complications occur. Materials and methods. There are 2 cases of observation (a girl of 8 years and a boy of 10 years). During the operation of maxilotomy there was a complication - damage of the lower wall of the orbit with subsequent impairment of the mobility of the eye and the development of enophthalmos. Patients underwent standard ophthalmological examination, computed tomography was performed. Operative treatment was performed - orbitotomy, plasticity of the bottom of the orbit. One patient subsequently had repeated interventions to correct strabismus. Results. Enophthalmos, strabismus were eliminated in both cases. Conclusion. Timely evaluation of the clinical picture and CT scan data allows you to assess the severity of damage and determine the tactics of management (8 figs, bibliography: 4 refs).
Russian Military Medical Academy Reports. 2018;37(2):66-71
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THE TECHNIQUE IS EXTENDED SUBTENANCY ANESTHESIA
Marova N.G., Kononov A.V., Klyushnikova E.V., Vasil’ev Y.I.
Abstract
The possibility of use of Sub-Tenon block for vitreoretinal surgery is well described in literature. Modification of this technique with a special catheter to Sub-Tenon space allows to perform prolonged vitreoretinal surgery, providing the adequate level of anesthesia, without rising of risk of development of adverts events not only of local ophthalmic blocks, but also the general anesthesia used at prolonged vitreoretinal surgery (bibliography: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):71-74
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SELECTIVE KERATOPLASTY USING THE FEMTOSECOND LASER
Tereshchenko A.V., Trifanenkova I.G., Dem’yanchenko S.K.
Abstract
Objective: is to assess the reproducibility of the technique of deep anterior lamellar keratoplasty and posterior lamellar keratoplasty using the femtosecond laser. Materiasls and methods. We analyzed the results of posterior lamellar keratoplasty with ultrathin graft and deep anterior lamellar keratoplasty using the femtosecond laser, conducted in the period from 2016 to 2018. Endothelial keratoplasty was performed in 85 eyes of 80 patients. The mean age of patients was 68 ± 12 years. Deep anterior layered keratoplasty was performed in 63 eyes of 61 patients. The mean age of patients was 28 ± 7 years. In the pre- and postoperative period, a complex highly informative ophthalmological examination was carried out. All operations were performed with the femtosecond laser support device on the unit «Femto LDV Z8» ( Ziemer , Switzerland). Results of the study. In patients after endothelial femtokeratoplasty, visual acuity without correction 1 month after the surgery was 0.21 ± 0.03, 6 months after surgery visual acuity was 0.3 ± 0.1 and 12 months - 0.35 ± 0.15. Best corrected visual acuity was 0.25 ± 0.05 1 month after the surgery, 0.5 ± 0.13 - 6 months and 0.55 ± 0.15 - 12 months after the surgery. Endothelial cell loss over 12 months was 21.5 ± 3.7 percent in average. In patients after deep anterior lamellar keratoplasty in a period of 6 months, visual acuity without correction was 0.35 ± 0.05, the GOAT - 0,55 ± 0,1. In 9 months after surgery, the visual acuity without correction was 0.37 ± 0.03, best corrected visual acuity - 0.6 ± 0.15. In a period of 12 months after the operation, visual acuity without correction was 0.35 ± 0,06, best corrected visual acuity was at the level of 0.62 ± 0.15. The value of astigmatism within 6 months after the surgery varied within 3.5 ± 1.0 diopters, and after 12 months astigmatism was 3.0 ± 1.1. Endothelial cell loss during 12 months was 3.4 ± 1.2% in average. Conclusion. The use of a femtosecond laser for various types of keratoplasty could be the basis for the formation of the modern standards of corneal surgery (bibliography: 7 refs).
Russian Military Medical Academy Reports. 2018;37(2):74-77
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FEMTOSECOND LASER REFRACTIVE AUTOKERATOPLASTY - A PERSONALIZED APPROACH
Tereshchenko A.V., Trifanenkova I.G., Dem’yanenko S.K., Erokhina E.V., Timofeev M.A., Golovach N.A., Vishnyakova E.N.
