Vol 10, No 2 (2017)

Aim. To compare the efficacy, safety, and predictability of simultaneous hyperopia and presbyopia correction using photorefractive keratectomy (PRK) with the application of a bi-aspheric multifocal profile on the cornea using PresbyMax software and hyperopia correction using LASIK.

Methods. Overall, 50 patients were divided into two groups: 25 patients (50 eyes) in group 1 underwent PRK with bi-aspheric multifocal profile application on the cornea using PresbyMax software for simultaneous hyperopia and presbyopia correction. Group 2 included 25 patients (50 eyes) who underwent LASIK with aspheric profile application on the cornea for hyperopia correction.

Results. One year after surgery in group 1, binocular distance uncorrected visual acuity (DUCVA) was 0.96 ± 0.16, near uncorrected visual acuity (NUCVA) was 0.77 ± 0.17, and intermediate uncorrected visual acuity (IUCVA) was 0.64 ± 0.15. Visual acuity loss of up to 0.2 was found in two eyes (4%). Target refraction in the dominant eye (emmetropia) was obtained in 72% of patients; in 28% of cases, a shift up to –0.75 D was observed. Target refraction in the non-dominant eye was found in 68% of patients, 12% of patients had a shift from the target refraction of –0.50 D, and 20% of patients of –0.75 D. Spherical aberration in the 6-mm zone was –0.22 ± 0.17 μm. One year after surgery in group 2, binocular DUCVA was 1.0 ± 0.10, NUCVA was – 0.37 ± 0.16, and IUCVA was – 0.43 ± 0.12. No monocular best corrected distance visual acuity loss was found. A myopic shift from the planned target (emmetropia) of –0.50 D was established in 4% of patients. Spherical aberration in the 6-mm zone was –0.10 ± 0.08 μm.

Conclusion. PRK with bi-aspheric multifocal profile application, unlike LASIK, not only achieves hyperopia correction but also improves near visual acuity in patients of presbyopic age.

In this article, treatment analysis of 81 patients (98 eyes) with optic nerve pathologic conditions using an author-developed method of continuous optic nerve electromagnetic stimulation (neuromodulation) is compared to traditional in-patient therapy. Authors present an original method of electrode implantation and show the dynamics of visual functional changes, as a result of treatment including visual acuity, electrophysiology testing results, and visual fields. The neuromodulation method enables stimulation therapy to be performed in out-patients; continuous stimulation regimen use causes an important and longstanding therapeutic effect without any negative impact on surrounding tissues.

Introduction. Ischemic maculopathy is the main cause of irreversible vision loss due to retinal vein occlusion (RVO). Fluorescein angiography (FA), which is the “gold standard” for evaluating retinal capillary plexuses, does not allow for the visualization of separate intraretinal capillary networks. Optical coherence tomography angiography (OCT-angiography) enables the possible visualization of four capillary plexi and allows for the quantitative analysis of microcirculation to quantitatively estimate capillary network density and non-perfusion areas.

Aim. To investigate microcirculation changes using OCT-angiography data and to compare the changes with opthalmoplethysmography indices in patients with RVO.

Material and methods. The study included 12 patients with RVO. In all patients, a routine ophthalmic examination was performed, and ocular blood flow was estimated using FA, OCT-angiography, and ophthalmoplethysmography.

Results. Ischemia in the macular area was detected in four patients (25%) according to FA results, and in eight (67%) accor ding to OCT-angiography data. Compared with the unaffected eye, significant decrease in the density of both superficial and deep capillary plexuses as well as a decrease in “flow area” and enlargement of foveal avascular zone were observed. A significant close direct correlation was established between capillary density in the superficial capillary plexus (r > 0.8) and the deep capillary plexus (r > 0.7), choroidal thickness, and opthalmoplethysmography indices (r > 0.6).

Conclusion. Compared with FA, OCT-angiography is a more sensitive method to detect macular capillary perfusion. In cases with RVO, the combination of the above mentioned methods with ophthalmoplethysmography allows for the comprehensive evaluation of regional hemodynamics.

External dacryocystorhinostomy (DCR) is still the gold standard procedure for treating nasolacrimal duct obstruction or chronic dacryocystitis.

Purpose: to evaluate the long-term functional outcome of the modified technique of external dacryocystorhinostomy.

