Vol 10, No 2 (2017)

Effect of crosslinking with riboflavin and ultraviolet a (UVA) on the scleral tissue structure
Bikbov M.M., Surkova V.K., Usubov E.L., Nikitin N.A., Astrelin M.N.

Aim. To evaluate the effect of scleral crosslinking with riboflavin and ultraviolet A (UVA) on scleral tissue structure in vitro.

Material and methods. The study was performed on seven porcine cadaver eyes. Two parallel scleral strips were excised from each eyeball; one was subjected to the crosslinking procedure (instillation of 0.1% aqueous solution of riboflavin mononucleotide for 20 min followed by UV irradiation of 3 mW/cm2 for 30 min), and the other was used as control. Scleral structure was evaluated using light (Van Gieson’s stain) and electron microscopy. Special software was used to perform morphometric analysis of the microphotographs.

Results. As a result of crosslinking, the average packing density of collagen fibers increased by 8.2%, the intermediate space decreased by 5.2%, and the average diameter of collagen fibrils increased by 12%. There were no pathological changes in the scleral structures.

Conclusion. Obtained results confirm the efficacy of scleral crosslinking with riboflavin/UVA in forming additional crosslinks and the safety of the procedure for the scleral tissue.

Ophthalmology journal. 2017;10(2):6-12
Results of presbyopia correction with multifocal profile application on the cornea by photorefractive keratectomy in hyperopic patients
Eskina E.N., Parshina V.A.

Aim. To compare the efficacy, safety, and predictability of simultaneous hyperopia and presbyopia correction using photorefractive keratectomy (PRK) with the application of a bi-aspheric multifocal profile on the cornea using PresbyMax software and hyperopia correction using LASIK.

Methods. Overall, 50 patients were divided into two groups: 25 patients (50 eyes) in group 1 underwent PRK with bi-aspheric multifocal profile application on the cornea using PresbyMax software for simultaneous hyperopia and presbyopia correction. Group 2 included 25 patients (50 eyes) who underwent LASIK with aspheric profile application on the cornea for hyperopia correction.

Results. One year after surgery in group 1, binocular distance uncorrected visual acuity (DUCVA) was 0.96 ± 0.16, near uncorrected visual acuity (NUCVA) was 0.77 ± 0.17, and intermediate uncorrected visual acuity (IUCVA) was 0.64 ± 0.15. Visual acuity loss of up to 0.2 was found in two eyes (4%). Target refraction in the dominant eye (emmetropia) was obtained in 72% of patients; in 28% of cases, a shift up to –0.75 D was observed. Target refraction in the non-dominant eye was found in 68% of patients, 12% of patients had a shift from the target refraction of –0.50 D, and 20% of patients of –0.75 D. Spherical aberration in the 6-mm zone was –0.22 ± 0.17 μm. One year after surgery in group 2, binocular DUCVA was 1.0 ± 0.10, NUCVA was – 0.37 ± 0.16, and IUCVA was – 0.43 ± 0.12. No monocular best corrected distance visual acuity loss was found. A myopic shift from the planned target (emmetropia) of –0.50 D was established in 4% of patients. Spherical aberration in the 6-mm zone was –0.10 ± 0.08 μm.

Conclusion. PRK with bi-aspheric multifocal profile application, unlike LASIK, not only achieves hyperopia correction but also improves near visual acuity in patients of presbyopic age.

Ophthalmology journal. 2017;10(2):13-21
Alloplant biomaterials as postburn skin scarring inhibitors
Nuraeva A.B., Musina L.A., Gareev E.M.

Allotransplants for eyelid frame plasty by “Alloplant”® may facilitate recovery of eyelid anatomical position and function and prevent postburn scar tissue traction. Purpose of the study. To determine the level of fibrogenic factors after skin burn wound treatment with Alloplant biomaterials in experiment. The tissue level of TGF-β1 and FGF-1 fibrogenic factors was detected immunohistochemically in 84 Wistar rats treated with Alloplant biomaterials for skin burn wounds. It was established that the tissue level of fibrogenic cytokines reduced significantly after treatment with allogenic biomaterials that leads to inhibition of fibroblast proliferation and prevents excessive collagen synthesis. At tissue reparation, allogenic biomaterials inhibit coarse scar formation.

Ophthalmology journal. 2017;10(2):22-28
Clinical functional results of the continuous electromagnetic stimulation in patients with optic nerve partial atrophy
Davydov D.V., Yakovlev A.E., Vybornaya T.R.

In this article, treatment analysis of 81 patients (98 eyes) with optic nerve pathologic conditions using an author-developed method of continuous optic nerve electromagnetic stimulation (neuromodulation) is compared to traditional in-patient therapy. Authors present an original method of electrode implantation and show the dynamics of visual functional changes, as a result of treatment including visual acuity, electrophysiology testing results, and visual fields. The neuromodulation method enables stimulation therapy to be performed in out-patients; continuous stimulation regimen use causes an important and longstanding therapeutic effect without any negative impact on surrounding tissues.

