2020, volume 16

The purpose of the study is to evaluate the relationship between the structures of the anterior chamber, disorders of the hydrodynamics of the eye and the work of the accommodation apparatus in patients with myopia. Material and Methods. The study involved 235 patients (235 eyes) with various degrees of myopic refraction. Patients are divided into 3 observation groups depending on the degree of myopia. Group 1 consisted of 103 patients (103 eyes) with mild myopia; group 2 consisted of 92 patients (92 eyes) with moderate myopia; group 3 consisted of 40 patients (40 eyes) with high myopia. Results. It was found that 95 patients with varying degrees of myopia (40.4%) had anterior chamber depth of more than 3.6 mm. During gonioscopy, goniodisgenesis was detected: in group 1 on 6 eyes (13%); in the 2nd group on 8 eyes (25%); in the 3rd group on 11 eyes (57%). A combination of increased corneal-compensated IOP of more than 21.0 mm Hg and habitual excess accommodation voltage (PINA) was recorded in group 1 in 1 case (2.3%), in group 2 in 3 cases (9.4%); in group 3 in 6 cases (31.5%). Conclusion. In myopic refraction, there is a syndrome of stretching of the anterior segment of the eyeball, which is more pronounced in high-grade myopia and is more often accompanied by ophthalmohypertension syndrome of overstrain of accommodation.

The purpose of the study is to evaluate the possibility of autofluorescence diagnostics (AFD)to determine the tumor boundaries and volume of surgery in patients with eyelid tumors of epithelial origin. Material and Methods. The study consisted of 3 parts: analysis of incidence of of eyelid basal cell carcinoma (BCC) recurrence; analysis of medical records of patients who underwent AFD at the primary visit for differential diagnostics between malignant and benign tumors; assessment of accuracy of determining tumor boundaries using visual diagnostics and AFD, based on the study of morphological sections of tumor fragments obtained after eyelid resection. Results. With 1.5 year follow-up period after surgical removal of BCC with visual diagnostics of its borders, the recurrence of the disease was verified in 18% patients. The use of AFD for differential diagnostics between malignant and benign tumors of eyelids skin and periorbital area showed that the method is effective for initial diagnosis of epithelial tumors in the outpatient unit. The AFD of the BCC boundaries compared with visual diagnostics is more accurate, it does not require long time and does not cause complications. Conclusion. The AFD can be used in ophthalmic oncology for early examination of the eyelid skin and periorbital area, it determines the boundaries of common pathological process more accurately, which guarantees complete removal of tumor and reduces the risk of its recurrence.

The purpose of the study is to determine the potential for diagnostics of human corneal endothelial cells functional activity based on a study of the transport of water and sodium ions by the endothelial cells of a pig's cornea. Material and Methods. The study was conducted on the disks of pig's cornea. Evaluation of cell volume dynamics was studied with a method based on fluorescence quenching effect of Calcein dye by cytoplasmic proteins. The intracellular sodium concentration was investigated by fluorescence microscopy method using sodium-specific dye Sodium Green. Micro-fluidic flow chamber was used to study the dynamics of corneal matrix deswelling. Results. Increase of temperature from 20 to 37° С activates Na/K-ATPase and leads to a decrease in the volume of corneal endothelium cells (characteristic time 73.5±12.6 s) (n=6). The relative concentration of intracellular sodium decreased with the characteristic time 130.0±26.3 s (n=5). Studies with temperature activation of endothelial cell pumping activity allowed us to estimate the initial rate ofthe matrix volume reduction: 0.36±0.006 um/s (n=5). Conclusion. The study of the dynamics of endothelial cells' volume and intracellular content of sodium in it during cold preservation allows to improve the quality of assessment of viability of a preserved cornea.

The purpose of the study is to analyze the processes of postoperative engraftment of various variants of a complex flap with a single-stage reconstructive blepharoplasty of perforating cicatricial eyelid defects. Material and Methods. The patients (40 eyes) who underwent a one-stage plastic reconstruction of cicatricial eyelid defects were divided into 2 groups depending on the variant of complex autograft: 20 patients 20 eyes with a three-layer flap in the main group, 20 patients 20 eyes with a double-layer in the control group. Evaluation criteria for the results were as follows: nature of complex autograft engraftment, cytological analysis of the wound exudate, clinical characteristics of the scar, size of the palpebral fissure, and microcirculation indexes. Results. 3 months after surgery the reparative process in 18 (90%) patients of the main group and in 15 (75%) patients of the control group ended with normotrophic scarring; in 2 patients (10%) of the main group there was pathological scarring, deviation in the size of the palpebral fissure was -9%; in 5 (25%) patients of the control group, we observed formation of complicated scars, deviation of palpebral fissure size was -22%. Conclusion. The main advantage of three-layer reconstructive blepharoplasty is the reduction in frequency of complicated scarring by 3 times. The mathematical algorithm that has been developed objectifies and individualizes the choice of the most rational surgical technology.

The purpose of the study is to define the dependence of choroid thickness (CT) from age and anteroposterior eyeball size (APES) in healthy persons. Material and Methods. We analysed data on 62 patients (62 eyes) aged 25 to 78 without retina and/or optic nerve pathology (45.5±1.7, M±m). Anteroposterior size of the eyeball was from 21.39 to 28.75 mm (23.97±0.18 mm, M±m). The examination included determination of the best corrected visual acuity, optical coherence tomography and optic biometry. Choroidal thickness was measured on two B-scans (vertical and horizontal) in the projection of the fovea and at 24 points from the fovea (in the superior, inferior, nasal and temporal sections) with an interval of 500 urn from each other. Results. CT is predominantly thinner peripapillary and in the inferior section of retina (p<0.01). CT is inversely proportional to the anteroposterior eyeball size (p<0.01). Calculation formula and a chart map of normal values of the choroid thickness depending on APES are proposed. Dependence on age was statistically unreliable (p=0.68). Conclusion. A method for calculating individual values of the choroidal thickness depending on the anteroposterior eyeball size is proposed. This method can be applied in practice in the diagnosis of pachychoroid diseases.

