Vol 7, No 3 (2014)

Articles
The use of Ozurdex intravitreal implant to treat post-RVO macular edema
Tultseva S.N., Nechiporenko P.A., Titarenko A.I.

Abstract

This reports on the efficacy and safety of Ozurdex intravitreal implant (1 up to 3 injections) in different types of retinal vein occlusion (RVO) was based on examination data of 26 patients, referred to the ophthalmology clinic of the First Pavlov Sate Medical University of St. Petersburg. Ophthalmic examination, fluorescein angiography, optical coherence tomography, fundus photography, and microperimetry were all routinely used to follow these patients. Intravitreal injections of Ozurdex in post-RVO macular edema resulted in a statistically significant visual acuity improvement and decrease in retinal thickness. No cases of lens opacity progression were observed. Ocular hypertension was transient and controlled by topical IOP-lowering therapy. In cases of ischemic central retinal vein occlusions, to prevent and treat neovascular complications it is necessary to resort to additional treatment methods.
Ophthalmology journal. 2014;7(3):5-16
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Is it possible to determine general pathways for the ocular tuberculosis therapy efficiency enhancement based on the treatment experience?
Ustinova Y.I.

Abstract

The analysis of 5-year material on patient population characteristics in the federal phthisioophthalmological sanatorium (4284 patients) demonstrates an insufficient prophylactic health assessment of patients as well as a high recurrence rate of ocular tuberculosis in the Russian Federation. The analysis of treatment results in the sanatorium based on data of 140 patients from the follow-up monitoring group 1 with terms of treatment on the preceding stage not exceeding 2 months allowed revealing significant fault reasons. In dispensaries, a treatment process not considering sub-groups (newly diagnosed process, or recurrence) was found, as well as insufficient period and amount of chemotherapy, insufficient number of phtisioophthalmologists, lack of specialized ophthalmological beds in tuberculosis clinics, etc. The efficacy of recommended methods is confirmed, which take into consideration the peculiarities of ocular tuberculosis therapy, as well as the regulations of the Order Health Care Ministry of the Russian Federation approved in 2003. In the conclusions, the necessity to improve the organization of medical and diagnostic care for ocular tuberculosis patients and to publish corresponding federal guidelines is presented.
Ophthalmology journal. 2014;7(3):17-27
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Comparative analysis of vitreofoveolar traction syndrome surgical treatment
Shkvorchenko D.O., Zakharov V.D., Rusanovskaya A.V., Belousova Y.V., Kakunina S.A., Mironova T.S., Pismenskaya V.A., Norman K.S.

Abstract

This article focuses on the surgical treatment of the vitreomacular traction ( VMT) syndrome comparing vitrectomy with and without internal limiting membrane (ILM) removal. Patients were randomly divided into 2 groups. In the 1st group, the procedure was performed without the ILM removal. In the 2nd group, the surgery was performed with perifoveolar ILM removal. A comparative analysis revealed that an anatomical result was reached in both groups, but in the 1st group, the development of epiretinal fibrosis was observed in 35 % of the cases in the late postoperative period; and this was not observed in the 2nd group. Visual function recovery was faster in the 1st group, but at 1 year visit, data from both groups were comparable. Thus, the treatment method with surgical ILM removal is preferable, due to more stable anatomical result.
Ophthalmology journal. 2014;7(3):28-33
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The assessment of the neuroprotective effect of herbal medicinal products in patients with early stages (I-II) of primary open-angle glaucoma and stabilized intraocular pressure, evidence from “Tanakan” use
Skorobogatov Y.V., Astakhov Y.S., Sokolov V.O., Morozova N.V.

