Vol 9, No 3 (2016)

Polymorphic markers of the G1639A form of VKORC1 involved in the development of retinal vessel occlusion
Moshetova L.K., Kaghktsyan S.S., Sichev D.A., Turkina K.I., Grishina E.A., Ryzhikova K.A., Sozaeva Z.A.


Retinal vessel occlusion (RVO) is an eye disease that leads to decreased visual acuity, ultimately resulting in blindness. It is observed in 1%-2% of individuals above the age of 40 years. The etiology of RVO still remains unclear. However, the most widely recognized risk factors include age, hypertension, hyperlipidemia, atherosclerosis, cardiovascular diseases, and diabetes. The number of patients with RVO among the young population has increased in recent years; hence, more attention has been focused on the genetic factors. Polymorphisms in the genes encoding proteins involved in the vitamin K cycle are among the genetic factors that may influence RVO. According to literature, the G1639A polymorphism in the vitamin K epoxide reductase complex subunit 1 (vKoRc1) is a possible risk factor for RVO.

Purpose. To estimate the association between carriers of the G1639A form of vKoRc1 and the development of venous RVO (VRVO) and arterial RVO (ARVO).

Materials and methods. The study included 126 patients aged between 40 and 80 years, mean age 61.5 years. Genotyping for the presence of the G1639A polymorphism of vKoRc1 was performed using polymerase chain reaction, and statistical analysis was performed using the Instat program.

Results. The GG genotype of G1639A was found to be significantly more common in patients with VRVO or ARVO than in those of the control group (VRVO, 42.6%; ARVO, 60%; control group, 32%; p = 0.0449 for VRVO, and p = 0.0925 for ARVO). However, the AA genotype was significantly less common in patients with VRVO or ARVO than in those of the control group (VRVO, 9.8%; ARVO, 6.7%; control group, 28%; p = 0.0238 for VRVO and p = 0.1593 for ARVO, RR 2.015, 95% confidence interval 1.011-4.16).

Conclusions. Our study demonstrates that the GG genotypic form of the G1639A polymorphism of VKORC1 is associated with the development of VRVO and possibly ARVO. However, the AA genotypic form of this polymorphism is not closely associated with the development of VRVO or ARVO.

Ophthalmology journal. 2016;9(3):5-9
Estimation algorithm of the lower eyelid tone
Potemkin V.V., Ageeva E.V.


The condition of ocular adnexal tissues plays an important role not only in determining the pathogenesis of eyelid malposition but also in the choice of surgical treatment. Most frequent types of eyelid malposition are involutional lower lid ectropion and entropion. An estimation algorithm of the lower eyelid tone was described in this article.

Ophthalmology journal. 2016;9(3):10-14
Pseudoexfoliation syndrome and ocular adnexa
Potemkin V.V., Rakhmanov V.V., Ageeva E.V., Alchinova A.S., Meshveliani E.V.


Pseudoexfoliation syndrome (PEX) is a relatively widespread generalized age-related disease of the connective tissue. Therefore, it is reasonable to evaluate the condition of ocular adnexa in patients with PEX. The purpose of the study. To evaluate the state of ocular adnexal tissue in PEX. Methods. Both eyes of 66 patients with PEX and of 64 control individuals were examined in this prospective study. We evaluated the function of the upper eyelid levator muscles and the lower eyelid retractors, horizontal lid laxity (HLL), canthal integrity, degree of retractor disinsertion, and orbicularis muscle tone. Results. The HLL, degree of retractor disinsertion, and the laxity of the medial canthal tendon were statistically expressed in patients with PEX (p < 0.05). However, the orbicularis muscle tone and the function of the lower eyelid retractors were statistically lower in these patients (p < 0.05). The function of the upper eyelid levator muscles, tone of the lateral canthal tendon and degree of ptosis was found to be similar in both groups. Conclusion. Signs of atonic changes in ocular adnexa are relatively more common in patients with PEX (p < 0.05).

Ophthalmology journal. 2016;9(3):15-21
Features of measurement of intraocular pressure in children
Tugeeva E.E., Brzheskiy V.V.


