Vol 16, No 3 (2023)

BACKGROUND: Primary open angle glaucoma is often associated with cataract. The correlation between the use hypotensive drops, in particular non-prostaglandin hypotensive drops with preservative, and the change in central retinal thickness after phacoemulsification with intraocular lens implantation continues to be relevant.

AIM: To evaluate central retinal thickness and pseudophakic cystoid macular edema incidence after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservatives.

MATERIALS AND METHODS: 94 patients (108 eyes) with cataract were enrolled in the study, divided into 3 groups: the first group — 21 patients (27 eyes), and the second group — 21 patients (23 eyes) with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservative; the third (control) group included 52 patients (58 eyes) without ocular comorbidities. All patients underwent uncomplicated phacoemulsification with intraocular lens implantation. In the post-op period, patients of the first group received topical antibiotics and steroids, patients of the second and the third groups received the same treatment and non-steroidal anti-inflammatory drops as well. Central retinal thickness was measured using optical coherence tomography before surgery, 2 weeks, 2 and 6 months after surgery.

RESULTS: The central retinal thickness increase in comparison with baseline values was more significant in the first group than in the second and the third groups, and the time of recovery to baseline values during 6 months after surgery was longer. Pseudophakic cystoid macular edema was not identified in any group.

CONCLUSIONS: The use non-prostaglandin drops with preservative in patients with primary open-angle glaucoma does not affect pseudophakic cystoid macular edema development after uncomplicated phacoemulsification. Instillations of non-steroidal anti-inflammatory drops in the post-op period reduce the time of central retinal thickness recovery to baseline value.

BACKGROUND: Over the past decades, various polymer implants have been actively used in the rehabilitation of patients with anophthalmos to form a volumetric support stump and improve the results of cosmetic prosthetics.

AIM: To assess clinical symptoms and features of the X-ray picture in patients with anophthalmos after implantation of polymeric spherical endoprostheses with a modified geometry.

MATERIALS AND METHODS: The study is based on the analysis of 30 patients with anophthalmos after enucleations (23) and eviscerations (7) performed using various methods of procedure and insertion into tissues of an implant made of domestic polytetrafluoroethylene. All patients underwent a multispiral computed tomography (MSCT) of the eye sockets according to the same algorithm.

RESULTS: On the basis of the performed studies, the fact of making a change in the geometry of the implanted spherical implants was revealed, while the parameters of the modified part of the spheres were different and ranged from 14 to 18 mm of final diameters with the initial diameters of the spheres ranging from 18 to 20 mm. A decrease in the volume of spheres with modified geometry from 0.114 to 0.651 cm³ was revealed with initial diameters ranging from 18 to 20 mm.

CONCLUSIONS: Changes in the geometry of the orbital spheres do not improve the results of cosmetic prosthetics in patients, increase the percentage of implant exposure at different times after surgery, and increase the manifestations of anophthalmic syndrome.

BACKGROUND: Nowadays, phacoemulsification with monofocal non-toric intraocular lens (IOL) implantation is a most common procedure in cataract surgery. Residual astigmatism has an important impact on uncorrected visual acuity. Therefore, development of residual astigmatism assessment method is relevant and may expand indications for toric IOL implantation.

AIM: To develop a method for calculating residual astigmatism in cases when non-toric monofocal IOL is implanted.

MATERIALS AND METHODS: The study included 351 patients (391 eyes, 105 men and 246 women, mean age 75.3 ± 8.5 years) who underwent phacoemulsification with non-toric monofocal IOL implantation. Biometry was performed by IOL-Master 500, postoperative refraction was assessed by autorefractometer Topcon-8800.

RESULTS: Using regression analysis, where the depended variable was residual astigmatism, and preoperative corneal astigmatism and steep corneal meridian axis location served as covariates, we revealed a significant relation (p < 0.001) with medium strength (R² = 0.51) between these parameters, which formed residual astigmatism calculation formula for monofocal non-toric IOL implantation: Ast = K_Ast · 0.71 – 0.62 · sinK_ax + 0.73.

CONCLUSIONS: This formula may allow to evaluate the residual astigmatism and justify a decision on the advisability of toric IOL implantation.

BACKGROUND: Cataract phacoemulsification is one of the most frequently performed surgical procedures, and a decrease in the corneal endothelial cell density (ECD) is the main postoperative complication leading to visual impairment. The average cell loss after phacoemulsification is 4.01–12.94% within a year, and within 2 months — 5.2–9.1%. The use of viscoelastics helps to reduce this loss, but it is impossible to completely prevent it.

AIM: Сomparison of ECD in the pre- and postoperative period of phacoemulsification using viscoelastic of different percentages at a critical level of corneal endothelial cells.

