Vol 11, No 4 (2018)

Possibilities of using cryotherapy in patients with ocular rosacea
Tlish M.M., Kolesnikova N.V., Gyunter V.E., Steblyuk A.N., Marchenko E.S., Shavilova M.E., Tserkovnaya A.A.

Objective: to evaluate the clinical efficiency of eyelid cryotherapy with an autonomous titanium nicke lide cryoapplicator in patients with ocular rosacea regarding the dynamics of pro- and anti-inflammatory cytokines contents at local levels.

Materials and methods. 65 patients with ocular rosacea were observed. Depending on the therapy received, the patients were divided into two groups: in the main group, eyelid cryotherapy was applied for 2 weeks with an autonomous cryoapplicator made of porous-permeable titanium nickelide, and in the reference group, the patients received a traditional treatment for a month. The contents of cytokines (IL-1β, IL-8, IFN-α, IL-2, IL-10) in lachrymal fluid was evaluated by ELISA on Days 3, 7 and 30 after treatment.

Results. The opposite nature of cytokine balance changes and the ratio of its pro- and anti-inflammatory link during the follow-up period were revealed. A reliable dynamic increase of examined IFN-α and IL2 content in the lacrimal fluid after cryostimulation can evidence for an adequate activation of cellular immunity link, as well as for enhancement of regeneration mechanisms.

Conclusion. The analysis of obtained data evidences for a high efficiency of clinical and immunological effect of lid cryotherapy using titanium nickelide cryoprobe for ocular rosacea treatment.

Ophthalmology journal. 2018;11(4):7-14
Subthreshold lasercoagulation (810 nm) for diabetic macular edema
Izmaylov A.S., Kotsur T.V.

Introduction. The threshold laser coagulation leads to irreversible damage of retinal structures, microscotomata appearance in the central visual field, contrast sensitivity decrease, and color vision impairment, being accompanied as well by the release of proinflammatory cytokines. For diabetic macular edema treatment, a method of high-density subthreshold laser coagulation (810 nm) was first developed, based on individualized choice of subthreshold parameters of laser irradiation, and permitting confluent application of laser impacts to the retina. Using multimodal diagnostic approach to the estimation of anatomic and functional treatment results, a minimally invasive character and safety of this DME treatment method were confirmed.

Purpose. The aim of this study was to comparatively evaluate the efficacy of a diode laser (810 mn) subthreshold laser treatment using high-density laser impact application in diode laser coagulation (DLC) and diode microphotocoagulation (DMP) modes.

Materials and methods. To compare the efficacy of subthreshold laser treatment methods (DLC and DMP), patients were divided into two groups, comparable in macular edema thickness and area. The first group (24 eyes) received a macular laser coagulation in grid pattern and MicroPulse diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns. The second group (29 eyes) received a macular laser coagulation in grid pattern and continuous diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns.

Results. After DLC and DMP, there was no statistically significant difference between compared groups in best corrected visual acuity. There was also no significant difference in retinal edema maximal height dynamics, retinal edema area, and central thickness in 2 and 4 months.

Conclusion. Subthreshold microphotocoagulation and laser coagulation methods at the same average power of laser exposure and other exposure parameters in the shortterm follow-up have comparable efficacy in the treatment of diabetic macular edema.

Ophthalmology journal. 2018;11(4):15-20
Study of the safety of long-term drainage of the suprachoroidal space with a polyurethane drainage tube (experimental study)
Kulikov A.N., Sosnovskii S.V., Shamrey D.V., Remigin A.S., Alekperov S.I., Suetov A.A., Berezin R.D., Churashov S.V.

The article describes the results of an experimental study of the safety of long-term drainage of the suprachoroidal space (SCS) with a polyurethane drainage tube. The work was performed on 10 rabbits (20 eyes) of the Chinchilla breed, in which a polyurethane drainage tube was implanted in the SCS. The safety of the proposed method was assessed using histopathological examination, eye biomicroscopy, ophthalmoscopy, fluorescein angiography. The study results show the safety of the polyurethane tube presence in the suprachoroidal space for up to 30 days. At the same time, the presence of the polyurethane drainage tube in the SCS for more than 30 days leads to irreversible pathological changes of inner eye tunics.

Ophthalmology journal. 2018;11(4):21-30
Morphological features of the corneal endothelium in patients with pseudoexfoliative glaucoma
Beletskaya I.S., Astakhov S.Y., Tkachenko N.V.

Purpose. To study the main morphological features of the corneal endothelium in patients with pseudoexfoliative glaucoma (PEG).