Abstract

Achievements in primary open-angle glaucoma (POAG) treatment unfortunately do not ensure an adequate neuroprotective effect in monotherapy of the disease that is why a search for effective and affordable neuroprotectors continues. The aim of the study was to assess the neuroprotective effect of herbal medicinal product “Tanakan” in treatment of POAG patients with normalized intraocular pressure. Methods. A complex clinical and morphological randomized crossover study. Thirty patients (57 eyes) with established stage I-II POAG were examined. Results. During the period from no treatment, up to 3 and 6 months from the treatment start, a reliable increase of the Jantch index (Jantch, 1958) was noted. A positive trend in values of electrophysiological indices was revealed: macular ERG (MERG) a-wave amplitude, and rhythmic ERG (RERG) a-wave amplitude increased. A positive dynamics was found when performing vacuum tests with dosated intraocular pressure (IOP) increase: p-100 complex amplitude increase without its latency changes, as a result of vacuum-compression test with visual evoked cortical potentials (VCT with VECP); with laser confocal tomography, a decrease of maximal optic disc excavation depth at maximal vacuum load was established. Conclusions. An increase of functional visual analyzer performance capabilities at the 1st, 2nd and 3rd neurons level without any changes in optic disc morphometric parameters could be qualified as a neuroprotective effect of the treatment. The increase in the Jantch index, as well as the decrease of maximal optic disc excavation depth as a result of artificial IOP increase may be qualified as an increase in optic nerve tolerance. Tanakan could be used complementary, as a neuroprotector, in combined therapy in stage I-II POAG patients at normalized IOP as long-term (up to 6 months) therapy courses.
Ophthalmology journal. 2014;7(3):35-44
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Current trends in the therapy of the ocular surface epithelial xerosis
Brzheskaya I.V., Brjesky V.V., Radukhan M.

Abstract

Depending on the cause of a “dry eye” the treatment of some patients continues to be a problem. While treatment is usually limited to tear replacement, other therapies may be needed based on the cause of the dry eye syndrome. In the article, the literature is summarized as to the agents used to treat the “dry eye syndrome” basssed on the etiology. and presence of accompanying xerosis complications In addition, the article describes additional treatment trends such as anti-inflammatories, immunosuppressives, and drops stimulating tear production. Attention is also paid to the lacrimal pathway occlusion methods in using punctual plugs and other surgical methods. The authors advocate for the wide use of the different treatment methods available to treat complex “dry eye” syndrome patients.
Ophthalmology journal. 2014;7(3):45-56
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Medically induced glaucoma
Vitovskaya O.P.

Abstract

The last decades have seen an increase of steroid use in ophthalmology to treat various diseases. These include allergic conjunctivitis, uveitis of different etiologies, age-related macular degeneration, central serous retinopathy, and post-operative complications, etc. In addition, recently, ophthalmologists have noted an increasing frequency of uncontrolled steroid use by patients. This could lead to ocular hypertension and steroid induced glaucoma. Recent data on prevalence, causes and pathogenesis of steroid induced glaucoma are presented in the article.
Ophthalmology journal. 2014;7(3):58-62
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The evolution of surgical methods for treatment of benign ocular adnexa diseases
Onishchenko Y.S., Novikov S.A., Beldovskaya N.Y., Zhabrunova M.A.

Abstract

In the article, currently known methods of surgical treatment of inflammatory, degenerative and benign neoplastic diseases of ocular adnexa are reviewed. Special attention is paid by the authors to the advantages and shortcomings of various treatment methods. The newer treatment trends in this field are considered as well.
Ophthalmology journal. 2014;7(3):63-71
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The influence of prostaglandin analogs on the retinal thickness after phacoemulsification with intraocular lens implantation in primary open-angle glaucoma patients
Astakhov S.Y., Astakhov Y.S., Gobedzhishvili M.V.

Abstract

Retinal OCT measurements were analyzed after phacoemulsification with intraocular lens (IOL) implantation in primary open-angle glaucoma (POAG) patients. A total of 190 patients (205 eyes) were examined. Two different groups were analyzed. Patients in Group 1 (32 eyes) had been treated with prostaglandin analogs before surgery (phacoemulsification or phacoemulsification + pressure lowering procedure) and after it when needed. However, these drops were stopped one day prior to surgery. Patients in Group 2 (173 eyes) were used as the control. The mean follow-up period after surgery was 12 months. During the entire follow-up period, in all patients had OCT monitoring at the 2nd-3rd day after surgery, 1 month, 2 months, 6 months, and 12 months. The OCT measurements were not statistically different between Group 1 (32 eyes) and Group 2 (173 eyes). According to our results, there was no significant influence of pre-operative prostaglandin use on the retinal thickness when compared to patients not using this therapy.
Ophthalmology journal. 2014;7(3):73-76
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The use of transcutaneous electric stimulation in patients with partial optic nerve atrophy due to chiasmo-sellar region tumors
Bikbov M.M., Safin S.M., Muslimova Z.R., Dautova Z.A., Safina Z.M., Voyevodin V.A.