Ophthalmology journal. 2017;10(2):29-35
Treatment of refractory glaucoma with cystoid macular edema
Nikolaenko V.P., Terehova I.V., Panova T.Y., Antonova A.V.

The article reviews clinical picture as well as treatment results of refractory glaucoma with cystoid macular edema.

Ophthalmology journal. 2017;10(2):36-39
Diagnostic value OF oct-angiography AND regional hemodynamic assesSment in patients with retinal vein occlusion
Tultseva S.N., Astakhov Y.S., Rukhovets A.G., Titarenko A.I.

Introduction. Ischemic maculopathy is the main cause of irreversible vision loss due to retinal vein occlusion (RVO). Fluorescein angiography (FA), which is the “gold standard” for evaluating retinal capillary plexuses, does not allow for the visualization of separate intraretinal capillary networks. Optical coherence tomography angiography (OCT-angiography) enables the possible visualization of four capillary plexi and allows for the quantitative analysis of microcirculation to quantitatively estimate capillary network density and non-perfusion areas.

Aim. To investigate microcirculation changes using OCT-angiography data and to compare the changes with opthalmoplethysmography indices in patients with RVO.

Material and methods. The study included 12 patients with RVO. In all patients, a routine ophthalmic examination was performed, and ocular blood flow was estimated using FA, OCT-angiography, and ophthalmoplethysmography.

Results. Ischemia in the macular area was detected in four patients (25%) according to FA results, and in eight (67%) accor ding to OCT-angiography data. Compared with the unaffected eye, significant decrease in the density of both superficial and deep capillary plexuses as well as a decrease in “flow area” and enlargement of foveal avascular zone were observed. A significant close direct correlation was established between capillary density in the superficial capillary plexus (r > 0.8) and the deep capillary plexus (r > 0.7), choroidal thickness, and opthalmoplethysmography indices (r > 0.6).

Conclusion. Compared with FA, OCT-angiography is a more sensitive method to detect macular capillary perfusion. In cases with RVO, the combination of the above mentioned methods with ophthalmoplethysmography allows for the comprehensive evaluation of regional hemodynamics.

Ophthalmology journal. 2017;10(2):40-48
The influence of pseudoexfoliative syndrome on corneal morphology based on in vivo confocal microscopy
Potemkin V.V., Varganova T.S., Akopov E.L., Ageeva E.V.

Background: Confocal microscopy is a modern examination method that enables real-time, noninvasive in vivo imaging of the cornea, limb, and conjunctiva.

Aim: To evaluate the main morphological changes observed using confocal microscopy in patients with pseudoexfoliation (PEX) syndrome.

Methods: Overall, 21 patients were examined: 12 with PEX syndrome were enrolled in the examination group and nine patients without PEX in the control group.

Results: In patients with PEX, a decreased cell density in the epithelium and stroma of the cornea as well as a significant increase of hyper-reflective intercellular microdeposits and dendritic cells was observed (p < 0.05).

Ophthalmology journal. 2017;10(2):49-55
The long-term outcome of the modified external dacryocystorhinostomy
Rakhmanov V.V., Potemkin V.V., Meshveliani E.V., Pirgunova A.A., Alchinova A.S., Morina K.Y., Ageeva E.V.

External dacryocystorhinostomy (DCR) is still the gold standard procedure for treating nasolacrimal duct obstruction or chronic dacryocystitis.

Purpose: to evaluate the long-term functional outcome of the modified technique of external dacryocystorhinostomy.

Materials. 55 patients (61 eyes) with lacrimal drainage system disorders who underwent the modified technique of external DCR between 2013-2015 were involved in the study. In this modified procedure of external DCR, anastomosis was created by suturing only anterior flaps of the lacrimal sac and nasal mucosa and excision of the posterior flaps. The mean age of the patients was 65.8 ± 12.38 years (range, 27-87 years), including 47 females and 8 males. The mean follow-up time was 19.4 ± 6.9 months (range, 4-33 months). The success rate was recorded during the follow-up period. Cosmetic result of surgery was interpreted by the patients.

Results. Criteria for surgical success were defined as no or minimal intermittent epiphora, no reflux on lacrimal irrigation postoperatively and a positive functional dye test. The modified external DCR with only anterior flap anastomosis had a success rate of 93.4%. 4 patients (6.6%) had recurrence of epiphora and not patent lacrimal system to irrigation. In our study, the operation time of DCR varies from 25-40 minutes. After surgery 15 of 55 patients (27.3%) described the incision scar as “invisible” and 3 of 55 patients (5.5%) graded it as very visible, hypertrophic scar. Five of 55 patients (9.1%) were not satisfied with the appearance of the incision.

Conclusion. The present study concludes that modified external DCR with anterior flaps anastomosis only is a simple, less time consuming surgical technique that is easy to perform and the outcome is comparable to conventional DCR.

Ophthalmology journal. 2017;10(2):56-61
Molecular genetic aspects of keratoconus pathogenesis
Kulikov A.N., Churashov S.V., Kamilova T.A., Reituzov V.A.