Abstract
Objective: is to develop an algorithm for calculating the parameters of femtoresection of the cornea when performing femtosecond laser refractive autokeratoplasty using personalized mathematical models. Materials and methods. 15 male patients with the diagnosis of keratoconus of the 3rd degree were operated. The average age was 34 ± 6 years. Patients did not notice a decrease in vision for 5-6 years. Mathematical model for calculating the parameters of femtosecond laser refractive autokeratoplasty was developed by us together with the Kaluga branch of the Bauman MSTU. Together with the engineering service of Ziemer Ophthalmic Systems (Switzerland) a specialized software was created that allows to perform two consecutive circular corneal cuts with the specified parameters within the framework of one procedure using femtosecond laser «Femto LDV Z8». Results of the study. In all cases, corneal resection was performed using individual parameters according to the calculations. The keratometry parameters were recorded at the level of 32 ± 4 diopters 1 week after surgery. The depth of the anterior chamber of the eye at this period decreased from 3.59 ± 0.2 to 2.45 ± 0,31 mm. 1 month after the surgery an average keratometry increased to 35 ± 6 diopters. The depth of the anterior chamber had a tendency to restore up to 2.8 ± 0.25 mm. 6 months after the operation the average keratometry was at 41 ± 3 diopters. The depth of the anterior chamber was 3.4 ± 0.1 mm. Indicators of astigmatism 6 months after the surgery was 3.5 ± 1.5 d as compared with initial values of 7 ± 2 diopters. Conclusion. Further studies and larger clinical experience are needed to obtain objective data about the efficacy and stability of refractive results of femtosecond laser autokeraplasty (bibliography: 7 refs).
Russian Military Medical Academy Reports. 2018;37(2):77-81
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RECONSTRUCTIVE SURGERY WITH THE OUTCOMES OF MODERN HOME AND INDUSTRIAL INJURY OF ADNEXA
Filatova I.A.
Abstract
Objective: to evaluate the terms of reconstructive treatment in the outcomes of modern trauma and evaluate its effectiveness in the combination of operations in one stage. Materials and methods. The analysis of reconstructive treatment for the last 5 years was carried out in 97 patients with deformities of eyelids, eyes, sockets and orbit aged 15 to 73 years (m = 39.1 ± 4.9). The period after the injury ranged from 1 month to 3.5 years. A review of the cause of the damage and description of the clinical picture are given. The methods described in combined reconstructive procedures on the eyelids, conjunctival cavity, the orbit with transplantation of free skin grafts, automucous grafts or synthetic implants if necessary. Results. Functional and cosmetic rehabilitation was achieved in all patients with post-traumatic pathology. In all patients with anophthalmos, it was possible to achieve the possibility of stable prosthetics, to restore the correct shape of the eyelids. Conclusion. In modern home and industrial injury combined surgery can reduce the time and increase the efficiency of staged surgical rehabilitation (bibliography: 7 refs).
Russian Military Medical Academy Reports. 2018;37(2):81-84
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AFLIBERCEPT “EYLEA®” FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN REAL-LIFE ROUTINE CLINICAL PRACTICE
Khudaynazarova V.S., Arslanov G.M., Dal’ N.Y., Krasavina M.I., Onishchenko E.S., Panfilova A.N., Chistyakova N.V.
Abstract
Objective: to evaluate the anatomical and functional characteristics of “Eylea®” treatment in patients with «wet» agerelated macular degeneration in real clinical practice. Materials and methods. We was performed a retrospective analysis of the results of treatment of 6 eyes (6 patients) with “wet” age-related macular degeneration. The mean age was 81.8 years (79-88), evaluation criteria were the best corrected visual acuity, central thickness of the retina (central subfield thickness) and the height of the pigment epithelium detachment. Results of the study. After 6 injections, best corrected visual acuity (0.44 ± 0.17) increased and had a statistically significant difference relative to baseline (p = 0.042, p < 0.05). Central subfield thickness after 6 injections decreased to 243.4 ± 33.1 (p = 0.043, p < 0.05). Pigment epithelium detachment after 6 injections (170.4 ± 120.8 microcres) remained stable (p = 0.095, p > 0.05). Conclusion. Improvement and stabilization of anatomical and functional characteristics in the treatment with “Eylea®” in patients with a “wet” form of age-related macular degeneration with the correct dosing regimen allows real clinical practice to be brought closer to indicators that meet world standards in the treatment of this disease (4 figs, bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):84-88
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CORRECTION OF CORNEAL ASTIGMATISM DURING SINGLE-STEP PHACOEMULSIFICATION: FEMTOLASER ARCHUAT INCISIONS AND IMPLANTATION OF TORIC INTRAOCULAR LENSES
Chuprov A.D., Mal’gin K.V.
