Vol 13, No 1 (2020)

Aim. To estimate the influence of concomitant glaucoma (including that after surgery) on IOL power calculation accuracy before phacoemulsification.

Materials and methods. 413 patients were included in the study divided in 4 groups: 1^st – patients with cataract and no concomitant glaucoma (251 cases); 2^nd – patients with cataract and primary open-angle glaucoma (POAG) on medical therapy (103 cases); 3^rd – patients with cataract and prior trabeculectomy (42 cases); 4^th – patients with cataract and primary angle-closure glaucoma (PACG) on medical therapy (17 cases). In all patients, the IOL power calculation was performed using optical biometry (IOL-Master 500). 1 month after surgery, desired refraction according to Barrett Universal II Formula and real obtained refraction estimated by automatic refractometry (Topcon-8800) were compared.

Results. There was no significant difference between study groups 1–3 in IOL power calculation accuracy (the calculation error was –0.09 ± 0.39 D, –0.08 ± 0.45 D, –0.03 ± 0.49 D, for each group respectively). However, we found a higher myopic shift (–0.47 ± 0.48 D, p = 0.095) in the 4^th group.

Conclusion. The presence of concomitant POAG on medical therapy, same as earlier trabeculectomy, does not demand any modification of the IOL calculation algorithm. However, in PACG patients we recommend taking –0.5 D lower optical power IOLs to avoid excessive myopic refraction after phacoemulsification.

Aim. A comparative study of Bowman layer transplantation (BLT) after its ultraviolet (UV) crosslinking and BLT without preliminary UV crosslinking in patients with advanced keratoconus (KC) stages III to IV.

Materials and methods. There were 30 patients aged 14 to 37 years with KC III–IV stages. The first group included 15 patients who underwent BLT without prior UV crosslinking. The second group included 15 patients who underwent BLT after UV crosslinking. The criteria for inclusion of patients in the study were: progressive KC, with corneal thinnest point (CTP) without epithelium of 400 μm or less, a maximum keratometric index (K_max) of 58 D and more, with patient satisfied by his visual acuity in a scleral contact lens (SCL) and refusing keratoplasty.

Results. In comparison with preoperative data in both groups, K_max decreased by an average 0.6 ± 0.5 D, and CTP increased in the first group by an average of 41.5 ± 16.3 µm, and in the second group by an average of 31,9 ± 9.2 μm. Best corrected visual acuity (BCVA) did not change.

Conclusion. During the follow-up of 26.6 ± 6.2 (from 6 to 36) months, CTP and K_max indices remained stable in operated patients, which indicates the arrest of KC progression after BLT with crosslinking and without it. The preservation of endothelial cell density and BCVA values indicates the safety of both methods.

Phacoemulsification is a main method of cataract surgery. The presence of pseudoexfoliation syndrome (PEX) may involve the procedure in difficulty and contribute to development of intra- and postoperative complications.

Purpose. To assess the effect of PEX on phacoemulsification.

Materials and methods. 1010 patients (580 with PEX and 430 without PEX) admitted for cataract surgery, underwent phacoemulsification with implantation of various IOL types. An analysis of main phacoemulsification parameters was carried out: cumulative dissipated energy (CDE), aspirated BSS amount, time of surgery. The prevalence of some possible intraoperative complications was assessed: descemet membrane detachment, posterior capsule rupture, retrolental lens material, and zonular dialysis.

Results. In patients with PEХ, local descemet membrane detachment and retrolental lens material were significantly more common, at the same time CDE was higher.

Conclusion. When planning phacoemulsification, patients with PEX require more thorough preoperative examination, higher alertness during surgery and longer follow-up in the postoperative period.

Telemedicine (TM) is one of the fastest growing segments of healthcare and medical business in the world. In a broad sense, TM means the use of the most modern data technologies in distant medical care practice. Teleophthalmology (TO) is an important area of TM, it includes several priorities, main of which being remote diagnosis, treatment and management of patients with ophthalmic diseases, in particular, diabetic retinopathy, glaucoma and age-related macular degeneration. The development of TO is conditioned by the need for high-tech specialized medical care for people in remote regions. On the path of introducing TO worldwide and in Russia, a huge number of obstacles exists: obtaining high-quality fundus images, training specialists to work in the TM area , creation of standards for image analysis and transmission, TM implementation into the legal field, ensuring of stable financing, creating positive patients and doctors attitude towards TO. In this part, we provide an overview of TO development trends, as well as ways to solve the problems standing in its way.

