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Vol 14, No 4 (2021)

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Original researches

Visual acuity and quality of life in heavy visual workload patients with bilateral cataract before and after phacoemulsification

Pokrovsky D.F., Ovechkin N.I.


BACKGROUND: To date, there is a number of debatable aspects of cataract phacoemulsification in the literature, one of which is the investigation of features of the surgery in patients with visually stressful work.

AIM: The aim is to investigate the dynamics of the best corrected distance visual acuity and quality of life in heavy visual workload patients with bilateral cataract before and after phacoemulsification.

MATERIALS AND METHODS: We observed 32 heavy visual workload patients with binocular cataracts. All patients underwent standard phacoemulsification using Infiniti (Alcon, USA) or Constellation (Alcon, USA) devices according to the standard technique. The quality of life was assessed using the tested in refractive surgery QOL-25 questionnaire.

RESULTS: The high efficiency of phacoemulsification surgery was established, which is confirmed (14 days after the second procedure) by an increase in best corrected distance visual acuity to an average value of 0.92–0.95 relative units. Along with this, a certain quality of life dynamics of was revealed, which is manifested by a statistically significant deterioration (by 2.3–4.7%, p = 0.02–0.008) in the index in 14 and 21 days after the first surgical procedure compared to the data obtained at 7 days after first operation.

CONCLUSION: Surgical treatment of binocular cataracts in heavy visual workload patients is based on earlier (in 7–10 days) surgery on the second eye or performing an immediately sequential bilateral cataract surgery.

Ophthalmology Reports. 2021;14(4):7-12
pages 7-12 views

Influence of the quality of viscoelastic removal on phacoemulsification results. Part 2. Dependence of “IOL – posterior lens capsule” interface status on viscoelastic visualization

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


BACKGROUND: Main methods of intraoperative secondary cataract prevention are measures aimed at the formation of full contact of the intraocular lens (IOL) with the posterior capsule. The diastasis between the IOL and the posterior capsule is explained by the presence of viscoelastic in the interface. Maximum visualization of the stained viscoelastic will obviously make it possible to completely remove it from the eye, which will increase the number of eyes with the optimal “IOL – posterior capsule” interface with standard phacoemulsification.

AIM: The aim was to study “IOL – posterior capsule” interface status after phacoemulsification of senile cataract in relation to viscoelastic visualization.

MATERIALS AND METHODS: 122 eyes of 122 patients were included, which underwent phacoemulsification of senile cataract with femto-laser assistance and were divided into 2 groups depending on viscoelastic characteristic (colored or transparent) used for anterior chamber filling prior to IOL implantation. “IOL – posterior capsule” interface status was examined on the 1st and 7th day post-op in order to evaluate the contact between two structures.

RESULTS: On the 1st day post-op, the absence of contact between IOL and posterior capsule was noticed more often in the second group, the number of eyes with this type of interface was 1.5 times lower in the 1st group. On the 7th day after surgery, optimal interface had place in 9 out of 10 eyes in the 1st group, in comparison with 2/3 of patients from the second group.

CONCLUSION: Conducted investigation showed that the use of colored viscoelastic allowed creating the optimal “IOL – posterior capsule” interface on the 7th day post-op in 87% of eyes of the main group in comparison with 67% eyes from the control group (the difference is statistically significant). The absence of contact between IOL and capsule can be considered as relative capsule block, which may form the high risk of secondary cataract.

Ophthalmology Reports. 2021;14(4):13-18
pages 13-18 views

Comparison of indicators of autologous serum obtained by different methods and used for the treatment of macular hole

Popov E.M., Kulikov A.N., Churashov S.V., Gavrilyuk I.O., Egorova E.N., Abbasova A.I.


BACKGROUND: In recent years, autologous serum has been increasingly used in the treatment of macular hole. The study carried out a biological analysis of autologous serum obtained by various methods.

AIM: The aim of the investigation is to compare the cellular and biochemical composition of autologous serum obtained using different methods for use in the macular hole treatment.

MATERIALS AND METHODS: The study of the number of platelets, leukocytes and fibrinogen level in the blood serum of 24 patients obtained by centrifugation in original systems for harvesting autologous serum and laboratory test tubes was performed.

RESULTS: The indices of P-PRP obtained in the Arthrex ACP system and in a laboratory test tube do not statistically differ in quantitative indices of fibrinogen and platelets (p < 0.05), and differ in the content of leukocytes (p > 0.05) in the direction of increasing the number of leukocytes in the substrate obtained in a laboratory test tube. The indicators of L-PRP obtained in the Ycellbio-Kit system and in a laboratory test tube do not statistically differ in the amount of fibrinogen (p < 0.05) and differ in the content of platelets and leukocytes (p > 0.05) in the direction of decreasing the concentration of leukocytes and platelets in the autologous serum obtained in a laboratory test tube.

