Vol 11, No 2 (2018)

Analysis of long-term results of collagen corneal cross-linking in patients with ectatic forms of corneal dystrophy
Frolov O.A., Astakhov S.Y., Danilov P.A., Novikov S.A.

Corneal collagen cross-linking became a permanent part of complex treatment for patients with different forms of corneal ectasia. In periodical literature, there are anecdotal reports concerning long-term results of this corneal disease therapy method, which is an isolated variant of photodynamic therapy.

Purpose. To carry out a retrospective study of corneal collagen cross-linking long-term results in various ectatic corneal diseases.

Materials and methods. Results of corneal collagen cross-linking in patients with ectatic forms of corneal dystrophy 6 years after surgery were analyzed. The nosological structure of the study included a group of patients with primary keratoconus, pellucid marginal corneal degeneration, secondary ectasias. The group with primary keratoconus includes 30 patients (31 eyes), that with pellucid marginal degeneration 10 patients (10 eyes), that with secondary ectasias – 10 patients (10 eyes). Data of the diagnostic examination before surgery, intermediate data of the dynamic follow-up during 6 years of observation were used for the analysis. Corneal collagen cross-linking was performed in the first or second year of follow-up, followed by monitoring of changes in the state of the cornea after corneal collagen cross-linking for 4-5 years.

Results. A statistically significant increase in visual acuity was observed after the corneal collagen cross-linking in patients with primary and secondary ectasias. In patients diagnosed with pellucid marginal degeneration, there was no statistically significant increase of visual function. A decrease in the corneal asymmetry index was revealed in all groups and confirmed by statistical analysis.

Ophthalmology Journal. 2018;11(2):6-12
Assessment of Corneal subbasal nerve plexus using confocal in vivo microscopy in patients with pseudoexfoliation syndrome after phacoemulsification
Potyomkin V.V., Varganova T.S., Terehova I.V., Ageeva E.V.

Phacoemulsification (PE) is the leading method of cataract surgery. Purpose. To assess the impact of PE on corneal subbasal nerve plexus in patients with pseudoexfoliation syndrome (PEX) using confocal in vivo microscopy. Methods. 42 patients (42 eyes) were enrolled in the study. The main group consisted of 24 patients (24 eyes) with PEX syndrome, and 18 patients (18 eyes) without it composed the control group. Confocal in vivo microscopy was performed before and after PHACO. Results. In patients with PEX after PE, an increase in number of nerve branches and pellet-like structures in them were noticed (p < 0,05).

Ophthalmology Journal. 2018;11(2):13-18
Pseudoexfoliative glaucoma and molecular genetic characteristics of vitamin D metabolism
Beletskaya I.S., Astakhov S.Y., Karonova T.L., Galkina O.V., Bogdanova E.O., Akopov E.L., Kozyreva A.A.

Purpose. To study the possible association of 25-hydroxyvitamin D level, and vitamin D receptor (VDR) gene polymorphisms (BsmI, ApaI, TaqI, FokI) with pseudoexfoliative glaucoma (PEG) clinical manifestations.

Methods. We examined 160 subjects (72 males (45%), and 88 females (55%)) aged from 55 to 75 years, residents of St. Petersburg and Leningrad region. 122 patients with PEG were enrolled in the main study group, the control group comprised 38 subjects without PEG, primary open angle glaucoma (POUG) and pseudoexfoliation syndrome (PES). 25(OH)D serum levels were assessed by chemiluminescent immunoassay (CLIA) method. Detection of VDR gene allele polymorphisms (ApaI, BsmI, FokI, and TaqI) was carried out using polymerase chain reaction – restriction fragment length polymorphism (PCR-RFLP) technique.