Abstract
Objective: to compare the effectiveness of astigmatism correction achieved during cataract surgery using the implantation of toric intraocular lenses and peripheral femtolaser corneal incisions. Materials and methods. 60 patients (80 eyes) with lens pathology of different genesis accompanied by corneal astigmatism from 0.75 to 4.5D underwent the surgery. 40 toric intraocular lenses were implanted and femtosecond laser arcuate keratotomy was performed on 40 eyes. Results of the study. In the early postoperative period visual acuity was 0.8-1.0 in both groups. Keratometry, keratopogram in group 1 with toric intraocular lenses did not differ from the preoperative data. The position of the toric intraocular lenses completely coincided with the steep axes (100%). In femtolaser keratotomy group on the 1st day a spherical component from +1.0D to +2.5D remained in 10 cases (25%); a cylindrical component from 1,0D to 2,0D - in 20 cases (50%); and both components were observed in 10 cases (25%). 1 month after the surgery: in group 1 visual acuity remained high 0.8-1.0 in the majority of patients - 35 eyes (87.5%), it was 0.5-0.7 with the correction cylindrical component (±)1,0 in 5 cases; in group 2 visual acuity also remained high 0.8-1.0 in the majority of patients - 36 eyes (90%). 6 months after the surgery: in group 1 due to the rotation of the intraocular lenses without contracture of capsular bag visual acuity decreased in some patients up to 0.5-0.6 with a correction cylindrical component (±)1.0 ± 0.5 - 7 eyes (17.5%); due to fibrosis and capsule contracture it was 0,3-0,4 without correction in 5 eyes (12.5%). In group 2 visual acuity decreased due to fibrosis of the posterior capsule, which did not affect the astigmatism index - 0.5-0.6 without correction in 4 cases (10%), and 0.5-0,6 with correction cylindrical component (±)1.0 ± 0.5 in 4 cases (10%). Conclusion. Phacoemulsification with implantation of the toric intraocular lens and femtosecond laser arcuate keratotomy are effective, safe, controlled ways to correct corneal astigmatism. Femtosecond laser arcuate keratotomy is effective in correcting astigmatism up to 4.5D. Stability of the functional results is higher when corrected using limbal relaxing incisions (bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):88-91
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SAFETY OF UV CROSSLINKING OF THE SCLERA IN EXPERIMENT IN VIVO
Bikbov M.M., Surkova V.K., Usubov E.L., Astrelin M.N.
Abstract
Objective: to assess the safety of the ultraviolet scrleral crosslinking by optical coherence tomography in the experiment in vivo. Materials and methods. The study was performed on 34 Chinchilla rabbits (68 eyes) in vivo . On the right eyes the scleral crosslinking procedure with riboflavin/ultraviolet A was performed, the left ones served as a control. The procedure of crosslinking was carried out as follows: the sclera was saturated with a photosensitizer by instillation of a 0.1% aqueous solution of riboflavin mononucleotide for 20 minutes; then the sclera was irradiated with ultraviolet A (wavelength 370 ± 5 nm, radiation power 3 mW/cm2) for 6 cycles of 5 minutes (total irradiation time - 30 minutes). The photosensitizer solution (2-3 drops) was additionally instilled between the cycles. The state of the layers of the eyeball was assessed using high-resolution optical coherence tomography before ultraviolet crosslinking, in 1 day, week and month after the surgery. Results. Optical coherence tomography did not reveal any pathological changes after the ultraviolet crosslinking of the sclera. The images clearly visualized the layers of the retina, the choroid and the sclera. The performed morphometric analysis did not show statistically significant differences in the thickness of the eye layers between the groups. Conclusion. Ultraviolet scleral crosslinking (irradiation with a power of 3 mW/cm2 for 30 minutes with a preliminary saturation of the sclera with 0.1% aqueous solution of riboflavin) is safe for the eye layers in the experiment in vivo according to optical coherence tomography (1 figure, 3 tables, bibliography: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):91-94
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THE VALUE OF CD4-LYMPHOCETES AND VIRAL LOAD IN THE EYE PATHOLOGY IN PATIENTS WITH HIV-INFECTION AND PULMONARY TUBERCULOSIS
Voronova I.N., Hokkanen V.M., Sanaeva S.I., Zhemkova M.V.