CONCLUSIONS: Currently, autologous serum obtained in the Arthrex ACP system is of great interest for macular hole surgery due to the minimal content of leukocytes, the closed character of the system, and the best coagulation properties of the substrate obtained. Laboratory test tubes may be considered a more affordable alternative for the production of autologous serum (P-PRP) for the treatment of macular hole. The autologous serum (L-PRP) obtained in the Ycellbio-Kit system and in a laboratory test tube is less suitable for macular hole surgery according to its composition.

Ophthalmology Reports. 2021;14(4):27-34
pages 27-34 views

Pellucid marginal degeneration classification development based on investigation of relationship between functional and refractive changes

Vasilieva I.V., Kostenev S.V., Vasiliev A.V.


BACKGROUND: One of the problems in the diagnosis and treatment of pellucid marginal degeneration of the cornea is the difficulty of systematizing its manifestations due to the lack of classification. This is due to the low frequency of pellucid marginal degeneration in the structure of primary keratectasia, the main type of which is keratoconus. The developed classifications of keratoconus cannot be fully applied to pellucid marginal degeneration.

AIM: The aim was to develop a classification of pellucid marginal degeneration based on investigation of relationship between functional and refractive changes.

MATERIALS AND METHODS: The study included 42 people (42 eyes) with pellucid marginal degeneration. Keratometry and refractometry were performed, uncorrected and best corrected visual acuity, as well as cylindrical and spherical components of subjective refraction were studied, and retinal visual acuity was determined. The 1st group – 12 patients (12 eyes) with fully corrected induced ametropia (best corrected visual acuity ≥0.8), the 2nd group – 17 patients (17 eyes) with partially corrected induced ametropia (<0.8 and ≥0.3), the 3rd group – 13 patients (13 eyes) with uncorrected induced ametropia (<0.3).

RESULTS: To develop a clinical classification of pellucid marginal degeneration by stages, we selected: the values of corneal astigmatism, best corrected visual acuity and Index of difference between the values of maximum and minimum keratometry (ΔK), all of which had good separation of obtained data, and their demarcate values in groups.

CONCLUSION: The study showed the presence of relationship between functional and refractive changes indices of eyes with pellucid marginal degeneration. The leading parameters of refractive status, objectively determining the value of best corrected visual acuity, are induced corneal astigmatism and ΔK. The developed classification of pellucid marginal degeneration is easy to use and makes it possible to determine the stage of keratectasia even if there is only induced corneal astigmatism or ΔK values.

Ophthalmology Reports. 2021;14(4):19-26
pages 19-26 views

Outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma

Sadovnikova N.N., Brzheskiy V.V., Prisich N.V., Zertsalova M.A., Baranov A.Y.


BACKGROUND: In many types of pediatric glaucoma, there is no clear algorithm for surgical management. In these situations, the procedure of choice can be the implantation of various types of drainage devices.

AIM: To evaluate the outcomes of Ahmed Glaucoma Valve implantation in refractory pediatric glaucoma.

MATERIALS AND METHODS: The treatment results of 52 children (67 eyes) aged 1 month – 17 years (6.6 ± 0.6 years) with unsuccessfully operated primary congenital glaucoma, with glaucoma associated with congenital anomalies of the eyeball, with secondary glaucoma were analyzed. The surgery was considered to be effective when stable intraocular pressure (IOP) was achieved, there were no complications, and no need for repeated interventions.

RESULTS: The effect of surgery was maintained for 6 months in 97% of patients, but after 1, 2 and 3 years it decreased to 91.8%, 82%, and 73.9%, respectively, and to 42.8% after 7 years. Postoperative complications included filtering bleb encapsulation (25.3%), iris retraction to the tube with pupil dislocation (4.5%); ciliochoroidal detachment (4.5%); cataract (3.0%), conjunctival erosion with tube eruption (4.5%), endophthalmitis (1.5%), retinal detachment (6.0%), tube retraction (1.5%), hyphema (3.0%). The risk factors for an unfavorable outcome of the procedure were: an increase in the anteroposterior axis of the eyeball length by 20% or more compared to the age norm, IOP at the time of the surgery higher than 32 mm Hg, as well as previous antiglaucoma filtering procedures.

CONCLUSIONS: The implantation of the drainage device Ahmed Glaucoma Valve is indicated for refractory pediatric glaucoma in case of ineffectiveness of previous surgeries. However, it is necessary to take into account the decrease in the effectiveness of the device over time, which, combined with the possibility of complications, requires long-term follow-up of patients.

