Saratov JOURNAL of Medical and Scientific Research

Chuprov A.D.

S. Fedorov Eye Microsurgery Federal State Institution, Orenburg branch, Director, Professor, DSc

A standardized approach to the choice of basic surgical treatment for large macular holes

Year: 2020, volume 16 Issue: №2 Pages: 687-690
Heading: Ophtalmology Article type: Short message
Authors: Chuprov A.D., Kazennov A.N., Mambetova Е.М.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to optimize the choice of tactics for surgical treatment of large macular holes. Material and Methods. Analysis of the surgical treatment of macular holes in 18 patients (18 eyes) was performed. Patients were divided into 3 groups. Group 1 (8 eyes) included patients with a hole diameter of up to 500±22 urn, group 2 (6 eyes) — with a diameter of up to 800±20 urn, and group 3 (4 eyes) — over 800 urn. In group 1 vitrectomy was performed with peeling of the inner border membrane (IBM), application of platelet rich plasma (PRP) mass and tamponade with air; in the group 2 vitrectomy was performed with IBM peeling, application of PRP mass or closed with a free inverted IBM flap and tamponade with SF6 gas; in group 3 vitrectomy was performed with IBM peeling and closing of the macular holes was performed using a free inverted IBM flap with silicone oil tamponade. Results. There was complete closure of the macular holes with the formation of a normal fovea profile and improvement of visual acuity in all cases of group 1. In group 2 (PRP application) in 2 cases of 6, a second intervention was required with the"plasty" of the macular hole using an inverted IBM flap. In group 3, in 1 case, the gap did not close and in 1 more case it closed with a defect at the level of the ellipsoid zone of the photoreceptors. Conclusion. The preliminary results' analysis showed the effectiveness of the developed algorithm for surgical treatment of macular holes, depending on their diameter, which is optimal and allows obtaining the required anatomical and functional result.

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Tactical approaches to management of patients with macular pathology

Year: 2020, volume 16 Issue: №2 Pages: 683-687
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Borshchuk E.L., Voronina A.E., Lositskiy А.О.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose is to evaluate the effectiveness of tactical approaches to macular pathology treatment based on retrospective data analysis. Material and Methods. Between 2014 and 2019, 12007 courses of treatment of patients with macular pathology (1372 patients) were conducted at the S. Fyodorov Eye Microsurgery Federal State Institution, Orenburg branch. 69.5% of patients were diagnosed with "Macular and posterior pole degeneration" (H35.3), "Retinal angiomatosis" (H35.0) was diagnosed in 11.3%, cases with "Other specified retinal disorders" (H35.8) 9.4%. Results. Comparison of the best corrected visual acuity (BCVA) was made and 2 groups were distinguished: group 1 consisted of patients with negative dynamics, group 2 included patients with positive dynamics. Among all patients, the best values of BCVA were in patients diagnosed with "Other specified retinal disorders", while BCVA improved by 0.13 in most patients with this nosology, in case of macular edema (1.8% of the sample), an improvement in BCVA by 0.13 was also noted. Tactical approaches were analyzed in patients with the best BCVA values, and it was found that intravitreal injection of drugs (IVID) more often led to an increase or stabilization of BCVA in patients with various pathologies of the macular zone. In the sample the majority of patients with macular pathology were diagnosed with "Macular and posterior pole degeneration", 65.35% of patients in this nosological group had positive dynamics in BCVA in the course of 3 years. Conclusion. The most effective method of treating patients with the diagnosis "Macular and posterior pole degeneration" was intravitreal injection of angiogenesis inhibitors (Aflibercept and Ranibizumab) according to the regimen described in the instructions for these drugs.

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Comparative evaluation of the efficiency of astigmatism correction methods in cataract surgery

Year: 2020, volume 16 Issue: №2 Pages: 678-683
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Begun D.N., Lositskiy А.О., Kazakova T.N., Voronina A.E.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study was to compare the effectiveness of methods of astigmatism correction in the surgical treatment of cataract. Material and Methods. Analysis of 157 cases (eyes) of surgical treatment of cataract with concomitant astigmatism was carried out, of which 131 eyes were operated using the ARKUATA method and 26 were operated using the TORIKA method. The age of patients ranged from 40 to 72 years. Results. As a result of the study we obtained statistically substantiated data, which showed that there were no objective differences in the compared methods for correcting corneal astigmatism: the formation of arcuate relaxing incisions and the use oftoric lOLs. Using the classification tree method, a model for predicting positive effect of the outcome of an operation with a value of un-corrected visual acuity of 1.0 was built. Conclusion. Both methods, in the absence of complications, can correct corneal astigmatism with the same statistical probability, allowing to achieve an uncorrected visual acuity of 1.0. However, from an economic point of view, the cataract surgery is most optimally performed using toric lOLs, as the cost of this treatment is 29.83% lower than when using femtosecond technologies.

