Vol 13, No 3 (2020)

Transconjunctival methods of ptosis correction gain popularity nowadays. The wide use of the technique is limited because of the lack of clear recommendations regarding the volume of the resection, especially in patients with negative phenylephrine test.

Purpose. To assess the influence of main predictive factors on superior tarsal muscle (STM) resection result.

Materials and methods. Patients were divided into two groups according to the result of phenylephrine test (PE). Patients with positive results were included in the first group, with negative and weak results – in the second group. All patients underwent STM resection according our new algorithm.

Results. The result of STM resection was influenced by PE test and intraoperative white line motility test (WLM), but not by levator function and the amount of superior tarsal muscle resection.

Conclusions. PE and WLM tests play main role in choosing a method for blepharoptosis correcting.

Relevance. Currently, all over the world, during cataract surgeries, a huge number of intraocular lenses (IOLs) made of different materials are implanted. Alongside with the development of modern IOL materials and designs, publications about their opacities appear. The nature and the localization of IOL opacities mainly depend on the properties of the material out of which the lens is made. Polymethyl methacrylate (PMMA) currently rarely used to manufacture IOLs, tends to cloud in the optical center due to structural breakdown, forming “snowflake”-like cracks. Opacities of acrylic IOLs depend on the degree of hydrophilic properties of the material. The deposition of crystalline deposits in the optical zone of hydrophilic acrylic lenses leads to a significant decrease in visual acuity and requires IOL explantation. There is a definite dependence of the occurrence of opacities in hydrophilic acryl on the patient’s concomitant diseases. In hydrophobic acrylic IOLs, vacuoles form, and glistenings occurs. Herewith, visual functions, as a rule, do not suffer.

Purpose: to find out what structural changes in the IOL led to the need to remove them from pseudophakic eyes due to a decrease in visual acuity.

Materials and methods. Four clouded IOLs made from different materials were examined. The lenses were studied using a SUPRA 55VP scanning electron microscope (Carl Zeiss, Germany) using a secondary electron detector. Element distribution maps on the surface and inside the lenses were collected using an X-max 80 mm² energy dispersive X-ray analysis detector (Oxford Instruments, UK).

Results. A hydrophilic lens with hydrophobic coating became cloudy 5 years after implantation. Hydroxyapatite crystals were found on all parts of the IOL along its surface. In a hydrophobic acrylic IOL, microvacuoles and cavities in the optical center were found using scanning electron microscopy. Two PMMA IOLs underwent self-destruction within 8 years after implantation. Chemical analysis of PMMA lenses did not reveal any inorganic compounds.

Conclusion. One of the complications of IOL implantation is an impairment of their transparency. Factors associated with IOL material and manufacturing, as well as the patient’s comorbidities, can lead to lens opacification at various terms after surgery.

Purpose. To evaluate the changes in the quality of life of patients with thyroid eye disease after different methods of orbital decompression.

Materials and methods. The study included 24 patients (37 orbits) with thyroid eye disease, aged 41.6 ± 20.6 (from 20 to 79 years), 18 women and 6 men. The patients were divided into two groups. The first group included 12 patients (19 orbits) who underwent orbital fat decompression. The second group included 12 patients (18 orbits) who underwent endoscopic endonasal bony orbital decompression. The Graves’ ophthalmopathy quality of life questionnaire (GO-QOL) was completed before surgery, and 3 and 6 months after it. Outcome analysis included also the assessment of visual acuity, proptosis, eyelid retraction, and palpebral fissure height.

Results. The GO-QOL visual function scores in both groups did not change significantly in 3 and in 6 months after orbital decompression (p > 0.05): in the first group, before and after 6 months, scores were 69.27 ± 20.02 and 68.96 ± 18.44, in the second group – 53.13 ± 29.13 and 57.81 ± 23.56, respectively. An improvement in the GO-QOL visual function estimation was observed in those patients whose visual acuity improved after surgery. The GO-QOL facial appearance scores significantly improved 3 months after surgery, and continued to increase up to 6 months: in the first group, facial appearance scores improved from 23.96 ± 23.01 to 48.42 ± 25.56 (p = 0.004), in the second group — from 47.92 ± 21.04 to 66.15 ± 23.15 (p = 0.037).

Conclusions. Orbital decompression significantly improves the quality of life of patients with thyroid eye disease, this is primarily associated with an improvement in facial appearance.

The aim was to analyze organizational and technical difficulties in introducing modern technologies of optical reconstructive surgery, and to find the options of their elimination.

Materials and methods. Organizational arrangements to develop and to introduce into clinical practice modern technologies of optical reconstructive surgery in treatment of corneal opacities of different origin in the Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution of the Ministry of Health of the Russian Federation has been analyzed.

Results and conclusions. An unified register of patients of the Far Eastern Federal district who need optical keratoplasty (bullous keratopathies, keratoconus stages 3–4, post-traumatic leukomas, hereditary corneal dystrophies) – a waiting list – has been created. The necessary equipment and instruments were acquired, 4 surgeons were trained who mastered the technologies of deep anterior lamellar keratoplasty and Descemet membrane transplantation along with penetrating keratoplasty. From 2014 to 2018, 160 optical keratoplasty were performed using donor material; by 2019, the need for this type of high-tech treatment has been reduced by 2 times. To date, more than 30% of optical keratoplasties are performed using lamellar technology. The organizational sequence of ordering biological material, performing surgeries; the postoperative care system is got up and running; the outpatient departments’ophthalmologists of the region are trained to use clear objective criteria for dynamic follow-up of these patients.

