Vol 11, No 3 (2018)

Peculiarities of ocular prosthetics in congenital anophthalmia and microphthalmia
Baranova N.A., Nikolaenko V.P.

Aim — to determine optimal terms of the primary ocular prosthetics, to develop the most auspicious regimen of adaptation to the ocular prosthesis in children with congenital anophthalmia and microphthalmia.

Material and methods. A total of 46 children aged from 1 month to 16 years with congenital defect were under observation. Among patients with congenital microphthalmia, only unpromising eyes were subject to ocular prosthetics. Examination methods in the laboratory included external examination of the orbit, palpebral fissure, and eyelids. The state of the cul-de-sac of eyelids, the configuration of the conjunctival cavity, the anterior segment of the abnormally small eyeball were assessed. Photography was performed to achieve a dynamic control of external prosthetics signs of, and to evaluate the face symmetry.

Results. Best results were observed at early stepwise ocular prosthetics with consideration of features of the ocular prosthesis material, without prior surgery. Long-term cosmetic performance of children with congenital anophthalmia and microphthalmia directly depended on age at which the non-surgical treatment began, on the timely replacement of the ocular prosthesis, compliance to the regimen developed for the adaptation to the prosthesis.

Conclusion. This study showed that the terms of primary ocular prosthetics are of crucial importance for the symmetrical development of soft tissues and facial skeleton. Prosthetics for patients with congenital anophthalmia should be started at the first month of life. The optimal term for primary prosthetics in congenital microphthalmia depends on the length of the antero-posterior axis at birth. If the axial length is less than 7.5 mm, prosthetics should be started at the first month of life, if the axis is longer than 10 mm — no later than from the fourth month of life.

Ophthalmology journal. 2018;11(3):6-14
Optical biometry features in silicon oil filled eyes
Kulikov A.N., Kokareva E.V., Kuznetsov A.R.

Background. The article presents results of axial length (AL) measurement in eyes filled with silicone oil and in those without silicone oil with IOLMaster and Lenstar LS 900 optical biometry methods.

Materials and methods. The anteroposterior axis was measured in 27 eyes of 27 patients with silicone oil tamponade after surgical treatment of several vitreoretinal conditions. Using IOLMaster, the AL of eyes without silicone oil tamponade varied from 21.99 mm to 29.38 mm, Lenstar LS 900 biometry gave results from 21.96 mm to 29.41 mm.

Results. According to data obtained and to their distribution, all cases were divided into 2 groups: I group — eyes with AL less than 23.63 mm, and II group — eyes with AL more than 23.63 mm. In the group II, the disparity of consecutive measurements was reliable and amounted to 0.28 ± 0.46 mm (р = 0.024) for IOLMaster and 0.23 ± 0.44 mm (р = 0.029) for Lenstar LS 900.

Conclusion. So AL values at IOLMaster and Lenstar LS 900 biometry of silicone oil filled eyes may significantly overestimate the real ones when exceeding 23.63 mm. In case of simultaneous phacoemulsification with IOL implantation, this could lead to hypermetropic shift of postoperative refraction. Lenstar LS 900 measurement error in silicon oil filled eyes is less than that of IOLMaster, thus making the first biometry method preferable. In eyes with AL shorter than 23.63 mm, the measurement difference was not reliable, thus the biometry accuracy in silicone oil filled “short” eyes becomes higher.

Ophthalmology journal. 2018;11(3):15-20
Episcleral venous pressure level in patients with thyroid associated orbitopathy
Potemkin V.V., Goltsman E.V., Kovaleva M.S.

Thyroid associated orbitopathy (TAO) occurs in patients with various diseases of the thyroid gland. The levels of episcleral venous pressure (EVP), intraocular pressure and intraorbital pressure are inter- related. There are no precise data on the change of EVP in patients with TAO.

Purpose. To evaluate EVP in patients with compensated and sub-compensated TAO forms.

Methods. Data of 41 eyes of 22 patients were enrolled into the study. The main index to be evaluated was the EVP.

Results. EVP level was significantly higher in complete venous compression in the lower- temporal quadrant in patients with sub-compensated TAO stage (p = 0.013).

Conclusion. The degree of venous outflow obstruction and the EVP level of are interrelated. Thus, the level of EVP can be used as an additional factor in assessing the severity of the disease course and the treatment efficacy.

Ophthalmology journal. 2018;11(3):21-25
Risk prediction of posttraummatic enophthalmos development on the basis of orbital volume calculations using multislice computed tomography data
Davydov D.V., Serova N.S., Pavlova O.Y.

Purpose. To elaborate a method of orbital volume measurement in patients with midface trauma at pre- and postoperative stages on the basis of multislice computed tomography (MSCT); to investigate the capabilities of orbital volume measurement to acquire additional diagnostic information and to estimate the risk of postoperative enophthalmos development.

