Vol 12, No 4 (2019)

Original researches
The effect of preset intraoperative intraocular pressure during phacoemulsification on the blood flow velocity in the central retinal artery
Takhtaev Y.V., Kiseleva T.N., Shliakman R.B.
Abstract

Aim. To evaluate the effect of preset elevated intraocular pressure (IOP) level during phacoemulsification on central retina artery and central retinal vein hemodynamics and to determine possible compensatory mechanisms of the ocular blood flow autoregulation in response to intraoperational IOP jump.

Methods. This prospective study included 23 cataract patients without concomitant ocular vascular conditions (15 women and 8 men) aged from 62 to 83 years. The mean age was 72.5 ± 5.7 years. In all patients, an intraoperational color duplex scanning in the regimens of color Doppler imaging and pulsed wave velocity imaging using ultrasound scanner Logiq S8 (GE). The blood flow was estimated in retrobulbar vessels: central retinal artery, central retinal vein with maximal systolic velocity, end-diastolic velocity of the blood flow, and resistance index (RI). The investigation was performed under IOP control, which was measured using Icare Pro tonometer, and under blood pressure control using patient monitoring system Draeger Vista 120. In the operating room, ocular blood flow was examined three times: immediately before surgery, straight after the surgical incision sealing at preset intraoperational IOP level, and after IOP normalization and repeated sealing of the corneal tunnel.

Results. Under preset intraoperational IOP maintenance on 58.01 ± 8.10 mm Hg level, there was a clinically significant (p < 0.05) decrease of blood flow velocity in the central retinal artery. In 30.4% of cases, the blood flow velocity in the central retinal artery during diastolic phase was not registered. The flow velocity in central retinal vein did not change significantly, and did not depend on IOP level (p < 0.05).

Conclusions. At the 55–60 mm Hg IOP level, in humans, compensatory blood flow autoregulation mechanisms in response to intraoperational IOP jumps are absent, up to complete blood flow stop in the central retinal artery at the diastolic phase, and this could be a risk factor for retinal ischemia.

Ophthalmology journal. 2019;12(4):5-12
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Innovative approach to barrier amnioplasty in surgical treatment of primary progressive pterygium
Bochkareva A.N., Egorov V.V., Smoliakova G.P., Pilipenko A.D., Banshchikov P.A.
Abstract

The aim is to evaluate the efficacy of new method of barrier amnioplasty in surgical treatment of primary progressive pterygium.

Materials and methods. 40 patients (40 eyes) with primary progressive pterygium, divided into two groups depending on surgical features of barrier amnionoplasty: in the main group (20 patients), plastic surgery was carried out in the semilunar fold area; in the control group (20 patients) – in the limbal area. All patients underwent special examination: tear pH measurement and cytological evaluation of the cellular composition from the wound surface. The treatment efficacy was evaluated: in the early postoperative period – by the timing of conjunctival inflammation disappearance, corneal epithelialization and vitalization of the amnion; after 1 year – according to the state of the limbus, cornea, visual acuity, degree of corneal astigmatism.

Results and conclusions. The use of amnioplasty method in the area of semilunar fold developed and implemented by us in clinical practice showed high efficacy: time reduction in local cellular inflammatory reactions in the cytological composition of swabs and scrapings and postoperative inflammation of ocular surface, which led to shortening of periods of corneal epithelization by 1.7 times and vitalization of the amnion by 1.5 times. Uncomplicated postoperative course of inflammatory-regenerative reactions allows avoiding the pterygium recurrence and causes reduction of the degree of corneal astigmatism and visual acuity increase.

Ophthalmology journal. 2019;12(4):13-21
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Modern extrascleral surgery in the treatment of regmatogenous retinal detachment: efficacy evaluation and functional results
Shchukin A.D.
Abstract

The basic principles of extrascleral surgery, which are currently used in the treatment of regmatogenous retinal detachment (RD), have not changed much since their heyday in the 70–80s of the 20th century, and they remain relevant both as an independent method to treat this disease in certain clinical cases, and in combination with vitrectomy.

The aim is to evaluate the efficacy of RD extrascleral treatment methods (anatomical result, visual acuity), as well as the frequency and timing of the relapses.