Abstract
A summary of the HIV infection most often develops tuberculosis lung lesion. Often, TB-HIV patients takes a generalized nature. Extrapulmonary tuberculosis occur twice as often in HIV-infected patients. The aim of the study was to determine what is the pathology of the eye occurs most frequently in HIV-infected patients, and the dependence of the number of CD4 cells and the pathology of the eye. Materials and methods. For two years in an urban Protivotuberkuljoznom Dispensary 3084 were surveyed patients with pulmonary tuberculosis, of which 320 patients with HIV infection. Results. Among 320 persons during this period eye disease defined at 55.9%. At 24.6% eye was diagnosed with tuberculosis in active phase of inflammation, 13.4% of tuberculosis defeat eye in the inactive phase of inflammation. Eye lesions diagnosed tuberculosis not at 62%. Conclusion. In HIV-infected patients on the background of the express immunodeficiency syndrome is most commonly diagnosed toxic retinovaskulity and focal peripheral horioretinity tubercular etiology as active and not active phase of inflammation. The number of CD4 cells was such patients 200-300/mm3 and lower. Normal CD4 cells up to 1600/mm3 (bibliography: 10 refs).
Russian Military Medical Academy Reports. 2018;37(2):94-97
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SIMULATION OF WEIGHTLESSNESS AND ASSESSMENT OF ITS INFLUENCE ON VISUAL PERFORMANCE
Dmitriyeva S.V., Gracheva M.A., Vasil’eva N.N., Smoleevskiy A.E., Man’ko O.M.
Abstract
Objective: to assess the influence of weightlessness on visual performance. Materials and methods. The subjects were 10 men from 21 to 43 y. o. All subjects spend 5 days in conditions of microgravity (simulation of weightlessness). To create microgravity conditions, a dry immersion technique was used: the subjects were immersed in a bath of warm water, being separated from the water by a freely floating waterproof elastic film. The characteristics of visual performance were assessed by means of interactive computer program. The subject’s task was to find an object, identical to the target shown at the display center, among several surrounding groups of similar objects. In each series, 3 types of operating conditions were used differing by the degree of crowding: the surrounding objects, among which it was necessary to detect the sought-for object, were presented singly, in groups of 4 objects and in groups of 7 objects. The sizes of the objects varied. Search time and number of identification errors were used to characterize visual performance. Results. Preliminary quantitative assessment of the influence of various factors on the dynamics of visual performance was carried out. The analysis of the data obtained has shown that the following factors could influence visual search performance of the subjects: the transition from “office” testing conditions to immersion conditions and back; learning - development of the skill of working with the program; the sizes of objects; degree of crowding. Conclusions. As a result of the experiment conducted, it was found that, in the case of rather complicated visual tasks (for example, searching for small target in groups), the transition from normal working conditions to immersion conditions led to an increase in the time for the task solving, i. e. to a decrease in visual performance. When analyzing data, it is necessary to take into account the effects of adaptation and learning, whose contribution depends on the parameters of the objects and the operating conditions (2 figs, bibliography: 11 refs).
Russian Military Medical Academy Reports. 2018;37(2):97-102
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INFLUENCE CYCLOPLEGICS FUNDS FOR THE DEVIATION ANGLE IN PATIENTS WITH ESOTROPIA
Efimova E.L.
Abstract
Objective: to evaluate the manifestations of increased esodeviation under cycloplegia in children with hyperopia and esotropia. Materials and methods. 27 children aged 3 to 8 years with a friendly convergentstrabismus and hypermetropicrefraction were taken to be studied. Ophthalmic examination included visometry, retinoscopy before and after cycloplegia, determination of the angle of deviation before and after cycloplegia. To cause the cycloplegia all patients went through instillation of 1% cyclopentolate, 0.5-1% tropicamide or mydrimax 3 times in a row with a five-minute interval. Results. 15 patients (55.6%) had accommodative strabismus, 7 (25.9%) - partially-accommodative strabismus, 5 (18.5%) had non-accommodative strabismus. Seven patients were diagnosed with amblyopia (25.9%). The average index of the manifest refractive was Hm 2.43 D, and the cycloplegic refraction was Hm 3.75 D. The angle of esodeviation before cycloplegia in average was 10 degrees at a long distance and 10 deg. at a close distance. The average angle of deviation after cycloplegia was 15 deg. at a long distance and 20 deg. at a close distance. After cycloplegia eleven patients (40.1%) had an increase of esodevisation, including 7 patients with accommodation and 4 patients with non- accommodation strabismus. Conclusion. Children with accommodative esotropia and hypermetropic refraction often have an elevated angle of deflection after using short-acting cycloplegics. Сycloplegics can cause a different influence on the esodeviation, and the increased angle of esodeviation can be assumed to help to reveal the hidden deviation in some patients with hypermetropia and esotropia (bibliography: 8 refs).