Results. Patients with PEG had lower 25(OH)D serum levels compared to patients in the control group (39.3 ± 1.2 and 52.7 ± 2.1 nMol/l, respectively, p < 0.01). The prevalence of vitamin D deficiency was found to be higher among PEG patients than among healthy subjects (86.4% and 59.5%, respectively, p < 0.01). The prevalence of b allele (p < 0.001) and bb genotype (p < 0.001) (BsmI polymorphism), as well as of f allele and ff genotype (p < 0.05) (FokI polymorphism) in PEG patients were higher compared to healthy subjects. We found that the Fallele carriers (FokI polymorphism) had greater corneal thickness than the ff genotype carriers (547.3 ± 4.1 μm and 502.1 ± 25.8 μm, respectively, p < 0.01). It was revealed, that bb genotype, Bb genotype (BsmI polymorphism), and ff genotype (FokI polymorphism) were associated with the increased risk of PEG (OR = 8.2, CI 95%: 3.4-19.9; OR = 3.9, CI 95%: 1.7-9.0; OR = 2.3, CI 95%: 1.2-4.5, respectively).

Conclusions. Results of this study for the first time ever showed the association between BsmI and FokI VDR gene polymorphisms and pseudoexfoliative glaucoma.

Ophthalmology Journal. 2018;11(2):19-28
Single step laser procedures combined technology in the treatment algorithm of advanced primary open-angle glaucoma stage after surgery
Tumanyan E.R., Lyubimova T.S., Kozlova E.E., Shormaz I.N., Ivashchenko E.V.

Results are presented of a combined laser treatment method of advanced primary open-angle glaucoma stagewith high trabecular meshwork pigmentation in anterior chamber angle and pseudoexfoliation syndrome stage 2, after non-penetrating deep sclerectomy at recurrent IOP increase in the post-op period. The laser treatment included a single-step modified selective laser activation of the trabeculum and a laser Descemet’s goniopuncture. The study results demonstrated more significant IOP-lowering effect as well as the integrity of surgically-formed aqueous humor outflow pathways during a follow-up period of 24 months compared with controls, in whom only classical Descemet’s goniopuncture (DGP) method was used.

Ophthalmology Journal. 2018;11(2):29-35
Preliminary results of extra-scleral and vitreoretinal procedures for rhegmatogenous retinal detachment
Shchukin A.D., Saigina E.A., Litvinova Y.A.

To date, the problem of rhegmatogenous retinal detachment (RD) relapses due to the proliferative vitreoretinopathy (PVR) progression remains unsolved, there is no single surgical treatment algorithm for retinal detachment, and even more so for its recurrence. The aim is to evaluate the structure of surgical care provided to patients with RD using extensive clinical material, taking into account different methods used, frequency of RD recurrences, frequency of reoperations. Materials and methods. The study was carried out in the vitreoretinal department of the Ophthalmological Center of the City Multifunctional Hospital No. 2 of St. Petersburg. 1502 cases of hospitalization for rhegmatogenous retinal detachment during 2015-2016 have been analyzed, results of surgical treatment have been assessed, number of relapses and frequency of reoperations have been established. Results. RD recurrence after surgical treatment occurs in 20.6% of patients, and vitrectomy is applied twice as often as extrascleral procedures. The use of endovitreal techniques is generally more effective than of extrascleral ones.

Ophthalmology Journal. 2018;11(2):36-40
Comparative assessment of the efficacy of primary and secondary corneal endothelial dystrophy treatment by isolated descemetorhexis and accelerated collagen crosslinking method
Astakhov S.Y., Riks I.A., Papanyan S.S., Novikov S.A., Dzhaliashvili G.Z., Bondareva I.B.

The article examines the efficacy of the author’s method of endothelial corneal dystrophy treatment, inclu ding descemetorhexis and accelerated collagen crosslinking. In primary endothelial dystrophy, corneal state improvement and restoration of its transparency were observed in 66.6% of cases (due to migration of endothelial cells from the periphery to the сentral zone). In secondary endothelial dystrophy, the treatment method described in the present article is ineffective, and the reasons for failures are not quite clear and require further investigation.