The purpose of the study is to develop and study clinical effectiveness of a hardware-software complex for objectively determining the range of eye movements in diagnosis and evaluation of treatment effectiveness of ophthalmic diseases. Material and Methods. A hardware-software complex has been developed to objectively determine the range of eye movements based on the analysis of digital images of the anterior segment of the eye. Digital images of the anterior segment of the eye are standardized by lighting parameters; they can be viewed on a tablet computer screen, archived, or sent via the Internet to a data processing server. The study of the range of movement is determined for each eye separately for 8 meridians. Results. We developed algorithms for estimating the range of eye movements in relation to diagnosis of ophthalmic diseases. The developed technique and hardware-software complex for objectively determining the range of eye movements were used in 120 patients aged 6 to 83 years. Conclusion. Automation and standardization of research process provides high diagnostic capabilities of the hardware and software complex and is recommended for use in medical and preventive scientific research.

The purpose of the study is to estimate the effectiveness of the cicatricial stage of choroidal neovascular membrane surgery with retina fixation after retinotomy of paracentral areas with the use of autologous conditioned platelet rich plasma (ACP), without performing endolaser photocoagulation and silicone oil tamponade. Material and Methods. The surgery technique involved performing the 25,27-gauge vitrectomy, removing the posterior hyaloid membrane, the inner limiting membrane in the presence of an epiretinal membrane, paracentral retinotomy, removing the choroidal neovascular membrane during retinotomy, pneumoretinopexy, ACP instillation in the retinotomy area in 2-3 layers without endolaser photocoagulation and silicone oil tamponade. Seamless closure of sclero and conjunctivotomy with a layer of autologous conditioned plasma. 17 patients with visual acuity from 0.02 to 0.08 were treated. Results. A full retinal reattachment and closure of the retinotomy opening in the late postoperative period was noted in all patients. Not a single recurrent retinal detachment was recorded. Complete closure of sclero and conjunctivotomy without the use of additional suture fixation in all cases was achieved. Visual acuity after removal of the cicatricial choroidal membrane in the long-term period was 0.03-0.2. Conclusion. Surgical treatment of the cicatricial stage of choroidal neovascular membranes using autologous conditioned plasma to close the retinotomy defect after removal of cicatricial choroidal neovascular membrane without endolaser coagulation of the retina and silicone tamponade, followed by seamless blocking of the sclero and conjunctivotomy with autologous conditioned plasma is a modern technique that allows to achieve high anatomical and functional results, minimizing the risk of postoperative complications.

The purpose of the study is to develop a method for selecting the most effective conservative method of treating myopia using mathematical modeling. Material and Methods. The study included data on treatment of two groups of patients (n=141) aged 12 to 17 years with mild and moderate acquired (school) myopia, who used various combined methods of conservative treatment of myopia. Mathematical modeling was based on the method of constructing classification trees. Results. A method has been developed for selecting the most effective conservative treatment of myopia with a good sensitivity of 84% and specificity of 74%. Prediction models formed the basis of a computer program designed to determine the most effective method of conservative treatment of myopia based on the most informative data: patient's medical history, initial visual indicators, integral index of vegetative status (intensity index) and initial vegetative status, results of psychological evaluation of the symptoms by the patient. Conclusion. The use of computer technologies makes it possible to optimize the choice of an adequate method of treating myopia with the exception of subjective factor.

The article presents a clinical case of a patient with intermediate uveitis (vitreitis) of viral etiology, which shows that simultaneous vitrectomy with phacoemulsification and implantation of an intraocular lens gives a positive result and saves visual functions after prolonged inflammation and poor conservative therapy.

The purpose of the study is to assess the state of microcirculation of the optic nerve disk of the peripapillary retina in patients with optic atrophy (OA) with multiple sclerosis without a history of optical neuritis (MS-ON). Material and Methods. We examined 34 eyes of patients with OA with MS-ON and 39 eyes of healthy volunteers comparable in gender and age. In addition to standard ophthalmological examination, all patients underwent optical coherence tomography with the function of angiography (OCT-A) of the optic nerve head (ONH) with the measurement of thickness of the peripapillary retina and the relative density of capillaries, as well as the measurement of thickness of the complex of retinal ganglion cells (GCC). To assess the diagnostic value of OKT-A, a ROC-analysis was performed using the most informative predictors. Results. According to the results of OCT-A in patients with MS-ON, the most pronounced differences in the indicators were revealed for all indicators of the thickness of the peripapillary layer of the retinal nerve fibers (RNFL) and the relative density of the retinal peripapillary capillaries (RPC) in all sectors compared with the control group, as well as a decrease in the average indicators in the complex of retinal ganglion cells (GCC). A moderate direct correlation was found between the thicknesses of the peripapillary RNFL and the density of the RPC (r = 0.50; p <0.05), as well as with the average GCC values (r=0.69; p<0.05). Conclusion. In patients with optic atrophy against the background of multiple sclerosis without optical neuritis in the anamnesis with the help of OCT-A, we detected a significant decrease in the RNFL thickness and RPC density, compared to the norm, which indicates a deterioration in the microcirculation of the peripapillary retina associated with the process of neurodegeneration.