Keratoconus is a bilateral, progressive corneal disease affecting all ethnic groups around the world. It is one of the major ocular problems with significant social impacts as the disease affects young generation, and is the leading cause of corneal transplantation. Although keratoconus is associated with genetic and environmental factors, its precise etiology is not yet established. Results from complex segregation analysis and patterns of gene expression show that genetic abnormalities may play an essential role in the susceptibility to keratoconus. There is a strong association between the polymorphism of a number of genes and corneal curvature. These polymorphisms explain only a small percentage of keratoconus cases, so genetic influences on keratoconus are most likely complex and varied. The aim of this review is to briefly provide the current knowledge on the genetic keratoconus basis - to understand the disease pathogenesis.

Ophthalmology journal. 2017;10(2):62-71
Analysis of treatment results in dry eye syndrome patients after phacoemulsification by preservative-free 0.3% sodium hyaluronate eye drops
Pirogov Y.I., Butina G.M., Oksentjuk A.A., Khromova E.S.

Postsurgical dry eye syndrome is found in a substantial proportion of patients after phacoemulsification.  Its onset could be explained by surgical trauma and by use of preservative-containing eye drops. In some patients, it causes substantial discomfort that continues unabated after 3-4 weeks after surgery.

Purpose. To investigate the results of 0.3% sodium hyaluronate instillation therapy used to treat dry eye syndrome after phacoemulsification.

Materials and methods. Basal tear secretion (Schirmer II test) and tear breakup time (TBUT) test were investigated in 33 patients with symptoms characteristic of dry eye syndrome in 1 month after phacoemulsification. These patients received 0.3% preservative-free sodium  hyaluronate instillations for 30 days, whereupon Schirmer II and TBUT tests were repeated. Symptom dynamics was estimated according to the OSDI questionnaire scale.

Results. Mean values of basal tear secretion and TBUT tests were slightly below normal ones. In one month of treatment, the TBUT index associated with “Gilan Ultra Comfort” use became somewhat better: mean TBUT value appeared to be 9.8 ± 2.5 sec. OSDI questionnaire patient symptom score evaluation also revealed in patients a mild degree of xerosis severity. Mean score before treatment was 19.6 ± 10.0. Positive disease dynamics after “Gilan Ultra Comfort” use is confirmed by a significant decrease of OSDI score index up to  12.3 ± 6.3.

Ophthalmology journal. 2017;10(2):73-77
Assessment of “Cytochrom C” influence on visual function restoration in patients with corneal opacities after keratitis recovery
Sokolov V.O., Morozova N.V., Florentzeva S.S., Morozov M.A., Veselov A.V.

Using objective examination methods, an assessment of visual function restoration, possible corneoprotective action, and safety of Cytochrom C® was carried out in patients with subepithelial corneal opacities after recovery from acute keratitis.

Ophthalmology journal. 2017;10(2):79-86
Enzymotherapy of toxic anterior segment syndrome after phacoemulsification
Suvorov A.S., Sazhin T.G.

Purpose. To investigate the efficacy of recombinant prourokinase (RPU) treatment in patients with toxic anterior segment syndrome after phacoemulsification.

Material and methods. We observed 123 patients (123 eyes) with toxic anterior segment syndrome after phacoemulsification; patients of the group I (n = 30) received only antiinflammatory treatment; in treatment of patients of the group II (n = 31), instillations of the RPU solution were used, in the group III (n = 31), RPU solution was injected subconjunctivally, in the group IV (n = 31) – RPU solution electrophoresis was used. Treatment result analysis was carried out within 30 days.

Results. Initial mean visual acuity in groups was 0.09 ± 0.04; 0.1 ± 0.04; 0.09 ± 0.04; 0.08 ± 0.04, and was virtually the same (p > 0.05). In 24 hours after treatment initiation, mean visual acuity in the group III was higher, than in the others. In three days and up to the end of observation period, the lowest mean visual acuity was noted in the group I (p < 0.05). Anterior chamber assessment showed that beginning from the first 24 hours after treatment initiation, in groups III and IV, fibrin lysis in the anterior chamber was more pronounced, than in groups I and II (p < 0.05); by the end of the observation period, worst indices of anterior chamber state were found in the group I (p < 0.05), in other groups, they were almost identical (p < 0.05). When using RPU, no allergic reaction was noted.

Conclusions. RPU use in combined toxic anterior segment syndrome therapy after phacoemulsification allows increasing visual acuity, reducing convalescence time, and reducing the number of laser dissections. It was established that all methods of RPU administration are effective. RPU may be administered as eye drops on an outpatient basis, receiving efficacy similar to other administration methods.

Ophthalmology journal. 2017;10(2):87-93
Aflibercept treatment in patients with diabetic macular edema
Astakhov Y.S., Nechiporenko P.A.

The article provides a brief description of diabetic macular edema pathogenesis highlighting the role of inflammation, along with a short review of aflibercept trials in diabetic macular edema patients. Three clinical cases of diabetic macular edema treatment with aflibercept (Eylea) intravitreal injections in treatment-naïve patients are described; therapy was performed for 1 year according to the scheme provided in the Summary of Product Characteristics.

Ophthalmology journal. 2017;10(2):94-109

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