Ophthalmology Journal. 2018;11(2):41-47
Current approaches to the problem of carrier selection for limbal stem cells cultivation in the treatment of limbal stem cell deficiency
Kulikov A.N., Churashov S.V., Chernysh V.F., Blinova M.I., Alexandrova O.I., Karpovich V.V., Khorolskaya Y.I.

Diseases and damages of the ocular surface are one of the common causes of decreased vision and blindness. Dysfunction or death of limbal epithelial stem cells (LESC) plays an important role in the development of pathological processes in these conditions, which leads to the development of the limbal stem cell deficiency (LSCD). Currently, one of the methods to treat LSCD is a transplantation of cultured ex vivo LESC. The most common carriers for the cultivation of LESC in the world is the amniotic membrane (AM). However, the presence of certain disadvantages in using AM for the cultivation of LESC compels to search new types of carriers made from biological or synthetic materials. In this review, we have analyzed various types of carriers: collagen, fibrin, chitosan with gelatin, silk fibroin, keratin, contact lenses, polylactide-co-glycolide, polycaprolactone, and the possibility of their application as carriers for the LESC cultivation followed by transplantation on the ocular surface is considered.

Ophthalmology Journal. 2018;11(2):48-56
The main aspects of retinal vein occlusion etiopathogenisis in young adults. Part I. Neuroretinovasculitis (prothrombotic potential, clinical manifestations)
Tultseva S.N., Lisochkina A.B., Titarenko A.I., Turgel V.A.

This review is dedicated to the neuroretinovasculitis, which is the leading cause of retinal vein occlusion in young adults. Presumed etiological factors, possible pathogenic mechanisms, and clinical manifestation are analyzed. Advisability of multidisciplinary approach in management and individual approach in treatment of patients with neuroretinovasculitis with secondary retinal vein occlusion are justified.

Ophthalmology Journal. 2018;11(2):57-67
The initial experience of using the drain implant to eliminate epiphora in patients with rhinogenous pathology
Beldovskaya N.Y., Karpichenko S.A., Shavgulidze M.A., Farikova E.E.

The pathology of upper lacrimal pathways associated with cicatrical strictures and obliteration, anatomical features of this zone is an essential problem of epiphora occurrence. The diseases of nasal cavity and paranasal sinuses play a significant role in the etiopathogenesis of this kind of epiphora. The search of new methods of preventing or eliminating epiphora, also caused by rinological pathology, is reasonable.

Aim: To estimate the efficacy of drainage implant HEALAFLOW (Aptissen, Switzerland) in patients with complains on epiphora and concomitant nasal cavity pathology.

Material and methods. 29 patients (50 eyes) with complains on permanent (more than 6 months) epiphora were under the supervision. Ge nerally accepted ophthalmological, dacryological, rhinological examinations, including cone-ray computer tomography of the paranasal sinuses with preliminary contrast of the lacrimal pathways were carried out. Patients were divided into two groups. 15 people (28 eyes) composed the main group (I). 14 people (22 eyes) formed a control group (II). In I group the drainage implant HEALAFLOW (Aptissen, Switzerland) was inserted in 1 day after operation aimed on elimination of nasal cavity pathology. Patients of the II group instillation of Tobradex according to the scheme and moistening drops were prescribed.

Results. According to dacryological examination 29 patients (50 eyes) with complains on epiphora had normal passive lacrimal pathway passablness, but delayed or negative results of probes characterizing active passablness. All 29 patients had a rhinological pathology, which was eliminated by the otorhinolaryngologist with the operation at the first stage. In I group 9 patients noticed an increased epiphora immediately after the administration of HEALAFLOW in lacrimal pathway, which lasted during the first 24 hours after the procedure. Based on the results of the follow-up examination, after 3 months, all patients showed an improvement, expressed in the absence or decrease of epiphora. It should be noted that in the I group (after the insertion of the implant) the positive effect was more expressed. In the I group 12 of 15 patients didn’t have epiphora and in 3 patients it decreased. In the II group — 7 patients didn’t have epiphora and in 6 patients it decreased.

