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Vol 14, No 3 (2021)

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Original researches

Macular edema risk factors after vitrectomy for rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy

Boiko E.V., Khizhnyak I.V., Bayborodov Y.V.


BACKGROUND: Despite significant advances in the technology of surgical treatment of regmatogenous retinal detachment, a certain proportion of patients with emerging macular edema against the background of silicone oil tamponade remains.

AIM: To evaluate the risk factors of macular edema development and to work out a mathematical model for its prediction based on a retrospective analysis of clinical data of patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy.

MATERIALS AND METHODS: A retrospective case series of 64 patients (64 eyes) with regmatogenous retinal detachment complicated by grade CP proliferative vitreoretinopathy who underwent primary retinal detachment repair. Patients were divided into two groups: with the presence of macular edema in the postoperative period and without it (32 patients in each group). In all cases, at the initial examination, retinal detachment involved the macular area.

RESULTS: Using regression analysis, two significant factors were identified: the sum of the 8 meridians of the visual field before surgery (p = 0.015) and the number of detached quadrants (p = 0.021). Based on the identified factors, a model for predicting macular edema occurrence in the postoperative period in the surgical treatment of regmatogenous retinal detachment was obtained.

CONCLUSIONS: The investigation results allowed establishing that the retinal detachment area and the sum of the 8 meridians of the visual field are significant pre-operative factors for macular edema development in retinal detachments with proliferative vitreoretinopathy of CP 1-2 degree. The developed mathematical model based on these indicators is characterized by significant information content and allows predicting macular edema occurrence in the postoperative period. The use of the proposed prognostic model determines a differentiated approach to surgical prevention of macular edema and allows making a decision on the removal of internal limiting membrane at the preoperative stage.

Ophthalmology Journal. 2021;14(3):7-16
pages 7-16 views

Preferred treatment regimen of aflibercept after treatment interruption in patients with neovascular age-related macular degeneration

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


BACKGROUND: The efficacy of antiangiogenic therapy in neovascular age-related macular degeneration depends on adherence to the intravitreal injection regimen and regular follow-up. In 2020, the COVID-19 pandemic and associated epidemiological restrictions in ophthalmological care delivery led to a massive lack of appropriate control and management of this condition.

AIM: To determine the preferred regimen of intravitreal anti-VEGF therapy in patients with neovascular age-related macular degeneration who experienced treatment interruption due to the COVID-19 pandemic.

MATERIAL AND METHODS: Thirty eyes of 26 patients (20 males and 6 females, mean age 73.7 ± 10.4 years) with neovascular age-related macular degeneration were included; all of them experienced treatment interruption due to the COVID-19 pandemic during the second year of aflibercept therapy. Re-starting therapy, all patients were divided in two groups and received treatment as per the fixed dosing (bimonthly), or as pro re nata (PRN) regimen. All patients underwent standard ophthalmological examination and optical coherence tomography before and after treatment interruption as well as six months after treatment re-start.

RESULTS: At six months after treatment re-start, best corrected visual acuity and central retinal thickness did not show statistically significant difference similar between the fixed dosing group and that of PRN dosing regimen (p = 0.34 and p = 0.85, respectively). However, patients of the fixed dosing group received for one more injection than those of the PRN group (median value – 2.0 injections, 95% confidence interval – 2.0-2.4; p = 0.0001). Preservation of the disease activity according to optical coherence tomography data, in the fixed regimen group was found in 10 eyes (71.4 %) versus 9 eyes (56.2 %) in the PRN group (p = 0.63).

CONCLUSIONS: For neovascular age-related macular degeneration patients at the second year of treatment, an adequate therapeutic strategy for re-starting anti-VEGF therapy after treatment interruption appears to be the PRN regimen. PRN regimen allows reducing one injection in comparison to fixed dosing regimen with comparable functional outcomes during first 6 month.

Ophthalmology Journal. 2021;14(3):17-24
pages 17-24 views

Complex use of energetic surgery in treatment of patients with primary open-angle glaucoma and cataract on the background of pseudoexfoliative syndrome

Dzhashi B.G., Balalin S.V.


BACKGROUND: Glaucoma remains one of the current problems of modern ophthalmology. The combination of glaucoma and cataract is observed in 17–38.6% of cases, and glaucoma with pseudoexfoliative syndrome – in 20–50% of primary open-angle glaucoma cases.

