Vol 7, No 4 (2014)

Articles
Approach to cataract surgery in patients with irregular astigmatism due to pronounced corneal pathology
Rakhmanov V.V., Khripun K.V., Astakhov S.Y., Ramazanova A.M.
Abstract
In the article, the results of cataract surgery results in a patient with irregular astigmatism due to corneal comorbidity are presented. The authors demonstrate the efficacy and the safety of the method of residual astigmatism correction with the implantation of an additional pseudophakic IOL Sulcoflex (Rayner, Great Britain).
Ophthalmology journal. 2014;7(4):5-9
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Ahmed valve implantation: intraoperative and early postoperative complications
Nikolaenko V.P., Kontantinova L.M., Pavlova O.G.
Abstract
Purpose. To analyze the causes of intraoperative and early postoperative complications and to develop a plan to improve the surgical technique. Methods. An Ahmed valve implantation by a standard method with obligatory posterior sclerectomy was performed in 238 patients aged from 18 to 88 years. Results. There were 7 cases of corneal perforation during the preparatory stage in excessively deep bridle suture; 3 cases of conjunctival and scleral perforation; 4 cases of inadvertent orifice enlargement in needle perforation of limbal scar tissue with consequent excessive filtration; in 37 patients, there was a hemorrhage from new vessels situated in the anterior chamber angle and the iris; 59 cases of serous cilio-choroidal effusion; 12 cases of hemorrhagic detachment. Conclusions. It is mandatory to follow the main principles of surgical technique and to take into consideration associated diseases.
Ophthalmology journal. 2014;7(4):10-12
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Influence of vitrectomyon the progressionof wet age related macular degeneration
Astakhov Y.S., Shaar G.B., Dal’ N.Y.
Abstract
Purpose. To study the effects of vitrectomy on the course of wet age-related macular degeneration (AMD). Materials and methods. 99 patients (99 eyes) with wet AMD associated with vitreo-macular adhesion or posterior hyaloid traction were included in the study. During the first 6 months, all patients received anti-VEGF treatment according to a PRN regimen. Then, they were divided into two groups: in 45 patients vitrectomy was performed and 54 patients did not receive surgical treatment. The follow-up period duration was one year. Results. At the beginning of the study, visual acuity was 0.27 ± 0.17 in the control group, and 0.17 ± 0.15 in the treatment group. Most prominent differences in visual acuity between the two groups were observed during the first 6 months (visual acuity in the treatment group before surgery was 0.12 ± 0.1) (p < 0.01 and p < 0.001), at the same time during the following 6 follow-up months, this difference decreased (p < 0.05 and p < 0.01). 1 year from the study start, visual acuity in the control group was 0.24 ± 0.17, and 0.17 ± 0.13 in the treatment one. Conclusions. Vitrectomy surgery in patients with wet AMD in association with vitreo-macular adhesion or posterior hyaloid traction does not exacerbate the disease course, stabilizes visual functions and improves the quality of life.
Ophthalmology journal. 2014;7(4):13-21
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The surgical experience in recurrent retinal detachments after episcleral procedures
Aliev A.D., Sharipova D.N., Aliev A.G., Mikailova M.T.
Abstract
The two major surgical treatments of retinal detachments are episcleral and intravitreal procedures. There is no general consensus as to which procedure is the most appropriate for this complex disease. The aim of the study was to define differentiated surgical tactics, and to look at five year results of extrascleral surgical procedures based upon clinical and statistical analysis. . The results showed that primary rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) stage A is an indication for episcleral buckling if tears are located in the retinal periphery. If there are multiple tears, a concomitant macular hole or a large flap tear, the surgery may also include drainage of subretinal fluid, intravitreal air or gas injection, and avoidance of the use of cryotherapy. The causes for 19 recurrences that required subsequent vitreoretinal surgery are: PVR progression after surgery and as a consequence of it a retinal detachment recurrence, epiretinal fibrosis, subretinal proliferation.
Ophthalmology journal. 2014;7(4):22-26
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A comparative analysis of the course of wet age-related macular degeneration in eyes with incipient cataract and in eyes after phacoemulsification
Astakhov Y.S., Dal’ N.Y., Chistyakova N.V.