Ophthalmology Reports. 2021;14(4):35-44
pages 35-44 views

Organization of ophthalmic care

The level of prevalence and risk factors of strabismus among children and adolescents, depending on the type of settlements in the Ganja-Gazakh economic district (Azerbaijan)

Abdiyeva Y.


BACKGROUND: Strabismus as a pathological condition complicating the visual function and affecting the behavioral functions of children is often in the center of attention of numerous studies. The presence of regional differences in the strabismus prevalence makes this problem a relevant to study issue in the regions of Azerbaijan.

AIM: To assess the prevalence rate of strabismus among children depending on the settlement type.

MATERIALS AND METHODS: A prospective observation of a sample of children aged 5–19 years was carried out; the sample size was determined taking into account the size of the margin of sampling error less than 5%. 300 children at the age 5–9, 10–14, 15–19 years (150 boys and 150 girls) in a large town (Ganja) and rural settlements of Ganja-Gazakh region (2700 children in total) have been observed. In all children, an ophthalmologic examination was performed by specialists of the mobile team of the National Ophthalmological Center named after academician Z. Aliyeva.

RESULTS: Strabismus was found in children aged 5-19 years in 4.6 ± 0.7% of cases in a large town and in 2.7 ± 0.5% of cases in rural settlements. Significant differences of prevalence rate of strabismus by age and gender were not confirmed.

CONCLUSIONS: In the region, the incidence of strabismus among children aged 5–19 years was 3.8 ± 0.4%. In a large town, the risk of strabismus among children is high. In children with strabismus, refractive errors and perinatal conditions (prematurity) are often found.

Ophthalmology Reports. 2021;14(4):45-53
pages 45-53 views


Recurrent corneal erosion

Trufanov S.V., Seyfeddin A.S., Turgel V.A.


Recurrent corneal erosion (RCE) is a common recurrent disease caused by abnormal adhesion of the corneal epithelium to the basement membrane. Previous corneal trauma is the most common cause of this disease. Corneal dystrophies, such as dystrophy of the epithelial basement membrane, Meesmann dystrophy, Reis–Bücklers dystrophy, lattice dystrophy and granular dystrophies, are also involved in the pathogenesis of recurrent corneal erosion. The main diagnostic methods for recurrent corneal erosion are slit-lamp examination and taking of medical history. Detectable RCE changes range from small corneal irregularities (such as epithelial microcysts) to large areas of loose epithelium or epithelial defects detecting by fluorescein staining. Areas of irregular epithelium with grayish inclusions or microcysts and a “fingerprint” pattern or a map-like defects are also revealed. The main goal of treatment is to relieve pain, stimulate re-epithelialization, and fully restore the adhesion of the basement membrane and epithelium. Lubricants and matrix proteinase inhibitors are prescribed as first-line therapy, and blood derivatives can be used as second-line therapy. When conservative therapy fails, surgical procedures are used (excimer laser phototherapeutic keratectomy, Bowman’s membrane polishing with diamond drill, anterior stromal puncture, corneal collagen cross-linking).

Ophthalmology Reports. 2021;14(4):55-64
pages 55-64 views

Experimental trials

Effect of ophthalmic drug films with methyluracil and 6-methyl-3-(thietan-3-yl)uracil on the thickness of the corneal epithelium

Gabdrakhmanova A.F., Kurbanov S.A.


BACKGROUND: Development and testing of drugs with regenerative and anti-inflammatory properties. It is advisable using them in keratopathy development and impairments of trophic processes, at the action of preservatives against the background of long-term local IOP-lowering therapy for glaucoma, as well as in the presence of a surgical wound in the area of the procedure, the last causing discomfort in many patients, foreign body sensation, and ocular irritation during the postoperative period in glaucoma treatment.

AIM: To evaluate the effect of ophthalmic drug films (ODF) with 6-methyl-3- (thietan-3-yl)uracil and methyluracil on the thickness of the corneal epithelium after experimental chemical burn.

MATERIALS AND METHODS: A histomorphological analysis of the cornea of 17 rabbits (34 eyes) of the Chinchilla breed after experimental chemical burn was carried out, the wound healing and keratoprotective properties of ophthalmic drug films were evaluated. Ophthalmic drug films with 6-methyl-3-(thietan-3-yl)uracil were placed in right eyes of 15 rabbits, and those with methyluracil were placed in left eyes of same rabbits. Two rabbits (4 eyes) served as control: their right eyes were left without wound healing therapy, while left eyes received dexpanthenol 5% gel (Corneregel) 4 times a day. The animals were followed-up for 21 days, morphological changes in the cornea were assessed on the 2nd, 7th, 14th and 21st days of the study.