AIM: The aim of this work is to develop an effective and safe technology of complex energetic surgical treatment of the incipient primary open-angle glaucoma stage and cataract on the background of pseudoexfoliation syndrome on the basis of modified laser, hydrodynamic and ultrasound methods’ use.

MATERIALS AND METHODS: 187 patients (187 eyes) with the incipient stage of primary open-angle glaucoma, cataract and pseudoexfoliation syndrome were examined. In the main group (111 eyes), selective laser trabeculoplasty followed by femtosecond laser-assisted cataract surgery with hydrodynamic trabeculocleaning was performed. Patients in the control group (76 eyes), after selective laser trabeculoplasty, underwent phacoemulsification according to the standard technique.

RESULTS: The developed technology allowed to reach the hypotensive effect in 35.2% (t = 23.0; p < 0.001) of baseline intraocular pressure values, of individual intraocular pressure level without adding IOP-lowering medications in 27% of cases, stabilization of visual functions and morphometric indices of the optic disc during 2 years of follow-up in 97.3% of cases unlike the selective laser trabeculoplasty with subsequent phacoemulsification (21.2, 5.3 and 81.6% respectively). The patients of the main group had significantly lower energy expenditure during the stage of phacoemulsification, a lower percentage of postoperative inflammatory reaction was noted, and a persistent hypotensive effect with stabilization of visual functions was achieved based on the results of a two-year follow-up.

CONCLUSIONS: Femtosecond laser-assisted phacoemulsification, performed as part of complex treatment in patients with cataract and incipient stage of primary open-angle glaucoma, is a sparing method that minimizes surgical trauma and achieves a persistent hypotensive effect, reduces intraocular pressure to an individual level and stabilizes visual functions in 97.3% of cases.

Ophthalmology Journal. 2021;14(3):25-34
pages 25-34 views

Influence of the quality of viscoelastic removal on phacoemulsification results. Part 1. Type of the postoperative period course depending on the quality of viscoelastic removal in phacoemulsification

Egorova A.V., Vasiliev A.V., Bai L.


BACKGROUND: The reasons for the development of postoperative reactive inflammation under optimal conditions for the operation are errors in the surgical technique and the presence of viscoelastic residues. The likelihood of developing ophthalmic hypertension exists with the use of viscoelastic of any type. Its incomplete evacuation can be explained by the difficult visualization due to its transparency. Analysis of the dependence of the postoperative period course on the quality of viscoelastic removal at phacoemulsification can be considered to be relevant and expedient.

AIM: The aim was to study the type of the postoperative period course depending on the quality of viscoelastic’s removal at phacoemulsification.

MATERIALS AND METHODS: 104 eyes of randomly chosen patients who underwent femto-laser assisted phacoemulsification, divided into 2 groups according to ophthalmic viscoelastic’s characteristics (colored or transparent). Both groups were split into 2 subgroups each depending on method of viscoelastic’s removal. Tonometry and biomicroscopy were performed 3 hours after phacoemulsification and on the post-op Day 1. Patients with Tyndall effect were examined daily until it’s disappearance.

RESULTS: At comparable preoperative IOP indices, its elevation 3 hours after surgery took place in subgroups 2a and 2b, the highest being in subgroup 2a. The greatest number of eyes with Tyndall effect, at all follow-up periods, was found in subgroup 2a, the lowest – in subgroup 1b. The total number of eyes with keratopathy (as epitheliopathy) observed 3 hours after surgery was 7, four of them being from subgroup 2a.

CONCLUSIONS: The conducted research showed that the type of early postoperative period course of phacoemulsification depends on visualization possibility of the viscoelastic and of the method of its removal. Minimal changes of hydrodynamics and maximal number of eyes with absence of inflammation took place when using colored viscoelastic and impulse – irrigation method.

Ophthalmology Journal. 2021;14(3):35-40
pages 35-40 views

The method of the exophthalmos value predicted calculation when planning the orbital decompression procedure in patients with endocrine ophthalmopathy

Davydov D.V., Lezhnev D.A., Konovalov K.A.


BACKGROUND: The most effective method of surgical treatment of lipogenic and mixed forms of edematous exophthalmos is currently the internal orbital decompression. During this surgical procedure, the excessive pathologically altered adipose tissue is removed from the external and the internal surgical spaces of the orbit. Many scientists are developing methods for calculating the volume of orbital fat, but the question on developing a method for predicted exophthalmos after internal orbital decompression, which could be used without attracting additional equipment and software, is easy to learn and does not require a long calculation time, remains actual. This method has to take into account the individual features of the patient’s orbital structure and be used for calculations in the bilateral proptosis correction.