Abstract
Many patients with wet age-related macular degeneration (AMD) also have a cataract in the same eye. Because there is a theoretical risk of progression of the degenerative processes in the macular area after surgical lens removal, this raises some ethical, clinical and economical questions for ophthalmologists. The purpose of the study was to compare the course of wet AMD in eyes with incipient cataract and the course in eyes after surgical cataract removal. Materials and methods: 135 eyes with wet AMD, 48 eyes - treated group - were subjects to phacoemulsification during the study, 87 eyes - control group - with incipient cataract without indications for surgery. Regular visits every 1.5 months during 2 years of follow-up with visual acuity testing, central retinal thickness analysis by optical coherence tomography (OCT). Anti-VEGF injections were performed according to a PRN regimen. Results: there was no statistically significant difference in visual acuity, central retinal thickness, intravitreal injection frequency between both groups during the study period. Conclusions: No influence of phacoemulsification on the wet AMD course was found.
Ophthalmology journal. 2014;7(4):27-32
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Morphometric and hemodynamic features of the age-related macular degeneration course in combined pathology: age-related macular degeneration in association with glaucoma
Panova I.E., Ermak E.M., Shaimova T.A., Galin A.Y.
Abstract
Purpose. To determine the characteristics of anatomical retinal changes and of the choroidal blood flow in patients with combined pathology: age-related macular degeneration (AMD) and primary open-angle glaucoma (POAG). Materials and methods. We investigated two study groups (SG): SG1 - AMD in association with POAG, 113 patients; SG2 - AMD without glaucomatous nerve damage , 92 patients; mean age - 71.9 ± 9.3 years. Measurements of the neuro-sensory retina (NSR) thickness and of the ganglion cells complex (GCC) thickness by optical coherence tomography (OCT) in manual regimen (42 eyes in SG1, 38 eyes in SG2) and the estimation of choroidal blood flow (HBF) by ultrasonography (18 eyes in SG1, 38 eyes in SG2) were performed in two areas: area I - 4 mm laterally to the optic nerve head; area II - 4 mm medially to the optic nerve head. Results. The GCC thickness in patients with combined pathology (SG1) was significantly lower than in patients with AMD (IG2) in the areas I and II; the thickness index of the GCC was significantly reduced in SG1 in areas I and II, whereas in SG2 this index was increased. Significant differences of HBF in areas I and II in SG1 were found, as well as reduced peak systolic flow velocity, the time-averaged maximum velocity of blood flow, maximum end-diastolic flow velocity, as compared with SG2. The index of peripheral resistance was reduced in SG1 in area I and increased in area II, whereas in SG2 it was increased in area I and reduced in area II. Conclusion. In patients with combined pathology - AMD and POAG - NSR thickness was reduced due to the thinning of the ganglion cell layer and the formation of an ischemic pattern of choroidal blood flow in the macula and medially to the optic nerve head.
Ophthalmology journal. 2014;7(4):35-42
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The results of Semax neuroprotective efficacy investigation
Strakhov V.V., Popova A.A., Fedorov V.N.
Abstract
Purpose. To study by Heidelberg diagnostics the efficacy and safety of Semax 0.1 % used as a neuroprotective agent in POAG treatment. Materials and methods. The study involved 36 patients (72 eyes) with primary glaucoma. The first group was represented by patients with POAG receiving Semax in addition to the basic IOP-lowering therapy (24 patients - 48 eyes). The second (control) group consisted of patients with POAG, receiving only the basic IOP-lowering therapy (12 patients - 24 eyes). All patients underwent ophthalmologic examination with Heidelberg diagnostics before the treatment initiation, and 1 month after Semax was prescribed. Results and discussion. The paper presents a study of the efficacy and safety of Semax treatment in primary glaucoma with the Heidelberg diagnostics - scanning laser tomography, HRT-perimetry in the SAP III mode, in-vivo confocal corneal microscopy. During the observation period, no negative changes in the structure of the optic nerve head and in the corneal subbasal nerve plexus were revealed. The functional state of the visual analyzer also did not change, according to perimetry data. No adverse reactions to Semax 0.1 % were observed.
Ophthalmology journal. 2014;7(4):43-51
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The experience of “Hyloparin” use in clinical practice
Tkachenko N.V., Astakhov S.Y.
Abstract
The incidence of the “dry eye” syndrome diagnosis in developed countries increases from year to year. It is a reason for continuous scientific search for effective and safe methods for its treatment, for new ophthalmic medications. Because of the registration in the Russian Federation of “Hyloparin-Comod” containing heparin, our chair carried out a study on the efficacy of the medication in treatment of several eye diseases associated with the “dry eye” syndrome.
Ophthalmology journal. 2014;7(4):53-62
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The “Signicef” ® use for prevention of postoperative infectious complications
Nikolaenko V.P., Kataeva M.V., Panova T.Y.
