Saratov JOURNAL of Medical and Scientific Research

Fabrikantov O.L.

S. Fedorov Eye Microsurgery Federal State Institution, Tambov branch, Director; Derzhavin Tambov State University, Medical Institute, Head of Department of Ophthalmology, Professor, DSc

Determination of properly sized capsulorhexis in lens sub-luxation to perform the best capsular bag fixation

Year: 2020, volume 16 Issue: №1 Pages: 253-258
Heading: Ophtalmology Article type: Original article
Authors: Pirogova E.S., Fabrikantov O.L., Nikolashin S.I., Kurbatova V.A.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

The purpose of the study is to determine the appropriate anterior capsulorhexis size for the best capsular bag fixation in lens subluxation using iridocapsular retractors. Material and Methods. The patients were divided into three groups: group 1 included 48 eyes, group 2-50 eyes, group 3-46 eyes. A total of 144 patients (144 eyes) had lens subluxation of the first and second degree according to Pashtaev's classification. In group 1 we performed manual capsulorhexis with the mean diameter of 5.5 mm. In group 2 the diameter was 5.0 mm, and in group 3-4.5 mm. Nuclear density was classified as that of the second and fourth degree according to Buratto's classification. All patients underwent phacoemulsification with implantation of iridocapsular retractors and capsular ring. Results. The largest share of postoperative complications at 5.6% was observed in group 2, it was at 4.0% in group 3, and at 1.3% in group 2. The postoperative visual acuity increased significantly in all groups both at discharge and one year after surgery. Intraocular pressure was normalized in all patients at discharge and one year after surgery. Conclusion. The best capsular bag fixation in lens subluxation is achieved with a 4.5 mm capsulorhexis. However, the risk of anterior capsule damage increases. A 5.0 mm capsulorhexis is the most appropriate one for the best capsular bag fixation and comfort phacoemulsification.

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Informativity of microperimetry in retinal pathology diagnosis

Year: 2020, volume 16 Issue: №1 Pages: 249-253
Heading: Ophtalmology Article type: Original article
Authors: Pilyagina А.А., Nenasheva Yu.V., Fabrikantov O.L.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

The purpose of the study is to estimate the functional status of central retinal zone with microperimetry method in patients with retinal pathology. Material and Methods. Microperimetry was performed on 16 patients (18 eyes) with different kinds of retinal pathology including thrombosis of central retinal vein branches, age-related macular degeneration, myopic maculopathy, lamellar macular hole, tapetoretinal degeneration, ocular albinism, central serous chorireti-nopathy, proliferative diabetic retinopathy. Mean age was 52.4 years old; male — 8, female — 8. Results. The average light sensitivity of central retinal zone was reduced in the majority of patients. The decrease in the index of retinal light sensitivity in the pattern point corresponding to fixation point did not correspond to the decrease in the best-corrected visual acuity in all cases. Central defects and depression zones topographically corresponded to pathological alterations on the eye fundus. In a patient with ocular albinism fixation was characterized as unstable, in the rest of cases we observed stable fixation. The analysis of fixation allowed receiving additional information about visual quality and the degree of visuomotor coordination in patients with retinal pathology. Conclusion. As a result of the study we showed high informativity of microperimetry for assessing central retinal zone's functional status in retinal pathology.

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Influence of optic disc size on the results of morphometric examinations at glaucoma

Year: 2020, volume 16 Issue: №1 Pages: 231-236
Heading: Ophtalmology Article type: Original article
Authors: Lvov V.A., Machekhin V.A., Fabrikantov O.L.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