Russian Military Medical Academy Reports. 2018;37(2):102-105
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CLINICAL CASE OF ACHROMATOPSIA WITH MUTATION IN CNGB3 GENE, VERIFIED WITH MOLECULAR GENETIC METHODS
Zol’nikova I.V., Ivanova M.E., Chernyak A.B., Rogatina E.V., Egorova I.V., Rogova S.Y.
Abstract
Objective: to describe a clinical case of achrtomatopsia with mutation in CNGB3 with molecular genetic verification of the diagnosis. Materials and methods. A patient with a rare here ditary retinal disease - achromatopsia was examined. Maximal electroretinogram, electroretinogram to 30 Hz flicker and macular electroretinogram were registered with electroretinograph MBN (Russia). Results. The patient was followed up for 10 with complaints on photophopsia, color vision disturbances and low visual acuity. Вest corrected visual acuity was 20/200OU. Severe color vision disturbance was revealed using Rabkin color vision plates. Severe photophobia, and amplitude pendel nystagmus was present. Nonrecordable 30 Hz flicker proved the lackofcone system function macular electroretinogram to red, green and blue stimulus was alsonon recordable which witnessed the lack of function of all cone types. Cone-rodresponse was of low norm value sandhad a configuration of scotopic electroretinogram, which showed the presence of rod components. Diagnosis «achrtomatopsia» was stated. It was verified after 10 year soffollow-up. Describe dear lierhet gerozy goes mutation in 10th ezone of CNGB3 gene (chr8:87656008AG>A, rs397515360), leading to the frame shift starting from 383 cod one (p.Thr383fs, NM_019098.4). Mutation was describes as compound heterozygote with mutation c.819_826delCAGACTCC (p.Pro273fs, NM_019098.4) in patients with сachtomatopsia, type3 (OMIM: 605080#0002). Conclusion. Etiopathogenetic approach in the diagnostics ofachromatopsia allows correct diagnosis, prevention and developing of new treatment methods considering ethiological factor (bibliography: 4 refs).
Russian Military Medical Academy Reports. 2018;37(2):105-108
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FIRST RESULTS OF EXPERIMENTAL TRANSPLANTATION OF LIMBAL EPITHELIAL STEM CELLS ON FIBRIN SCAFFOLD
Mikhailova V.I., Ponyatovskaya A.P., Alexandrova K.A., Bat’kov E.N., Pozdeyeva N.A., Mukhina I.V.
Abstract
Objective: is developing of method for transplanting cultured limbal epithelial stem cells on a fibrin scaffold with use of soft contact lens in case of limbal stem cells deficiency. Materials and methods. The cultured limbal epithelial stem cells were transplanted on fibrin scaffold. Transplantation of cultivated limbal stem cells deficiency on a fibrin scaffold with use of soft contact lens was performed to rabbit with limbal stem cells deficiency. Results of the study. The recovery of cornea was observed 8 days after limbal stem cells deficiency transplantation, the fibrin scaffold was completely resorbed. The conclusion. The use of a transplant of cultured limbal cells on a fibrin scaffold is a promising method for the subsequent successful keratoplasty in case of limbal stem cells deficiency (3 figs, 8 refs).
Russian Military Medical Academy Reports. 2018;37(2):108-112
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VISUAL PERCEPTION AND DECISION-MAKING, NEW TECHNOLOGIES OF THEIR EVERYDAY ANALYSIS
Moiseenko G.A., Pronin S.V., Shelepin Y.E.
Abstract
Objective: A study of visual perception, decision making and assessment of visual acuity in recognition mode using two different instructions to the observer: 1) classify images by signs of animate/inanimate, 2) classify images on the basis of a clear/fuzzy object. Materials and methods. Method of cognitive evoked potentials, wavelet filtration of images. Results. The instruction can be any, and the experimenter, analyzing the responses of the brain, can evaluate the possibilities of image recognition and decision-making, even if the subject wants to deceive the experimenter. Conclusion. An original method of studying visual perception, decision making and assessment of visual acuity was developed (3 figs, bibliography: 2 refs).
