Saratov JOURNAL of Medical and Scientific Research

2019, volume 15

Comparison of the efcacy and safety of the elaborated combined laser technology and «grid» laser photocoagulation in patients with the initial stages of the idiopathic epiretinal membrane

Year: 2019, volume 15 Issue: №2 Pages: 546-550
Heading: Ophtalmology Article type: Original article
Authors: Takhchidi K.P., Kachalina G.F., Kasmynina T.A., Tebina E.P.
Organization: Russian State Medical University
Summary:

Purpose: to evaluate the efectiveness and safety of the developed combined laser technology in comparison with «grid» laser photocoagulation in the treatment of patients with the initial stages of the idiopathic epiretinal membrane. Material and Methods. The analysis of two groups of patients was carried out. The frst group (32 patients (32 eyes)) was treated using the developed combined laser technology; the second group (30 patients (30 eyes)) was treated using grid» laser photocoagulation. The assessment uncorrected visual acuity, best corrected visual acuity, central retinal thickness and central retinal sensitivity was performed. The maximum follow-up is 5 years. Results. In the frst group of patients the maximum visual-functional results (UCVA, BCVA, CRS) were obtained from 3 to 12 months, followed by their stabilization until the end of the observation period. The CRT gradually decreasedduring all observation period. In the second group of patients a short-term positive efect was achieved up to 3 months of observation with an increase UCVA, BCVA, CRS. 12 months post op there was increasing of CRT with decreasing UCVA, BCVA, and CRS until the end of study. Conclusion. The technology of combined laser treatment showed high efciency in comparison with «grid» laser photocoagulation with stabilization / increase of UCVA, BCVA, CRS and stabilization / improvement of the morphological parameters of the retina — the decrease of CRT.

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Surgical treatment of the patient with keratectasia after keratotomy followed by LASIK

Year: 2019, volume 15 Issue: №2 Pages: 544-546
Heading: Ophtalmology Article type: Case report
Authors: Syrykh I.Yu., Gavilovskaya V.A., Fabrikantov O.L.
Organization: S. Fedorov Eye Microsurgery Federal State Institution
Summary:

A clinical case of treating a patient with keratoectasia after keratotomy followed by LASIK is presented

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The frst results of combined treatment of central serous chorioretinopathy using subthreshold micropulse laser exposure with 577 nm wavelength and injections of platelet autoplasma

Summary:

Aim: to compare the efects of a combination of subthreshold micropulse laser irradiation (SMPLI) with injections of autologous platelet plasma (PP) in the region of the pterygopal fossa on the afected side with the efect of SMPLI in central serous chorioretinopathy (CSСR). Material and Methods. This study was conducted on 60 patients (60 eyes) with CSCR. Patients were divided into 2 groups: in the comparison group patients received treatment only with SMPLI with a wavelength of 577 nm. In the experimental group patients received SMPLI with TP injections. TP was started after 72 hours, with 3 injections into the area of pterygopalatine fossa in the afected eye, with an interval between injections of 72 hours. Ophthalmologic examination, OCT and fuorescent angiography were carried out before treatment and 1, 3, 6 and 12 months after treatment, and ELISA assessment of IL-4, — 6 and -17A levels in lacrimal fuid was performed. Results. In the experimental group, where SMPLI+TP were performed, visual acuity has signifcantly improved, thickness of central section of macula was noted to have been decreased, and photosensitivity of central zone of retina signifcantly improved when compared to the SMPLI group. In the SMPLI+TP group the levels of IL-4, IL-6 and IL-17A in tear fuid increased. SMPLI was performed using Supra 577 nm laser device (Quantel Medical, France) over the entire area of macular edema. Conclusion. SMPLI+PRP treatment in patients with acute CSCR is efective for restoration of visual function.

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The results of femtolaser scleropuncture in experiments on isolated animal tissue (preliminary report)

Year: 2019, volume 15 Issue: №2 Pages: 536-539
Heading: Ophtalmology Article type: Original article
Authors: Smetankin I.G., Vasilyeva A.E.
Organization: Privolzhskiy Research Medical University
Summary:

The purpose of the study is to evaluate the results of femtolaser sclerotomy in the experiment on isolated eye of animal, as well as the prospects of applying the method of laser transscleral puncture of the sinus canal of sclera. Material and Methods. We performed a series of experiments on fresh scleral tissue of isolated pig eyes using industrial femtosecond laser PH-1SP with a wavelength of 1028 nm, pulse energy of 0.5–1.5 MJ, frequency of 1–20 kHz. Series of 10–15 pulses with duration less than 100 FS were performed. In order to assess the depth of femtosecond laser exposure to scleral tissue, as well as the quality of the obtained punctured holes, histological preparations were made, studied using routine light microscopy with multiplicity of magnifying up to ×400. Serial sagittal and frontal sections 15 µm thick and hematoxilin eosin staining were used. Results. Puncture channels of diferent confgurations with a minimum marginal coagulation of no more than 5 microns were obtained due to the efect of ablation of the scleral tissue. The maximum depth of the formed channels is 500 microns at a power of 1.5 MJ and a frequency of 10 kHz. Since the thickness of the scleral tissue of the human eye in the limbal zone is 600–800 µm, there is prospect of using a femtosecond laser for the laser transscleral puncture of the schlemm channel. Conclusion. The infuence of femtosecond laser on tissue of sclera is characterized by the almost complete absence of heat, the coagulation efect and the pronounced depth of the ablation, thus it is possible to discuss the use of femtosecond laser for the laser transscleral puncture of the sclera sinus channel.

