Saratov JOURNAL of Medical and Scientific Research

2018, volume 14

The analysis of microcirculation parameters of the macular area after ultrasonic vitrectomy using optical coherence tomography-angiography

Year: 2018, volume 14 Issue: №4 Pages: 856-862
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Dibaev T.l., Ismagilov T.I..
Organization: Saratov State Medical University, ZAO Optimedservis
Summary:

Purpose: to analyze the parameters of the microcirculation of the macular area in patients operated on by the method of ultrasound vitrectomy 25G for idiopathic through macular opening (IMO) and epiretinal fibrosis (ERF). Material and Methods. ОСТ angiograms of 35 patients operated on by ultrasound vitrectomy for idiopathic through macular opening (IMO) and epiretinal fibrosis (ERF) before and for 3 months after surgery were analyzed. The following parameters of microcirculation of the retina were investigated: the area of the foveal avascularzone (FAZ), the density of the foveal vessels in the ring 300 urn around the FAZ, the density of the vessels in the superficial and deep capillary networks of the retina. Results. The FAZ area with IMO decreased within 3 months, while with ERF an increase in this parameter was recorded (p<0.05). In the superficial capillary network in both pathologies there was a decrease in the density of the vascular pattern (p<0.05), in IMH there was a tendency to recovery to the pre-op values. The deep capillary network was characterized by decrease of vascular pattern density to 1 month with following increase to 3 month (p<0.05). Conclusion. Features of the dynamics of the parameters of the microcirculation of the macular area in different periods of the postoperative period largely depend on the nature of the pathology, the stress response of the tissue to the operative traumaand the degree of recovery of the vascular pattern of the retinal neuroepithelium in the superficial and deep capillar networks.

Keywords: macular area, optical coherence tomography-angiography, parameters of microcirculation of the retina, ultrasonic vitrectomy,, vascular density of the retina

Intraoperative OCT-assisted vitreoretinal surgery

Year: 2018, volume 14 Issue: №4 Pages: 849-855
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Dibaev T.l., Husniyarova A.R.
Organization: Bashkir State Medical University of the Russian Health Care
Summary:

Purpose: comparative analysis of clinical and functional results of surgery of vitreomacular interface and rheg-matogenous retinal detachment with the use of intraoperative optical coherence tomography. Material and Methods. Clinical and morphofunctional data were analyzed in 102 patients with epiretinal fibrosis (ERF), idiopathic macular hole (IMH), and rhegmatogenous retinal detachment (RRD), who were divided into 2 groups. In the main group (n=52), the surgery was performed using intraoperative ОСТ control, in the control group without it. In the main group intraoperative control was performed at 4 stages of the surgery: before vitrectomy, after vitrectomy, during the main stage of the surgery and after completion of endotamponade of the vitreous cavity. During surgery for macular disorders intraoperative complications were assessed, in RRD the intraoperative screening for the detection of undiagnosed pathological changes was performed. In the postoperative period, clinical and functional results were assessed in up to 6 months. Results. The use of intraoperative ОСТ control allowed to reduce the frequency of intraoperative complications, such as capillary retinal bleeding (19.2% in the control group, 11.5% in the main group) and pinching of the inner retinal layers (not observed in the main group, in the control group its incidence was 23.1%) in macular surgery. Intraoperative ОСТ made it possible to better identify concomitant retinal pathology (secondary epiretinal membranes in the main group were found during the surgery in 11.5% of cases, in the control group in 4.2%, while in the postoperative period in 12.5%). In complicated cases of RDD, tomographic control allows to identify microstructural features of the posterior pole of the eye, which are important in achieving stability of the anatomical result, such as retinal defects over staphyloma of the posterior pole in high myopia cases. Conclusion. Intraoperative OCT-assisted vitreoretinal surgery reduces the rate of intraoperative complications during macular surgery and gives valuable diagnostic information in complicated retinal detachment cases.