Russian Military Medical Academy Reports. 2018;37(2):112-116
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THE POSSIBILITY OF EXPERIMENTAL MODELING OF THE DIFFERENT PATHOGENETIC TYPES CORNEAL-CONJUNCTIVAL XEROSIS IN REX RABBITS
Popov V.Y., Brzheskiy V.V., Kalinina N.M.
Abstract
Objective: the aim was to design the experimental models of dry eye disease in rabbits of the various pathogenetic types. Materials and methods. Modelling of dry eye disease was carried out on 30 rabbits with the help of transconjunctival injections of the botulinic toxin A into the main lacrimal glands, diathermocoagulation of the excretory ducts of the meibomian glands and a combination of these methods. Estimation of functional parameters, namely, precorneal tear fluid osmolarity, tear film stability by M. Norn sampling, total tearing according to O. Schirmer as well as the intensity of its colouring by lissamine green and fluoroscein sodium. Results of the study. In all cases, on rabbits was developed clinical and functional signs of dry eye disease, manifested by a decrease in tear production, stability of the tear film and increased osmolarity of the lacrimal fluid. At the same time, there were also marked xerotic changes in the epithelium of the eye surface. These clinical and functional changes in the epithelium of the ocular surface were manifested on 3-7 days after xerosis modeling and continued to increase by the 21st day of the experiment. The most pronounced changes in the epithelium of the ocular surface were achieved in rabbits with a combined model of dry eye disease. Conclusion. The proposed methods of modeling the production of tears and/or lipids, can stimulate the development of xerosis of the ocular surface epithelium, which allows to recommend a wide use of this technique as a dry eye disease experimental model (1 tabl., bibliography: 9 refs).
Russian Military Medical Academy Reports. 2018;37(2):116-120
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ARE THERE TRUE REASONS TO CONSIDER ETDRS CHARTS AS A “GOLDEN STANDARD” FOR MEASURING VISUAL ACUITY?
Rozhkova G.I.
Abstract
The charts having different design and containing various optotypes - geometrical forms, sinusoidal gratings letters, figures, simplified object images, textual fragments - are used traditionally in clinical practice for visual acuity assessment. Visual tasks are also various: detection, localization, recognition, reading. The visual acuity values obtained by means of each chart reflect inevitably not only the quality of the images created on the photoreceptor matrix, but also functioning of different brain path- ways tuned to the images of different types. The choice of the chart depends on the aim of measurement. Despite evident impossibility of creating a universal chart, the best in all respects, recently, there appeared a tendency to promote ETDRS charts with letters into clinical and educational practice as some “gold standard” for measuring visual acuity. However, objective optometric qualities of the ETDRS charts as the instruments for clinical examination - comfort of the procedure, accuracy of measurements, test-retest reliability - are not better than of many other charts and their usefulness is limited. In the present work, some shortages of the ETDRS charts are discussed and the necessity of employing different charts for screening, monitoring, diagnostics and expertise is outlined (2 figs, bibliography: 10 refs).
Russian Military Medical Academy Reports. 2018;37(2):120-124
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PSYCHOPHYSIOLOGICAL EFFECTS OF LED LIGHTING IN CONDITIONS OF THE HERMETIC OBJECTS
Smoleevskiy A.E., Man’ko O.M., Bubeev Y.A., Smirnova T.A.
Abstract
Objective: research of psychophysiological effects of LED lighting with different spectral and energy characteristics to justify the advisability of using LED light sources in hermetic objects. Materials and methods. An assessment was made of mental performance, psycho-emotional state, subjective indicators of the quality of sleep of the human operator and the functional activity of his visual analyzer under the conditions of LED lighting with constant and time-varying spectral and energy characteristics (simulating natural diurnal dynamics). Four hermetic chambers with duration of 11.5-12 days were carried out. Results ofthestudy. It is shown that the mental performance of operators in the approved LED lighting modes remained at a high level throughout the exposure period. The integral indicator of mood increased under the conditions of dynamic lighting by 78.9%, and in conditions of constant illumination by 14.1% compared to the background. The negative influence of experimental light regimes on subjective indicators of the quality of sleep and the state after awakening was not revealed. Dynamic LED lighting did not have a significant negative effect on the functional activity of the visual analyzer under the conditions of the hermetic volume. Conclusion. The results of the research indicate the possibility of using light-emitting diodes on board manned spacecraft and other hermetic objects without harm to mental performance, psychoemotional state and sleep quality of crew members (bibliography: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):124-127
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CONTRIBUTION OF PROFESSOR N. PIROGOV, ACADEMICIAN OF THE IMPERIAL MEDICAL-SURGICAL ACADEMY, TO THE DEVELOPMENT OF RUSSIAN OPHTHALMOLOGY
Emelyanova N.A.
