Vol 10, No 4 (2017)

Experience in personalized cell therapy clinical implementation for treatment of patients with primary endothelial dystrophy after phacoemulsification
Astakhov S.Y., Riks I.A., Papanyan S.S., Kasparov A.A., Kasparova E.A., Pavlyuk A.S., Fedotova K.

The article presents treatment results of the personalized cell therapy (PCT) method in patients with early post-operative bullous keratopathy which developed in eyes with pre-existing primary Fuchs’ corneal endothelial dystrophy (ED). The patented PCT consists in incubating in vitro the patient’s blood with the stimulator (polyA:polyU), collecting serum with activated leukocytes weighted in it, and introducing the obtained cell preparation in the anterior chamber of the patient’s eye. The study included 12 patients with ED and pseudophakia. The observation period ranged from 8 to 12 months. The therapeutic effect of PCT was obtained in 58.3% of cases, allowing to avoid further surgical procedures. To achieve a good therapeutic effect, several PCT sessions are recommended. To date, PCT is the only effective therapeutic treatment method for early corneal edema after phacoemulsification.

Ophthalmology Journal. 2017;10(4):6-12
Lacrimal system pathology in patients with malignant thyroid tumors after radioactive iodine therapy, and its correction methods
Beldovskaya N.Y., Karpichenko S.A., Baranskaya S.V., Karpov A.A.

Introduction. Radioactive iodine therapy after thyroidectomy is the standard of differentiated thyroid cancer treatment in the modern world. Main dose-dependent side effects described in the literature include: sialadenitis, xerostomia, taste and/or odor loss, swelling of surrounding tissues. Ophthalmic complications are rarely reported.

Aim. To assess the lacrimal system condition in patients after radioactive iodine therapy for thyroid cancer.

Material and methods. The study included 17 patients (34 eyes). There were female patients aged 19 to 43 years (mean age was 31 years) who underwent a course of radioactive iodine therapy for thyroid cancer. All of them complained of periodic or constant tearing in the period from 2 months to 1 year after therapy course. In four patients, there was a permanent or periodic mucopurulent discharge when pressing on the lacrimal sac area. All patients underwent a standard ophthalmological examination, including visual acuity testing, anterior segment biomicroscopy, ophthalmoscopy, and tear production tests. Dye disappearance test, Jones I and II tests, lacrimal pathways irrigation, and, if necessary, cone-ray computer tomography with preliminary lacrimal pathways contrasting were performed to evaluate the tear outflow abnormalities.

Results. Tear production disorders were detected in 20 eyes (58.8%) (among them, moderate dry eye syndrome was diagnosed in 3 cases); tear outflow pathology was revealed in 14 eyes (41.2%) (namely naso-lacrimal duct obstruction and stenosis, and chronic purulent dacryocystitis). For patients with tear production pathology artificial tears were prescribed, and endoscopic endonasal dacryocystorhinostomy was performed in cases of tear outflow disturbances.

Conclusion. The use of radioactive iodine in doses exceeding 80 mCi leads to the development of lacrimal system pathology: dry eye syndrome of various severity, and tear outflow disorders. Lacrimal system pathology significantly worsens the patient's quality of life, and the prophylaxis of these diseases before the radioactive iodine therapy course remains the imminent key problem.

Ophthalmology Journal. 2017;10(4):13-17
Role of pterygopalatine blockade in the early rehabilitation program of children after congenital cataract surgery
Shchuko A.G., Iureva T.N., Oleshchenko I.G.

Nowadays, the surgical treatment of congenital cataract is a “small-incisions” surgery (aspiration, in some cases — ultrasound phacoemulsification). It corresponds to the Fast Track surgery principles, and as a quick recovery technology it requires optimization of pain control in the early postoperative period.  

Purpose. To estimate the efficiency of the pterygopalatine block as a component of an optimized Fast Track protocol in children after congenital cataract surgery.