The purpose of the study is to analyze morphometric parameters of the optic disc, peripapillary retina and ganglion cells complex of the retinal macular area in eyes with different disc area. Material and Methods. 150 patients (294 eyes) aged 62.1 ±9.6 years old were examined (male — 69, female — 81). The eyes were divided into two groups according to the optic disc area (OD): eyes with average disc area (1.63-2.43 mm2) and eyes with small disc area (less than 1.63 mm2). Analysis of the morphometric structure of the OD, peripapillary retina and ganglion cells complex of macula was performed with Heidelberg laser retinal tomography HRT-3 and optical coherence tomography RTVue-100 (Optovue, USA). Computed perimetry of the central visual field was conducted using Carl Zeiss (USA) device with HFA30-2 software. Results. In the group of eyes with small discs according to HRT we revealed the significant difference in the OD parameters (cup area, rim area, cup/disc area) between normal eyes and eyes with preperimetric glaucoma, as well as in the group with average discs (p<0.001). We detected a significant difference of the peripapillary retina parameters (RNFL) between all stages of glaucoma, including normal limits, preperimetric and advanced stages of glaucoma in the group with small discs according to OCT. Conclusion. Both HRT and ОСТ have identical capability in early diagnosis of glaucoma, however, HRT evaluates the optic disc parameters better, while the ОСТ is preferable at peripapillar retina parameters evaluation. Preperimetric glaucoma, being the principal part of diagnosing glaucoma suspect, provides for accumulation of structural alterations of the optic disc and thus early detection of glaucoma.

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Polymer micro-shunt Reper-NN in combined glaucoma and cataract surgery

Year: 2020, volume 16 Issue: №1 Pages: 223-227
Heading: Ophtalmology Article type: Original article
Authors: Kolpakova О.А., Fabrikantov O.L., Nikolashin S.I.
Organization: Tambov State University n. a. G.R. Derzhavin, S. Fedorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to estimate the efficacy of polymer micro-shunt Reper-NN in combined glaucoma and cataract surgery. Material and Methods. The examination group consisted of 34 patients (34 eyes) with cataract and glaucoma of different stages. All patients were divided into 2 groups: 1)16 patients underwent micro-shunt Reper-NN implantation with simultaneous phacoemulsification with IOL implantation; 2) 18 patients underwent micro-invasive non-penetrating deep sclerectomy with simultaneous phacoemulsification with IOL implantation. The diagnosis was made based on the anamnesis and data of objective and instrumental examinations. Preoperatively all patients underwent examination of visual acuity, intraocular pressure, perimetry, ophthalmometry, ultrasound scanning. Results. Intraocular pressure was normalized in all patients. Conclusion. Combined cataract and glaucoma surgery using polymer micro-shunt Reper-NN is an effective and safe method of treating open-angle glaucoma and cataract.

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Estimation of diagnostic value of optical coherence tomography angiography parameters in patients with diabetic retinopathy

Year: 2020, volume 16 Issue: №1 Pages: 210-215
Heading: Ophtalmology Article type: Original article
Authors: Goydin А.Р., Fabrikantov O.L., Pronichkina M.M., Misyurev D.M.
Organization: Tambov State University n.a. G.R. Derzhavin, S. Fedorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to estimate diagnostic value of optical coherence tomography angiography (OCT-angiography) parameters in patients with diabetic retinopathy. Material and Methods. The investigation included 102 patients with diabetes mellitustype II and different stages of diabetic retinopathy and 48 clinically healthy people. Apart from routine ophthalmological examination all patients underwent optical coherence tomography of the macular area. To estimate diagnostic value of OCT-angiography, we performed ROC-analysis of the most informative parameters. Results. The most significant differences in OCT-angiography data between patients with different stages diabetic retinopathy (groups I and II) and healthy people (control group) were noted for general vascular density in all sectors (Whole image) and parafoveal zone (Parafovea) of the superficial vascular plexus. The ROC-analysis showed high sensitivity and specificity of the same zones for control group and group I, as well as for groups I and II. Conclusion. The capillary network density for Parafovea in patients with diabetes mellitus is less than 52% and for Whole image it is less than 48.5%, which indicates the presence of non-proliferative and pre-proliferative retinopathy, while the reduction of Parafovea parameters lower than 43.6% and Whole image lower than 47.5% indicates proliferative diabetic retinopathy.

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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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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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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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