Abstract
The article is devoted to the contribution of the academician of Imperial medical-surgical Academy, Professor N. Pirogov’s theory and practice of ophthalmology (1 figure, biblio- graphy: 6 refs).
Russian Military Medical Academy Reports. 2018;37(2):127-130
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PAGES OF HISTORY OF OPHTHALMOLOGY STAVROPOL REGION
Korenyak G.V., Cherednichenko N.L.
Abstract
The article is devoted to the development of the ophthalmologic service of the Stavropol Region. A significant contribution to the development of ophthalmology was played by professors N. M. Pavlov and L. P. Cherednichenko. Currently, microsurgical technologies are actively introduced in the region.
Russian Military Medical Academy Reports. 2018;37(2):130-133
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PAGES OF HISTORY OF THE OPHTHALMOLOGY SERVICE OF THE MANDRYKA CENTRAL MILITARY CLINICAL HOSPITAL OF THE DEFENSE MINISTRY OF RUSSIA
Kuroyedov A.V., Aleksandrov A.S., Sol’nov N.M., Gorodnichiy V.V., Kuroyedova V.Y., Gapon’ko O.V., Kondrakova I.V.
Abstract
Objective: purpose is to study the history of the ophthalmo- logical service of the “Mandryka Central Military Clinical Hospital” of the Defense Ministry of Russia Materials and methods. The study included the data of scientific research in archival materials from 1919 to 2018 research. Methods: historical (historical-genetic), ideographic, historical, historical-typological. Results. The features of the formation and development of ophthalmic care to patients of the of the “Mandryka Central Military Clinical Hospital” of the Defense Ministry of Russia were investigated. The first ophthalmologist was A. I. Kuraev, who was then replaced by A. O. Gromyka. Great contribution to the improvement of ophthalmological care and organization of medical examination made by the chief of the hospital N. M. Nevsky. On his initiative, a new clinical base of the hospital in Krasnogorsk was built and in 1968 a stationary Ophthalmology Department was opened (the first chief of the Ophthalmology Department - N. P. Pureskin). In 1989 in connection with the opening of a new clinical base of the hospital, the Ophthalmology Department began its work. Chiefs of the Ophthalmology Department were: V. D. Antonyuk, S. V. Shishov, N. M. Solnov. Currently, the chief of the Ophthalmol- ogy Department is A. V. Kuroyedov. Conclusion. For 99 years of the hospital’s work, ophthalmic care was provided to tens of thousands of servicemen and their families. According to the results of the last two years (2016-2017), about 4000 patients were treated, more than 3700 operations were performed, including high-tech surgical interventions in glaucoma and combined ophthalmopathology. The Ophthalmology Department actively introduces new diagnostic and therapeutic technologies, improving the previously used methods.
Russian Military Medical Academy Reports. 2018;37(2):133-137
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NIKOLAY GENNADYEVICH IVANOV (TO THE 100th ANNIVERSARY SINCE BIRTH)
Kul’nev S.V., Kryuchkov O.A.
Abstract
Nikolai Gennadievich Ivanov (toward the 100th anniversary of his birth) - This year marks the hundredth anniversary of the birth of a famous figure in the history of the S. M. Kirov Military Medical Academy and military medical science - head of the C. M. Kirov Military Medical Academy (1968-1988) colonel general of the medical service, doctor of medical sciences, professor, academician of the USSR Academy of Medical Sciences, laureate of the USSR State Prize Nikolai Gennadievich Ivanov. This article does not pretend to a complete and detailed description of the biography and professional activities of Nikolai Gennadievich. The authors set a goal to give an idea of N. G. Ivanov, first of all, as a person with a capital letter and his most significant achievements in the development of military medical science, improving the teaching process in the Military Medical Academy. S. M. Kirov and strengthening the international prestige of national military medicine. Also in the article an attempt is made to correct a number of inaccuracies concerning the biography of N. G. Ivanov, found in previous publications (13 figs, bibliography: 13 refs).
Russian Military Medical Academy Reports. 2018;37(2):137-148
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