Vol 12, No 3 (2019)

Original researches
Сorneal endothelium after laser activation of trabecular meshwork in patients with primary open-angle glaucoma
Yashina V.N., Sokolovskaya T.V., Volodin P.L.

Background. Nowadays, laser surgery methods for glaucoma treatment gained wide use in clinical practice due to their efficacy, safety, and minimal risk of postoperative complications. In the scientific literature, data are presented on the effect of laser radiation on corneal endothelial cells that is why this aspect should be investigated when using new laser technologies in glaucoma treatment. One of the most modern methods of corneal examination is confocal microscopy, which allows visualizing corneal tissue at cellular level.

Purpose: to study the impact of laser radiation on the state of corneal endothelial cells in YAG-laser activation of trabecular meshwork in patients with primary open-angle glaucoma.

Materials and methods. Sixteen eyes of 15 patients were included in the analysis. The mean age of patients was 65.8 ± 5.35 years. In all patients, YAG-laser activation of trabecular meshwork was performed. At different follow-up terms (up to 6 months after laser surgery) the level of IOP was controlled, the state of corneal endothelium was studied using confocal microscopy.

Results. According to dynamic follow-up confocal microscopy results, no statistically significant difference between average density of endothelial cells, polymegathism, and pleomorphism have been identified (p > 0.05).

Conclusion. The study did not reveal any negative impact of YAG-laser activation of trabecular meshwork on the endothelium of the cornea, suggesting the safety of this technology.

Ophthalmology journal. 2019;12(3):7-11
Retinal and optic nerve functional activity after vitrectomy for vitreomacular traction syndrome
Nikolaenko E.N., Kulikov A.N., Volkov V.V., Danilichev V.F.

Background. Impacts of vitrectomy for vitreomacular traction syndrome on retinal and optic nerve functional activity are analyzed.

Materials and methods. The electrophysiological monitoring was carried out before vitrectomy and on Days 1, 3, 7, 14, 30, 60, 180 after surgery in 59 patients (59 eyes). Patients were divided into three groups depending on the intraocular tamponade type: the first group – air tamponade, the second group – gas (C3F8) tamponade, the third group – BSS (balanced salt solution).

Results. A significant inhibition of the functional activity of neurons of internal layers of the retina and of the optic nerve was revealed on the Day 1 after surgery compared to baseline data (р < 0.001). In groups I and III, the functional activity of inner layers of the retina and of the optic nerve restored twice as actively as that in the second group.

Conclusions. Vitrectomy causes a reversible and significant inhibition of functional activity of retina and optic nerve. The duration of vitrectomy procedure is a significant negative factor determining the degree of depression of the functional activity of inner layers of the retina and of the optic nerve in the post-op period. The gas tamponade of the vitreous cavity with perfluoropropane-air mixture, compared to air and BSS tamponades, is a significant negative factor influencing the degree of functional activity inhibition of retina and optic nerve after surgery.

Ophthalmology journal. 2019;12(3):13-20
Is it possible to cut down the number of unknown etiology in uveitis?
Kuznetcova T.I., Astakhov Y.S.

Background. According to the data in national literature, uveitis comprises 5–15% among all eye diseases. The etiological data on uveitis are still under discussion. Our

aim was to decrease the percent of undefined uveitis.

Methods. The first part was to collect the retrospective data on uveitis etiology (2008–2012). The second one consisted of examining all new patients seen in our uveitis center at the Department of Ophthalmology of the Academician I.P. Pavlov First State Medical University (2014–2016) with up to date methods, like laser photometry, dual angiography and other laboratory and instrumental investigational tests.

Results. The percent of unknown etiology was decreased from 61,9 % to 17 %.

Conclusion. The complex of modern investigational ophthalmological, laboratory and instrumental methods give the opportunity not only to diminish the proportion of undefined uveitis, but also to treat patients with more specific entities.

Ophthalmology journal. 2019;12(3):21-30
Focal ossification as one of the reasons for erroneous diagnosis of chorioretinal lesions
Stoyukhina A.S.

Focal calcifications of the retina and choroid occur usually in such well-known tumors as: retinoblastoma, choroidal osteoma, choroidal hemangioma, retinal astrocytoma. In addition, cases of idiopathic or secondary calcification are known, the most common of them is sclerochoroidal calcification. The article provides a detailed analysis of the clinical and tomographic pictures of ossifying conditions occurring in adults. It is shown that, in addition to a different ophthalmoscopic picture, these conditions are characterized by a different level of localization of the pathological calcification zone and a different stage of retinal damage.

