卷 17, 编号 3 (2024)

Background: The uveitis–glaucoma–hyphema syndrome is a disease caused by iris injury due to extracapsular fixation of intraocular lens (IOL). ES Treatment involves IOL fixation or exchange.

Aim: To compare the effectiveness of various surgical methods of uveitis–glaucoma–hyphema syndrome treatment.

Materials and methods: The study group included 95 patients (95 eyes), divided into six subgroups depending on surgical treatment methods used: hydrophobic IOL exchange on hydrophilic model (HYDRO) with its transscleral fixation (n = 20); transscleral fixation (TSF) of native IOL (n = 18); hydrophobic IOL exchange on polymethylmethacrylate iris-claw IOL (CLAW; n = 22); iris-fixated IOLs (IRIS; n = 8); IOL immobilization with scleral bandage sutures (BS; n = 4); conservative treatment (CT; n = 23). The methods were compared using a scoring system.

Results: The final score of surgical methods effectiveness is presented in descending order: HYDRO — 5.36 ± 1.05, TSF — 5.21 ± 1.80, CLAW — 3.87 ± 3.34, IRIS — 1.26 ± 4.41, BS — –0.74 ± 3.66, CL — –3.26 ± 2.51 (p < 0.001).

CONCLUSIONS: Uveitis–glaucoma–hyphema syndrome surgical management is a complex problem due to necessity of several interventions performing directed to eliminate the cause factor of recurrent hemorrhages — mechanical traumatization of iris by IOL. The comparison of various surgical techniques demonstrated the greatest effectiveness of HYDRO, TSF, and CLAW. Suture fixation of the IOL to the iris showed slightly less effectiveness. Using of bandage sutures for UGH treatment is inappropriate due to the high risk of relapse.

Background: To date, the assessment of morphofunctional changes within eyelids is performed using laser scanning confocal microscopy, which has extensive diagnostic capabilities. Identification of the indicators equivalence of this method and laser Doppler flowmetry will confirm the existence of an alternative, objective and economical method of eyelid examination in chronic blepharitis.

Aim: To prove the possibility of laser Doppler flowmetry application as an alternative method of eyelid morphofunctional state assessment.

Materials and methods: The study included 62 patients (124 eyes) with an established diagnosis of chronic mixed demodecticosis blepharitis, including 46 women and 16 men, mean age 65.8 ± 3.2 years, randomly assigned into two groups with identical age and gender composition. Group 1 patients (31 patients, 62 eyes) were treated with cosmeceuticals containing terpenes and terpenoids 2 times a day and tear substitute 3 times a day for 1.5 months. Group 2 patients (31 patients, 62 eyes) used an eyelid care gel containing sulphur medicaments 2 times a day and a tear substitute 3 times a day for 1.5 months. In addition to standard ophthalmological examination, laser Doppler flowmetry and laser scanning confocal microscopy were performed. Dynamic follow-up was performed after 1.5 and 3 months.

Results: The analysis of laser scanning confocal microscopy and laser Doppler flowmetry parameters revealed a high inverse correlation between the density of inflammatory cells of the eyelids tarsal conjunctiva and neurogenic oscillations of blood flow, as well as high direct correlation with the index of blood flow shunting. A marked direct correlation between the density index of meibomian gland acinuses and the parameters of myogenic oscillations of blood flow and neurogenic oscillations of lymph flow was established.

Conclusions: Pearson’s correlation analysis performed on laser scanning confocal microscopy and laser Doppler flowmetry parameters assessing the morphofunctional state of the eyelids demonstrated the presence of equivalence in both study groups with high statistical reliability. The obtained data confirm the possibility of using laser Doppler flowmetry method for objective assessment of eyelid condition and allow the parameters of this method to serve as criteria for choosing pathogenetically oriented therapy of chronic blepharitis with evaluation of its effectiveness.

Background: Forensic examination plays a key role in establishing the severity of injuries, especially of orbital trauma, which can lead to serious consequences, including vision loss. Examination of forensic reports associated with orbital trauma provides valuable information about the nature of the injuries, their prevalence, and factors influencing the severity of the injury.

Aim: Analysis of the possibilities of an interdisciplinary approach based on the presence of a full ophthalmological status and computed tomography data of the skull in conducting a forensic medical examination of living persons and in the final qualification of the degree of harm to health in orbital injuries.

Materials and methods: An analysis of 37 completed forensic medical examinations of living persons with orbital injuries who were treated in multidisciplinary hospitals in Moscow was carried out. The forensic medical examination was carried out in the Bureau of Forensic Medical Examination of the Moscow Health Department. In 23 cases, the ophthalmological status was assessed at periods from 1 week to 6 months after the injury. In all cases (n = 37; 100%), computed tomography of the facial and cerebral skull was performed. The age of the victims at the time of injury ranged from 12 to 82 years (average 39.7 ± 9.2 years). There were 29 adults among the victims (78.3%), 8 children (21.6%). In terms of gender distribution, there was a significant male predominance — 27 men (73%) versus 10 women (27%).

Results: According to the results of the analysis of forensic medical reports, polytrauma with the simultaneous presence of several severe injuries to various organs and systems, combined with orbital trauma, was recorded in 12 victims (32.4%). A combination of traumatic brain injury and orbital injury without involvement of other organs and systems was detected in 9 victims (24.3%), isolated orbital trauma — in 13 people (35.1%), isolated injury of two orbits simultaneously — in 3 victims (8.1%). From the conclusions of forensic experts, it follows that in 89% of cases, the bone walls of the orbits, formed by the frontal, ethmoid and sphenoid bones, as well as the upper jaw, were damaged, which could subsequently lead to damage to the globe, optic nerve and other orbital structures. Damage to the soft tissue of the orbits with globe contusion was noted in 11% of cases. In 3 cases (n = 3; 8.1%), moderate harm to health was determined based on significant persistent loss of general ability to work. In 14 cases (n = 14; 37.8%), it was not possible to focus on the acuteness of the injured globe before the traumatic episode, due to the fact that the victims had no documented visits to an ophthalmologist before the injury.

