2019, volume 15

Purpose: assessment of retinal neuroarchitectonics in presence of optic nerve head (ONH) drusen. Materials and Methods. 108 patients (216 eyes) with bilateral drusen of the optic disc aged 18–60 years were examined, and the control group consisted of 28 healthy subjects. All patients underwent optical coherence tomography (OCT) using Cirrus HD-OCT 5000–7544 device (Carl Zeiss Meditec Inc.). Results. Three types of ONH drusen localization relative to the Bruch membrane were identifed: superfcial, deep and difuse. Difuse localization of the drusen was determined in 48.6 % of cases, deep — in 40.3 %, superfcial — in 11.1 %. Deep optic disc drusen were more common in a young age (35.5±13.1 years), difuse — in medium age (42.0±13.2 years), superfcial — at an older age (51.7±12.8 years). With superfcial and difuse drusen of the optic disc, a signifcant (p<0.05) decrease in the thickness of the ganglion cell (GC) layer in all studied sectors, a decrease in the minimum and average GC thickness was found, as well as a signifcant (p<0.05) decrease in the average thickness and cubic volume of the neuroepithelium. With deep drusen opacities, the changes in GC were less pronounced and statistically insignifcant. Conclusion. analysis of the obtained data showed that deep drusen of the optic disc are the initial stage of congenital pathology, difuse drusen are a developed stage, and superfcial drusen of the optic disc characterize the development of fnal stage.

Purpose: identifcation of diagnostic criteria for optic nerve atrophy by spectral optical coherent tomography in patients with multiple sclerosis (MS). Material and Methods. 81 patients with optic nerve atrophy due to MS (37 men, 44 women, mean age 35.6±3.7 years) were examined using spectral optical coherent tomography (S-OCT). Results. We obtained reliable data suggesting on the asymmetry of S-OCT parameters in patients with multiple sclerosis and optic nerve atrophy. In the process of a detailed assessment of the thickness of the GCS+IPL complex, signifcant difer-ences in the worst and paired eyes were obtained. In addition, when the total aggregating all of the results obtained by the method of binary logical regression determined the threshold for partial atrophy of the optic nerve due to MS. The average thickness of GCS+IPL complex, as determined by S-OCT, is a reliable marker of neuroaxonal degeneration in patients with optic nerve atrophy due to MS. Conclusion. S-OCT criteria for optic nerve atrophy in multiple sclerosis are a decrease in the average thickness of the retinal nerve fber layer of less than 62 microns, combined with a decrease in the average thickness of retinal ganglion cell complex and the inner plexiform layer less than 52 microns, thickness of upper segment of GCS+IPL less than 51 μm, and the lower segment of GCS+IPL less than 50 microns.

The development of optic neuropathy in leukemia and lymphomas has a wide range of etiological factors, being a result of neoplastic, infectious, compression, ischemic and toxic damage. Patients in the older age group may have cardiovascular risk factors that increase the risk of developing lesions of the optic nerve. Timely diagnosis of optic neuropathy in hemoblastosis and the choice of the optimal treatment method allow to maintain high visual function and improve patients» quality of life. The paper presents a clinical case of unilateral ischemic neuropathy in patients with clinical and hematological remission of acute myeloblastic leukemia and the presence of cardiovascular risk factors, as well as heart failure.

Purpose: to determine diferential diagnostic criteria and surgical tactics in the treatment of swelling cataract and cataract in combination with subclinical lens subluxation associated with phacogenic glaucoma with a small anterior chamber. Material and Methods. Clinical traits and surgical treatment of 54 patients (54 eyes) were analyzed. Patients were divided in two groups. In patients of the frst group (32 eyes) the lens thickness did not difer from the paired eye. In patients of the second group (22 eyes) the diference was 1.1±0.3 mm. Results. In the frst group the mobility of the lens associated with a defect in the ligamentous apparatus was detected. In this case the methods of capsular bag stabilization were used. In the second group decrease in intraocular pressure and a deepening of the anterior chamber were noted after the opening of anterior lens chamber and evacuation of a part of cortical masses. Conclusion. In the diferential diagnosis of swelling cataract and cataract with subclinical lens subluxation the main criterion is signifcant between-eyes diference in the anteroposterior size of the lense according to the results of ultrasound biomicroscopy. Preoperative diferential diagnosis of swelling cataract and subclinical subluxation of the lens allows selecting the optimal surgical technique of cataract extraction and minimizing the possible complications. The method of simultaneous vitrectomy with transciliary access and cataract phacoemulsifcation is efective in treating of swelling cataract and cataract with subclinical subluxation of the lens associated with phacogenic glaucoma with small anterior chamber.