Conclusion. Insertion of drainage implant HEALAFLOW in the lacrimal pathway after elimination of rhinological pathology in patients with complains on epiphora is safe, well tolerated and produces a positive drainage effect. This allows to recommend the implant to patients with tear-off device abnormality in the complex treatment of tear outflow disorders.

Ophthalmology Journal. 2018;11(2):69-73
The state of conjunctival flora and its susceptibility to “Vitabakt” in cataract patients compared to other antibiotics used in ophthalmologic practice
Pirogov Y.I., Shustrova T.A., Oblovatskaya E.S., Khromova E.S.

The problem of increasing microbial antibiotic resistance antimicrobial requires a detailed study of all antimicrobial drugs’ spectrum of activity. In the available literature, there are no data on microbial flora in vitro susceptibility to picloxydine.

The aim of this study was to study the conjunctival flora composition and its susceptibility to antimicrobial drugs in patients before phacoemulsification, and to detect the conjunctival flora sensitivity to picloxydine in the postoperative period.

Materials and methods. Before phacoemulsification, 117 swabs (116 patients) were taken from the conjunctiva before any drop instil lation. All swabs were examined using the routine cultural method and 14 antibiotics-panel susceptibility testing. Picloxydine susceptibility was tested four times during the postoperative period in 28 patients.

Results. In 66.7%, bacterial growth was obtained preoperatively. All isolates were gram-positive, St. epidermidis was found most frequently (78.8%). In 1 hour after surgery, bacterial growth was obtained in 27.6%. Fluoroquinolones, linezolid, and picloxydine revealed highest efficacy toward St. epidermidis and St. aureus.

Conclusion. Moxifloxacin, linezolid, and picloxydine turned out to be the most effective antimicrobial drugs. Сonjunctival flora was detected in 1 hour after phacoemulsification. Сonjunctival flora remains sensitive to picloxydine during 1 month in the postoperative period.

Ophthalmology Journal. 2018;11(2):75-79
Therapeutic efficacy of 3% NaCl hypertonic solution in postoperative corneal edema
Khripun K.V., Nizametdinov Y.S., Varganova T.S.

Currently phacoemulsification (PE) is the main technique of cataract surgery, which provides for patients early clinical and functional rehabilitation. Post-operative corneal edema is a frequent and undesirable clinical situation.

The purpose of the study was to evaluate clinical efficacy of 3% sodium chloride (“Ocusaline”) treatment in patients with corneal edema in the early post-operative period.

Materials and methods. 60 patients (65 eyes) with post-operative corneal edema were included in the study. The main group consisted of 35 eyes; 30 eyes were included into the control group. Patients in the group 1 in addition to the routine post-operative treatment were treated with 3% sodium chloride hypertonic eye drops (“Ocusaline”); and patients in group 2 were treated according to the standard protocol. In all patients before and after surgery (in 1 day, 7 days and 1 month), subjective and objective indices of functional ophthalmic state (visual acuity, pachymetry in the central area and in the tunnel incision zone) were estimated.

Results. The study results demonstrated that 3% sodium chloride hypertonic solution use facilitates visual acuity improvement due to the decrease of corneal thickness in the central area already at one week after surgery. The use of “Ocusaline” in the early post-operative period allows to decrease clinical and functional rehabilitation terms and to reduce subjective complaints of patients.

Ophthalmology Journal. 2018;11(2):81-86
Cyclodialysis diagnosis and treatment revisited
Litvinova Y.A., Laptev D.A., Nikolaenko V.P., Koulicov V.S.

The article presents clinical cases of diagnosis and treatment of patients with cyclodialysis of different extension.

Ophthalmology Journal. 2018;11(2):87-94
Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature
Panova T.Y., Nikolaenko V.P.

The article reviews a clinical case of unilateral mydriasis after uncomplicated video-assisted thoracic thymectomy as well as results of literature data analysis of.

Ophthalmology Journal. 2018;11(2):95-100

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