Materials and methods. 54 children operated for congenital cataract were included in the study. All patients were divided into 2 groups. In the first group (n = 26), a regional component of combined anesthesia on sevoflurane basis was carried out in combination with a pterygopalatine block; in the second group (n = 28), there was an implementation of a retrobulbar block. The efficiency of the methods was evaluated by a comparative analysis of hemodynamic parameters, the index of the vegetative system tension, the assessment of pain intensity by a verbal rating scale, as well as by the severity of ocular inflammatory reactions.

Results. Obtained data show that the pterygopalatine ganglion block as a component of a combined anesthesia in congenital cataract surgery allows providing adequate anesthesia, creating prolonged pain control, reducing the inflammatory reaction in postoperative period during the first 24 hours.

Conclusion. On the basis of our analysis, the possibility of a safe implementation of optimized (Fast-Track) protocol was proven.

Ophthalmology Journal. 2017;10(4):18-23
Clinical care of acanthamoeba keratitis patients
Skryabina Y.V., Astakhov Y.S., Konenkova Y.S., Varganova T.S., Petukhov V.P., Nokhrina K.V., Dnestryanskaya K.O.

Recently, akanthamoeba keratitis (AK) is seen more and more often in ophthalmological practice. However, today there are no standard guidelines concerning diagnosis and treatment of patients with AK. In the article, the experience in care for such patients is presented.

Purpose: to estimate the efficiency of diagnosis and treatment of patients with AK.

Materials and methods. Case histories of patients, who received treatment for akanthamoeba keratitis in the Eye Microsurgery Department No. 4, City Ophthalmologic Center of the City Hospital No. 2, from 2011 to 2016, were analyzed. Under observation, there were 25 patients (26 eyes) with akanthamoeba keratitis aged from 18 to 77 years; there were 15 men and 10 women. Patients were observed during 1 year. Full ophthalmologic examination was conducted in all patients. Additional diagnostic methods included microbiological investigation of corneal scrapes and washings, culturing them on innutritious agar (with E. сoli covering), confocal corneal microscopy (HRT 3 with cornea module, Heidelberg Retina Tomograph Rostock Cornea Module). A superficial punctate keratits (AK stage 2) was found in one patient. All other patients were divided into two groups. Stromal ring-shaped keratitis was diagnosed in patients of the first group (7 patients, AK stage 3). The 2nd group consisted of 17 patients with corneal ulcer (AK stage 4). All patients received medicamentous treatment. However patients of the 2nd group required different kinds of surgical treatment.

Results. In AK diagnosis, corneal confocal microscopy is the most informative method. In patients with AK stages 2 and 3, there was an improvement in visual functions as a result of medicamentous therapy. As a result of treatment at the discharge from the hospital, the best corrected visual acuity was 0.5-1.0 for most patients. In the 2nd group patients, who were subjects to different types of surgical treatment visual functions stabilized. However non-compliance with recommendations led to disease recurrences with worse outcomes in four cases.

Conclusion. It is possible to stop the inflammatory process preserving at the same time high visual functions only when patients are addressed in time, and when appropriate AK therapy is prescribed and patients are compliant with it for a long time.

Ophthalmology Journal. 2017;10(4):24-31
Personalized analysis of foveal avascular zone with optical coherence tomography angiography
Burnasheva M.A., Kulikov A.N., Maltsev D.S.

Aim. To investigate the relationship between the foveal avascular zone (FAZ) and inner nuclear layer (INL) – free zone in order to provide a personalized approach for evaluation of the FAZ area with optical coherence tomography-angiography (OCTA).

Material and methods.Thirty-six healthy individuals (36 eyes) and 9 patients (12 eyes) with nonproliferative diabetic retinopathy (nPDR) were included in this study. The FAZ area as well as INL-free zone were measured in superficial capillary plexus on OCTA images. The FAZ area, INL-free area, and the ratio of the INL-free area to the FAZ area were compared between healthy subjects and nPDR patients.