This review discusses the results of various studies conducted in recent years on the comparison of modern methods of measuring intraocular pressure (IOP) in children: pneumotonometry, Maklakov applanation tonometry, and tonometry using Perkins tonometer, Goldmann tonometer, Icare tonometer, Ocular Response Analyzer, TonoPen handheld tonometer, transpalpebral tonometer TIOP01, or a dynamic contour Pascal tonometer. This study discusses the advantages and disadvantages of different methods of measurement of IOP in children, including the evaluation of patients with fibrous lens capsules that might affect the measurement of IOP and an analysis of the characteristics of evaluation of IOP in children with congenital glaucoma.

Ophthalmology journal. 2016;9(3):23-31
Efficacy of 0.01% dexamethasone solution in comprehensive therapy of dry eye disease
Brzheskiy V.V., Popov V.Y., Kalinina I.V., Kalinina N.M., Chenenova L.V.


Introduction. The officinal dosage of dexamethasone solution (0.1%) has a marked localized antiinflammatory effect. But the widespread use of this dose in the management of dry eye diseases is limited by the risk of damage to the cornea. Therefore, the authors developed a solution containing 0.01% dexamethasone phosphate in combination with 6% polyvinylpyrolidone and 1.5%–5.5% dextrose [3]. 
Aim. To study the effects of this novel anti-inflammatory solution on corneal inflammatory processes. 

Materials and methods. This study included a cohort of 25 patients (50 eyes) with corneal–conjunctival xerosis. Lower tear meniscus index, precorneal tear film production, stability and osmolarity, and the degree of staining of the ocular surface epithelium with vital solutions were assessed prior to the treatment and on day 28 of the study. The presence of the cytokines IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, IL-1Ra, TNF-α, INF-α, and INF-γ in patients’ tear fluid and blood plasma was quantified using ELISA. 
All patients were asked to complete a questionnaire to evaluate subjective signs of xerosis of the ocular surface. 

Results. Statistically significant increases in tear meniscus index, precorneal tear film stability, and main and total tear production, with a significant decrease in tear film osmolarity were observed by day 28 of the study. In addition, positive changes in objective parameters relating to the ocular surface epithelium were further confirmed by the patients’ evaluations of their quality of life. Furthermore, the degree of staining of the ocular surface epithelium with vital solutions also decreased. 

Conclusions. The results of the study demonstrate the high level of effectiveness of the developed medication as a treatment for dry eye diseases of various etiologies.

Ophthalmology journal. 2016;9(3):32-44
Differential diagnosis of dirofilariasis of the lower lid: a clinical case from Ophthalmological diagnostic center no. 7 for children and adults, Saint Petersburg
Astakhov Y.S., Sokolov V.O., Morozova N.V., Skorobogatov Y.V., Drobyshevskaya E.N., Morozov M.A.


We present a brief literature review on dirofilariasis and its incidence in Russia. The diagnosis and operative treatment of a patient with dirofilariasis caused by infection with Dirofilaria repens is described. The diagnostic criteria (epidemiological analysis, ultrasonographic, and laboratory-based and parasitological work-up) are presented. Ultrasonography plays an important role in the differential diagnosis of dirofilariasis and cavernous hemangiomas. Different non-surgical and surgical treatment approaches are discussed.
Ophthalmology journal. 2016;9(3):45-54
A rare late complication of silicone orbital implant
Khatskevitch G.A., Soloviev M.M., Onokhova T.L., Nikolaenko V.P., Panova T.Y.


This study describes clinical and radiological implications as well as early surgical treatment results of a rare and late complication of a nonporous silicone orbital implant, in particular its encapsulation with the formation of an inclusion cyst.

Ophthalmology journal. 2016;9(3):55-60
A clinical case of acute (middle) macular neuroretinopathy
Lobanova M.M., Golikova E.L.


This study presents a case of acute (middle) macular neuroretinopathy. Acute onset of this disease corresponds with the appearance of paracentral scotomas and reddish brown lesions on the retina. The pathophysiology is unclear, but recent research suggests a microvascular etiology. Fluorescein and indocyanine green angiography usually reveal normal features. No specific treatment exists.
Ophthalmology journal. 2016;9(3):61-67
Switching of an inhibitor of vascular endothelial growth factor in the treatment of resistant to ranibizumab neovascular form of age-related macular degeneration. Case study
Ivanova N.V., Rasin O.G., Savchenko A.V., Litvinenko O.A.


