Saratov JOURNAL of Medical and Scientific Research

Smoliakova G.P.

The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution, Ophthalmologist of the Clinical-Expert Department, Postgraduate Institute for Public Health Workers, Professor of Department of Ophthalmology, Professor, DSc

Improvement of surgical treatment efficiency for malignant eyelid tumors of epithelial origin using autofluorescence imaging

Year: 2020, volume 16 Issue: №2 Pages: 587-591
Heading: Ophtalmology Article type: Original article
Authors: Bochkareva A.N., Egorov V.V., Smoliakova G.P., Banshchikov P.A.
Organization: Postgraduate Institute for Public Health Workers, S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

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.

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Improving methods of one-stage reconstructive surgery for cicatricial eyelid defects

Year: 2020, volume 16 Issue: №2 Pages: 578-583
Heading: Ophtalmology Article type: Original article
Authors: Banshchikov P.A., Egorov V.V., Smoliakova G.P.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Postgraduate Institute for Public Health Workers
Summary:

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.

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Assess of treatment effectiveness of chronic ocular ischemic syndrome due to internal carotid artery stenosis of varying degrees

Year: 2020, volume 16 Issue: №1 Pages: 308-312
Heading: Ophtalmology Article type: Original article
Authors: Tuzlaev V.V., Egorov V.V., Kravchenko I.Z., Smoliakova G.P.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Postgraduate Institute for Public Health Workers
Summary:

The purpose of the study is to investigate treatment effectiveness for patients with chronic ocular ischemic syndrome (COIS) due to internal carotid artery (ICA) stenosis of varying degrees. Material and Methods. The study involved 15 patients with stage 3 COIS. They were divided into 2 groups according to treatment type: the 1 st group consisted with 7 patients with COIS and hemodynamically significant ICA stenosis, carotid endarterectomy (CE) was performed; the 2nd group consisted of 6 people with COIS and hemodynamically insignificant ICA stenosis, panretinal photocoagulation (PRP) was performed. Results. Monitoring of groups of patients for 1 year after COIS treatment allowed us to determine differentiated approach to treatment of patients depending on the degree of ICA stenosis. Reconstructive surgery at hemodynamically significant ICA stenosis caused positive dynamics in the improvement of blood flow in the ophthalmic artery (OA) by 63.8% relative to initial maximum systolic blood flow velocity, and decreased in the arterial resistivity index by 12.2%. PRP, due to improvement of microcirculation, which led to stabilization or improvement of best corrected visual acuity and COIS stabilization. Conclusion. The study has shown the appropriateness of differentiated approach to treatment of patients with severe degree COIS due to changes of ICA hemodynamics. Using stage-by-stage PRP and CE at COIS, depending on the degree of ICA stenosis, allows stabilization of ischemic process in the retina and delays the pathological metabolism processes aggravated in the ocular metabolism system.

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Clinical and etiological and hemostasiological features of isolated optic disk vasculitis

Year: 2019, volume 15 Issue: №2 Pages: 465-469
Heading: Ophtalmology Article type: Original article
Authors: Emanova L.P., Egorov V.V., Smoliakova G.P., Danilova L.P., Povalyaeva D.A., Zhajvoronok N.S.
Organization: Postgraduate Institute for Public Health Workers, The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution
Summary:

 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.

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Evaluation of the efcacy of neuroprotective therapy after endovitreal surgery for rhegmatogenous retinal detachment

Year: 2019, volume 15 Issue: №2 Pages: 460-464
Heading: Ophtalmology Article type: Original article
Authors: Egorov A.V., Egorov V.V., Smoliakova G.P.
Organization: The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution
Summary:

 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

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New approach to amnioplasty in surgical treatment of primary progressing pterygium

Year: 2019, volume 15 Issue: №2 Pages: 428-433
Heading: Ophtalmology Article type: Original article
Authors: Bochkareva A.N., Egorov V.V., Smoliakova G.P., Banshchikov P.A., Belous A.V.
Organization: Postgraduate Institute for Public Health Workers, Regional Clinical Oncological Center, The Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to improve the efcacy of surgical treatment of primary progressing pterygium by developing a new method of amnioplasty. Material and Methods. 85 patients were divided into two groups based on topographical features of amnioplasty site. The main group included 42 subjects who underwent amnioplasty using a technique which was proposed by us (after surgical removal of primary progressive pterygium at the initial site); the control group included 43 subjects in whom amnioplasty at the zone of limbus was performed after removing the pterygium. The criteria for evaluating treatment efcacy were time to disappearance of symptoms of postoperative infammation, time to complete corneal epithelialization and vitalization of the amnion, visual acuity in the frst year after surgery, reduction of corneal astigmatism, recurrence rate. Results. Amnioplasty technique proposed by us showed high efcacy: time of postoperative ocular surface infammation decreased, which led to an increase in corneal epithelization rate by 1.7 times and in amnion vitalization rate by 1.2 times; reduction of astigmatism by 3 times and an increase in visual acuity by 3.9 times when compared to the control group. Conclusion.

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