Materials and methods. A total of 71 patients (100%) with midface trauma were examined at the Sechenov University clinic. At pre- and postoperative stages, all patients (n = 71, 100%) were examined using MSCT (Toshiba Aquilion One 640) with 0.5 mm slice thickness in bone and soft tissue regimen. To measure orbital volume, MSCT data were processed using Vitrea workstation: bone borders of the right and left orbit were marked before and after surgical treatment on every axial slice, and orbital volumes were presented in ml.

Results. Preoperative MSCT data management revealed increased orbital volume due to orbital trauma in 64 patients (90%), the difference between healthy and traumatized orbit was between 2 ml and 14 ml. In these patients, reconstructive surgical procedure was performed. In 7 patients (10%) with mild midface trauma, the difference between orbital volumes was less than 2 ml, this was considered as a positive prognostic factor, and these patients were not subjects to surgical treatment. After surgery, in 55 patients (77%) the orbital volume restored, the difference between orbital volumes was less than 2 ml. In 9 cases (13%), the difference in orbital volume was more than 2 ml, considered as adverse prognostic factor which means that there still was a risk of postoperative enophthalmos development. In this patient group, additional diagnostic examination was necessary, and patients required planning of residual enophthalmos surgical correction with MSCT control during the post-op period.

Conclusion. Postprocessing of the MSCT data gave the possibility to calculate pre-and postoperative orbital volume changes and present it in mathematical units (ml) in 3D mode. As the result the additional information can be acquired in order to identify the risk of postoperative enophthalmos.

Ophthalmology journal. 2018;11(3):26-33
Analysis of retinal and optic nerve electrogenesis dynamics after vitrectomy for complicated catarct surgery
Kulikov A.N., Sosnovskii S.V., Nikolaenko E.N.

Background. The article presents impact results of vitrectomy for complicated cataract surgery on retinal and optic nerve electrogenesis.

Materials and methods. 30 patients (30 eyes) with history of dropped nucleus (1st group) or intraocular lens dislocated into the vitreous cavity after phacoemulsification (2nd group) underwent electrophysiological examination before vitrectomy, and on Day 1, Day 3, Day 7, Day 14, Day 30, Day 60, and Day 180 after surgery.

Results. In the 1st and 2nd groups, on the 1st day after vitrectomy, we observed a significant decrease in retinal and optic nerve electrogenesis in comparison to normal indices (p > 0.01); to Day 180, electrophysiologic indices returned to normal values. In the 1st group, baseline retinal and optic nerve electrogenesis was decreased in comparison to normal parameters. In the 1st and 2nd groups, the electrogenesis of photoreceptors recovered twice as rapidly, as that of bipolar cells; papillomacular bundle neurons were more resistant to vitrectomy.

Conclusion. Thus, the presence of lens nucleus fragments in the vitreous cavity results in a reliable inhibition of the retinal and optic nerve electrogenesis due to phacotoxic effect. Vitrectomy causes a short-term depression of the retinal and optic nerve electrogenesis, followed by normalization of indices to Day 180. Photoreceptors have greater rehabilitation activity than bipolar cells. The neurons of axial topographic orientation have the highest resistance to vitrectomy impact.

Ophthalmology journal. 2018;11(3):34-47
Molecular genetic aspects of complicated myopia pathogenesis
Kulikov A.N., Churashov S.V., Reytuzov V.A.

Complicated myopia (CM) is not only a refractive error but a complex, multifactorial disorder characterized by a mismatch between the optical power of the eye and the axial length that causes the image to be focused off the retina. Genetic factors in progressive myopia play a key role in determining the impact of ecologic factors on refraction development. The majority of genetic variants underlying CM are characterized by modest effect and/or low frequency, which makes them difficult to identify using classic genetic approaches. The genes identified to date account for less than 10% of all myopia cases, suggesting the existence of a large number of yet unidentified low-frequency and/or small-effect variants, which underlie the majority of myopia cases. Genome analysis revealed dozens of loci associated with non-syndromic myopia, and showed that refractive errors are associated with mutations in genes that are involved in the growth and development of the eye by regulating ion transport, neurotransmission, remodeling of extracellular matrix of the retina and other ocular structures. Genetic study of refractive error provides a unique opportunity to detect key molecules that may play important roles in the development of refractive error. Identifying the molecular basis of refractive error helps to understand mechanisms, and subsequently to design rational therapeutic intervention for this condition.

Ophthalmology journal. 2018;11(3):48-56
Upon possibilities of simultaneously “radical and sparing” endovitreal removal of choroidal melanoma
Yarovoy A.A., Gorshkov I.M., Korobov E.N., Yarovaya V.A.

