Saratov JOURNAL of Medical and Scientific Research

S. Fyodorov Eye Microsurgery Federal State Institution

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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Modern complex rehabilitation of a patient after removal of tumor of iridociliary zone (clinical case)

Year: 2020, volume 16 Issue: №2 Pages: 671-673
Heading: Ophtalmology Article type: Case report
Authors: Khodzhaev N.S., Sobolev N.P., Shkandina Yu.V., Soboleva M.A.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

A clinical case of optical reconstructive treatment of a patient after removal of an iridociliary zone tumor (ICZ) is presented. 1 year after blockexcision of the right eye, patient A., 63 years old, treated to the S. Fyodorov Eye Microsurgery Federal State Institute with the aim of correcting visual functions, where him was scheduled for optical reconstructive surgery (ORS): phacoemulsification of cataract with implantation of an intraocular lens, capsular ring and iris-lens diaphragm. 1 year after the ORS, there was no recurrence of the tumor process, and the obtained clinical and functional results remained stable, a patient did not complain. The proposed deadlines and technical features of ORS in a patient with a history of ICZ tumor removing create the necessary conditions for improving of functional results and the quality of life after organ-preserving operations.

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Comparative analysis of the content of biochemical markers of endothelial dysfunction in women with preeclampsia and in the development of vascular retinal pathology

Year: 2020, volume 16 Issue: №2 Pages: 668-671
Heading: Ophtalmology Article type: Original article
Authors: Fil А.А., Sorokin E.L., Kolenko O.V.
Organization: Far Eastern Federal University, Postgraduate Institute for Public Health Workers, S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Purpose: to study the level of markers of endothelial dysfunction (ED) in women with preeclampsia and with the development of retinal vein occlusions. Material and Methods. The main group was formed by 62 pregnant women with preeclampsia (124 eyes). Their age ranged from 22 to 43 years (30±6.9 years). The 1st comparison group was formed by 20 women with a physiological course of pregnancy, a comparable age and duration of pregnancy. The 2nd comparison group included 16 non-pregnant women with occlusions of the superior temporal branches of the central retinal vein (16 eyes). As a control group, 20 somatically healthy, non-pregnant women (40 eyes) were selected. Markers of ED were studied twice in the main and 1st comparison groups (III trimester of pregnancy and 6-8 months after delivery). In the control and 2nd comparison groups — once. Results. The levels of von Willebrand factor and endothe-lin-1, which are known to be the main markers of ED development, turned out to be high in women of the main group (109.3±33.2% and 2.69±1.49 ng/ml respectively), and in the 2nd comparison group (110.3±29.2% and 2.6±0.4 ng/ml respectively). Conclusion. Increased endothelin-1 in the tear fluid and von Willebrand factor in blood plasma in women with preeclampsia, as well as maintaining their high levels after 6-8 months, after childbirth may indicate the presence of generalized ED, which is a favorable background for the development of vascular retinal pathology in the remote postpartum period.

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Clinical and ophthalmic evaluation of the effectiveness of comprehensive treatment regimen for central serous chorioretinopathy

Year: 2020, volume 16 Issue: №2 Pages: 662-668
Heading: Ophtalmology Article type: Original article
Authors: Stanishevskaya О.М., Chernykh V.V., Bratko V.I., Bratko G.V., Poveshchenko O.V.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
Summary:

The purpose of the study is to evaluate the clinical-ophthalmological effectiveness of the developed complex treatment for central serous chorioretinopathy (CSC) using subthreshold micro-pulse laser (SMILV) exposure with a wavelength of 577 nm combined with platelet autoplasm (TP) injections in the pterygopalatine fossa, which is the region of hemolymphocirculation. Material and Methods. The study was conducted on 60 patients (60 eyes) with CSC. Patients were divided into 2 groups: in the comparison group patients received treatment with SMILV with a wavelength of 577 nm only, while in the main group they received treatment with SMILV and subsequent TP injections. The patients were prescribed 3 injections into the pterygopalatine fossa on the side of the affected eye, which is the region of the hemolymphocirculation, with the 72-hour-long interval between injections. SMILV was carried out on a Supra 577 nm laser (Quantel Medical, France) over the entire area of macular edema. Results. The results of the application of the developed and patented treatment for patients with CSC with the use of SMILV 577 nm combined with enriched TP injections are presented in the study. Comparative analysis of clinical and ophthalmic effectiveness of the proposed method of treatment was compared with monotherapy with SMILV 577 nm 1, 3, 6 and 12 months after treatment. Conclusion. This method has been developed and introduced into clinical practice for combined treatment of patients with CSC. The study demonstrates great clinical and ophthalmic effectiveness of the combined treatment.

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Pedicled retinal pigment epithelium — choroid graft autotranslocation in scarred age-related macular degeneration

Summary:

The purpose of the study is to analyse the effectiveness of pedicled RPE (retinal pigment epithelium) — choroid graft autotranslocation in scarred neovascular age-related macular degeneration (AMD) treatment. Material and Methods. Pedicled RPE — choroid graft autotranslocation was performed on 8 patients with scarred wet AMD. Follow-up was from 6 to 30 months. Visual acuity, ophthalmoscopy, optical coherent tomography and indocian-green angiography were analysed. Results. The average visual acuity increased from 0.009±0.006 to 0.018±0.022 (p=0.15). Visual acuity increased in 50% of the patients. In 50% of patients visual acuity decreased, which was associated with proliferative vitreoretinopathy in post-op period with retinal detachment formation. No cases of choroidal neovascularization recurrence were detected. According to angiography data normal choroidal perfusion in the rotated RPE — choroid patch was revealed after 1 month during the follow-up examination. Conclusion. Pedicled RPE — choroid graft translocation can be successively performed in case of scarred neovascular age-related macular degeneration.

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Implantation of «reverse» intraocular lens in a patient with high-grade myopia after phacoemulsification cataract (clinical case)

Year: 2020, volume 16 Issue: №2 Pages: 656-658
Heading: Ophtalmology Article type: Case report
Authors: Sorokoletov G.V., Soboleva М.А.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

This clinical case demonstrates the result of successful phacoemulsification cataract with implantation of a "reverse" intraocular lens that has a high correcting ability and allows to achieve high acuity and quality of vision in eyes with high myopia.

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Reasonable choice of a surgical method for rehabilitation of patients with defects of the iris

Year: 2020, volume 16 Issue: №2 Pages: 652-655
Heading: Ophtalmology Article type: Original article
Authors: Sobolev N.P., Bessarabov A.N., Shkandina Yu.V., Soboleva M.A.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to develop an objective method for calculating the square of the iris defect area. Material and Methods. Clinical and functional surgical treatment results for 98 patients (98 eyes) with the consequences of traumatic damage of the eyeball's anterior part were analysed. The uncorrected visual acuity (UCVA) was 0.12±0.05, and the best corrected visual acuity (BCVA) was 0.41±0.15. Results. In orderto objectively assess the iris defect area, we developed a grid palette. We calculated the square of iris defect area using this palette in percent, after this surgical algorithm was determined. The visual functions in all patients after the treatment were increased and by the seventh day after the surgery were as follows: UCVA0.58±0.28; BCVA0.71±0.15. Conclusion. Using the designed palette for objective assessment of the iris defect area helps to choose the correct algorithm of surgery. In cases when the iris defect square is less than 30%, it is possible to use the technique of closed iridoplasty with patients own eye tissues. If the iris defect area is more than 30%, implantation of the iris-lens diaphragm is recommended.

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