Vol 16, No 2 (2023)

BACKGROUND: Measurement of intraocular pressure in the presence of combined ophthalmic condition could determine further therapy and prognosis. However, tonometry in corneal diseases could lead to unreliable results. The search for methods for intraocular pressure measurement in these settings is a critical task intended to expand diagnostic capabilities.

AIM: Evaluation of the transpalpebral tonometry diagnostic value for intraocular pressure monitoring in patients with corneal conditions of various origin.

MATERIALS AND METHODS: Measurements of intraocular pressure were carried out in 39 patients with glaucoma and/or cataract (mean age 62.34 ± 9.1), with corneal changes due to various ophthalmic conditions: post-traumatic scars; keratotomy scars as a result of refractive surgery; corneal defects due to ulcerative process of various etiology; corneal erosions; bullous keratopathy; deformities and leukomas after surgical treatment of pterygium or exposure to an infectious agent. Intraocular pressure measurement was carried out using several methods: palpation, using “rebound” and transpalpebral tonometry, in some cases tonometry was performed according to Maklakov method.

RESULTS: The averaged data were comparable: palpation; “rebound” tonometry — 23.34 ± 4.7 mm Hg; transpalpebral tonometry — 24.27 ± 4.7 mm Hg; and Maklakov tonometry — 23.16 ± 5.4 mm Hg. The accuracy and reproducibility of measurement results increased significantly with the improvement of skills in using tonometers.

CONCLUSIONS: Transpalpebral tonometry using TVGD-02 tonometer makes it possible to adequately assess intraocular pressure in patients with corneal pathology. The absence of contact during the implementation of technique makes it possible to recognize it as a priority when measuring intraocular pressure in certain categories of patients.

BACKGROUND: An improved technique of cyclophotocoagulation appeared — cyclophotocoagulation in micropulse mode with splitting of the continuous stream of laser energy into short micropulse series with intervals.

AIM: The aim of the study is to clinically evaluate the efficacy and the safety of micropulse cyclophotocoagulation for acute angle-closure glaucoma jugulation.

MATERIALS AND METHODS: In the study, 14 patients with acute angle-closure glaucoma with 3–7 days duration were included. The mean intraocular pressure was 35.1 ± 2.4 mm Hg against the background of hypotensive therapy, best corrected visual acuity was from 0.005 to 0.3. All patients on admission underwent laser iridotomy, consistent peripheral colobomas of the iris were obtained. On the following day, taking into account the intraocular pressure level of 30–36 mm Hg against the background of hypotensive therapy, all patients underwent micropulse cyclophotocoagulation with Cyclo G6® Glaucoma Laser System (USA).

RESULTS: After surgery, there were no complications noted. The pain syndrome was completely eliminated in all patients on the first day after the procedure. Intraocular pressure decreased in average to 18.1 ± 2.8 mm Hg. Within 3–18 months after micropulse cyclophotocoagulation, phacoemulsification was performed in 9 eyes. During the 2 years of the follow-up period, intraocular pressure in all eyes remained normal, from 16 to 23 mm Hg, best-corrected visual acuity varied from 0.4 to 0.9.

CONCLUSIONS: Cyclophotocoagulation in micropulse mode allowed an effective and safe lowering of intraocular pressure to normal values in all eyes with acute angle-closure glaucoma; this provided pain relief and preservation of visual functions during the follow-up period up to 2 years.

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy is the second most common optic neuropathy after glaucoma. The effectiveness of the glucocorticosteroid therapy use for the non-arteritic anterior ischemic optic neuropathy treatment remains a subject of debate. Currently, the search for markers of the disease’s “therapeutic window” is under way.

AIM: The aim of this study is to evaluate the use of local glucocorticosteroid therapy as an emergency care for non-arteritic anterior ischemic optic neuropathy.

MATERIALS AND METHODS: 41 patients with non-arteritic anterior ischemic optic neuropathy were enrolled in the study. To evaluate optic nerve head and macula morphometric characteristics, optical coherence tomography was performed, additionally, diameters of arteries and veins were assessed at 4 vascular arcades. Patients were divided into 2 groups according to the presence of intraretinal fluid. The first (main) group consisted of 23 patients with intraretinal fluid, in the second (control) group 18 patients without intraretinal fluid were included. The first group was further divided into two subgroups according to the medical aid recourse periods — up to 5 days, and from 6 to 21 days (subgroup 1 — 9 patients, subgroup 2 — 14 patients).

RESULTS: Correlations between the dynamics of optic nerve head edema changes and the caliber of arteries (negative correlation) and that of veins (positive correlation) were revealed. Sub-tenon injection of long-acting glucocorticosteroid did not lead to morpho-functional improvement in first group patients. Local short-acting glucocorticosteroid therapy accomplished in the acute period of the disease made it possible to achieve an improvement in best corrected visual acuity during the first month in group 1 patients without any further worsening of it.

CONCLUSIONS: When providing emergency care to patients with non-arteritic anterior ischemic optic neuropathy during the first 5 days from the disease onset, the local use of glucocorticosteroid therapy is advisable.