Methods. We included 193 subjects aged from 55 to 75 years. The main study group (PEG) included 96 patients (192 eyes), the primary open angle glaucoma (POAG) group included 36 patients (72 eyes) with POAG, the PEX group included 31 patients (62 eyes) with pseudoexfoliation syndrome without glaucoma. The control group consisted of 30 healthy subjects (60 eyes). Main corneal endothelium parameters were evaluated using a non-contact endothelial microscope EM-935 (Haag Streit, Switzerland). Data were analyzed by STATISTICA 9 software for Windows.

Results. The patients with PEG had lower endothelial cell density (ECD) in comparison to the control group (p < 0.01), and PEX group (p < 0.05). The polymegatism level in patients with PEG and POAG was higher than in the control group (p < 0.001, and p < 0.01, correspondingly). In patients with moderate and advanced PEG, the ECD was significantly lower (p < 0.01), and the polymegatism level was significantly higher (p < 0.01) than the same parameters in patients with early PEG. The lowest ECD and the highest polymegatism percentage were observed in PEG patients with more pronounced PEX manifestations, p < 0.05. No effect of IOP-lowering eye drops on the corneal endothelium parameters was revealed, p < 0.05.

Conclusions. Significant morphological changes of the corneal endothelium (decreased endothelial cell density, increased polymegatism percentage) were revealed in patients with PEG. It was established that the severity of these changes is associated with the PEG and PEX severity. No effect of IOP-lowering eye drops on the corneal endothelium parameters was detected.

Ophthalmology journal. 2018;11(4):31-44
Comparative analysis of morphometric parameters of the retina and optic nerve head, obtained with different types of optical coherence tomographs
Belekhova S.G., Astakhov Y.S.

The article presents the results of a comparative analysis of central retinal thickness, macular volume and retinal nerve fiber layer thickness obtained with Stratus OCT 3000, Cirrus HD-OCT 4000 and Spectralis OCT. Statistically significant differences in central retinal thickness and macular volume were revealed. The absence of a difference pattern in retinal nerve fiber layer thickness measurements on different tomographs was found.

Ophthalmology journal. 2018;11(4):45-50
Anti-angiogenic therapy for diabetic macular edema
Shadrichev F.E., Grigor'eva N.N., Rozhdestvenskaya E.S.

Diabetic retinopathy remains one of the greatest challenges for healthcare system worldwide despite the fact that the incidence of visual acuity impairment in diabetic population has decreased due to examination quality improvement and dynamic observation of patients. Visual acuity impairment in diabetic patients is often related to diabetic macular edema. Until recently, laser photocoagulation of the retina was regarded as gold standard for diabetic macular edema treatment. Laser photocoagulation of the retina provides visual acuity stabilization rather than improvement. Since early 2000s, pharmacological approach to this severe disease has been established. As vascular endothelial growth factor (VEGF) is one of the crucial factors involved in the pathogenesis of diabetic retinal disorders, VEGF inhibitors are now recognized as a treatment of choice for diabetic macular edema. This article considers results of different clinical trials investigating anti-VEGF therapy efficacy in DME treatment.

Ophthalmology journal. 2018;11(4):51-66
Methods of cadaver donor cornea evaluation for keratoplasty (literature review)
Budnikova E.A., Trufanov S.V., Rozinova V.N., Osipyan G.A., Mitichkina T.S., Makarova M.A.

At present time, a large amount of patients with corneal diseases require keratoplasty, therefore there is a quite high demand of constant donor cornea stock. In present article, methods of cadaver donor corneal material analysis are described in a sequence that is necessary for its qualitative assessment before surgery or for the choice of the optimal method of preservation in the Eye Bank conditions. It is known that corneal endothelial cells and their viability play a main role in the maintenance of transparency of transplanted corneal flap after penetrating keratoplasty or endothelial keratoplasty. It is for these types of keratoplasty that the highest quality of donor material with preservation of a large number of viable corneal endothelial cells is needed. Corneal flaps with poorer quality of corneal endothelial layer could be successfully used for different types of anterior lamellar keratoplasty and interlamellar keratoplasty. Therefore the adequate evaluation of donor corneal material before surgery allows reducing the risk of postoperative complications associated with failure of the corneal endothelial layer, and increasing graft survival in patients after surgery. In addition, the choice of the optimal type of preservation is of great relevance for maintaining the corneal material as viable in the long run for various types of transplantations.

Ophthalmology journal. 2018;11(4):67-73
New approaches to the treatment of patients with dry age-related macular degeneration and concomitant mild stabilized open-angle glaucoma
Sokolov V.O., Morozova N.V., Florentseva S.S., Veselov A.V., Morozov M.A.