Toxic damage to the optic nerve is one of the causes of the development of degenerative processes in the fibers of the optic nerve, leading to its atrophy. Exposure to methanol and ethanol is associated with the damaging effects of metabolites, which lead to ATP deficiency. Knowledge and understanding of pathogenetic processes can help the doctor to make a timely diagnosis, which will allow the start of etiopathogenetic therapy as early as possible. The prognosis for acute poisoning with methanol and ethanol depends not only on the degree of intoxication, but also on the timeliness and accuracy of diagnostic and therapeutic tactics.

Aim. To determine the optimal shape of the locomotor stump and the configuration of the corresponding ocular prosthesis, ensuring their maximum motility in patients with anophthalmia with different methods of eye removal.

Materials and methods. The study group consisted of 132 patients aged 18–80 years after enucleation or evisceration. Examination methods included medical history; examination of eyelids, measurement of length and width of the palpebral fissure, as well as of the depth of conjunctival fornices on both sides; assessment of the volume, shape, surface topography, position and excursions of the locomotor stump, of the protrusion of the ocular prosthesis compared to the contralateral eye; photo registration of the studied parameters.

Results. During the study, there were 3 types of locomotor stump identified: moderate with retraction in the upper third; voluminous flattened; voluminous hemispherical. The locomotor stump after enucleation was voluminous flattened or moderate with retraction in the upper third. The best motility of the locomotor stump was noted nasally and downward. The motility of the ocular prosthesis was 47.4% compared to the contralateral eye. The locomotor stump after evisceration with keratectomy was voluminous hemispherical or voluminous flattened. Its motility in all four directions was about the same. The motility of the ocular prosthesis in comparison to the contralateral eye was 55.9%. The locomotor stump after evisceration without keratectomy was voluminous hemispherical, uniform, smooth. The motility of the locomotor stump was maximal in comparison to other groups and relatively equal in all four directions. The motility of the ocular prosthesis in comparison to the contralateral eye was 68.2%.

Conclusion. The optimal shape of the locomotor stump, providing the greatest motility of the ocular prosthesis is voluminous hemispherical. The same protrusion of the eyeball and that of the cosmetic prosthesis relatively to the frontal plane after enucleation is achieved by increasing the thickness of the prosthesis itself, which reduces its motility. Evisceration with implantation of the orbital prosthesis involves the use of a thin-walled ocular prosthesis, the back surface of which ideally repeats the locomotor stump surface and does not prevent its maximum motility. When removing a squinting eyeball with preserved corneal diameter, a smaller implant should be used to prevent excessive opening of the palpebral fissure, or to prefer evisceration with keratectomy.

I invite our dear readers to participate in the discussion on the proposed topic.

The article presents a rare case of combination of von Hippel–Lindau disease and Hodgkin’s disease. The disease began with neurological symptoms with gradual progression over the next 3 years. The diagnosis of von Hippel–Lindau disease was made after MRI of brain and spinal cord, abdominal MICTs, and detection of brain stem and spinal cord tumors, multiple pancreatic cysts. We performed resection trepanation of the posterior cranial fossa and microsurgical total removal of hemangioblastoma of the medulla oblongata. After 1.5 years the patient is diagnosed with Hodgkin’s disease and several courses of chemotherapy are carried out, reaching full remission, confirmed by PET with CT. 14 months later, the patient consulted an ophthalmologist due to visual impairment and floating opacities in her left eye. The ophthalmologic examination for the first time revealed multiple bilateral retinal hemangiomas and vitreal hemorrhages from tractional retinal tears caused by posterior hyaloid detachment and unrelated to hemangiomas in the left eye. The barrier laser coagulation of the left eye retinal tears was performed, and the observation tactics was adopted.

This article contains a case of central retinal artery occlusion in a young man associated with cocaine abuse. Survey data, dynamic monitoring of the patient are presented in the article. Possible mechanisms of vascular pathology associated with stimulant drugs are described.