Materials. 55 patients (61 eyes) with lacrimal drainage system disorders who underwent the modified technique of external DCR between 2013-2015 were involved in the study. In this modified procedure of external DCR, anastomosis was created by suturing only anterior flaps of the lacrimal sac and nasal mucosa and excision of the posterior flaps. The mean age of the patients was 65.8 ± 12.38 years (range, 27-87 years), including 47 females and 8 males. The mean follow-up time was 19.4 ± 6.9 months (range, 4-33 months). The success rate was recorded during the follow-up period. Cosmetic result of surgery was interpreted by the patients.

Results. Criteria for surgical success were defined as no or minimal intermittent epiphora, no reflux on lacrimal irrigation postoperatively and a positive functional dye test. The modified external DCR with only anterior flap anastomosis had a success rate of 93.4%. 4 patients (6.6%) had recurrence of epiphora and not patent lacrimal system to irrigation. In our study, the operation time of DCR varies from 25-40 minutes. After surgery 15 of 55 patients (27.3%) described the incision scar as “invisible” and 3 of 55 patients (5.5%) graded it as very visible, hypertrophic scar. Five of 55 patients (9.1%) were not satisfied with the appearance of the incision.

Conclusion. The present study concludes that modified external DCR with anterior flaps anastomosis only is a simple, less time consuming surgical technique that is easy to perform and the outcome is comparable to conventional DCR.

Postsurgical dry eye syndrome is found in a substantial proportion of patients after phacoemulsification.  Its onset could be explained by surgical trauma and by use of preservative-containing eye drops. In some patients, it causes substantial discomfort that continues unabated after 3-4 weeks after surgery.

Purpose. To investigate the results of 0.3% sodium hyaluronate instillation therapy used to treat dry eye syndrome after phacoemulsification.

Materials and methods. Basal tear secretion (Schirmer II test) and tear breakup time (TBUT) test were investigated in 33 patients with symptoms characteristic of dry eye syndrome in 1 month after phacoemulsification. These patients received 0.3% preservative-free sodium  hyaluronate instillations for 30 days, whereupon Schirmer II and TBUT tests were repeated. Symptom dynamics was estimated according to the OSDI questionnaire scale.

Results. Mean values of basal tear secretion and TBUT tests were slightly below normal ones. In one month of treatment, the TBUT index associated with “Gilan Ultra Comfort” use became somewhat better: mean TBUT value appeared to be 9.8 ± 2.5 sec. OSDI questionnaire patient symptom score evaluation also revealed in patients a mild degree of xerosis severity. Mean score before treatment was 19.6 ± 10.0. Positive disease dynamics after “Gilan Ultra Comfort” use is confirmed by a significant decrease of OSDI score index up to  12.3 ± 6.3.

Purpose. To investigate the efficacy of recombinant prourokinase (RPU) treatment in patients with toxic anterior segment syndrome after phacoemulsification.

Material and methods. We observed 123 patients (123 eyes) with toxic anterior segment syndrome after phacoemulsification; patients of the group I (n = 30) received only antiinflammatory treatment; in treatment of patients of the group II (n = 31), instillations of the RPU solution were used, in the group III (n = 31), RPU solution was injected subconjunctivally, in the group IV (n = 31) – RPU solution electrophoresis was used. Treatment result analysis was carried out within 30 days.

Results. Initial mean visual acuity in groups was 0.09 ± 0.04; 0.1 ± 0.04; 0.09 ± 0.04; 0.08 ± 0.04, and was virtually the same (p > 0.05). In 24 hours after treatment initiation, mean visual acuity in the group III was higher, than in the others. In three days and up to the end of observation period, the lowest mean visual acuity was noted in the group I (p < 0.05). Anterior chamber assessment showed that beginning from the first 24 hours after treatment initiation, in groups III and IV, fibrin lysis in the anterior chamber was more pronounced, than in groups I and II (p < 0.05); by the end of the observation period, worst indices of anterior chamber state were found in the group I (p < 0.05), in other groups, they were almost identical (p < 0.05). When using RPU, no allergic reaction was noted.

Conclusions. RPU use in combined toxic anterior segment syndrome therapy after phacoemulsification allows increasing visual acuity, reducing convalescence time, and reducing the number of laser dissections. It was established that all methods of RPU administration are effective. RPU may be administered as eye drops on an outpatient basis, receiving efficacy similar to other administration methods.