Relevance. The endoresection of the choroidal melanoma (CM) is carried out from its top to the base with the formation of surgical coloboma within the healthy choroid visible in the operating microscope, which does not guarantee the absence of residual tumor cells in it at the microscopic level. Excision of the choroid with a large amount of healthy tissues leads to a risk of unnecessary resection of functionally significant tissues with corresponding loss of vision, especially in juxtapapillary and paramacular localization of CM.

Purpose: to develop a method to increase the radicality of endovitreal removal of the choroidal melanoma while achieving the maximum functional result.

Material and methods. At the basis of the “radical and sparing” endovitreal removal of CM lays the principle of micrographic Mohs-surgery used in the treatment of skin cancer. When CM of paramacular localization is mushroom-shaped, the tumor peak often hangs over the macular zone and prevents its visualization and does not allow to determine true boundaries of the CM base in this area. In this situation, it is possible to carry out an endoresection of CM under video endoscopic control.

Results. According to the proposed method, 3 patients were operated: 2 men and 1 woman. All patients in the pre-operative period had exudative retinal detachment, in 1 of them it was vesicular. For the maximum period of observation, all 3 patients are alive, in none of them metastatic lesions and tumor recurrence were detected. All eyes have been preserved. The best corrected visual acuity was: in patient No 1 – 0.3; in patient No 2 – 0.4; in patient No 3 – 0.1.

Conclusion. The proposed treatment method makes possible to carry out the most radical endovitreal removal of CM, which at the same time is sparing for functionally significant healthy surrounding tissues with a decrease in intra- and postoperative complications.

Ophthalmology journal. 2018;11(3):57-62
Diagnosis and treatment of fungal keratitis. Part I
Skryabina Y.V., Astakhov Y.S., Konenkova Y.S., Kasymov F.O., Zumbulidze N.G., Varganova T.S., Petukhov V.P., Pirgunova A.A., Masian J., Klimko N.N., Bogomolova T.S., Desyatik E.A.

Fungal keratitis (FK) is a difficult diagnostic challenge for ophthalmologists.

The aim is to familiarize practicing physicians with the diagnostic algorithm worked out in the Ophthalmological Center of SPB City hospital No. 2 using modern research methods, and to assess the epidemiology of fungal keratitis in the North-West Region.

Materials and methods. Patients underwent laboratory diagnostics (fluorescence microscopy of corneal scrapings from the cornea, сulture on Sabouraud agar and broth), confocal in vivo microscopy, optical coherence tomography.

Results. During the period from 2007 to 2017, 41 cases of FK were identified in the City hospital No. 2, of which filamentous fungi were the causative agent in 32 cases (78%), yeast fungi — in 9 cases (22%). Our analysis included patients with fungal keratitis over the past three years, all of them underwent a full diagnostic cycle. Filamentous fungi were found among 12 of them (63%), yeast — in 7 (37%). Our data, considering the statistics of fungal keratitis in the North-West of Russia — a region with a high level of urbanization and industrialization, and located in the temperate zone — showed a predominance of filamentous fungi as pathogens (prevalence 1.3 times higher). Our scheme of keratitis diagnostics — confocal in vivo microscopy, OCT, fungal culture — is a reliable way to identify fungal pathogens in the cornea, and can be recommended for use in practical ophthalmology.

Ophthalmology journal. 2018;11(3):63-73
A rare case of mechanical conjunctivitis
Riks I.A., Papayan S.S., Nechiporenko P.A.

Introduction. Mechanical conjunctivitis is a rare form of eye surface inflammatory condition. One of its types, a mucus fishing syndrome, leads to a chronic eye surface trauma.

Purpose. To review the available literature data on the mechanical conjunctivitis prevalence, and to describe the diagnosis and treatment methods of its rare type, the mucus fishing syndrome.

Materials and methods. The article describes the case of the mucus fishing syndrome development in a patient suffering from this type of mechanical conjunctivitis for about 3 years.

Results. The correct diagnosis was not established in our patient for a long period of time that is why an improper treatment had been prescribed, which led to complications and to the need for surgical treatment.

Conclusions. The prevalence of mechanical conjunctivitis is low, and in the available literature, there are only 4 publications on the topic. The mucus fishing syndrome should be treated in cooperation with a psychiatrist, since the usual use of topical reparative and lubricating therapy is not enough.

Ophthalmology journal. 2018;11(3):74-77
Pseudotumor or decompensated edematous proptosis?
Toropova O.S.

The article presents the main differential diagnostic signs of pseudotumor orbit and decompensated edematous exophthalmos on the basis of its own clinical observation.

Ophthalmology journal. 2018;11(3):78-81

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