Materials and methods. The study was carried out at the vitreoretinal department of the Ophthalmological Center of the City Hospital No. 2 of St. Petersburg. A sample of 466 patients with RD, operated with extrascleral methods in 2015–2016 has been analyzed. Anatomical results, visual acuity, number and timing of relapses have been assessed.

Results. The efficacy of extrascleral surgery reaches 89%, RD recurrence after surgical treatment occurs in 21% of patients.

Ophthalmology journal. 2019;12(4):23-28
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Long-term results of corneal collagen crosslinking with ectatic forms of corneal dystrophy
Frolov O.A., Astakhov S.Y., Novikov S.A.
Abstract

Corneal collagen crosslinking is one of the most effective methods of prophylactics and treatment of progressive corneal ectasias. In the literature, there are occasional data related to remote results concerning only the most common form of ectasias – keratoconus. In published studies, no remote results are met concerning the efficacy of corneal collagen crosslinking in other forms of corneal ectasias, which are now on the rise, including secondary ectasias that became more frequent with refractive surgery. The number of diagnosed cases of pellucid marginal degeneration increased as well. The literature shows no data on comparative analysis of remote results concerning the efficacy of this method in treatment of various forms of corneal ectasias.

The aim of the investigation was to evaluate the efficacy of corneal collagen crosslinking based on the analysis of long-term results of this treatment method for various forms of corneal ectasias.

Materials and methods. The results of corneal collagen crosslinking in patients with various forms of corneal ectasia 6 years after surgery were analyzed. The nosological structure of the study included patients with keratoconus, pellucid marginal degeneration, and secondary ectasia. The group of patients with keratoconus included 30 patients (30 eyes), that with pellucid marginal degeneration – 30 patients (30 eyes), and that with secondary ectasia – 30 patients (30 eyes). Corneal collagen crosslinking was performed by the same specialist, during the first or the second year of follow-up. Then changes in the state of the cornea and visual functions were monitored for 6 years. To assess the efficacy, preoperative examination results and interim data were used.

Results. In all groups, there was an increase in the best corrected visual acuity, a decrease in the index of asymmetry of the corneal surface and its refractive power in the center of ectasia. However, best corneal collagen crosslinking results were obtained in groups of patients with keratoconus and secondary corneal ectasia.

Ophthalmology journal. 2019;12(4):29-34
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Reviews
Stem cell-based technologies in treatment of age-related macular degeneration patients: current state of the problem
Gayduk K.Y., Churashov S.V., Kulikov A.N.
Abstract

Age-related macular degeneration (AMD) is the most common disease of the macula – the area responsible for central vision. With regard to the pathogenesis of AMD, the main focus of most researchers is on the pathological processes occurring in the retinal pigment epithelium (RPE), which is considered as the main target of the disease. For the treatment of the “dry” form of the disease, which accounts for about 90% of all AMD cases, up to now no effective treatment methods were elaborated, while in the therapy of the “wet” form, antiangiogenic therapy, photodynamic therapy, and surgical treatment methods have been used with concrete success. Stem cells, possessing enormous therapeutic potential, are gradually being introduced into medical technologies, including ophthalmology. A number of pre-clinical studies have proven the safety of using cultured cells of the RPE, which gave rise to the beginning of clinical trials of the use of stem cells in the treatment of AMD patients. The review analyzes the data of scientific literature on the current understanding of the pathogenesis of AMD, pathogenetically substantiated therapies, including those using cell-based technologies, prospects and problems of using stem cells in the treatment of AMD patients.

Ophthalmology journal. 2019;12(4):35-41
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Two-stage or single-stage vitreoretinal surgery with phacoemulsification in patients with advanced proliferative diabetic retinopathy?
Konovalova K.I., Shishkin M.M.
Abstract

The literature review compares the combined (vitreoretinal surgery with silicone tamponade and phacoemulsification of incipient cataract with intraocular lens implantation) and two-stage (phacoemulsification with intraocular lens implantation as a second step, simultaneously with the silicon oil removal, after vitreoretinal surgery) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated incipient cataract. Modern concepts of treatment tactics of this disease, its efficacy are analyzed. Benefits and drawbacks of each of the discussed surgical treatment methods are specified.