Results. The mean FAZ area in healthy subjects and nPDR patients was 0.33 ± 0.1 and 0.56 ± 0.28 mm2 (p < 0.05), respectively. The mean INL-free zone in healthy subjects and nPDR patients was 0.33 ± 0.07 and 0.28 ± 0.1 mm2 (p > 0.05), respectively. The ratio of the INL-free area to the FAZ area in healthy subjects and nPDR patients was 1.08 ± 0.25 and 0.57 ± 0.2 (p < 0.001), respectively. Receiver operating characteristic analysis showed that the ratio of the INL-free area to the FAZ area had the higher area under curve (0.98; 91.7% sensitivity and 97.2% specificity) compared to the FAZ area (0.8; 66.7% sensitivity and 87.1% specificity) for differentiating nPDR from healthy eyes.

Conclusion. This study showed that personalized analysis of the FAZ area based on the relationship between the actual FAZ and INL-free zone has better diagnostic accuracy compared to the conventional FAZ area measurement on OCTA images.

Ophthalmology Journal. 2017;10(4):32-40
The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery
Petrov S.Y., Lovpache D.N., Loskutov I.A., Safonova D.M.

Nowadays, a wide choice of local IOP-lowering medications allows ensuring a successful intraocular pressure compensation and primary open angle glaucoma stabilization. However, taking into consideration a long term action of drugs on the ocular surface, even without clinical manifestations there is a direct inflammatory cells’ activation with mixed toxic and allergic changes, which is confirmed by histology, immune-histology, and impression cytology methods. Such chronic sub-clinical inflammation represent a potential risk of excessive fibroblast proliferation with subsequent rapid postoperative scarring of new outflow pathways and atypical filtration bleb formation. It is shown that there is a clear relationship between number of glaucoma drugs used, treatment duration, intensity of conjunctival infiltration with inflammatory cells and fibroblasts, and risk of episcleral fibrosis and subconjunctival scarring during post-op period.

Ophthalmology Journal. 2017;10(4):41-47
Lacrimal stents in the lacrimal pathways’ surgery
Orlova E.I., Davydov D.V.

This review addresses various types of lacrimal implants, which are used in the surgery of lacrimal pathways. The authors describe modern and used in the past methods of lacrimal passage restoration recanalization techniques, and dacryocystorhinostomy procedures by external and endonasal approaches using stents of various shape, size and design, which often determine the outcome of surgery and the degree of its efficacy. Lacrimal implants are constantly modified and improved. Indications for intubation and the extubation terms are not yet clearly defined. Techniques for lacrimal drainage restoration, lacrimal stents’ use, most effective stent models, indications and contraindications, conduct of experimental studies – all that questions are still awaiting further investigation.

Ophthalmology Journal. 2017;10(4):48-55
Experience in Gilan Comfort eye drops use of in patients after excimer laser surgery
Astakhov S.Y., Riks I.A.

The article presents treatment results of the dry eye syndrome after excimer laser refractive surgery (LASIK). This procedure often leads to dry eye symptoms and signs, so there should be a mandatory prescription of lubricative eye drops for up to 3-6 months. For treatment, non-preserved Gilan Comfort containing hyaluronic acid (Russian Federation trade mark) was used. The study included 30 patients after LASIK who received Gilan Comfort 4 times a day for 3 months. Treatment was well tolerated; there were no adverse effects in any of the patients. The treatment results observed in all 30 people consisted in distinct decrease of dry eye symptoms after 3 months of Gilan Comfort instillations after LASIK surgery.

Ophthalmology Journal. 2017;10(4):57-60
Orbital varix
Potyomkin V.V., Ageeva E.V.

In the article, we report on pathogenesis, clinical features, and methods of diagnosis and treatment of orbital varix.

Ophthalmology Journal. 2017;10(4):61-63
Wyburn-Mason syndrome
Astakhov Y.S., Belekhova S.G., Shakhnazarova A.A., Ovnanyan A.Y.

In the article, a description of a clinical case of an extremely rare isolated ophthalmic form of the Wyburn-Mason syndrome is presented. Etiology, pathogenesis, clinical picture, and diagnostic criteria of this disease are also described.

Ophthalmology Journal. 2017;10(4):64-68

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