Keywords: epiretinal fibrosis, intraoperative ОСТ, retinal detachment, vitreoretinal surgery

Microinvasive non-surgical treatment of vitreomacular traction

Year: 2018, volume 14 Issue: №4 Pages: 846-849
Heading: Ophtalmology Article type: Original article
Authors: Lyskin P.V., Zakharov V.D., Shpak А.А., Zgoba M.l.
Organization: The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: evaluation of the effectiveness of treatment for vitreomacular traction below 500 urn in length uncomplicated by epiretinal fibrosis and macular holes. Material and Methods. Enzymatic vitreolysis was used to treat 23 patients (23 eyes) with uncomplicated vitreomacular traction up to 500 urn in length. Results. Elimination of vitreomacular traction was achieved in 17 cases (74%). The goal of intervention was not achieved in 5 cases (21 %), in 1 case (5%) a macular hole was formed. Conclusion. The results have shown that enzymatic vitreolysis can be a method of choice for treatment of vitreomacular traction up to 500 urn uncomplicated by epiretinal fibrosis and macular holes.

Keywords: bacterial collagenase, enzymatic vitreolysis, vitreomacular traction

Clinical and functional results of surgical treatment of regmatogenous retinal detachment by ultrasonic vitrectomy 25G

Year: 2018, volume 14 Issue: №4 Pages: 841-845
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.M., Dibaev T.I., Mukhamadeev T.R., Shatunova A.S.
Organization: Bashkir State Medical University of the Russian Health Care, ZAO Optimedservis
Summary:

Objective: to analyze clinical and functional outcomes of surgical treatment regmatogenic retinal detachment by ultrasound vitrectomy. Material and methods. Clinical and functional results of treatment of 70 patients (70 eyes) with regmatogenous retinal detachment (ROS) who received surgical care in the clinic OPTIMIZED from 2015 to 2018 In the main group (n=33) operations were performed by ultrasound vitrectomy 25G, in the control group (n=37) — by traditional guillotine pneumatic vitrectomy using the tools of the same caliber. During surgery, were analyzed: time of vitrectomy stage (sec), total duration of operation (min), achievement planned anatomical result (%). In the postoperative period (up to 12 months) analyzed: stability of anatomical result (%), maximum corrected visual acuity, intraocular pressure, morphometric criteria retinal conditions (OCT, OCT-angiography), incidence of complicated cataract (%). Results. Average value of vitrectomy stage time in the main group (378.3±125.2 sec) lower than in the control (490.9±175.5 sec), p<0.05. Total duration operations in both groups did not differ, but on average was somewhat shorter in the main group. group (53.6±9.4 and 64.2±23.5 min, respectively). Planned anatomical result in retinal adhesion in all sectors was achieved at the end of the operation in 100% of cases in both groups. No intraoperative complications were recorded in any of the cases. Ultrasonic vitrectomy permits the use of smaller values of the vacuum as on the stage initiation of posterior vitreous detachment (333.3±40.1 mm Hg).St) and at the stage of peripheral vitrectomy (203.2±51.5 mm Hg.art.) compared with traditional vitrectomy, where high vacuum was required: 600 mm Hg.art. at the stage of initiation of ZOST, 305,4±66,4 mm Hg.article on stage of peripheral vitrectomy. The anatomical result remained stable in all terms of the postoperative period in the main group in 100% of cases. In control group relapses of retinal detachment were registered in 8.1% of patients and successfully eliminated conducting an audit of the vitreous cavity. In the late postoperative period the most frequent complication was the development of complicated cataracts (27.1 % in the main group, 40.5% in the control). In both groups, by the 12th month of follow-up, high maximum corrected visual acuity (0.5 and higher in 66.6% of patients and in the main 47.3% of patients in the control group). Conclusion. Comparative study conducted the method of ultrasonic vitrectomy in the surgical treatment of rhegmatogenous detachment the retina has shown that this technique is an effective method that provides and stable anatomical and functional result.

Keywords: rhegmatogenous detachment, ultrasonic vitrectomy,, vitrectomy

Effect of cataract phacoemulsification on the dynamics of intraocular pressure in patients with primary open-angle glaucoma

Year: 2018, volume 14 Issue: №4 Pages: 837-841
Heading: Ophtalmology Article type: Original article
Authors: Kolesnikov A.V., Kolesnikova M.A., Mironenko L.V., Baranova O.V., Tarasova N.S.
Organization: Ryazan State Medical University n.a. I.L.Pavlov, Regional Clinical Hospital n.a. N.A. Semashko
Summary:

Purpose: to assess the dynamics of intraocular pressure (IOP) after cataract phacoemulsification (CFE) with intraocular lens (IOL) implantation in patients with cataract in combination with primary open-angle glaucoma (POAG). Material and Methods. The subject of this study was the analysis of IOP after CFE in 65 patients (89 eyes) with cataract in combination with POAG. Among the examined patients, the initial stage of glaucoma was noted in 14.6% cases; developed stage in 55.1 % cases, far-reaching stage in 30.3% cases. IOP was compensated in 84.5% cases, and sub-compensated in hypotensive mode in 15.5% cases. The observation period was from 1 month up to 2 years. Results. In dependence of IOP after surgery, patients were divided into three groups: IOP exactly like in preoperative level, below and above the initial IOP In most cases, at all times IOP corresponded to the preoperative level and after 2 years it was noted in 77.4%. The number of patients with ophthalmotonus below the baseline (1-8 mm) decreased from 63.2% in 1-3 months after surgery to 16.1 % in two years. An increase in ophthalmotonus (by 3-4 mm) was noted in 27% of cases, however, a persistent increase in IOP, which required correction, was 7.9% at stage III of glaucoma, and in the rest of the eyes IOP normalized by itself. Conclusion. According to the results of the study, it can be concluded that there is an ambiguous effect of CFE with IOL implantation on IOP in patients with cataract in combination with POAG, which necessitates further study.

Keywords: phacoemulsification of cataracts, intraocular pressure, cataract

The effect of intraoperative application of Cyclisporin A on the regeneration of the tissues of the anterior segment of the eye in experimentally induced glaucoma

Year: 2018, volume 14 Issue: №4 Pages: 833-837
Heading: Ophtalmology Article type: Original article
Authors: Zhigalskaya Т.А., Krivosheina O.I., Dzyman A.N.
Organization: Siberian State Medical University
Summary:

Purpose: to study in vivo the features of regeneration of a conjunctiva and sclera after surgery with application of a 0.05% Cyclosporin A against the background of experimentally induced glaucoma. Material and Methods. The experiment was performed in 29 rabbits. At the first stage, the animals were induced with a steroid model of glaucoma by subconjunctival injections of 0.5 ml 0.4% Dexamethasone 1 time per week for 3 months. At the second stage rabbits (24 animals) were subjected to a through incision of the conjunctiva and an incision of the surface layers of the sclera of one of the eyes. Depending on the course of the operation, the animals were divided into the main group and the comparison group. Rabbits of the main group (16 animals) were subjected to local application of a 0.05% Cyclosporin A fora duration of 3 minutes in subgroup "a" (8 animals) and 6 minutes in subgroup "b" (8 animals). In rabbits of the comparison group (8 animals), wasn't used cytostatic. Results. In animals of the comparison group, the inflammatory and reparative reaction, despite the presence of dystrophic changes due to an increase in intraocular pressure, proceeds with the stereotypic dynamics of the change of cellular phases. Using a 0.05% Cyclosporin A suppresses the migration of cells from different populations to the surgical zone, increasing the duration of the macrophage reaction phase and slowing down the transition to the regeneration phase. Conclusion. Using of 0.05% Cyclosporin A during surgical intervention slows down the repair of the tissues of the conjunctiva and sclera, preventing pronounced fibroblation in the area of surgical trauma, which can be an effective way to prevent scarring during antiglaucoma operations.

Keywords: Cyclosporin A,, excessive regeneration,

Modifications of trabeculectomy in glaucoma treatment

Year: 2018, volume 14 Issue: №4 Pages: 831-833
Heading: Ophtalmology Article type: Original article
Authors: Kiseleva О.А., Bessmertny A.M., Suleiman Е.А., Lugovkina K.V.
Organization: Moscow Helmholtz Research Institute of Eye Diseases
Summary:

Purpose: to study efficacy of new trabeculectomy modifications for surgical treatment of primary open- angle glaucoma (POAG). Material and Methods. 49 patients with POAG (49 eyes) aged 51-73 years underwent modified surgery. The main technique of first new modification includes preparation of scleral flap, excision of trabecular tissue along the scleral spur, torsion of scleral flap for 180° and reposition of scleral flap in its original bed secured with interrupted nylon sutures (group 1). The main technique of second new modification includes preparation of scleral flap, excision of trabecular tissue, sewing of scleral flap in the middle with resorbable thread and tightening it into folds. Reposition and fixation of scleral flap and conjunctival flap closure completes the operation (group 2). The efficacy of new modifications of trabeculectomy was assessed during 12 months using complete ocular examination, optical coherence tomography of the anterior segment of the eye (ASOCT) in the early postoperative period and ultrasound biomicroscopy (UBM) subsequently. Results. One month after the surgery average intraocular pressure (ave. IOP) was 10.1±1,9 mmHg in group 1 and 11.2± 1.8 mmHg in group 2 (M±a). At 6 months this parameter was 12.6±3.0 mmHg (group 1) and 13,3±2,7 mmHg (group 2). At 12 months ave. IOP was 15.9±4.1 mmHg (group 1)and 17.3±2.7 mmHg (group 2). Conclusions. The newly developed modifications of trabeculectomy allow to obtain a prolonged hypotensive effect after surgical treatment of POAG.