Ophthalmology journal. 2019;12(4):43-48
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Ophthalmopharmacology
The use of new cohesive ophthalmic viscoelastic in cataract surgery
Loskutov I.A., Korneeva A.V., Lebedev P.A.
Abstract

The article presents the results of an original study which was dedicated to the investigation of the new cohesive viscoelastic Cogevisc (sodium hyaluronate 1.6%) in ophthalmic surgery.

Aim. Analysis of the efficacy and safety of a new cohesive viscoelastic (Cogevisc, Solopharm) in phacoemulsification.

Patients and Methods. The clinical study was based on an assessment of the clinical and functional state of 80 patients (80 eyes), which were divided into 2 groups depending on viscoelastic used during the phacoemulsification procedure (Softshell technology): in group I (40 patients, 40 eyes) Viscoat was used to protect tissues, and Amvisc Plus was added to create volume; in group II (40 patients, 40 eyes) Viscoat was used to protect tissues, and Kogevisc was used to create volume. In the postoperative period, all patients received standard anti-inflammatory treatment. There was no significant difference in mean age, gender, preoperative intraocular pressure (IOP) and preoperative central corneal thickness (CCT) between the two groups. Before surgery and in the postoperative period (in one day, 7 days, and 1 month), IOP, CCT, and endothelial cell density (ECD) were measured. The duration of the procedure and the amount of the consumed fluid were estimated.

Results. There was no significant difference in IOP, CCT, ECD 1 day and 1 week postoperatively between the two groups. Mean absolute refractive error was also not significantly different between the two groups. There was no significant difference in procedure duration between groups I and II (1523.81 ± 75.66 seconds, 1500.33 ± 92.56 seconds, respectively, p < 0.001). No complications were observed during the intraocular lens implantation in both groups.

Conclusion. The investigated viscoelastic Cogevisc allows creating and effectively maintaining the necessary depth of the anterior chamber and the maximum diameter of the pupil, which simplifies different stages of phacoemulsification and minimizes the risk of intraoperative complications. Promising for further research is its use in combination with an adhesive viscoelastic of the same production. Reduced cost of Cogevisc is the advantage of this viscoelastic.

Ophthalmology journal. 2019;12(4):51-56
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Modern opportunities for the prevention and treatment of inflammatory eye diseases of an infectious nature in children
Brzheskiy V.V.
Abstract

The development of inflammatory diseases of the cornea and conjunctiva, as well as the occurrence of infectious complications of intraocular surgery, are largely associated with the presence of saprophytic and pathogenic microflora in the conjunctival cavity. This circumstance is more characteristic of children. At the same time, the possibilities of antibacterial therapy of inflammatory eye diseases of bacterial and chlamydial etiology, as well as perioperative prophylaxis of infectious complications of intraocular surgical procedures in children, have significantly expanded today. The widespread use of fluoroquinolones has significantly improved the treatment of children with acute and chronic bacterial conjunctivitis, keratitis, blepharitis, meibomyitis, chalazion, as well as those with chronic conjunctivitis of chlamydial etiology. At the same time, levofloxacin – fluoroquinolone of the 3rd generation, which is used in our country in the form of a 0.5% solution as eye drops Oftaquix® (Santen, Finland), has demonstrated high efficacy for this purpose. The widespread introduction of the original 0.5% levofloxacin (Oftaquix®), in the treatment regimen for children with inflammatory diseases of the cornea and conjunctiva, as well as for a perioperative prevention of infectious complications of surgical procedures involving them, is a promising way to solve the problem.

Ophthalmology journal. 2019;12(4):57-65
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In ophthalmology practitioners
Balloon dacryoplasty in the treatment of recurrent dacryocystitis
Zhukov O.V., At’kova E.L., Krakhovetskiy N.N.
Abstract

Causes of the recurrence after dacryocystorhinostomy are errors during surgery (small size of the bone window, wrong localization of the dacryostomy (too high or too low); inadequate formation of flaps at the medial wall of the lacrimal sac and at the mucosa of the nasal cavity) or problems occurring in the follow-up period (granulation in ostium area, synechiae between the structures of the nasal cavity near the dacryostomy, canaliculi ostium obliteration). A literature review considers various methods of dacryocystitis recurrence treatment both with external and endonasal approaches. In published studies, promising results were obtained using balloon dacryoplasty in the dacryostomy area after dacryocystitis relapse.