RESULTS: Different results were obtained depending on the ODF used. The use of ODF with methyluracil on days 2–7 led to an increase in the thickness and the number of epithelial layers compared to ophthalmic drug films with 6-methyl-3-(thietan-3-yl)uracil, where epithelial reactivity was observed by 14 days. On the 21st day of follow-up, the microscopic picture of the cornea in the right and the left eyes was characterized by total restoration and healing of the corneal epithelium.

CONCLUSIONS: Ophthalmic drug films therapy with methyluracil and 6-methyl-3-(thietan-3-yl)uracil leads to histologically correct and rapid epithelialization of the cornea after a chemical burn.

Ophthalmology Reports. 2021;14(4):65-71
pages 65-71 views

Case reports

Pathomimia in a practice of an ophthalmologist

Potemkin V.V., Marchenko O.A., Goltsman E.V., Anikina L.K., Gladysheva E.K.


Non-suicidal self-inflicted injuries are encountered in the practice of doctors of all specialties. Within the framework of this article, a case of surgical treatment of a female patient with pathomimia and lagophthalmos will be presented.

Ophthalmology Reports. 2021;14(4):73-78
pages 73-78 views


Comment on the article “Pathomimia in a practice of an ophthalmologist”

Davydov D.V.


Comment of the Editor-in-chief on the article by Potemkin V.V., Marchenko O.A., Goltsman E.V., Anikina L.K., Gladysheva E.K. “Pathomimia in the practice of an ophthalmologist”, 2021, V. 14, No. 4.

Ophthalmology Reports. 2021;14(4):79-81
pages 79-81 views

In ophthalmology practitioners

Why are patients with mature cataract admitted to hospital? Challenges for cataract surgery

Ivachev E.A., Denisova I.P., Anisimova E.V., Tanash M.A.


BACKGROUND: A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period.

AIM: To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients.

MATERIALS AND METHODS: 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts.

RESULTS: 95.2% (n = 138) of patients did not seek ophthalmological attention, 4.8% (n = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was “absence of an ophthalmologist in the outpatient polyclinic”. The patient’s lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm – 37.2%; pseudoexfoliation syndrome – 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber – 44.8%; lens subluxation – 24.1%; atrophy of the pupillary margin – 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively – 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one – 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 ± 0.27, on Day 7 – 0.73 ± 0.22, after 3 months – 0.76 ± 0.25.

CONCLUSIONS: Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.

Ophthalmology Reports. 2021;14(4):83-90
pages 83-90 views

History of Medicine

Professor Pavel Efremovich Tikhomirov. On the occasion of 125th anniversary of the birth

Ustinova E.I.


In the article, data on creative activity and personality of the Professor in ophthalmology Pavel Efremovich Tikhomirov are presented. Under the guidance of Academician M.I. Averbakh in the Helmholtz Moscow research institute of eye diseases, Pavel Efremovich raised through the ranks from a medical extern to Senior research fellow, Professor, Vice-Director of the institute. From 1945 to the end of his life (1964), he was the Head of the Ophthalmology chair of the Leningrad Medical Institute of Sanitation and Hygiene (currently the North-Western State Medical University named after I.I. Mechnikov). P.E. Tikhomirov took part in two wars: in 1919–1922 served in the Red Army in the position of a regimental doctor, during the Great Patriotic War, he was a Head ophthalmologist of a Hospital Administration of the Ministry of Health of the Russian Federation (he organized and headed the military hospital department in Moscow, took multiple missions to evacuation hospitals of the country).

Main scientific activities of P.E. Tikhomirov: problems of the military ocular injuries, diagnosis and treatment of lacrimal system diseases, glaucoma, pre-glaucoma, and ocular tuberculosis. His writings include three monographies, two sections of the multi-volume edition on eye diseases, more than 100 scientific articles, a compendium of scientific articles “Glaucoma” (1960).

Pavel Efremovich was an experienced organizer and a good psychologist. He began teaching Ophthalmology in 1933 in two Moscow institutes of higher education. During 1945–1964, being the Head of the Ophthalmology chair of the Leningrad Medical Institute of Sanitation and Hygiene, excellent teacher and lecturer, very good clinician, Professor P.E. Tikhomirov prepared hundreds of ophthalmologists, 6 candidates of medical sciences, was a consulting specialist of three doctorate theses.

Real professional and clinician, outstanding ophthalmic surgeon, Professor P.E. Tikhomirov during 45 years of his medical career recovered the sight of many thousands of patients and was widely well-known not only in Leningrad, but in the whole country.

Ophthalmology Reports. 2021;14(4):91-94
pages 91-94 views

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