Ophthalmology journal. 2019;12(3):31-39
Experimental trials
Original two-component fibrin glue preparation technique for use in ophthalmic surgery
Kulikov A.N., Churashov S.V., Kuznetsova A.Y., Gavriluk I.O.

The study is aimed to modifying the method of a two-component fibrin glue production, as well as studying the possibility of applying glue fixation of the amniotic membrane to the stroma of the cornea, in comparison with interrupted sutures. An experimental study allowed us to determine the optimal composition of the first (base) and second (activating) components, to modify the method for fibrin glue production, and also to test in vivo in six Chinchilla rabbits the fixation of the amniotic membrane using the proposed protocol. The resulting fibrin glue allows not only to securely fix the amniotic membrane to the stroma of the cornea, to reduce the time of the procedure, but also to create conditions for an earlier onset of epithelization while maintaining the transparency of the cornea compared to suture fixation.

Ophthalmology journal. 2019;12(3):41-44
Cyclodestructive interventions in refractory glaucoma treatment: history, reality, perspectives
Sokolovskaya T.V., Tikhonova M.I.

This article presents a historical evolution review of cyclodestructive methods in glaucoma treatment. It also provides the analysis of mechanism of action for each technology, their advantages and disadvantages. Results of clinical studies and most frequent complications of cyclodestructive procedures are also presented. The main attention is paid to the new MicroPulse laser technology, which is used for the treatment of primary open-angle glaucoma at various stages in patients with high visual acuity, as well as refractory forms of glaucoma. Data of clinical and experimental morphological studies of various modifications of transscleral cyclophotocoagulation technology are specified. Theories, research hypothesis upon the mechanism of MicroPulse laser action. In most researchers opinion, despite the relatively short observation period (from 6 months to 5 years), MicroPulse technology is recognized as effective and advanced.

Ophthalmology journal. 2019;12(3):45-58
Pathophysiological features of development, clinical features and treatment of malignant glaucoma
Kiseleva O.A., Kosakyan S.M., Yakubova L.V., Bessmertny A.M., Vasilenkova L.V.

Malignant glaucoma is a difficult task for an ophthalmologist in the treatment process. This is a multifactorial condition that occurs in anatomically predisposed eyes. Malignant glaucoma remains one of the most severe clinical forms of glaucoma requiring timely diagnosis and immediate treatment. Diagnostic issues, pathophysiological mechanisms of development and methods of treatment are still controversial. The diagnosis of malignant glaucoma is often late due to similarity with some other pathological conditions. In many cases malignant glaucoma is resistant to medication and laser treatment. Surgical treatment of malignant glaucoma is complex and not always effective. The review discusses the possible pathophysiological mechanisms of development, diagnostic methods of research, as well as the applied conservative, laser and surgical methods of treatment of malignant glaucoma.

Ophthalmology journal. 2019;12(3):59-65
Monitoring the antimicrobial activity of antiseptic eye drops
Okolov I.N.

Introduction. Antiseptic drugs currently occupy an important place in the treatment and prevention of ocular infectious and inflammatory diseases. Often microorganisms are characterized not only by resistance to a single antibiotic, but also by the presence of multiple resistances, which limits the choice of an effective drug. This problem requires a detailed study and monitoring of the sensitivity of the main pathogens of ocular infections, not only to antibiotics but also to antiseptics.

The aim was to study the species composition of conjunctival microflora in patients with ocular surface infection and to evaluate the antimicrobial activity of antiseptic eye drops.

Materials and methods. Investigation was carried out in 2012–2018 in 4237 bacterial conjunctivitis patients. The sensitivity to antiseptic preparations of pathogens isolated from patients with conjunctivitis was detected.

Results. 1068 strains of microorganisms isolated from the conjunctival cavity of patients were tested. Gram-positive cocci dominated among clinically significant pathogens – 47.4%. Antimicrobial activity of Vitabact® eye drops against gram-positive cocci was higher than that of antiseptic Okomistin®.

Summary. Antimicrobial activity of the studied antiseptics against gram-positive and gram-negative pathogens was different. It is necessary to conduct further research on the antimicrobial activity of antiseptic eye drops.

