Vol 37, No 2 (2018)

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).

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).

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).

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).

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)

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).

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).

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).

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).

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).

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).

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).

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).

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).

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).

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).

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).

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.

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).