AIM: To develop and evaluate the effectiveness of a new method for calculating the eyeball position after orbital decompression.

MATERIALS AND METHODS: 64 patients (126 orbits) with lipogenic and mixed forms of endocrine ophthalmopathy were examined. All patients underwent internal orbital decompression, during which the orbital fat was removed, the volume of which was calculated according to the developed original method. Patients underwent ophthalmological examination and MSCT before surgery and 6 months after it. .

RESULTS: As a result of orbital decompression in the examined group, a decrease in proptosis was observed in all patients, and the exophthalmos calculated by the method corresponded to the eyeball position in patients in 6 months after surgery. The level of statistical significance of the planned postoperative eyeball position in relation to the actual postoperative exophthalmos calculated according to the Student’s t-test was 0.98 (p > 0.05), that is, it can be argued that the groups do not differ, and no statistically significant differences were found.

CONCLUSIONS: The developed method for calculating the estimated postoperative exophthalmos is effective without using additional software. This technique allows you to achieve a symmetrical eyeball position in the postoperative period and to reduce the risk of complications.

Ophthalmology Journal. 2021;14(3):41-48
pages 41-48 views


Optical coherence tomography-angiography in diabetic retinopathy diagnosis and monitoring

Pomytkina N.V., Sorokin E.L.


Optical coherence tomography-angiography is a modern noninvasive method of 3D imaging and quantitative analysis of the retinal and choroidal microvasculature. It allows detecting manifestation and progression of diabetic retinopathy, planning treatment and evaluating its results.Optical coherence tomography angiography expands our understanding of microvascular changes in retinal vascular plexuses at different disease stages and deepens the understanding of its pathogenesis.

Ophthalmology Journal. 2021;14(3):49-60
pages 49-60 views

Quality of life study in ophthalmic practice

Ovechkin I.G., Kovrigina E.I., Konovalov M.E., Kumar V.


The article discusses various methods for studying the quality of life in all kinds of eye diseases. General and special questionnaires used in modern ophthalmological practice are presented. The presence of a sufficiently large amount of data indicating the relationship between the quality of life and objective indicators of the visual system was established. A fairly good comparability of results obtained in the assessment of various quality of life questionnaires in a patient with ophthalmic condition was revealed.

Ophthalmology Journal. 2021;14(3):61-70
pages 61-70 views

In ophthalmology practitioners

Diagnosis and staging of ophthalmic manifestations of the graft-versus-host reaction after allogeneic hematopoietic stem cell transplantation

Chistyakova N.V.


Graft-versus-host reaction is a common complication of allogeneic hematopoietic stem cell transplantation. This condition develops in approximately 40–70% of patients. Its most common clinical manifestations include xerotic keratoconjunctivitis and cicatricial conjunctivitis. It is important to correctly diagnose and classify the ocular condition after surgery. Ocular graft-versus-host reaction can present as either classic acute or chronic form, acute form with late onset or with overlap syndrome. It may lead to severe ocular surface disease, which can significantly decrease the quality of life and restrict daily activities of patients. It is thus important to monitor the ocular condition closely since with early diagnosis of the condition and timely treatment start, risks of irreversible damage could be diminished. This article is dedicated to modern criteria of diagnosis and staging of ocular graft-versus-host reaction.

Ophthalmology Journal. 2021;14(3):91-102
pages 91-102 views


Experience of the anti-inflammatory eye drops Ivinak®-SOLOpharm use in patients after cataract surgery

Pirogov I.I., Rozhdestvenskiy F.N., Dzitstsoeva P.A., Artiushenko A.Y.


BACKGROUND: The prevalence of inflammatory complications that occur after phacoemulsification remains an unsolved problem.

AIM: To analyze the results of the use of Ivinak®-SOLOpharm eye drops containing 0.09% bromfenac solution in the complex of anti-inflammatory therapy in patients after cataract surgery in comparison with similar drugs from other manufacturers.

MATERIALS AND METHODS: The study included 60 patients (60 eyes) with a diagnosis of “age-related cataract”, who underwent phacoemulsification. All patients were divided into 2 groups: in the first group, patients used Ivinac eye drops 3 days before surgery and 20 days after it; in the second group, patients used another similar drug containing 0.09% bromfenac solution according to an identical scheme. All patients underwent visual acuity testing and keratopachimetry before and after surgery. On Day 4 and Day 20 after surgery, the degree of inflammatory reaction of the eye was assessed by the number of cells in the anterior chamber fluid, subjective signs of inflammation in patients, using the OSDI (Ocular Surface Disease Index) questionnaire.