Purpose: to identify the key factors determining the functional outcome of surgical treatment of rhegmatogenous retinal detachment. Material and Methods. The study group included 39 patients operated for rhegmatogenous retinal detachment, which 6 months after surgery were divided into 2 groups depending on visual acuity obtained. All patients underwent standard ophthalmologic examination and color computed perimetry, electrophysiological studies, electro-retinography and registration of visual evoked potentials, optical coherent tomography, color Doppler mapping of posterior pole vessels. Results. 6 months after the surgical treatment of retinal detachment in the 1st group, best corrected monocular visual acuity increased by 4 times in comparison with the 2nd group. When analyzing color-opponent perim-etry results in patients of the frst group, a threefold improvement in medium sensitivity and reliability factor indices for both red and blue stimuli was detected in comparison with the 2nd group. Patients in the 2nd group showed an increase in the phosphene index. In patients of this group in late postoperative period there was an increase in peripheral resistance of vascular wall in both arterial and venous parts of the blood fow, which was probably one of important reasons for non- recovery of vision in patients of this group. Conclusion. Full restoration of regional blood fow and receptor channels of organ of vision, as well as restoration of local and general electrical sensitivity of retina and visual pathway conductivity, is a necessary component of successful restoration of visual functions.

 Purpose: the study clinical, etiological and intravascular hemostasiological features of isolated optic disk vasculitis (IODV). Material and Methods. 27 patients with IODV. Duration of the disease at the time of initial appeal ranged from 5–7 days to 12 weeks. The criterion for inclusion in the study was the absence in patients systemic vasculitis, severe cardio and cerebrovascular diseases and systemic immunopathological diseases. One of the main places in the study was devoted to laboratory diagnosticmethods — enzyme-linked immunosorbent assay using set of reagents (test system «Bioservice», Russia) for detection of specifc antibodies to various infections in blood serum. The average period of study patients was 12 months. Results. The exudative type of infammation (67 %), moderate hemorrhagic activity and high risk of macular lesions are typical for IODV; in etiological structure of IODV prevail herpes viral infection and foci of chronic bacterial infections. High average infectious index (2.0±0.1) indicates predominance of mixed infections in patients. The results of laboratory studies have established that pathogenetic mechanisms of development of IODV are associated with activation of the vascular-platelet and coagulation hemostasis and depression of fbrinolysis. Conclusion. Close relationship established between changes in intravascular hemostasis and the clinical activity of disease, which necessitates inclusion in program of complex treatment patients with IODV, along with basic corticosteroid therapy and sanitation of infection foci, medications that normalize hemostasis.

 Purpose: to develop optimal approaches to the use of cytofavin for neuroprotection and to evaluate their efective-ness in patients after endovitreal surgery for rhegmatogenous retinal detachment (RRD) with anatomically complete retinal attachment. Material and Methods. 68 people (68 eyes) with primary RRD. Three-port vitrectomy with silicone oil tamponade in the vitreous cavity and its subsequent removal were performed. The patients were divided into 2 groups: the main group (38 people who received cytofavin added to standard therapy), and the control group (30 people with standard therapy only). Depending on visual prognosis calculated before surgery, the main and control groups consisted of patients with tolerable and low levels of visual prognosis. We used laser doppler fowmetry (to register microcirculation index (MI) and microcirculation efciency index (MEI)). Morphological signs of macular ischaemia were recorded by optical coherence tomography angiography (OCT-angiography). Results. Regardless of visual prognosis, the response dynamics of the chorioretinal microcirculation in patients was unidirectional. In patients of the main group 6 months after the surgery, more signifcant positive changes in growth of amplitude of MI and MEI, as well as positive dynamics of OCT-angiography were observed. Conclusion. Including cytofavin neuroprotection in postoperative treatment in patients after