Abstract
Purpose. To study the efficacy and the tolerability of “Signicef” when used during the early post-operative period after ophthalmic surgeries. Materials and methods. The treatment group consisted of 82 patients, in whom ophthalmic surgeries were performed. All patients received treatment of antibiotics and anti-inflammatory medications according to standard pattern that included instillations of “Signicef” eye drops. The anterior segment of the operated eye was examined every day until discharge from the hospital, as well as after 7 and 14 days after surgery. Results. There were no cases of purulent complications among the study group. No objective signs of infection or drug intolerance were observed. Conclusions. “Signicef” ensured an adequate prevention of infectious complications at early postoperative period and demonstrated a good tolerability in patients of the study group.
Ophthalmology journal. 2014;7(4):63-66
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Racemose haemangioma of the iris:
Astakhov Y.S., Marchenko O.A., Terekhova I.V., Potemkin V.V.
Abstract
Two cases of iris racemose haemangioma are described. We described clinical features, angiographic and ultrasonic characteristics of the tumor. We presume that racemose haemangioma can lead to cataract. Phaco surgery was uncomplicated.
Ophthalmology journal. 2014;7(4):67-68
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Grönblad-Strandberg syndrome
Timokhov V.L., Rusanovskaya A.V.
Abstract
The Grönblad-Strandberg syndrome is an inherited disease characterized by mineralization of elastic fibers in the skin, blood vessels, and the eye. Skin lesions are represented by flat xanthomatous ivory-white nodules. Eye lesions are divided into stages. In the first stage, there is angioid streak formation. In the second stage, subretinal neovascular membranes may form. If this occurs in the subfoveal area, the patient may lose central vision. The third stage is characterized by scarring.
Ophthalmology journal. 2014;7(4):69-72
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A patient was admitted to a sanatorium with insufficiently confirmed tuberculosis etiology of uveitis: what is to be done?
Ustinova Y.I., Lyapin S.L., Simchuk M.N.
Abstract
The results of ocular tuberculosis diagnostics in a specialized sanatorium “Krasny Val” during 2005-2009 were analyzed, and compared with those of the previous 5-year period. The percentage of patients admitted to the sanatorium with non-confirmed tuberculosis as the etiology of eye diseases increased from 11.0% to 18.9%, p < 0.05. We believe that this is due to the insufficient staffing level of ophthalmologists in dispensaries. Only in one third of patients, ocular tuberculosis was diagnosed; in the rest of the cases indications to anti-tuberculosis therapy were excluded. (Excluded or not found?) Because of the complexity of the diagnosis of ocular tuberculosis, it is necessary for the specialized sanatoria to help the dispensaries in making the proper diagnosis. Because of high medico-social and economic significance, we recommend proper staffing of phthisioophthalmologists in anti-tuberculosis dispensaries, and enhanced education of all ophthalmolgists in the diagnosis of ocular tuberculosis.
Ophthalmology journal. 2014;7(4):73-78
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An improvement of medical care for children and adolescents with ocular tuberculosis in Saint-Petersburg - an important goal of city dispensary
Il'kova O.P., Ustinova Y.I., Sal'nikov N.N.
Abstract
The medical care for children with ocular tuberculosis until the end of the nineties was delivered in the Saint-Petersburg City Diagnostic Centre # 7, OLS. Under dispensary observation in the tuberculosis department, there were no less than 100 patients with hematogenous tuberculosis (in association with tuberculosis contamination or local forms of non-ocular localizations). Recently, there has been only a half time ophthalmologist in the dispensary to admit children and adolescents with ocular tuberculosis or suspected cases. Upon an initiative of phthisioophthalmology section of the Saint-Petersburg scientific medical ophthalmological society to the staff of the city dispensary ophthalmologist O.P. Il’kova was recommended and admitted, with a specialization to work as pediatric phthisioophthalmologist. During 2014, O.P. Il’kova attended to adult patients at the ophthalmology department of the dispensary, consulted adolescents in the “Drujba” tuberculosis sanatorium and analysed the treatment results of tuberculosis patients who became ill at their childhood. The phthisioophthalmology section of the Saint-Petersburg scientific medical ophthalmological society and the ophthalmology department of the Saint-Petersburg anti-tuberculosis dispensary solicit the chief executives of the dispensary to allocate ophthalmologist, nurse positions and to create necessary conditions to examine and treat children and adolescents with ocular tuberculosis or suspected cases.
Ophthalmology journal. 2014;7(4):79-83
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