RESULTS: When analyzing the obtained data, no statistically significant differences were found between the groups in terms of best corrected visual acuity, corneal thickness, number of cells in the anterior chamber fluid, and subjective symptoms of inflammation in patients.

CONCLUSIONS: Ivinak®-SOLOpharm has proven its effectiveness and safety in the perioperative prevention of inflammatory processes in phacoemulsification.

Ophthalmology Journal. 2021;14(3):71-76
pages 71-76 views

Case reports

Differential diagnosis of peripheral exudative hemorrhagic chorioretinopathy and neoplasm of the choroid (clinical case)

Malafeeva A.Y., Alyabev M.V., Getmantseva Y.V., Kulikov A.N., Maltsev D.S.


Peripheral exudative hemorrhagic chorioretinopathy is a relatively rare and difficult to diagnose disease. This condition is clinically similar to choroidal melanoma, which is why it is called “pseudomelanoma”. An erroneous diagnosis of choroidal melanoma can lead to the wrong choice of aggressive treatment tactics. The aim of this work was to present a case of differential diagnosis of suspected neoplasm of the choroid with peripheral exudative hemorrhagic chorioretinopathy. The described clinical case demonstrates characteristic clinical picture and results of ultrasound with Doppler mapping, spectral optical coherence tomography, optical coherence tomography–angiography, scanning laser ophthalmoscopy for this condition, as well as important differential diagnostic signs of choroidal melanoma. Complaints, history, clinical picture and the results of instrumental examinations were characteristic of peripheral exudative hemorrhagic chorioretinopathy and allowed to exclude the diagnosis of choroidal neoplasm. Pathogenetic treatment (intravitreal injection of anti-VEGF agents) and observation were recommended to the patient, since this disease often affects both eyes. The main differential diagnostic criterion for suspected choroidal melanoma is Doppler ultrasound imaging. In difficult clinical cases, structural optical coherence tomography, optical coherence tomography–angiography, and scanning laser ophthalmoscopy provide valuable additional information for verifying the diagnosis.

Ophthalmology Journal. 2021;14(3):77-82
pages 77-82 views

Neurotrophic keratopathy and Wallenberg – Zakharchenko syndrome: a clinical case

Ezugbaya M.B., Astakhov S.Y., Riks I.A., Papanyan S.S., Boutaba R., Mikhalchenko Y.G., Yakushenko A.R.


BACKGROUND: Degenerative changes of cornea after transection of the trigeminal nerve were first described by F. Magendie in 1824. Neurotrophic keratopathy is considered to be an orphan disease which lately has been recognized more and more often. According to literature data, neurotropchic keratopathy affects 5 individuals in 10,000. The diagnosis is difficult due to the lack of information about this condition, the rare occurrence and the presence of a large number of etiological factors.

AIM: To determine the causes of the neurotrophic keratopathy development and the treatment tactics in a patient with a neurological disease. The article presents a case of neurotrophic keratopathy in a patient with Wallenberg – Zakharchenko syndrome.

Because of the fact that neurotrophic keratopathy was diagnosed late and the correct treatment did not start in time, further progression of the pathological process in the cornea could not be avoided. Periodic recurrence of neurotrophic keratopathy is associated with an underlying chronic neurological disease.

CONCLUSIONS: Neurotrophic keratopathy requires early diagnosis. In certain clinical cases, for the successful treatment of this pathology, it is necessary to prescribe systemic therapy.

Ophthalmology Journal. 2021;14(3):83-90
pages 83-90 views


Report on the xxvii international ophthalmic congress "white nights" - the 17th congress of the all-russian public organization "association of doctors - ophthalmologists"

Fedotova K.


From May 31 to June 4, 2021, the XXVII International Ophthalmological Congress "White Nights" - the 17th Congress of the All-Russian public organization "Association of Ophthalmologists" was held in St. Petersburg. This annual event, held in accordance with the order of the Ministry of Health of the Russian Federation and dedicated to the diagnosis and treatment of diseases of the organ of vision, is the largest and most significant not only for Russia, but also for the whole of Northern Europe.

Ophthalmology Journal. 2021;14(3):103-104
pages 103-104 views

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