Relevance. In the treatment of inflammatory diseases of the ocular surface, in order to achieve high efficiency in the shortest possible time, it is necessary for the therapy to be comprehensive. Today, in addition to traditional treatment methods, new technologies based on the use of low-energy lasers, which have high biological activity, are spreading.

Aim. To improve the treatment results of the inflammatory diseases of the ocular surface by implementing photodynamic therapy (PDT) in experiment and clinic, using domestic equipment and elaborating optimal energetic parameters of laser irradiation.

Methods. Objects of research: 130 nonlinear sexually mature rats weighing 150 grams contained in standard vivarium conditions and 110 eyes of patients with inflammatory eye diseases. Carrying out the investigation, experiments on animals, clinical and functional examination results of patients, and statistical analysis were taken into consideration.

Results. A methodology for complex treatment of inflammatory diseases of the ocular surface was developed (with inclusion of PDT by the laser therapy device “Vostok”), based on experimental data and confirmed by clinical and functional ocular indices. PDT helps to increase the effectiveness of treatment, which is manifested by accelerated tissue regeneration, restoration of corneal transparency, increase of visual function in 86.7%, and reduction of treatment terms to 6 days.

Conclusions. Anti-inflammatory and regenerative effectiveness of the proposed complex treatment of inflammatory diseases of the ocular surface with the PDT use was established: improvement in the clinical picture of conjunctivitis and keratitis was revealed, manifested by increase in corneal epithelization.

In recent years, telemedicine (TM) has been gradually introduced into ophthalmology in the form of teleophthalmology (TO), because most of the eye diseases can be photographed and transmitted via Internet. The most wide development of TO has involved the field of diabetic retinopathy (DR) diagnosis, primarily due to the high prevalence of diabetes mellitus in the world. Examples of the well-established operation of remote DR screening centers exist in different countries of the world. There are many studies published, which compare a remote examination with a personal one, and according to their data, TO screening is no worse, than traditional screening. In addition to DR, TO also covers the diagnosis of glaucoma, age-related macular degeneration, and other ophthalmic conditions. In this article, we present an overview of modern TO centers in different countries, the features of their organization and global results that have been achieved during their existence. New technologies developed to facilitate the work of such centers will also be touched: image analysis algorithms, portable diagnostic equipment, medical information systems. The prospects for introducing TO into Russian medical practice are considered separately.

Background. In recurrent dacryocystitis after dacryocystorhinostomy, a re-operation is indicated. In recent years, some publications appeared concerning endonasal dacryoplasty using 9 mm-balloon in treatment of patients with recurrent dacryocystitis.

Purpose – to evaluate the possibility of using endonasal balloon dacryoplasty in recurrence after dacryocystorhinostomy.

Materials and methods. Into the study, 6 patients (6 cases) were included who underwent endonasal endoscopic dacryocystorhinostomy for dacryocystitis 1-3 years before. In all patients, evaluation of Munk’s scores for epiphora, optical coherence tomography (OCT) based lacrimal meniscometry, dye disappearance test, lacrimal drainage system syringing and probing of its horizontal part, nasal endoscopy, multispiral computed tomography of lacrimal drainage system with contrast enhancement. In all patients, endonasal dacryoplasty using a balloon with 6 mm diameter was carried out. The follow-up period after surgery was 6 months.

Results. In 4 patients, “recovery” was achieved, in 1 patient “improvement“ was obtained, in 1 patient there was dacryostoma cicatrization.

Conclusion. Preliminary results received in this study of the balloon dacryoplasty performed in 6 patients afford ground to consider it possible to use this method in patients with dacryocystitis recurrence after dacryocystorhinostomy. The matter of the prospects when using this method may be solved after further research aimed to increase the number of clinical observations to enhance the possibility of adequate statistical processing of obtained results, to extend the postoperative follow-up period, to develop the indications for this procedure, and to investigate the necessity in additional manipulations improving the effectiveness of endonasal balloon dacryoplasty.

Report on the work of the XXVI International Ophthalmological Congress "White Nights" - the 16th Congress of the All-Russian public organization "Association of Ophthalmologists"

The article is dedicated to the 90th Anniversary, which was celebrated on June 30, 2020, an outstanding Soviet and Russian ophthalmologist, founder of the Russian ophthalmic and oncological school, Honored Scientist of the Russian Federation (1991), Academician of the Russian Academy of Sciences (2013), Professor of the Department of Ophthalmology with a course of pediatric ophthalmology and orbital pathology of the Russian Medical Academy of Postgraduate Education Brovkina Alevtina Fedorovna. It examines her life path: clinical, scientific and pedagogical activities and achievements.

Acanthamoeba keratitis with bacterial, fungal superinfection or without it leads to development of an aggressive and long-standing corneal inflammation; up to now, the efficacy of its treatment stays doubtful and demands further investigation. For a long time, there were discussions on the possibility and expediency of corneal collagen cross-linking (PACK-CXL – photo activated chromophore for keratitis) in patients with bacterial, fungal and Acanthamoeba keratitis. This article presents a clinical case of effective treatment of mixed etiology keratitis by multiple high fluence accelerated PACK-CXL in a patient with severe local toxico-allergic reaction.