Vol 11, No 1 (2018)


Investigation of tear production dynamics in patients with age-related cataract before and after phacoemulsification

Tonkonogiy S.V., Bai L.U., Vasilyev A.V.


Purpose. To investigate the tear production (TP) dynamics in patients with age-related cataract before and after phacoemulsification (PE).

Material and methods. 136 patients (136 eyes) admitted for age-related cataract treatment. Age – 69.3 ± 6.4 years. 64 men and 72 women. Besides standard ophthalmological examination, in all patients Schirmer`s I test was performed before surgery on the next day, 7, 14 and 30 days after surgery. Patients were divided into 4 groups. The 1st group consisted of 32 patients (32 eyes) with TP 15 mm and more. The 2nd group – 48 patients (48 eyes) with TP from 10 to 15 mm. The 3rd group – 40 patients (40 eyes) with TP from 5 to 10 mm. The 4th group – 16 patients (16 eyes) with TP less than 5 mm. In all patients, PE was performed according to standard technology.

Results. All surgeries were performed without complications. In 56 eyes of groups 3 and 4 (41.2%) there was depression of TP of moderate and severe degree before surgery. The first day after surgery in all study groups there was twofold increase of Schirmer`s test indices. Starting from 7th day after surgery, in all groups, a 22-35% decrease of TP from baseline was observed. Later on, a gradual increase of TP was noted. On the 30th day after PE, Schirmer`s test indices were lower than those of baseline in 4 eyes (13%) of the 1st group, 10 eyes (21%) of the 2nd group, 31 eyes (77%) of the 3rd group, and 10 eyes (63%) of the 4th study group.

Conclusions. The study of TP in patients with age-related cataract showed that during one month after surgery TP returned to baseline indices only in 59.6% of patients. Regardless of its baseline indices, after the surgery, there is an universal TP dynamics, which is characterized by its initial increase, subsequent decrease and gradual return to baseline indices. Patients with initial low TP indices have potentially high risk of developing clinically significant dry eye syndrome.

Ophthalmology Reports. 2018;11(1):6-9
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A comparative analysis of the application of piezoelectric surgery and mechanical osteoperforation techniques in modeling an orbital decompression

Konovalov K.A., Davydov D.V., Roshchin V.Y.


Currently a wide range of instruments for surgical procedures on the bony structures of the orbits is offered. Each of them has its advantages and disadvantages. Cutter causes less injury, in comparison with a chisel or an ultrasonic saw [15]. In using a drill during surgery there was an increase in temperature of bone edge of the opening above acceptable values [17]. The use of low frequency ultrasonic tools allows you to create holes in the bones of any desired size and shape with smooth edges [5, 11, 16, 20]. The disadvantages of this method include the heating of tool’s tip up to 140° during prolonged continuous action [6]. Thus, techniques using tools for formation of the bone window require further study and improvement.

Aim: to compare surgical equipment for bone window formation in modeling an orbital decompression.

Materials and methods. In an experimental study in vivo, 12 surgical interventions on the scapula on both sides were performed in 6 Chinchilla breed rabbits. On the right side, the formation of a bone window was carried out by the ultrasonic bone scalpel MISONIX, on the left side – by a drill.

Results. It was found that during first 7-21 days there was more pronounced inflammation of soft tissues on the left side. At the same time, delayed proliferation and maturation of fibrous connective tissue was observed in comparison to the opposite side. Bone tissue inflammation and subsequent regeneration took place without significant differences on both sides. The experiment showed that the use of ultrasonic scalpel in flat bones creates less inflammation of surrounding tissues and the bone itself as compared to a diode laser. A.V. Kravchenko (2006) reports that, after exposure to a diode laser in an acute experiment there was a scalloped edge with an area of photocarbonization (charring) on the 7th and the 21st day; while the use of an ultrasonic scalpel did not create any signs of infiltrative inflammation, later on a nonspecific inflammation developed.

Conclusion. Ultrasonic scalpel has a number of advantages when performing osteoperforation, such as time-saving during surgical procedure, control of the osteotomy process, less trauma to surrounding tissues during action and less pronounced inflammatory response of the wound during early postoperative period.

Ophthalmology Reports. 2018;11(1):10-18
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Antibodies to myelin basic protein as a diagnostic marker of primary open-angle glaucoma

Cherednichenko N.L., Karpov S.M., Baturin V.A., Barbos Y.A.


Recently, many authors resort to immunomolecular diagnostics of glaucoma. We found conflicting information about the concentration of antibodies to the myelin basic protein (AB to MBP) in primary open-angle glaucoma in the literature.

Aim: to determine the concentration of antibodies to the myelin basic protein in the serum of patients with primary open-angle glaucoma to assess the diagnostic significance of the test.