Ophthalmology journal. 2019;12(4):67-72
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Vitelliform changes in the central retina occurring in adults
Matcko N.V., Gatsu M.V., Grigoryeva N.N.
Abstract

Introduction. Vitelliform lesions of the central retinal area in adult patients represent a heterogeneous group of diseases. This article describes different variants of vitelliform changes in adults, based on the published literature data.

Materials and methods. We have analyzed and described different variants of vitelliform changes in adults, based on literature data, examples from own clinical practice using multimodal approach are included.

Discussion. Vitelliform lesions of the central retinal area are can debut at various ages, occurring in mono- or multifocal way, have various stages of degradation of vitelliform material, masquerading as other lesions of the macular area and of the posterior pole. Many of these diseases appear due to mutations in determined genes, though, a fairly large proportion of cases is considered to be sporadic. Nowadays, characteristic signs of different diseases with the vitelliform material are described. But differential diagnosis with other similar diseases (some age-related macular degeneration forms and those of central serous chorioretinopathy) is fairly difficult and requires a multimodal ophthalmologic approach, and in some cases genetic studies.

Conclusions. Vitelliform lesions of the central retinal area, occurring in adult patients are a group of diseases that are difficult to diagnose and masquerade themselves as other diseases of the central retina, which requires certain doctor’s knowledge and ability to carry out a multimodal imaging and prescribe the appropriate treatment if needed.

Ophthalmology journal. 2019;12(4):73-86
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White line motility test in transconjunctival muellerectomy for blepharoptosis
Potyomkin V.V., Goltsman E.V.
Abstract

Introduction. It is common knowledge that positive response to phenylephrine (PE) test remains the main indication for superior tarsal muscle (STM) resection for mild and moderate blepharoptosis. However, in recent times, there have been reports about possibility of STM resection in patients with weakly positive and negative responses to the PE test. However, the question remains open what a surgeon should focus on when planning STM resection in these cases? Authors have developed a test for assessing motility of the white line that could help to answer this question.

Materials and methods. 75 patients (103 eyelids) operated for blepharoptosis with STM resection in Saint Petersburg City Hospital No. 2 from November 2017 until august 2019 were enrolled in the study.

Results. We found no significant correlation between the result of white line motility test in patients with positive response to PE test and the effect of surgery, while in patients with week and negative PE test results there was a strong correlation.

Conclusion. The white line motility test could help to assess the desired amount of STM resection in patients with week and negative phenylephrine test results.

Ophthalmology journal. 2019;12(4):87-91
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Interdisciplinary aspects
Individual hygiene program of stomatologic conditions prevention in ophthalmologic patients
Ulitovskiy S.B.
Abstract

Aim. To describe features of formation and carrying-out of an individual hygiene program of stomatologic conditions prevention in ophthalmologic patients.

Methods. The formation of hygiene program of prevention.

Results. Action tendency and procedure of the program stages conduct with consideration for patient’s status are stated. Peculiarities of professional and individual oral hygiene during pre-op and post-op periods are reflected.

Conclusions. It is necessary to take into account physical characteristics of oral hygiene products (vibration, sound, ultrasound, etc.) concerning subsequent ophthalmic procedures and special aspects of post-op period course.

Ophthalmology journal. 2019;12(4):93-100
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Case reports
Ocular dirofilariasis: the increasing incidence in a temperate zone
Zumbulidze N.G., Konenkova J.S., Laskin A.V., Kasatkina O.M., Belov D.F., Vigonyuk D.V.
Abstract

Over the last years, there is a pronounced tendency of increase in number of dirofilariasis infected animals and humans in the temperate climate area. Earlier, we described five cases of ophthalmodirofilariasis from 2015 to 2018. This article presents four new cases. One of the clinical cases relates to extremely rare localization in the anterior chamber of the eye. Only few reports of Dirofilaria detection in sclera, vitreous and retina have been published.

Ophthalmology journal. 2019;12(4):101-106
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Combination treatment of a rare case of a cavernous hemangioma of the orbit
Gorbachev D.S., Kulikov A.N., Svistov D.V., Savello A.V., Kol’bin A.A., Martynov R.S., Leongardt T.A.
Abstract

A case of atypical course of cavernous hemangioma of the orbit. A necessity of a multidisciplinary approach to the diagnosis and surgical treatment of an orbital neoplasm is shown.

Ophthalmology journal. 2019;12(4):107-120
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