MATERIALS AND METHODS: The study included 60 eyes with emmetropic refraction: in the first group: 30 eyes with initial cataract and low ECD level (1694/1218 cells/mm²), an apyrogenic moderately cohesive viscoelastic 1.6% sodium hyaluronate solution (Kogevisk®, Solopharm) was used, in the second group: 30 eyes with mature cataract and ECD level (1646/1183 cells/mm²) an apyrogenic, highly purified viscoelastic was used, consisting of medium-molecular fractions of chondroitin sodium sulfate 4% and sodium hyaluronate 3% (Adhevisk®, Solopharm). Before surgery and a month after surgery, patients were tested for uncorrected visual acuity in the distance, ECD measurements, and intraocular pressure measurement.

RESULTS: In phacoemulsification with IOL implantation, the use of viscoelastics of different percentages shows that the condition of the cornea remained stable a month after surgery. Postoperative ECD loss in all clinical cases, regardless of the stage of cataract, was less than 3%.

CONCLUSIONS: Viscoelastics allow to solve the tasks set: in the case of cohesive — maintaining the depth of the anterior chamber and the width of the pupil, adhesive — protecting the corneal endothelium, good visualization. Rational consistent use of adhesive and cohesive components facilitates basic manipulations during phacoemulsification and IOL implantation. To do this, it is necessary to correctly use and select viscoelastic for a particular operation based on the number of endothelial cells.

BACKGROUND: Optical coherence tomography (OCT) is the main method for in vivo examination of the morphology of ocular posterior segment structures, used in modern ophthalmological practice.

AIM: Study of special aspects in performing and interpreting the results of OCT of the macula by ophthalmologists working in the healthcare system of the Russian Federation.

MATERIALS AND METHODS: In the anonymous survey, conducted using an original online questionnaire of 12 questions 59 respondents took part. They confirmed being ophthalmologists with experience in performing OCT and gave their consent to took part in the survey.

RESULTS: The majority of respondents (79.6%) reported that they face the need to perform OCT without obtaining the patient’s clinical data. 66.1% of respondents always evaluate the correct placement of segmentation boundaries. Only 56% of the respondents always or often perform frontal (“en face”) scans during OCT examination of the macula. At the same time, 16.9% of specialists indicated that they did not know what “segmentation boundaries” are, and 8.5% noted that they did not understand the term “en face scan”. The principle of layer-by-layer analysis is used by 94.9% of respondents when describing images. Significant discrepancies were also revealed in the interpretation by the respondents of some parameters on specific examples of OCT scans. 71.2% of respondents have experience in using templates when describing OCT images, and 13.6% use them constantly. The proportion of specialists who consider it expedient to develop and introduce into clinical practice a standard protocol (template) for describing macular OCT images was 84.7%.

CONCLUSIONS: Insufficient awareness of some ophthalmologists about particular principles of interpreting the results of an OCT imaging and about certain practical aspects of its application was revealed. This indicates the need in improving the quality of informational support and training of specialists. A request was received from ophthalmologists about the need to develop a standard protocol (template) for describing OCT images of the macular area with the aim of subsequent implementation into the clinical practice of the healthcare system of the Russian Federation.

The article describes a case report of bilateral inactive macular neovascularization in Stargardt’s disease in a young woman. The data of the ophthalmological examination, as well as those of the molecular genetic analysis are presented, the tactics of the patient’s care is discussed. No case report of the kind has been described in the literature previously, and therefore this one is of great interest.

The aim of this study is analysis of current methods for diagnosis and treatment of neovascular glaucoma to assess their effectiveness, and based on these data, further development of a method of surgical treatment based on morphological factors involved in its progression. The review was performed using the domestic RSCI database and the international PubMed database, with the search keywords being “neovascular glaucoma”, “secondary glaucoma”, “ophthalmic hypertension”. An analysis of 39 literature sources was performed. The search depth was 13 years (2009–2022). Variants of neovascular glaucoma development of and of its diagnosis were considered, it was noted that it is necessary to pay attention to the study of minimally invasive methods for diagnosing the anterior segment using optical coherence tomography, which will help in the future to choose the right tactics for medical or surgical treatment. Particular attention is paid to the analysis of surgical treatment methods, which often turn out to be ineffective and require re-operations. It is necessary to develop a new method of surgical treatment of neovascular glaucoma, which provides the most sparing approach to surgical treatment, which will improve the anatomical and functional results and help reduce the number of intra- and postoperative complications and provide a longer period without re-operations.

The article is dedicated to the life path of the ophthalmologist Professor Valentina M. Hokkanen, who celebrated her 75^th anniversary on July 15, 2023.