Materials and methods. We included 48 people aged from 42 to 79 years: fourteen people had the diagnosis of the first stage of primary open-angle glaucoma (POAG), 10 people had the second (advanced) stage of POAG, 8 people had the III (far-gone) stage of POAG, and 16 subjects made the control group. Exclusion criteria: mature or almost mature cataract, age-related macular degeneration, severe concomitant ophthalmologic, neurological pathology, oncological and autoimmune diseases, glucocorticoid or immunosuppressive therapy, exacerbation of any acute and subacute respiratory infection, chronic inflammatory processes and craniocerebral trauma. The serum level of AB to MBP was determined by enzyme immunoassay method (ELISA).

Results. The concentration of AB to MBP was significantly higher in patients with first and second stages of POAG (177.5 ± 63.93 μg/ml and 262.63 ± 34.78 μg/ml, respectively) than in the control group (38.69 ± 11.77 micron/ml, p < 0.05). To establish the diagnosis of POAG in at risk patients it is appropriate to use the level of IgG to MBP > 60 μg/ml; the sensitivity of the method is 78% and its specificity is 87%.

Ophthalmology Reports. 2018;11(1):19-24
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Clinical and etiological characteristic, classification and treatment of aseptic corneal ulcers

Brzheskaya I.V., Somov E.E.


Introduction. Aseptic corneal ulcers are among rare, but severe, torpid diseases. The aim is to study the etiology, develop a clinical classification of the corneal aseptic ulcer, and determine the tactics of their treatment.

Material and methods. A total of 40 patients (47 eyes) were examined when admitted as emergency with an aseptic ulcer of the cornea. In addition to traditional examination methods, the optical coherence tomography was performed, ulcer area and depth were recorded, and the collagenolytic activity of the tear fluid was also determined. The defect closure with a biological transplant (amniotic membrane preserved in glycerin, allogeneic sclera, self-tissues – a free flap of the sclera or a pedicle flap of the conjunctiva). The procedure was completed by blepharorrhaphy or flap covering with a soft contact lens.

Results. Initial procedures were successful in 34 eyes out of 47 (72.3%). In the remaining 13 cases, repeated surgeries were required: in 11 cases – during first three months, and in 2 cases – between 4 and 12 months. In two patients with high lytic tear activity (more than 700 kU/ml) repeated procedures were performed twice, due to rapid lysis of the amniotic membrane during 14 days.

Conclusion. All patients with a progressive aseptic corneal ulcer need surgical treatment in the form of its coverage with a biological tissue of allo- or autogenous nature. Anterior stromal ulcers should preferably be covered with a free amniotic flap, and the posterior stromal ulcers should be closed with an autoconjunctival-tenon pedicle flap or with a free flap of the sclera. High collagenolytic activity of the tear fluid is the main cause of biological tissue lysis. Primary and repeated plastic surgery allowed a reliable replacement of the corneal ulcer defect area with scar tissue.

Ophthalmology Reports. 2018;11(1):25-33
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Informative value of biometric indices of iris, sclera and cornea in primary open-angle glaucoma diagnosis

Strakhov V.V., Alekseev V.V., Al-Mrrani A.M., Popova A.A., Klimova O.N.


Aim: to study the thickness of cornea, iris and scleral tissue, to determine its asymmetry between fellow eyes in healthy subjects and in patients with primary glaucoma. To determine the relationship between changes in biomechanical properties of the cornea and sclera and iris thickness in healthy subjects and in patients with primary glaucoma.

Materials and methods. 10 patients (20 eyes) with primary glaucoma were examined. The control group consisted of 10 people (20 eyes). In all patients ultrasound biomicroscopy (Humphrey Instruments (USA), Model 840) was performed.

Results and discussion. The article presents a study of the corneoscleral and iris tissue thickness in primary glaucoma, as well as the increase pattern of the revealed asymmetry in corneoscleral and iris tissue thickness from normal state to glaucoma. A positive direct correlation between the indices of cornea, sclera, and iris thickness in the primary glaucoma group and between biometric parameters of sclera and iris and the of corneal hysteresis value in primary open-angle glaucoma.

Ophthalmology Reports. 2018;11(1):34-40
pages 34-40 views

Zonular instability in patients with pseudoexfoliative syndrome: the analysis of 1000 consecutive phacoemulsifications

Potyomkin V.V., Ageeva E.V.


Phacoemulsification (PHACO) is the gold standard of cataract surgery. Сataract surgery in eyes with pseudoexfoliative (PEX) syndrome is associated with increased risk of intra- and postoperative complications. Zonular laxity is one of the main causes of surgical complications.

Purpose. To assess the degree of zonular weakness in patients with PEX.

Materials and methods. 1010 eyes (580 eyes with PEX and 430 eyes without it) that underwent consecutive PHACO at the Ophthalmology Department No 5 of the City Multifunctional Hospital No 2 from May 2016 until October 2017 were enrolled in the study. The zonular laxity was assessed preoperatively and intraoperatively.