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Comparative analysis of the application of the above- threshold laser coagulation and micropulse laser exposure in central serous chorioretinopathy

Year: 2019, volume 15 Issue: №2 Pages: 532-536
Heading: Ophtalmology Article type: Original article
Authors: Popova N.V., Fabrikantov O.L., Goydin A.P.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

Purpose: to determine the efectiveness of above-threshold (focal) laser coagulation and micropulse laser exposure (MPLV) in patients with central serous chorioretinopathy (CCA). Material and Methods. 91 people with a diagnosis of CCA were examined. The median age was 35.2 years. Patients of the 1st group (n=19) was performed MPLV a wavelength of 810 nm; group 2 (n=31) — about threshold photocoagulation with the wavelength of 810 nm. Control group — 50 people with a natural course of the process. Results. After 1 month after treatment in group 1, visual acuity increased from 0.5±0.08 to 0.8±0.03. According to optical coherence tomography (OCT), the neuroepithelial detachment decreased from 446 to 341.3 MK. With the chronic course of the process after laser treatment, recurrence of the disease was revealed, which required an additional session of MPLV. In group 2, after 1 month, visual acuity increased from 0.6±0.20 to 0.8±0.03, neuroepithelial detachment decreased from 365 to 269 MK. Relapse of the disease in chronic form required an additional session of MPLV. After 3 months, both groups showed complete adhesion of the neurosensory retina and increased visual acuity to 0.9±1.0. Conclusion. Laser coagulation (above- threshold laser coagulation, micropulse laser exposure) is minimally invasive and highly efective in the treatment of central serous chorioretinopathy. The choice of laser treatment method depends on the

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Tactics of delivery and diagnostic evaluation in pregnant women with peripheral vitreoretinal dystrophy

Year: 2019, volume 15 Issue: №2 Pages: 528-532
Heading: Ophtalmology Article type: Original article
Authors: Popova N.V., Goydin A.P., Fabrikantov O.L., Goydin D.A.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

Purpose: to develop recommendations on delivery tactics based on the analysis and terms of detection of various forms of peripheral vitreoretinal dystrophies in pregnant women with myopia. Material and Methods. 44 women were examined with a mean age of 31 years. Peripheral vitreochorioretinal dystrophy was detected in 82 %. All patients underwent the following studies: visometry using device TOPCON CV-5000 (Japan), autorefractometry using TOPCON KR-8900 (Japan), ultrasound biometry using TOMEY AL-3000 (Japan), eye fundus was examined by Goldman three-mirror lens using the slit lamp TAKAGI SM-70N. When severe peripheral vitreochorioretinal dystrophy is detected, it is recommended to perform peripheral laser coagulation using laser device IRIDEX IQ-810 (USA). Results. In most cases (68 %) peripheral retinal laser photocoagulation was performed with subsequent recommendations on the possibility of natural delivery, and in 32 % of cases caesarean section delivery was recommended to these women. Conclusion. Decision on delivery tactics in pregnant women with myopia should not be determined by the degree of myopia, but by the severity of pathological changes on the periphery of the retina. Medical examination of pregnant women with obligatory examination of the eye fundus with mydriasis medicamentosus in 30–34 weeks allows to identify patients at risk of retinal detachment and conduct early treatment, thereby initially reducing the frequency of operativedelivery according to the ophthalmological indications.

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Informativeness of optical coherence tomography in differential diagnosis of central chorioretinitis and age-related macular degeneration

Year: 2019, volume 15 Issue: №2 Pages: 524-528
Heading: Ophtalmology Article type: Original article
Authors: Popova L.I., Kudryavtseva Yu.V., Demakova L.V., Obsekova K.S.
Organization: Kirov State Medical University
Summary:

Purpose: the analysis of the informativeness of optical coherence tomography as an additional method in the diferential diagnosis of central chorioretinitis and age-related macular degeneration. Material and Methods. Studies conducted in 44 patients. The frst group included 20 patients with central chorioretinitis. The second group consisted of 24 patients with diferent forms of age-related macular degeneration. The informativeness of optical coherence tomography was analyzed in the diferential diagnosis of central chorioretinitis and AMD. Results. Uncomplicated forms of AMD and central chorioretinitis have a diferent tomographic picture. Using the OCT method it is possible to judge the change in the thickness of the choroid which increases in the acute phase of chorioretinitis. In the atrophic form of AMD, the thinning of the choroid extends over a considerable distance. OCT provides additional information on the localization of the infammatory focus. Conclusion. OCT-diferences were found at the level of the pigment epithelium, retinal photoreceptors and choroid in infammatory processes and degenerative diseases, which can help in difcult cases of diferential diagnosis. However, secondary choroidal neovascularization does not have specifc OCT signs in various diseases, since it is a complication of the main process.