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Comparative characteristics of melatonin content in lacrimal fluid and blood serum depending on the stage of senile cataract with age-related macular degeneration

Year: 2020, volume 16 Issue: №2 Pages: 673-678
Heading: Ophtalmology Article type: Original article
Authors: Khodzhaev N.S., Chuprov A.D., Smolyagin A.I., Kim S.M., Filippova Yu.V.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to evaluate factors affecting concentration of melatonin in the tear and blood serum in patients with a non-exudative form of age-related macular degeneration (AMD). Material and Methods. 140 patients (140 eyes) were examined, of which 52% were women, 48% were men. The following groups of patients were formed: 1) patients with non-exudative AMD and senile cataract who took melatonin; 2) patients with non-exudative AMD and senile cataract who did not take melatonin; 3) without AMD and cataract; 4) patients with non-exudative AMD, not requiring surgical treatment of cataract; 5) patients with neovascular (exudative) form of AMD (nAMD). The melatonin content was determined using immunosorbent assay. Results. The content of melatonin in all examined patients' serum ranged from 0.001 to 0.161 ng/ml, the highest median of melatonin values was observed in healthy individuals (0.125 ng/ml), and the lowest in patients with nAMD (0.021 ng/ml). The level of melatonin in the tear varies from 0.067 to 0.477 ng/ml, while its highest median was found in group 1 patients: 0.324 ng/ml. In group 2 and reference groups (without cataract with AMD and with nAMD), the melatonin content in the tear was significantly reduced (p <0.05) compared with the level in the group of healthy individuals. Conclusion. The content of melatonin in the blood serum and lacrimal fluid depends on the following factors: age, arterial hypertension, body mass index (BMI), insomnia, smoking, hair and eye color, night shifts. Using melatonin in the treatment of patients with AMD helps to increase the concentration of melatonin in tear.

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The effectiveness of subtotal vitrectomy with retinotomy in surgical treatment of severe forms of proliferative diabetic retinopathy with retinal detachment

Year: 2020, volume 16 Issue: №1 Pages: 315-317
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Gorbunov A.A., Kazennov A.N., Kuvaitseva Yu.S.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to increase the efficacy of surgical treatment of severe stages of proliferative diabetic retinopathy in combination with circular retinotomy. Material and Methods. The operations performed in 2016-2018 on patients with proliferative diabetic retinopathy in combination with traction retinal detachment (17 eyes). The patients' age ranged from 24 to 69 years. Tractional retinal detachment was diagnosed alongside with PDR3-4 in all eyes. In 10 (58.8%) previously operated eyes we diagnosed the relapse of retinal detachment. In 14 eyes (82.3%), vitrectomy was performed in combination with phacoemulsification, 3 eyes (17.6%) were already pseudophakic. Results. We obtained complete anatomical attachment of the retina in all 17 cases (100%). All patients we kept on 5700 cSt silicone tampon-ade. Circular retinotomy was performed on 10 (58.8%) eyes with a relapse. The period of keeping silicone oil 5700 cSt in the vitreous cavity after a circular retinotomy varied (from 1 to 3 years), emulsification of silicone oil occurred in none of the cases. Secondary glaucoma developed in 3 eyes. Conclusion. Circular retinotomy in combination with prolonged tamponade of the vitreous cavity with silicone oil provides stable anatomical effect.