Ophthalmology journal. 2019;12(3):67-74
Cyclosporine use in “dry eye” syndrome
Riks I.A.

This literature review focuses on the need for anti-inflammatory therapy for “dry eye” disease (DED). Causes of development and mechanisms of pathogenesis of DED are presented. Principles of action of various groups of anti-inflammatory medications, as well as recommendations for cyclosporine use of are described. The results of studies on cyclosporine efficacy are highlighted, principles of cyclosporin prescription in DED are listed.

Ophthalmology journal. 2019;12(3):75-82
In ophthalmology practitioners
New algorithm for planning superior tarsal muscle resection for blepharoptosis: description of technique and results
Potyomkin V.V., Goltsman E.V.

Background. Transconjunctival techniques for blepharoptosis correction are popular because of ease of implementation and good predictability. For a long time, the phenylephrine test remained the main factor influencing the choice of blepharoptosis correction method. Recently, more and more researches indicate the possibility of the superior tarsal muscle resection in patients with negative responses to the phenylephrine test. Authors have proposed and described a new modified technique for resection of the superior tarsal muscle, which can be used to correct blepharoptosis in patients with different responses to phenylephrine test.

Materials and methods. The study included 2 groups of patients with mild to moderate blepharoptosis with levator muscle function 8 mm or more. The main group (75 patients, 103 eyelids) underwent a modified resection of the superior tarsal muscle, and in the comparison group (26 patients, 35 eyelids) an open sky resection of the superior tarsal muscle was performed. Surgery in the main group was planned according to the following algorithm. In positive and sufficient response to the test, 2/3 of the superior tarsal muscle was resected. In case of positive but insufficient response to the phenylephrine test, subtotal superior tarsal muscle resection was performed. In case of negative or slightly positive result of phenylephrine test, an assessment of the white line motility was additionally performed intraoperatively. If the motility of the white line (in mm) was equal to the amount of ptosis, subtotal superior tarsal muscle resection was performed without resection of the superior tarsal plate. If the motility of the white line was less than desired amount of correction, then subtotal superior tarsal muscle resection was combined with tarsal plate resection to reach the desired amount of correction. The residual height of the tarsal plate was always left 5 mm or more. If superior tarsal plate was compromised or not high enough to perform desired amount of resection then white line was advanced to the tarsal plate.

Results. The degree of ptosis, the result, the width of the palpebral fissure in the center, lateral and medial limbus, MRD 1 and MRD 2 did not significantly differ between the groups (p > 0.05). However, the frequency of hypo- and hypercorrections was significantly lower in the main group (p < 0.05).

Conclusion. New algorithm of planning modified superior tarsal muscle resection gives an opportunity to use transconjuctival methods of blepharoptosis correction in cases of weak and negative phenylephrine test and to reduce the amount of hypo- and hypercorrections

Ophthalmology journal. 2019;12(3):83-90
Modern aspects of polypoidal choroidal vasculopathy diagnosis and treatment
Sokolov K.V., Smirnov A.K.

Polypoidal choroidal vasculopathy (PCV) is one of the choroidal neovascularization forms, being a subtype of neovascular age-related macular degeneration (nAMD). These two conditions share many characteristics, while PCV has some distinctive features with aneurysmal dilatations (polyps) at the end of abnormal branching vascular network being the most specific of them. Low documented incidence of PCV in European population (up to 13%) may be related to the absence of indocyanin-green angiography (ICG) – the only reliable method for PCV diagnosis confirmation – in routine clinical practice. In that regard, there should be a universal method of treatment suitable for any patient with nAMD irrespectively of whether he or she has PCV. To date, there is no common approach to PCV treatment – anti-VEGF therapy, photodynamic therapy (PDT), and combination of these methods are used in clinical practice. Key diagnostic criteria helping to suspect the presence of PCV without ICG as well as results of clinical trials aimed at assessing effectiveness of different anti-VEGF agents as monotherapy or in combination with PDT are described in this article.

Ophthalmology journal. 2019;12(3):93-100
Case reports
Asymmetric features of keratopathy associated with pseudoexfoliation syndrome
Potyomkin V.V., Goltsman E.V., Varganova T.S., Belov D.F., Kasymov F.O.

In this article, using a clinical case as example we report clinical features of keratopathy associated with pseudoexfoliation syndrome, as well as pathological changes found by confocal microscopy.

Ophthalmology journal. 2019;12(3):101-106

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