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Vol 13, No 2 (2020)

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In memory of Yuri Sergeevich Astakhov


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!

Ophthalmology Reports. 2020;13(2):6-8
pages 6-8 views

Original researches

Conditions for improving the effectiveness of surgical treatment of patients with chronic dacryocystitis in endonasal endoscopic procedures

Davydov D.V., Маgomedov М.М., Маgomedova N.М.


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%.

Ophthalmology Reports. 2020;13(2):15-21
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Optimization of energy parameters during surgery of high-density cataract

Tereshchenko A.V., Trifanenkova I.G., Ivanov A.M., Okuneva M.V., Orlova N.A.


The goal is to develop a combined technique for preliminary YAG laser fragmentation and Femto laser exposure on a CATALYS device and to evaluate its role in reducing the time and energy parameters of a surgery of high-density cataract.

Material and methods. The study included 118 patients (118 eyes) with age-related cataracts of the 3rd and 4th degrees of lens nucleus density. In the main group, before phacoemulsification (PE) with a Femto laser support and IOL implantation, preliminary YAG laser phacofragmentation of the lens nucleus was performed. In the first control group, PE was performed with Femto laser support and IOL implantation. In the second control group – PE with IOL implantation.

Results. A 35% decrease in the energy of the Femto laser action at a 3rd degree of lens nucleus density was achieved, and 40% – at the 4th degree, in comparison with the PE with the Femto laser support without preliminary YAG laser phacofragmentation, a 38% decrease in the cumulative ultrasound energy at 3rd degree of the lens nucleus density, and 42% at 4th degree compared with isolated ultrasonic cataract phacoemulsification.

Conclusion. The proposed modification of the technique of combined YAG laser and Femto laser exposure allows achieving during cataract surgery a complete fragmentation of the lens nucleus of a high degree of density, helps minimizing the risk of complications and reaching quick postoperative rehabilitation of patients.

Ophthalmology Reports. 2020;13(2):23-30
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Representativity of macular edema mapping using en face optical coherence tomography, retinal thickness map, and fluorescein angiography

Maltsev D.S., Kulikov A.N., Kazak A.A., Vasiliev A.S.


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.

Ophthalmology Reports. 2020;13(2):9-14
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Corneal hydrops: diagnosis and treatment

Sitnik G.V.


Acute corneal hydrops is a pathological condition which clinically presents by marked corneal edema developing due to a break in Descemet’s membrane.

Background. To analyze the results of diagnosis and treatment in patients with acute corneal hydrops.

Materials and methods. 42 patients (47 eyes) suffering from acute corneal hydrops were included in the study. This condition appeared on both eyes simultaneously or sequentially in 5 patients. Mean age was 28.7 ± 10.1 years (from 19 to 54 years), 31 men, 11 women. In case of complications or inefficacy of medical therapy surgical procedures were performed: 10% gas (C3F8, SF6) injection into the anterior chamber, amniotic membrane transplantation, partial lamellar keratoplasty, DALK, PKP.

Results. Duration of corneal ectasia before acute hydrops occurrence was 12.6 ± 4.6 years. Disease was not diagnosed before in 11.9%. Corneal thickness varied from 692 ± 98 µm in focal hydrops to 1200 ± 220 µm in total hydrops. Area of edema, height of Descemet detachment and gap between break margins were significantly above in cases of subtotal and total hydrops compared with focal and partial hydrops (χ2, p < 0,001). Injection of 10% gas (C3F8, SF6) in the anterior chamber allowed to significantly accelerating the resolution of this condition in cases of subtotal and total hydrops.

Conclusion. Analysis of this case series showed the feasibility of a differentiated approach in the treatment of acute corneal hydrops depending on its severity.

Ophthalmology Reports. 2020;13(2):31-42
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Intrastromal descemet membrane transplantation in eyes with advanced keratoconus

Oganesyan O.G., Getadaryan V.R., Ashikova P.M., Makarov P.V., Khandzhyan A.T.


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 Kmax). 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.

Ophthalmology Reports. 2020;13(2):43-48
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Modern principles of the diabetic macular edema management

Mazurina N.K., Stolyarenko G.E.


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.

Ophthalmology Reports. 2020;13(2):51-65
pages 51-65 views

Selective laser trabeculoplasty: mechanisms of action and predictors of efficacy

Kulikov A.N., Kazak A.A., Maltsev D.S.


This review considered selective laser trabeculoplasty in comparison with other methods for therapeutic and surgical treatment of primary open-angle glaucoma and ocular hypertension, including argon laser trabeculoplasty. In this paper, we reviewed current knowledge on the mechanisms of action of selective laser trabeculoplasty, predictors of intraocular pressure-lowering effect, repeatability, and safety of this procedure.

Ophthalmology Reports. 2020;13(2):67-76
pages 67-76 views

Lamellar macular holes: the evolution of ideas about pathogenesis and the clinical picture. The development of diagnostic approaches. Modern classification

Zhogolev K.S., Bayborodov Y.V.


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.

Ophthalmology Reports. 2020;13(2):77-88
pages 77-88 views

Case reports

Bilateral lacrimal gland enlargement as a clinical manifestation of sarcoidosis

Martirosyan S.S., Simonyan D.R., Musheghyan I.K., Ghazaryan M.A.


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.

Ophthalmology Reports. 2020;13(2):89-94
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Complex clinical case of optic neuropathy differential diagnosis

Sakhovskaya N.A., Frolov M.A., Kazakova K.A., Belyaeva E.S.


The outcome of any damage or disease of the optic nerve is the atrophy of the optic nerve, which causes the irreversible loss of vision. The reasons of damage of the optic nerve are polymorphous, and early diagnosis allows to improve the efficacy of treatment and prevent irreversible consequences. The article presents a difficult clinical case of optic neuropathy differential diagnosis.

Ophthalmology Reports. 2020;13(2):95-99
pages 95-99 views

Recurrent pterygium – features of surgical treatment

Riks I.A., Astakhov S.Y., Papanyan S.S., Ezugbaya M.B., Boutaba R., Sokolov I.A.


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.

Ophthalmology Reports. 2020;13(2):101-107
pages 101-107 views

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