Conclusions: To objectively assess of the orbital trauma and determine the degree of harm to human health, it is necessary to have a full ophthalmological status, including such clinical and instrumental criteria as visual acuteness, presence or absence of ophthalmoplegia and globe dystopia, as well as computed tomography data of the skull, which must be presented in the primary medical documentation.

The development and the improvement of new imaging methods are current trends in ophthalmology. The literature review is devoted to the use of standardized A-echography in the diagnostics of ocular pathology. The history of the development of this method, the basic principles of obtaining A-sonograms, the features of the qualitative and quantitative assessments of pathological changes in the structures of the eye based on echographic data are presented. Standardized A-echography is most widely used in the diagnostics of vitreoretinal pathology, intraocular mass (choroidal melanoma, choroidal hemangioma, non-tumor formations) and assessment of orbital structures (optic nerve, extraocular muscles, orbital tumors).

Neurotrophic keratopathy is a progressive condition resulting from corneal denervation, leading to the development and persistence of corneal ulcers. Among the pathogenetic treatment methods there are corneal neurotization, a technically challenging approach associated with a prolonged rehabilitation period, and the usage of recombinant human nerve growth factor (cenegermin), which is practically inaccessible due to its high cost and lack of registration in Russian Federation. We propose a technique of orbital fat transposition to the sclerocorneal pocket for the treatment of persistent ulcers associated with neurotrophic keratopathy. This method is based on neuronal embryology of orbital adipose tissue, as well as the abundance of neurotrophic factors and stem cells. This method was applied to three patients with different etiologies of neurotrophic keratopathy, reaching the observation endpoint in two months after the operation. Visual acuity was ranging from 0.005 to 0.01. All patients received standard therapy for 1–2 months without significant improvement. Surgery was then performed using the proposed technique, which involves repositioning the medial and central orbital fat pads into the sclerocorneal pocket. In the postoperative period, partial epithelialization was observed in all patients during the first week, followed by complete healing and scar formation. The maximum visual acuity in 2 months ranged from 0.06 to 0.3.

Ocular Dirofilariasis is one of the frequent manifestations of this disease. The primary manifestations of dirofilariasis of the visual organ (soreness, redness, itching in the eyelid area) may be nonspecific and weakly expressed at the beginning of the disease. The peculiarity of this disease is that if earlier most cases of human infection with Dirofilaria repens were registered in southern countries and southern regions of the Russian Federation, recently there has been a tendency for this disease to spread to northern regions. Diagnosis of this disease based on the data of instrumental methods of investigation is difficult, although cases of detection of the parasite at the preoperative stage have been described in the literature. This publication presents a clinical case of the orbital form of dirofilariasis, which was diagnosed at the intraoperative stage using transconjunctival access. This access is sufficient for complete removal of the neoplasm, and the rehabilitation of patients after surgery with such an access is short and without the formation of a cosmetic defect. Surgical intervention is the main and only treatment tactic and does not require additional specific antiparasitic treatment.

Until recently, the assessment of individual retinal cells was possible only with the help of histological examination, since such retinal imaging methods as scanning laser ophthalmoscopy and optical coherence tomography had low resolution to obtain images of structures at the cellular level, which was mainly due to aberrations caused by the optics of the eye. Adaptive optics technology has improved the performance of optical systems by correcting optical wavefront aberrations. Adaptive optics allows noninvasively visualizing the retina at the microscopic level in vivo, providing the opportunity to analyze individual structures such as photoreceptors, blood vessels, nerve fibers, ganglion cells and a lattice plate. Adaptive optics imaging in patients with diabetic retinopathy makes it possible to accurately determine the spatial distribution of cones, a decrease in which is associated with the presence of diabetic retinopathy and an increase in the severity of the disease. The detection of differences in cone distribution density between the control group and patients with diabetes mellitus without clinical signs of diabetic retinopathy may contribute to its early diagnosis, as well as a deeper understanding of the consequences of changes in the photoreceptor apparatus. Adaptive optics imaging methods are able to identify disorders of photoreceptor cells and assess the degree of progression of age-related macular degeneration, which definitely expands diagnostic capabilities at the early stages of its detection. Assessment of the condition of nerve fiber bundles through the use of Adaptive optics helps to identify changes associated with glaucoma, and also provides the ability to visualize details that cannot be evaluated using optical coherence tomography. Adaptive optics imaging allows you to directly measure the wall of retinal vessels and the diameter of their lumen. The ratio of wall thickness to vessel lumen and the cross-sectional area of the vessel wall directly reflect the remodeling process and can be used for the purpose of early diagnosis and monitoring of hypertension.

The name of Dmitry S. Gorbachev has a worthy place in the list of teachers and ophthalmic surgeons of the Department of Ophthalmology of the Kirov Military Medical Academy and military ophthalmology in general.D.S. Gorbachev dedicated his life to military medicine, training and education of future military doctors. He is a student of Professor V.V. Volkov, and was deeply immersed in the complex problem of orbital surgery. At the Department, D.S. Gorbachev, due to his deep scientific immersion in the problem, brought the field of orbital surgery to a modern multidisciplinary level. He constantly passed on his knowledge and skills to his students, who are currently continuing his work.