Aim: To analyze the spontaneous reattachment of retinal pigment epithelium (RPE) after replacing the anti-VEGF drug - ranibizumab, with aflibercept in the treatment of neovascular AMD based on the example given in our clinical study. Material and methods. We carried out a retrospective analysis of the patient’s history with exudative detachment of RPE due to choroidal neovascularization in age-related macular degeneration. This patient was treated with anti-angiogenic treatment in the form of monthly IVI ranibizumab. At the time of treatment, the visual acuity of the left eye was 0.3 with sph + 1,5D = 0,5, in the fundus of the eye there was a high exudative detachment of RPE in the macular region common to the vascular arcades. The edges were determined by the detachment of the neuroepithelium and abundance of hard drusen. Using optical coherence tomography, (OCT) we saw that the center of the macula of the left eye had a high detachment of RPE, local detachment of the neuroepithelium at the edge of the RPE detachment and an abundance of hard drusen. The foveola was flattened, and beneath it, the RPE was detached in the center - thickness of 247 microns (m). After the seventh injection of ranibizumab, we used OCT to assess the condition of the retina. The retinas condition was almost the same as before. The thickness in the central zone was 251 m, detachment of neuroepithelium was not seen, the dome of the RPE detachment circuit was unchanged and visual acuity improved to 0.7 with a maximum correction. We then replaced ranibizumab with another anti-angiogenic drug - aflibercept. Results and discussion. Two weeks on from our control examination, we noticed there was a smooth bubble detachment of the RPE and a retinal prominence over the choroidal neovascular membrane area (CNM). The OCT scan indicated minimal RPE detachment, resorption of the exudate, presence of subretinal spindle - shaped formation near the temporal side (CNM? Scar?). Retinal thickness was 178 m at the fixation point. Intravitreal injections were stopped. Visual acuity increased to 0.8 and remained stable for 5 months, but there were signs of renewed activity of choroidal neovascularization. According to OCT, the thickness in the central parts of the retina increased to 230 m, there were intraretinal cysts and increased spindle - shaped formation under the RPE. After 10 months of IVI aflibercept, acute vision decreased to 0.5, the thickness at the point of fixing increased to 250 m, subretinal formation increased and oozing of fluid was observed mainly parafoveal, which explains the high visual acuity. We then administered IVI ranibizumab. Two weeks later, the retinal thickness was 169 m, visual acuity improved to 0.8, but 1 month later we found that the retinal thickness had increased once more and decreased to 0.7. After 3 months after IVI ranibizumab, retinal thickness at the fixation point reached 286 m and visual acuity dropped to 0.5. Conclusion. In our practice, we face patients with neovascular AMD, who respond badly to ranibizumab. For such patients, it is important to replace ranibizumab with a better, more therapeutically effective anti-VEGF drug with anti-vaso proliferative properties. Aflibercept is an effective substitute for ranibizumab which was shown in this clinical case.
Ophthalmology journal. 2016;9(3):69-76
Choroidal osteoma
Astakhov Y.S., Astakhov S.Y., Potemkin V.V., Marchenko O.A., Belekhova S.G., Ovnanyan A.Y.


This study describes the clinical features, methods of diagnosis, and treatment of a rare intraocular tumor, choroidal osteoma, based on our observation of three patients and a literature review.

Ophthalmology journal. 2016;9(3):77-81
Squamous papilloma of the lacrimal sac and the nasolacrimal canal (clinical case report)
Poritskii Y.V., Gorbachev D.S.


The article gives a detailed description of the clinical case of a rather rare eye disease - tumors of the lacrimal SAC and nasolacrimal duct, that usualy is difficult in diagnosis and treatment. We used computer tomography, dacryocystography, endoscopy for examination. The operation of removing tumor of the lacrimal SAC is well described and illustrated. Distinctive appearance of squamous papilloma, which is different from the prevailing views of papilloma attracts attention. Also we noted the number of postopertive features. The paper includes review of the literature concerning tumors of the lacrimal SAC and nasolacrimal duct, analisys of criteria for differential diagnostics of tumors of the lacrimal SAC, classification of malignant tumors of the lacrimal SAC in stages. The information obtained can contribute to the proper diagnosis and treatment of patients with pathology of the lacrimal drainage than will be useful for clinical ophthalmologists.
Ophthalmology journal. 2016;9(3):82-88

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