Vol 13, No 2 (2020)

He passed a long and bright path, A worthy person. He did not betray, he did not lose heart And disappeared forever ... How difficult it is for you and me to accept that he will never send a smile in return, he will not ask: "How are you?" That there was a AMAZING MAN next to us in life!

Introduction. Surgical treatment of patients with chronic dacryocystitis is a complex interdisciplinary problem. Lacrimal sac can be reached externally and internally (endonasally). The effectiveness of the treatment largely depends on the results of complete diagnosis and choice of a treatment method.

Purpose. To analyze the effectiveness of surgical treatment of patients with chronic dacryocystitis in endonasal access.

Materials and methods. The study of 225 patients consisted in the analysis of two groups of patients (2015–2019) with chronic dacryocystitis: the first group (110 patients) underwent an endonasal endoscopic dacryocystorhinostomy in the form of monooperation, the second underwent endonasal endoscopic dacryocystorhinostomy with additional intranasal interventions (115 patients). All patients underwent endoscopic examination of the nasal cavity and midface multispiral computed tomography (MSCT).

Results. The results of the obtained data convincingly showed a higher efficiency of treatment in the group of patients with combined operations with the pathological processes revealed in intranasal localization in comparison with the group of monoperations.

Conclusion. According to the study data, patients with chronic dacryocystitis should undergo full ophthalmologic and endonasal diagnostics, including multispiral computed tomography-dacryocystorhinography of the middle facial zone according to the described algorithm. When detecting pathological processes hindering the standard endonasal endoscopic dacryocystorhinostomy, it is necessary to perform an expanded scope of surgical interventions which will contribute to the efficiency of treatment of patients with chronic dacryocystitis up to 91.3%.

Aim. To study the representativity of macular edema mapping using en face optical coherence tomography (OCT), retinal thickness map, and fluorescein angiography (FA). 

Methods. In this retrospective cross-sectional study, 8 patients (15 eyes) with diabetic macular edema (2 females and 6 males, mean age 66.5 ± 8.1 years) were included. All patients OCT (retinal thickness map and en face OCT) and FA were performed. En face slab was constructed between inner plexiform layer and retinal pigment epithelium. The area of macular edema was measured by two masked graders independently. 

Results. There was no statistically significant difference in the area of macular edema between FA, en face OCT, and retinal thickness maps, 12.7 ± 8.1, 14.5 ± 8.4, 10.4 ± 6.9 mm², respectively (ANOVA × 3, p = 0.34). Intraclass correlation coefficient for three methods was 0.87 and 0.95, for individual and mean values, respectively. 

Conclusion. En face OCT is an adequate non-invasive alternative for FA in evaluating the area of macular edema and planning of grid macular laser photocoagulation.

Background. To report the outcomes of intrastromal Descemet membrane (DM) transplantation in corneas with advanced keratoconus.

Materials and methods. Three eyes of 3 patients presented with advanced, progressive keratoconus. None of the eyes had prior UV-crosslinking or any other ocular surgery performed. All eyes had a donor DM implanted into a mid-stromal pocket under local anesthesia, and clinical outcomes were evaluated at 12 months after surgery.

Results. To the best of our knowledge, this is the first report of DM transplantation performed in cases of advanced keratoconus. At 12 months after surgery, the DM graft was well positioned and barely visible within the recipient stroma, and all corneas were clear. None of the eyes showed signs of keratoconus progression throughout the follow-up period. No significant changes were observed in uncorrected (UCVA) and best contact lens corrected visual acuity (BCLCVA), central endothelial cell density (ECD), corneal thinnest point (CTP) pachymetry, and maximum keratometry values (SimK and K_max). No early or late postoperative complications were observed.

Conclusions. Intrastromal DM transplantation may potentially be an alternative to intrastromal Bowman layer transplantation in eyes with advanced keratoconus, to postpone deep anterior lamellar or penetrating keratoplasty.

Diabetes mellitus and diabetic retinal lesions are a global challenge for healthcare systems and one of the leading causes of severe vision loss among the working age population. Retinal laser coagulation remained the standard of therapy and the only possible treatment for diabetic macular edema (DME) in the 80-90s of the last century. The introduction of anti-VEGF therapy and glucocorticoids into the wide practice has significantly expanded the range of possibilities of DME treatment, allowing not only to stabilize patients’ vision, but also to improve it. The analyses of the large randomized clinical trials results are made and presented in this article, that highlight the basic principles of the contemporary DME treatment. This information is intended to help the ophthalmologist to develop the most optimal approach to treatment, considering the individual characteristics of each patient and the “evidence-based” efficacy and safety data of different methods.

This review presents the development of modern ideas about the pathogenesis of lamellar macular holes, anatomical changes, as well as the formation of a modern classification based on the expansion of diagnostic capabilities, and differences from other similar conditions of the vitreomacular interface. An evolutionary breakthrough in the investigation of this disease was associated with the widespread introduction of optical coherence tomography, while the development of its resolution allowed us to detect some features of epiretinal proliferation that occurs in lamellar macular holes, which are also addressed in the review.

Sarcoidosis is an inflammatory disorder of unknown etiology. The main characteristics of sarcoidosis are non-caseating granulomas which can be formed in affected organs. Eye and its adnexal tissues can also be involved. In the early stages of sarcoidosis, the clinical picture may be mild and not always specific. Although the early signs of sarcoidosis are lung associated, we present a clinical case with diffuse enlargement of the lacrimal glands as a first sign of systemic sarcoidosis. A 21-years-old woman presented to the ophthalmological center with a 2-weeks history of having swollen, painful upper eyelids. Primary eye examination revealed palpable tender masses in the locations of the lacrimal glands. Characteristic for sarcoidosis X-ray findings and blood tests demanded lacrimal gland and lung biopsy for diagnosis verification. In spite sarcoidosis of lacrimal glands is a rare condition, it has to be taken into consideration in the differential diagnosis of lacrimal gland masses.

Pterygium is a fibrovascular degenerative condition of the subconjunctival tissue that proliferates and grows into the cornea in the form of a vascularized fold, destroying the surface layers of the stroma and Bowman’s membrane. This disease is common throughout the world. The etiology is not clear, but it is known that the appearance of pterygium is associated with exposure of the eye to ultraviolet rays. The treatment of the de novo occurring pterygium is a relatively simple task and involves surgical removal. But a simple excision is currently unacceptable due to the high recurrence rate. In order to minimize the risk of relapse, numerous adjuvant treatment methods are used, which include anti-metabolites such as Mitomycin C and 5-fluorouracil, amniotic membrane, various types of conjunctival and or limbal grafts; medications such as anti-vascular endothelial growth factor are sometimes used. In the clinical case presented in the article, we successfully used the technique of anterior lamellar keratoplasty and autoconjunctival transplantation in combination with intra-operative use of anti-metabolite Mitomycin C in a young patient with recurrent stage IV pterygium (degree of activity 3) twice unsuccessfully operated on. As a result of this surgical technique, the transparency of the cornea was restored and high visual acuity was obtained.