Results. Zonular weakness was observed more often in patients with PEX, both at preoperative and intraoperative evaluation (p < 0.05). However, in both groups, the percentage of zonular weakness estimated intraoperatively, was several times higher, than that estimated preoperatively. Nevertheless there was no difference in the rate of capsular bag related intraoperative complications between two groups.

Ophthalmology Reports. 2018;11(1):41-46
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Influence of eye diseases on the mortality rate of the population

Zolotarev A.V., Karlova E.V., Miroshnichenko E.V.


Evaluating of the correlation between quality of life, life expectancy and mortality rate is an important problem of modern ophthalmology. Many researchers note that eye pathology, which leads to a visual acuity decrease and blindness, has a significant impact on the mortality rate of the population. This review of literature is dedicated to studies examining the impact of eye diseases on the mortality rate of the population.

Ophthalmology Reports. 2018;11(1):47-53
pages 47-53 views

Computer perimetry in the diagnosis of primary open-angle glaucoma

Serdyukova S.A., Simakova I.L.


Static perimetry, made using Humphrey and Octopus expert class perimeters, is called the standard automated perimetry (SAP); and for more than 30 years, it is the “gold standard” in assessing the visual field in glaucoma diagnosis. Currently, many computer perimeters appeared on the Russian market. The article reviews modern methods of computerized perimetry which are most widespread in our country and presents their comparative characteristics.

Ophthalmology Reports. 2018;11(1):54-65
pages 54-65 views

The experience of the first Russian latanoprost 0.005% (Trilactan) use in the treatment of primary open-angle glaucoma

Tatarintseva A.O.


Summary. The problem of the reproduced (generic) and original (branded) medications coexistence on the pharmaceutical market is very relevant for Russia. Numerous polls have shown that very few among patients and even doctors clearly understand the differences between original drugs and generics, nor they know how these drugs are produced, and what advantages and weaknesses they have.

Aim. This paper covers the study of Trilactan (0.005% latanoprost, Solopharm, Russia) use in patients with different stages of primary open-angle glaucoma, and includes the analysis of the hypotensive effect and adverse events rate.

Material and methods. The study included 47 patients divided into 3 groups. The first group included 17 treatment-naïve patients (32 eyes). The second group included 14 patients (28 eyes) previously treated with latanoprost 0.005% once a day in the evening at least for a month. The third group consisted of 16 patients (32 eyes) treated with beta-blockers or carbonic anhydrase inhibitors, in whom the target level of intraocular pressure had not been reached. All patients received 1 drop of Trilactan every evening; the observation lasted for 3 months.

Conclusions. The treatment was well tolerated. The intraocular pressure decrease was observed in all cases (p > 0.05). Local and systemic adverse events under Trilactan treatment did not differ from possible side effects typical to the drugs of this pharmacological group in terms of its type and rate.

Ophthalmology Reports. 2018;11(1):67-70
pages 67-70 views

Dome-shaped macula phenomenon

Melikhova M.V., Gatsu M.V.


This article provides a review of the literature of domestic and foreign studies on the newly described, insufficiently explored and poorly diagnosed pathology of the organ of vision – the dome-shaped macula (DSM). This pathology is an anatomical feature of the structure of the eye and is formed in most cases at medium and high myopia. For the first time, this condition was revealed in 2008 with the help of high resolution optical coherence tomography, and is characterized by local thickening of the sclera in the macular area with dome formation. Currently the final reason for DSM formation is not yet found. Studies are conducted to identify the mechanisms for the formation of this feature and to predict the variants of its course. Particular attention in the article is paid to the review of various changes in the retina and pigment epithelium in patients with dome-shaped macula. Methods and features of diagnosis of this condition, as well as differential diagnosis with choroidal hemangioma, which is very difficult, are also considered. The article presents an overview of current methods of treating this condition. Failures, as well as effective and promising methods of treating the neurosensory retinal detachment, occurring on the background of the dome-shaped macula, are described. Timely and correct diagnosis on the basis of characteristic clinical picture allows to avoid ineffective treatment, as well as to select the necessary set of diagnostic procedures for dynamic observation and identification of features of the disease.

Ophthalmology Reports. 2018;11(1):71-77
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About a new approach to surgical treatment of corneal endothelial dystrophy

Astakhov S.Y., Riks I.A., Papanyan S.S., Novikov S.A., Dzhaliashvili G.Z.


Primary endothelial dystrophy of the cornea is a fairly common disease in people older than 50 years. Well-developed methods of conservative treatment, as a rule, do not lead to improvement or stabilization of the functional state of the cornea. The choice of tactics of surgical treatment from the existing variety of techniques is complicated. There are isolated reports of the restoration of corneal transparency after descemet membrane removal. The author's method of endothelial corneal dystrophy treatment addressed in this particular clinical case – a combination of isolated descemetorhexis and collagen cross-linking – resulted in impressive increase in visual acuity and significant improvement in objective criteria for the morpho-functional state of the cornea.

Ophthalmology Reports. 2018;11(1):78-84
pages 78-84 views

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