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Clinical and functional results of bifocal and trifocal intraocular lenses implantation: a comparative analysis

Year: 2019, volume 15 Issue: №2 Pages: 518-524
Heading: Ophtalmology Article type: Original article
Authors: Pershin K.B., Pashinova N.F., Konovalova M.M., Tsygankov A.Yu., Konovalov M.E.
Organization: Konovalov Eye Center, Ophthalmological clinics «Eximer»
Summary:

Purpose: comparative analysis of the results of implantation of bifocal refractive-difractive IOLs and new trifocal single-piece aspherical difractive IOLs. Material and Methods. A prospective open study included 193 patients (291 eyes) with presbyopia. The average age of patients was 58.4±11.3 years. Group I consisted of 71 patients (108 eyes) with implantation of the AcrySof PanOptix trifocal IOL; Group II — 122 patients (183 eyes) with the AcriSof Restor bifocal IOL with addidation 3 Dioptr. Results. After 6 months of follow-up in group I, an increase in UCNVA from 0.2±0.09 to 0.85±0.17, an UCFVA from 0.2±0.07 to 0.78±0.13, and a UCIVA from 0.3±0.1 to 0.84±0.2, BCNVA from 0.58±0.24 to 0.98±0.21, BCFVA from 0.68±0.26 to 1±0.1 and BCIVA with 0.59±0.28 to 0.95±0.18 (p<0.05 in all cases). In group II, signifcantly lower values of UCNVA (0.62±0.09), UCIVA (0.31±0.14) and BCIVA (0.6±0.19) were observed when compared with group I (p<0.05). In all groups, a decrease in the spherical and cylindrical component of refraction was observed. Level of contrast sensitivity after implantation of the AcrySof Restor was higher for all frequencies. According to the results of the survey on a scale of VF-14 in group I, the average value was 97.9±1.2 points, and in group II — 80.1±6.4 (p<0.05). Conclusion. In this paper an advantage of a new trifocal IOL for vision correction at an average distance under various lighting conditions is shown, as well as the best indicators of vision quality on the VF-14 scale.

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Preliminary results of modifed cryogenic scleroplasty

Summary:

Purpose: to assess preliminary results of modifed cryogenic scleroplasty efcacy in patients with progressing myopia. Material and Methods. Modifed cryogenic scleroplasty was developed by us in order to decrease the risk of deformation, torsion and displacement of scleroplastic material during its implantation. 38 children (72 eyes) aged 7–17 years with diagnosis of acquired progressing medium and high myopia with documented annual gradient of progressing more than 1 D were operated. 35 children (64 eyes) were the control group. They underwent standard scleroplasty by Pivovarov — Pristavko method. Results. No complications and adverse reactions to the transplantation material were observed during modifed cryogenic scleroplasty. Due to exposition in liquid nitrogen solution transplant keeps form and is not deformed during immersion and its partial location under the muscle. Stabilizing efect of the studied method (according to clinical refraction and axial length) is comparable to other types of scleroplasty. Conclusion. The developed technology of surgical treatment of progressing myopia is characterized by technological simplicity, convenience in material implantation, exclusion of transplant deformation and torsion on episclera surface, high stabilizing efect during the frst year after the surgery.

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Comparative analysis of morphometric parameters of the optic disc in glau-comatous eyes with discs of average and large size

Year: 2019, volume 15 Issue: №2 Pages: 510-514
Heading: Ophtalmology Article type: Original article
Authors: L'vov V.A., Machekhin V.A., Fabrikantov O.L.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, Tambov State University, Medical Institute
Summary:

Purpose: using HRT and OCT to compare the outcomes of the examination of optic disc parameters in normal eyes and glaucomatous eyes with discs of standard (average) and large size. Material and Methods. 306 eyes of 160 patients (71 male, 89 female) aged 61.1±10.0 years old were analyzed retrospectively. All eyes were divided into 2 groups: group I included 162 eyes with the disc area of 1.63–2.43 mm2; group II — 144 eyes with the disc area of 2.44– 3.5 mm2. Both groups were divided into fve subgroups (healthy eyes, eyes with preperimetric glaucoma and with different stages of glaucoma). Disc parameters were analyzed using HRT 3 and RTVue-100 simultaneously in the same eyes. Results. In the group of eyes with average discs both methods (HRT and OCT) revealed the same examination outcomes of all disc parameters indicating high statistical signifcance of the diference between groups of healthy eyes and eyes with preperimetric glaucoma. In the group with large discs the parameters of peripapillar retina (RNFL) play a signifcant role. Conclusion. Preperimetric glaucoma is a valuable indicator to detect early glaucoma in the group of eyes with average discs. However, in large discs according to either HRT or OCT data peripapillar retinal parameters are the most sensitive, whereas the alterations of the internal structure of the disc itself appear later.

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