Relevance. Dystrophic processes in the retina and different types of glaucoma occupy a significant place among ocular disabling conditions. In the present article, the institution’s experience concerning a new approach to treatment of patients with dry age-related macular degeneration and concomitant mild stabilized open-angle glaucoma.

Aim. To clinically estimate the influence of the biologically active dietary supplement “Proluksa” on main visual functions and on the quality of life in patients with dry age-related macular degeneration and concomitant mild stabilized open-angle glaucoma.

Materials and methods. Into the study, 60 patients were included; they were divided into two groups. Patients of the first group received the biologically active dietary supplement “Proluksa”, 2 capsules once a day during three months, and instilled IOP-lowering drops; patients of the second group did not take the biologically active dietary supplement “Proluksa”, they instilled IOP-lowering drops only. Both groups were followed during six months. Three times a standard ophthalmologic examination and instrumental investigations (macular electroretinography, vacuum-compression test with control of visual evoked cortical potentials using a “suction cup”, HRT III of the optic disc, OCT of the macular area) were performed in both groups.

Results. There was a statistically significant positive visual acuity dynamics at stable optimal correction for distance in the group 1; the percentage of relative scotomata decreased in the group 1; vacuum-compression test gave negative results at Visits 1, 2, and 3; the p-100 wave amplitude increased – in the group 1 on the background the biologically active dietary supplement “Proluksa” intake; the a-wave amplitude of the macular ERG increased; according to OCT results, there were no reliable changes in the central retinal area; the optic disc neuroretinal rim width at HRT III remained stable during the whole follow-up period.

Conclusions. According to performed investigations, there were: statistically reliable visual acuity increase at stable optimal correction, statistically significant positive dynamics in retinal photosensitivity, and increase in functional activity of external and internal retinal layers in the macular area. To the third month of preparation intake, patients from the group 1 taking the biologically active dietary supplement “Proluksa” noted the enhancement of image resolution, decrease in visual “defocusing”, better color perception.

Ophthalmology journal. 2018;11(4):75-83
Drug-induced mydriasis in infants born at different gestation terms
Saidasheva E.I., Biyanovskaya S.V., Kovshov F.V., Petrachkova M.S., Dolgova O.S., Levadnev Y.V.

Background. At the present time, the problem of choice of eye drops to achieve adequate mydriasis with minimal side effects for retinopathy of prematurity screening remains an urgent challenge.

Purpose. To estimate the clinical efficacy of combination mydriatic eye drops Fenicamide in infants born at different gestation terms.

Materials and methods. Under observation, there were 75 newborns (150 eyes) and babies aged from 1 day to 3 months (average, 38.2 ± 32.2 days). Patients were distributed into 3 groups depending on gestational age: group 1 consisted of 25 full-term infants; group 2 – of 25 premature babies, and group 3 – of 25 extremely preterm infants. To achieve mydriasis, 1 drop of combination eye drops (5% phenylephrine and 0.8% tropicamide) was instilled. Dynamics of pupil diameter change in each group of patients was registered within 4 hours, and side effects were recorded within 24 hours. The quality of fundus visualization was estimated using a pediatric retinal camera RetCam 3.

Results. Maximal pupil dilation (average, 6.5 ± 0.5 mm) was reached to 60 ± 14 min after instillation on average; pupil remained dilated within 1 hour, its diameter became normal in 4 hours. Mydriasis varied from 5.9 mm in extremely premature infants to 7 mm in the full-term newborns (p > 0.05), and allowed a full and high quality examination of the fundus in all patients, including the visualization of peripheral zones of the retina for retinopathy of prematurity screening. It was established that drug side effects were absent in 76% (57) of infants, they were present in 24% (18) of infants, mostly as local reaction.

Conclusion. Fenicamide eye drops are an effective mydriatic medication, with a convenient instillation regimen, have minimal side effects, and can be recommended for retinopathy of prematurity screening and monitoring.

Ophthalmology journal. 2018;11(4):85-92
Enhanced S-cone syndrome (clinical case)
Skvortsova N.A., Zolnikova I.V., Ivanova M.E., Skvortsova Y.A.

A case of enhanced S-cone syndrome misdiagnosed as idiopathic retinal vasculitis is presented. Etiology, pathogenesis and clinical features are described below.

Ophthalmology journal. 2018;11(4):93-98
Urrets-Zavalia syndrome after penetrating keratoplasty
Riks I.A., Papanyan S.S., Astakhov S.Y., Dzhaliashvili G.Z.

The article presents a case of Urrets-Zavalia syndrome development in a patient after a subtotal penetra ting keratoplasty, carried out for corneal opacity. Since this syndrome was diagnosed in time, it was possible to avoid further complications and worsening of visual functions in 25-year-old patient.

Ophthalmology journal. 2018;11(4):99-103

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