卷 13, 编号 3 (2020)

经结膜入路矫正上睑下垂的方法已经越来越普遍。然而，其广泛应用主要约束是因为没有明确的手术切除量的标准，尤其是对去氧肾上腺素检测反应呈阴性的患者。

目的. 评估影响上睑板肌（STM）切除术的一些因素。

材料和方法. 研究过程中对75例（103只眼睑）接受手术治疗上睑下垂的患者进行了检查。根据去氧肾上
腺素（PE）的测试结果将患者分为2组。第一组包括PE测试呈阳性的患者，第二组包括PE测试呈弱阳性的患者。所有的患者均接受了“开放天空”式STM切除术，在某些情况下还结合上睑板切除。

结果. PE测试和白线活动度会影响STM切除术的结果，而其他因素则不会。

结论. PE测试和白线活动度对上睑下垂矫正方法的选择具有重要意义。

重要性. 现如今，全世界白内障手术中植入了大量不同材质的人工晶状体（intraocular lens，IOL）。随着现代IOL材料和设计的发展，出现了关于IOL混浊的报导。IOL混浊的部位和特点主要取决于材料属性。目前，聚甲基丙烯酸甲酯较少用于制作IOL，常常由于结构损坏导致光学中心变混浊，形成“雪花状”裂纹。丙烯酸酯IOL浑浊取决于材料的亲水程度。通常，亲水性丙烯酸酯IOL视光区因结晶物沉积导致视力明显下降且需要将其取出。亲水性丙烯酸酯IOL发生混浊取决于患者的伴随疾病。疏水性丙烯酸酯IOL中形成液泡，并发生“闪光”现象。此外，视功能通常不受影响。

目的. 找出IOL哪些结构改变导致视力下降进而必须从人工晶体眼中取出。

材料和方法. 研究了4种不同材质混浊的IOL。通过使用扫描电子显微镜SUPRA 55VP（Carl Zeiss,德国）和二次电子检测器对IOL进行了研究。使用Xmax 80mm2能量色散X射线分析检测器（英国，牛津）收集IOL表面和内部的元素分布图。

结果. 人工晶体植入5年后，带有疏水涂层的亲水性IOL已经变混浊。在IOL表面的所有部位发现了羟基磷灰石晶体。在疏水丙烯酸酯IOL中，通过扫描电子显微镜确定了视觉中心有微小液泡和腔。2个聚甲基丙烯酸甲酯IOL在植入8年后，自身结构被破坏。此类IOL的化学分析中未发现任何无机化合物。

结论. 植入IOL并发症之一是丧失其透明性。导致术后不同时期晶状体变混浊可能与人工晶状体的材料和制造有关，也可能与患者的伴随疾病有关。

Purpose. To evaluate the changes in the quality of life of patients with thyroid eye disease after different methods of orbital decompression.

Materials and methods. The study included 24 patients (37 orbits) with thyroid eye disease, aged 41.6 ± 20.6 (from 20 to 79 years), 18 women and 6 men. The patients were divided into two groups. The first group included 12 patients (19 orbits) who underwent orbital fat decompression. The second group included 12 patients (18 orbits) who underwent endoscopic endonasal bony orbital decompression. The Graves’ ophthalmopathy quality of life questionnaire (GO-QOL) was completed before surgery, and 3 and 6 months after it. Outcome analysis included also the assessment of visual acuity, proptosis, eyelid retraction, and palpebral fissure height.

Results. The GO-QOL visual function scores in both groups did not change significantly in 3 and in 6 months after orbital decompression (p > 0.05): in the first group, before and after 6 months, scores were 69.27 ± 20.02 and 68.96 ± 18.44, in the second group – 53.13 ± 29.13 and 57.81 ± 23.56, respectively. An improvement in the GO-QOL visual function estimation was observed in those patients whose visual acuity improved after surgery. The GO-QOL facial appearance scores significantly improved 3 months after surgery, and continued to increase up to 6 months: in the first group, facial appearance scores improved from 23.96 ± 23.01 to 48.42 ± 25.56 (p = 0.004), in the second group — from 47.92 ± 21.04 to 66.15 ± 23.15 (p = 0.037).

Conclusions. Orbital decompression significantly improves the quality of life of patients with thyroid eye disease, this is primarily associated with an improvement in facial appearance.

The aim was to analyze organizational and technical difficulties in introducing modern technologies of optical reconstructive surgery, and to find the options of their elimination.

Materials and methods. Organizational arrangements to develop and to introduce into clinical practice modern technologies of optical reconstructive surgery in treatment of corneal opacities of different origin in the Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution of the Ministry of Health of the Russian Federation has been analyzed.

Results and conclusions. An unified register of patients of the Far Eastern Federal district who need optical keratoplasty (bullous keratopathies, keratoconus stages 3–4, post-traumatic leukomas, hereditary corneal dystrophies) – a waiting list – has been created. The necessary equipment and instruments were acquired, 4 surgeons were trained who mastered the technologies of deep anterior lamellar keratoplasty and Descemet membrane transplantation along with penetrating keratoplasty. From 2014 to 2018, 160 optical keratoplasty were performed using donor material; by 2019, the need for this type of high-tech treatment has been reduced by 2 times. To date, more than 30% of optical keratoplasties are performed using lamellar technology. The organizational sequence of ordering biological material, performing surgeries; the postoperative care system is got up and running; the outpatient departments’ophthalmologists of the region are trained to use clear objective criteria for dynamic follow-up of these patients.