Purpose: to evaluate the peripheral vitreoretinal interface changes after combined laser-surgical treatment of local rhegmatogenous retinal detachments revealed by wide-feld OCT. Material and Methods. 21 patients (21 eyes) with local rhegmatogenous retinal detachment localized in the upper half of the fundus were enrolled in this study. All patients underwent a combined laser-surgical treatment, which included 3 steps: 1) Nd: YAG laser excision of the vitreoretinal adhesion zone, determined by wide-feld OCT; 2) pneumatic retinopexy; 3) barrier laser photocoagulation at the edge of the tear after retinal reattachment. All patients underwent OCT of the peripheral vitreoretinal interface to identify areas of pathological vitreoretinal adhesions in the post-operative period. Results. OCT analysis of 21 patients has demonstrated the complete elimination of the traction component in the treatment area. However, vitreoretinal adhesions near the tear area were found in 4 patients. These patients underwent additional barrier laser photocoagulation at zones of pathological vitreoretinal traction. Conclusion. Visualization of

Trabeculocleaning (TC) in the cataract extraction process is the procedure of debris aspiration from the drainage angle, one of the components inducing hypotensive efect after phacosurgery. When being preceded with selective laser trabeculoplasty (SLT) at suprathreshold values which provides a pigment granules' splatter, the described procedure makes it possible to clean the anterior chamber angle (ACA) of the released trabecular debris including pseudo-exfoliation material and pigment granules. Purpose: to study the efciency of trabeculocleaning performed in course of femto-laser assisted cataract surgery (FLACS), with a preliminary suprathreshold SLT. Material and Methods. The study included 26 patients (32 eyes) with a complicated cataract and primary open angle glaucoma with concomitant pseudoexfoliation syndrome. All patients underwent a suprathreshold SLT preceding FLACS and hydrodynamic tra-beculocleaning, in course of which trabecular debris were removed with the help of aspiration-irrigation tips. Results. One month postoperatively mean IOP value decreased by 9.5 mm Hg from initial values (40.95 %), the outfow facility coefcient improved to 0.21±0.002 mm3 / mm Hg*min (t=14.3; p<0.001). In 24 cases (77 %) IOP was compensated without application of antihypertensive drugs, in 7 cases (22.4 %) it reduced under medication. Conclusion. Hydrodynamic trabeculocleaning in course of FLACS with preliminary suprathreshold SLT ensures ACA detersion from trabecular debris: pseudoexfoliation material and pigment granules, therefore aiding to preserve and activate natural pathways to the outfow of intraocular fuid.

Purpose: to determine the role of hormonal and lipid imbalance in the formation of myopic chorioretinal neovascularization in women. Material and Methods. The frst clinical group includes the results of the study of patients with the active form of myopic chorioretinal neovascularization, the second — the results of the study of their paired eyes. The control groups were formed separately. Ophthalmologic and somatic status of all patients and people in the control groups were thoroughly examined. Results. An increase in the level of prolactin to 501.7±28.2 mlU/ml was established, in the control group to 272.9±33.4 mlU/ml, the level of follicle-stimulating hormone 13±0.1 mlU/ml, the control group 4,6±1.2 mlU/ml. The concentration of estradiol is reduced 35.2±3.1 pg/l, progesterone 2.8±0.1 nmol/l, compared to the control group 66.8±8.1 and 6.2±1.1 nmol/l respectively. An increase in the level of acute-phase proteins was revealed: fibrinogen 3.8 (14.0±0.5) and C-reactive protein 2 times (5.72±2.30) compared with the control group 3.6±0.5 and 2.5±0.7. Increased lipoprotein level (a) 50.2±1.2 g/l and ApoB/ApoA 0.6±0.1 compared with the control group 9.1±1.1 et 0.4±0.1 g/l. Conclusion. The fndings confrm the pathogenetic signifcance of systemic risk factors in the development of choroidal dysfunction and, as a