Keywords: filtration cushion, glaucoma surgery, modernization of education, primary open-angle glaucoma

Effectiveness of neure-protective therapy in patients with glaucoma

Year: 2018, volume 14 Issue: №4 Pages: 828-831
Heading: Ophtalmology Article type: Case report
Authors: Aprelev А.Е., Barbos Yu.A., Mukhanko I.Zh., Cherednichenko N.L., Abdulgazizova Z.F., Kataganova A.A., Bernovskaya A.A.
Organization: Mineralovodsky district hospital, Orenburg Regional Clinical Hospital, Orenburg State Medical University, Regional Clinical Diagnostic Center in Stavropol City, Stavropol Regional Clinical Hospital, Stavropol State Medical University
Summary:

The results of clinical evaluation of three patients who were included in the multicenter study of the
effectiveness of neuroprotective treatment and its impact on the quality of life of patients with POAG are
presented in the article. Dynamics of visual acuity, intraocular pressure, total visual fields, photostress
test, contrast sensitivity and quality of life (according to the NEIVFQ-25 questionnaire) in patients
treated with neuroprotective study drug with 10 intramuscular injections administered 5mg once a day
are presented. Data on the improvement of visual functions and quality of life in patients with Stage I, II
and III of POAG who had undergone treatment with the study drug are demonstrated.

Keywords: quality of life

Glaucoma incidence analysis and prognosis in adult population of Bashkortostan Republic

Year: 2018, volume 14 Issue: №4 Pages: 825-828
Heading: Ophtalmology Article type: Original article
Authors: Aznabaev В.М., Zagidullina A.Sh., Fakhretdinova E.V.
Organization: Bashkir State Medical University of the Russian Health Care
Summary:

Purpose: to analyze the general and primary incidence of glaucoma in the adult population in the Republic of Bashkortostan over the 2010-2017 period; make a medium-term forecast for five years. Material and Methods. The analyzed data was based on official statistics of the Ministry of Health of the Russian Federation over the 2010-2017 period. The level of general and primary incidence per 100 thousand population was estimated; the five-year forecast for glaucoma incidence was simulated using mathematical modeling. Results. The Republic of Bashkortostan had the highest rate of general and primary glaucoma incidence in the adult population as compared with the incidence rate in the Russian Federation. The Republic of Bashkortostan ranks first in the absolute number of patient with glaucoma and fourth ranks in general incidence per 100 thousand comparing with Volga Federal District data. The level of general glaucoma incidence in the adult population increased by 23.0% over the 2010-2017 period and primary incidence — by 47.0%. The five-year simulated forecast predicts possible further growth of general and primary glaucoma incidence in the republic by 2022. Conclusion. The performed analysis and simulated forecast of general and primary glaucoma incidence for the adult population in the Republic of Bashkortostan show growth trends.

Keywords: general and primary incidence, Republic of Bashkortostan

Main markers of vascular endothelium dysfunction in primary open-angle glaucoma

Year: 2018, volume 14 Issue: №4 Pages: 820-824
Heading: Ophtalmology Article type: Review
Authors: Nugmanova A.R., Zagidullina A.Sh.
Organization: Bashkir State Medical University of the Russian Health Care
Summary:

The review presents current literature data on the functions of the vascular endothelium, its role in the pathogen-esis of vascular pathologies, as well as the main markers of its dysfunction. Vascular endothelium plays a role in the development of thrombosis, angiogenesis, remodeling of the vascular wall. It is involved in the regulation of vascular tone, local hemostasis, proliferation. The results of clinical studies of the endothelium capacity, which disorders may accompany primary open-angle glaucoma and contribute to the progression of glaucomatous optic neuropathy, are presented here.

Keywords: glaucomatous optic neuropathy, primary open-angle glaucoma, vascular endothelium