BACKGROUND: The search for an effective method for the treatment of limbal stem cell deficiency of various etiologies, leading to intense clouding and vascularization of the cornea, followed by a significant decrease in visual acuity, remains an important and relevant topic in ophthalmology. The results of the studies showed that transplantation of buccal epithelial cells could significantly improve the prognosis of treatment in this category of patients.

AIM: To determine the optimal fixation period of a combined bioconstruction with buccal epithelial cells for the treatment of limbal cell deficiency in experiment.

MATERIALS AND METHODS: At the first stage, the corneal epithelium was removed with a scraper in the eyes of experimental animals (12 eyes), and the limb was excised along the entire circumference. Next, to isolate epithelial buccal cells and manufacture a combined bioconstruction consisting of buccal cells, a collagen carrier and a soft contact lens, a flap of the mucous membrane of 5 × 5 mm was taken from the cheeks of rabbits. At the second stage, after the formation of a fibrovascular pannus on the cornea, it was excised to transparent layers of the cornea, a combined bioconstruction was placed on top. Further, one U-shaped suture was applied at the border of the inner and outer third of the eyelids. Temporary blepharorraphia persisted for 3 days (6 eyes) and 5 days (6 eyes), after the specified time, stitches were removed from the eyelids, and bioconstructions were removed. The bioconstructions removed from the eyes were stained with a vital (lifetime) fluorochrome dye based on tripaflavin and acridine orange, followed by analysis in a fluorescent microscope. The structure of cell nuclei, the overall integrity of the cytoplasm, and the presence of secretory vesicles were evaluated. After 7 and 14 days after transplantation of the bioconstruction, the area of erosion, the extent of new vessels and the transparency of the cornea were evaluated. When the observation was completed, the rabbits were removed from the experiment, and the eyes were enucleated and subjected to histological examination.

RESULTS: On the surface of all bioconstructions removed after 5 days, only leukocytes were detected. At the same time, on collagen matrix of bioconstructions removed after 3 days, in addition to leukocytes, there were also buccal epithelial cells with normal nuclear structure and chromatin topography in its composition, as well as with secretory vesicles. On days 7–14, both groups showed a decrease in the area of erosion, while the dynamics of ocular surface recovery processes was more pronounced in the group with fixation of the bioconstruction for 5 days.

CONCLUSIONS: According to the results of in vivo staining with fluorochrome dye of combined bioconstructions removed from the cornea of experimental animals 3 and 5 days after superficial keratectomy, as well as the data of clinical and histological examination, the optimal period for bioconstruction fixation was established to be 5 days.

BACKGROUND: One of the purposes of ocular prosthetics is to prevent the progression of pathological processes in the eyelids and conjunctiva of the anophthalmic socket.

AIM: The aim of this study is to assess the effectiveness of therapeutic eyelid hygiene products: “Blepharowipe”, “Blepharogel cleansing” (Geltek-Medica, Russia), used in the late postoperative and long-term rehabilitation periods, in patients with anophthalmia who lost the eyeball as a result of an injury.

MATERIALS AND METHODS: For the study, 3 main (50 patients) and 3 corresponding control groups (50 patients) were created. The examination of patients included: complaints, medical history; biomicroscopy of the eyelids, the conjunctiva of the anophthalmic socket, and the surface of the ocular prosthesis. In the main groups, therapeutic eyelid hygiene products were used for 8 weeks in combination with regular ocular prosthesis care. In the control groups, eyelid hygiene products were not used. Assessment and analysis of the effectiveness of the products was carried out after 1, 2 and 4 weeks in group I and after 4 and 8 weeks in groups II and III based on the dynamics of patient complaints and objective examination indicators.

RESULTS: In the main groups I and II, there was a positive dynamics: normalization of the state of the eyelids and the conjunctiva of the anophthalmic socket; increasing comfort of an ocular prosthesis wear. In the main group III and in all control groups, no significant positive dynamics was noted.

CONCLUSIONS: The results of using the products included in the course of therapeutic hygiene of the eyelids: “Blepharowipe”, “Blepharogel cleansing” showed high efficiency, and give reason to recommend them in late postoperative and long-term rehabilitation periods in patients with anophthalmia.

In contrast to the Ahmed valve implantation technique and solutions of possible problems associated with its implantation, the available literature does not clearly state the indications for the choice of classical glaucoma filtering surgery (especially for primary open-angle glaucoma) and of a valve hypotensive device. This publication aims to fill this gap.

Myelinated retinal nerve fibres are a rare, benign and asymptomatic lesion that is detected incidentally at fundus examination. In some cases, they may be associated with various abnormalities of the eye or have a complicated course. The article presents a clinical case of myelinated retinal nerve fibers associated with retinal vascular abnormalities and retino-vitreal neovascularization complicated by recurrent vitreous hemorrhage.

In pathological myopia, axial elongation of the eye is accompanied by various changes of the fundus. The introduction of the method of optical coherence tomography into clinical practice made it possible to describe new variants of structural changes in myopia, in particular, peripapillary intrachoroidal cavitation. The article presents a clinical case and provides known data on this rare condition in pathological myopia.