Relevance. In the treatment of inflammatory diseases of the ocular surface, in order to achieve high efficiency in the shortest possible time, it is necessary for the therapy to be comprehensive. Today, in addition to traditional treatment methods, new technologies based on the use of low-energy lasers, which have high biological activity, are spreading.

Aim. To improve the treatment results of the inflammatory diseases of the ocular surface by implementing photodynamic therapy (PDT) in experiment and clinic, using domestic equipment and elaborating optimal energetic parameters of laser irradiation.

Methods. Objects of research: 130 nonlinear sexually mature rats weighing 150 grams contained in standard vivarium conditions and 110 eyes of patients with inflammatory eye diseases. Carrying out the investigation, experiments on animals, clinical and functional examination results of patients, and statistical analysis were taken into consideration.

Results. A methodology for complex treatment of inflammatory diseases of the ocular surface was developed (with inclusion of PDT by the laser therapy device “Vostok”), based on experimental data and confirmed by clinical and functional ocular indices. PDT helps to increase the effectiveness of treatment, which is manifested by accelerated tissue regeneration, restoration of corneal transparency, increase of visual function in 86.7%, and reduction of treatment terms to 6 days.

Conclusions. Anti-inflammatory and regenerative effectiveness of the proposed complex treatment of inflammatory diseases of the ocular surface with the PDT use was established: improvement in the clinical picture of conjunctivitis and keratitis was revealed, manifested by increase in corneal epithelization.

In recent years, telemedicine (TM) has been gradually introduced into ophthalmology in the form of teleophthalmology (TO), because most of the eye diseases can be photographed and transmitted via Internet. The most wide development of TO has involved the field of diabetic retinopathy (DR) diagnosis, primarily due to the high prevalence of diabetes mellitus in the world. Examples of the well-established operation of remote DR screening centers exist in different countries of the world. There are many studies published, which compare a remote examination with a personal one, and according to their data, TO screening is no worse, than traditional screening. In addition to DR, TO also covers the diagnosis of glaucoma, age-related macular degeneration, and other ophthalmic conditions. In this article, we present an overview of modern TO centers in different countries, the features of their organization and global results that have been achieved during their existence. New technologies developed to facilitate the work of such centers will also be touched: image analysis algorithms, portable diagnostic equipment, medical information systems. The prospects for introducing TO into Russian medical practice are considered separately.

引言. 在鼻腔泪囊吻合术后复发泪囊炎的情况下，需要进行二次手术。近年来，出现一些关于应用鼻内球囊泪道成型术（球囊直径为6mm）治疗泪囊炎复发的论著。

研究目的. 应用鼻内球囊泪道成型术治疗鼻腔泪囊吻合术后泪囊炎复发的评估。

材料和方法. 该项研究中包括1到3年前因泪囊炎接受了鼻内镜下鼻腔泪囊吻合术的6例患者。对所有患者进行了一下检查：根据Munk法分级评估了溢泪程度，通过光学相干断层扫描评估了泪河高度，荧光素试验，泪道冲洗试验，泪道水平探测，鼻腔内窥镜检查，多层螺旋CT泪道造影。所有患者均通过6mm直径球囊进行了鼻内球囊泪道成型术。术后患者观察期为6个月。

结果. 观察发现有4例患者“康复”，1例患者得到改善，1例患者泪囊造口疤痕愈合。

结论. 从6例患者行鼻内球囊泪道成型术获得的初步结果显示，该方法可用于治疗鼻腔泪囊吻合术后泪囊炎复发的患者。通过继续研究，如增加临床观察数量以使所得结果进行充分的统计学处理、延长患者术后观察期、拓展手术适应症及研究其他能改善鼻内球囊泪道成型术有效性的措施等研究后，这种方法的应用前景还是可以得到解决的。

Report on the work of the XXVI International Ophthalmological Congress "White Nights" - the 16th Congress of the All-Russian public organization "Association of Ophthalmologists"

The article is dedicated to the 90th Anniversary, which was celebrated on June 30, 2020, an outstanding Soviet and Russian ophthalmologist, founder of the Russian ophthalmic and oncological school, Honored Scientist of the Russian Federation (1991), Academician of the Russian Academy of Sciences (2013), Professor of the Department of Ophthalmology with a course of pediatric ophthalmology and orbital pathology of the Russian Medical Academy of Postgraduate Education Brovkina Alevtina Fedorovna. It examines her life path: clinical, scientific and pedagogical activities and achievements.

Acanthamoeba keratitis with bacterial, fungal superinfection or without it leads to development of an aggressive and long-standing corneal inflammation; up to now, the efficacy of its treatment stays doubtful and demands further investigation. For a long time, there were discussions on the possibility and expediency of corneal collagen cross-linking (PACK-CXL – photo activated chromophore for keratitis) in patients with bacterial, fungal and Acanthamoeba keratitis. This article presents a clinical case of effective treatment of mixed etiology keratitis by multiple high fluence accelerated PACK-CXL in a patient with severe local toxico-allergic reaction.