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Application of multivariate statistical analysis for evaluation of management of ophthalmological care to the population of the Orenburg region

Year: 2019, volume 15 Issue: №2 Pages: 568-572
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Lositsky A.O., Trubnikov V.A.
Organization: Orenburg branch of S. Fedorov Eye Microsurgery Federal State Institution
Summary:

The purpose of this study was to identify and study clusters (groups) of medical organizations of the Orenburg region with similar parameters, refecting the level of organization of ophthalmic care to the population. Material and Methods. The proposed method of evaluation is based on the use of the method of multivariate statistical analysis of the structure and activity of ophthalmological units of primary health care of the Russian Federation, with the allocation of groups of structures under research with similar evaluation characteristics and graphic representation of the results. Evaluation criteria are: availability of specialized ophthalmological care for the population, stafng level, overall and primary disease incidence, incidence on separate nosological groups, general and primary disability indicators. Results. Based on the data representative of the organization of ophthalmic care 50 medical organizations of the Orenburg region, providing primary health care were divided into 3 clusters. Indicators of the ophthalmic care management for each of the clusters were characterized. Conclusion. The results of the study allow us to identify groups of medical organizations that require diferent approaches in management decision-making in order to improve the ophthalmological service of an individual subject of the Russian Federation.

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Corneal endothelial cells condition after thermokeratocoagulation in a long-term period.

Year: 2019, volume 15 Issue: №2 Pages: 566-568
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Kuznetsov I.V., Pasikova N.V., Kuznetsova V.I.
Organization: Orenburg branch of S. Fedorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the research was to assess the quantitative and qualitative state of the corneal endothelium after thermokeratocoagulation in a long-term period. Material and Methods. The main group consisted of 18 patients (36 eyes) after thermokeratocoagulation, which was performed from 19 to 28 years ago. The control group consisted of 22 patients (44 eyes) aged from 45 to 58 years (middle age 51.3±3.2 years) from refraction and axial hypermetropy various degree without the previous surgical interventions. The research was performed on a non-contact mirror scanning microscope EM-3000 (Tomey, Japan). Results. The endothelial cells density in the main group averaged 2245.4±316.2 cells / mm2, in the control group 2661.7±169.2 cells / mm2 (p<0.05). The coefcient of endothelial cell size variability counted 0.34, in the control group 0.26 (p<0.05). The percentage of hexagonal corneal endothelial cells in patients after thermokeratocoagulation averaged 53.7±14.9 % in patients of the control group 74.3±6.5 % (p<0.05). Conclusion. In the long-term period patients showed a statistically signifcant decrease in the corneal endothelial cells density, a decrease in the percentage of hexagonality and an increase in the coefcient of cell size variability.

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Eyesight condition in frst-year pupils

Year: 2019, volume 15 Issue: №2 Pages: 563-565
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Voronina A.E.
Organization: Orenburg branch of S. Fedorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to determine the characteristics of eyesight in frst-year pupils. Material and Methods. Parents were initially interviewed to establish the presence and severity of symptoms of dry eye syndrome in their children. The second stage involved ophthalmologic examination which included non-contact autorefractometry on Plusoptix A09 device and checking visual acuity with and without correction. Results. Autorefractometry revealed emmetropia in the majority of cases (79.16 %), myopia was identifed in 3.34 %, accommodation disturbance — in 11.25 %, hypermetropia — in 3.75 %, astigmatism — in 2.5 %. Visual acuity test in the majority of children revealed the maximum acuity, while visual acuity of less than 0.5 was detected in 5.4 % of frst-year pupils. A survey for symptoms of dry eye syndrome showed minimal manifestations in frst-year pupils from 0 points for the majority, up to 8 points. The most frequent complaint among the respondents was hypersensitivity to light (33.75 %) and frequent eye infammation (23.3 %). Watching TV was the most frequently reported visual workload. Conclusion. The majority of frst-year pupils (78.3 %) had high visual acuity of 1.0; 3.34 % of the children had myopia; 11.25 % had accommodation disturbance.

Role of melatonin in pathogenesis of age-related macular degeneration

Year: 2019, volume 15 Issue: №2 Pages: 559-563
Heading: Ophtalmology Article type: Review
Authors: Khodzhaev N.S., Chuprov A.D., Kim S.M.
Organization: The S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in people aged 50 years and older in the advanced world. The article deals with the epidemiology and pathogenesis of the disease. Special attention is given to a new approach to the prevention and treatment of AMD with the help of melatonin; modern management options and scientifc achievements are discussed. Many researchers have shown that melatonin is able to protect retinal epithelial cells from oxidative damage. Perhaps the physiological reduction of melatonin in the elderly may be an important factor in the dysfunction of the retinal pigment epithelium, which is the cause of AMD.

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