Abstract

Purpose - to increase functional results of treatment of partial optic nerve atrophy in patients after surgical procedure for chaismo-sellar region neoplasm by improvement and realization of a new approach to impulse electrical stimulation of visual analyzer. Material and methods. A clinical case of patient’s visual rehabilitation after surgical procedure for chiasmo-sellar region tumor and visual function impairments due to this disease are presented. Preoperatively, evident visual function impairments were present. We observed visual acuity decrease of the right eye (RE) up to 0.09 (no correction possible), in her left eye (LE) up to 0.01 (no correction possible); visual fields limits sum in 8 meridians made up 183º in RE and 100º in LE, electrophysiological indices (electric sensitivity threshold was 480 mkA in RE, 580 in LE, electric liability was 28 Hz in RE, 26 Hz in LE) and visual evoked potentials were tested. No visual acuity restoration was observed postoperatively. Brain tractography was fulfilled in order to visualize the orientation and the integrity of conduction pathways. A treatment course of transcutaneous impulse electric stimulation of the visual analyzer was fulfilled for residual vision stabilization and possible visual function increase. We used software complex sets ESOM-KOMET, ESOM-MASTER (“Neuron”, Russia) applying an improved method. We increased the number of sessions from 10 to 20 using the individual microprocessor-based set ESOM- Micro (“Neuron”, Russia) with the option of setting up a personal program of treatment for each eye separately. Results. Considerable positive changes of visual functions in this patient were obtained after the whole course of prescribed treatment (20 sessions) was finished. At the beginning of treatment, visual acuity of the right eye increased from 0.09 to 0.9-1.0 (correction with -2.0 Dptr.); of the left eye from 0.01 to 0.3 eccentrically (correction with -1.5 Dptr.). Limits of visual fields in 8 meridians broadened from 185º to 230º in the right eye and from 100º to 110º in the left eye. Electrophysiological indices improved so as the electric sensitivity threshold of the right eye decreased from 480 mkA to 240 mkA, the left eye threshold changed from 580 to 420 mkA. Stabilization of electric liability figures was marked, it made up 28 Hz in the right eye and 26 Hz in the left eye. When investigating visual evoked potentials (in dynamics) in both eyes latency reduced from 105 to 100 msec., the amplitude increased from 9.2 to 11.9 mV, evidencing the activation of functionally depressive neural elements. Conclusion. The use of improved approach to impulse electric stimulation of visual analyzer elements is the instrument to visual acuity increase, visual fields broadening and electrophysiological indices improvement. The possibility to make an individual treatment program with setting it up on the equipment for personal use allows reducing the time of in-patient stay in the hospital and guarantees the succession of treatment therapy ful- fillment for this category of patients.
Ophthalmology journal. 2014;7(3):77-83
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Diagnostic perspectives and treatment efficacy in the Vogt-Koyanagi-Harada disease
Astakhov Y.S., Kuznetcova T.I., Khripun K.V., Konenkova Y.S., Belozerova Y.V.

Abstract

Vogt-Koyanagi-Harada (VKH) disease should be part of the differential diagnosis of a bilateral granulomatous uveitis. VKH is more common in the Mongoloid race (most frequently in Japanese, American Indians), and people of Hispanic descent. In Europeans, it is rare; mostly in women aged 30-50 with dark skin and hair pigmentation. The prodromal stage of VKH disease is non-specific but may include headache, vomiting and general malaise. Indocyanine green angiography may be helpful in making the diagnosis. Presenting a clinical case, the authors discuss the methods for diagnosis and follow-up for patients with Vogt-Koyanagi-Harada disease. Effective and timely treatment with high dose corticosteroids, if necessary in combination with immunosuppression, could save good visual functions.
Ophthalmology journal. 2014;7(3):84-92
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The 155th anniversary of the birth of L.G. Bellarminov
Boyko E.V., Kirillov Y.A., Reituzov V.A.

Abstract

The article is dedicated to the 155th anniversary of the birth of the academician L.G. Bellarminov. In pre-revolutionary Russia he founded the biggest school of professors - ophthalmologists. On its initiative, “flying groups” to eliminate avoidable blindness were created. The authors consider his life, scientific and pedagogic activities.
Ophthalmology journal. 2014;7(3):93-101
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Travel essays of a russian ophtalmologist
Astakhov S.Y.

Abstract

Ophthalmology journal. 2014;7(3):102-105
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