№2, 2017, volume 13

The purpose of study is to evaluate the effectiveness of antiglaucomic operations with the use of the Ex-Press mini glaucoma shunt and Repegel-1 drainage in patients with primary open-angle glaucoma. Material and Methods. 65 patients (65 eyes) with an established diagnosis of uncompensated primary open-angle glaucoma of Stage III were observed. All patients underwent anti-glaucoma surgery. Patients of group 1 (15 patients, 15 eyes) underwent penetrating deep sclerectomy with implantation of the Ex-Press mini shunt under the scleral flap. Patients of group 2 (25 patients, 25 eyes) — penetrating deep sclerectomy with Repegel 1 drainage. Patients of group 3 (25 patients, 25 eyes) underwent sinus trabeculectomy without drainage. Results. In the early postoperative period, a good hypotensive effect was obtained in patients of all three groups. The most persistent antihypertensive effect was obtained in patients who underwent anti-glaucoma surgery with Repegel-1 drainage implantation. In patients who were implanted with the Ex-Press mini shunt, there was a significant decrease in the perimetrical MD index for 3 months. Conclusions. 1. Improvement of the photosensitivity of the retina in patients who underwent an antiglaucoma operation with Ex-Press shunt implantation, possibly due to the low invasiveness of the intervention and the absence of a sharp drop in IOP level. 2. Preliminary results (analysis 3 months after the operation) indicate a lower number of postoperative complications in the implantation of Repegel-1 drainage and a persistent hypotensive effect. 3. Patients who underwent antiglaucoma operations with implantation of drainage systems showed improvement of hemodynamic parameters in the pool of posterior short ciliary arteries in the postoperative period.

Цель: сравнить показатели диска зрительного нерва (ДЗН) у пациентов с псевдоэксфолиативным синдромом (ПЭС) и псевдоэксфолиативной глаукомой (ПЭГ). Материал и методы. Под наблюдением находился 81 больной (157 глаз) в возрасте 55-74 лет: 71 женщина (76%), 25 мужчин (24%). Все пациенты подразделены на три группы. Группа 1: 40 больных (77 глаз) с диагнозом «первичная открытоугольная la глаукома» (группа 1а: 20 больных (37 глаз) с псевдоэкфолиативной формой первичной открытоугольной глаукомы (ПОУГ); группа 16: 20 пациентов (40 глаз) с простой формой ПОУГ). Группа 2: 18 пациентов (34 глаза) с диагнозом «ПЭС». Группа 3: 23 пациента (46 глаз) без признаков глаукомы и ПЭС. Всем пациентам проводили офтальмологическое обследование с оценкой толщины слоя нервных волокон (RNFL), площади ДЗН, площади нейроретинального пояска (НРП) и объема экскавации. Результаты. У больных с ПЭГ выявлялось значимое отклонение всех показателей ДЗН от нормы, в поле зрения отмечались характерные глаукомные изменения. У пациентов группы 2 получено значимое различие показателей толщины слоя нервных волокон, толщины нейроретинального пояска и объема экскавации с показателями пациентов группы 3. Выводы: 1) ангио-ОКТ является объективным методом оценки состояния кровотока ДЗН; 2) у пациентов с ПЭС выявлено достоверное ухудшение состояния перфузии ДЗН, пациенты с ПЭС находятся в группе повышенного риска развития глаукомы и требуют более пристального внимания и диспансерного наблюдения; 3) состояние перфузии ДЗН у больных с ПЭГ хуже, чем у больных ПОУГ той же стадии.

Diabetic macular edema (DME) is a leading cause of blindness in patients with diabetes. The purpose of the research is to evaluate the effectiveness of treatment of patients with DMOs resistant to the administration of ranibi-zumab, using the intrauritreal implant "Ozurdex". Material and Methods. 66 patients (98 eyes) are examined. All of the patients were divided, into three groups, depending on a stage of a diabetic retinopathy. The patients underwent a complex of examinations: along with traditional methods, optical coherence tomography, fluorescence angiography of the fundus, multifocal electroretinography, determination of the content of VEGF-Aand cytokines in serum were used. Results. According to ОСТ of a retina and a visometry there are differences in efficiency of treatment depending on a condition balance of cytokine. Conclusion. The use of the intrauretic implant "Ozurdex" was more effective in patients with DMO in the stage of p re-pro I iterative diabetic retinopathy and in patients resistant to anti-VEGF therapy.

The purpose of study is an assessment of the informative value of various diagnostic parameters in monitoring and prognosis of the state of the visual organ in patients with primary open-angle glaucoma. Material and methods. 216 patients (216 eyes) were examined. 126 patients (126 eyes) with the diagnosis of primary open-angle glaucoma I, II or III stage were included in the main group (I), and 90 patients (90 eyes) without ophthalmologic pathology were included in the control group (II). All patients underwent complex examination. Laser confocal scanning tomography for the analysis of the optic disc morphology was performed using a Heidelberg Retina Tomograph II from Heidelberg Engineering (Germany). Evaluation of the field of view was carried out using the computer static perimeter Oculus twinfield-2 (Germany). Electrophysiological studies (apparatus Roland Consult, Germany) included: the study of visual cortical potentials on the outbreak, the pattern-electroretinogram, photopic negative response. Neurotrophic brain factor, ciliary neurotrophic growth factor and protein NF-200, S-100 protein, monocyte chemoattractant, vascular endothelial growth factor were determined in the serum. Results. An increase in the concentration of the S-100 protein with progression of POAG testifies to the existence of parallels between apoptosis of retinal ganglion cells and systemic neurodegenera-tion affecting the central nervous system as a whole. The importance of electrophysiological research methods, which give information about the third neuron of the visual pathway, has been confirmed. Pattern-electroretinogram, photopic negative response most reflect abnormalities in the work of ganglion cells of the retina, including before the appearance of structural changes in the optic disc and the retina. Conclusion. The interrelation of dynamics of functional, morphological and immunological criteria of progression of POAG is revealed, which allows to predict the further course of the pathological process. Since the study involved patients with IOP target values, it is important not only to maintain IOP on target values, but also to carry out neuroprotection.

The aim ofthisworkwasto analyze the intensity of the laser coagulates in the treatment of diabetic macular edema conducted in navigation mode on robotic laser system Navilas. Material and Methods. Retrospective analysis of outpatient cards and photographs of the fundus 20 patients (28 eyes) had been done. The patients had type II diabetes mellitus. We performed laser treatment of diabetic macular edema. There were evaluated 4260 coagulates, of which 0 degree 2166 (50.85%), I degree —525 (12.32%), II degree —747 (15.74%), III degree—498 (11.96%), grade IV — 324 (7.6 per cent). Result. The thickness of the retina before treatment in the area of edema was made 339.72±45.3 urn, and after treatment 346±70 urn, student's t-test 0.7124, a difference of 6.5±57.4. Visual acuity before treatment 0.532±0.3, after— 0.521±0.3mm, student's t-test 0,889. Conclusion. The facts obtained in the analysis suggests that the algorithm of selection of power and the way it adjustments in the course of treatment are the weak point of this technique. Development of new methods, giving the possibility to adjust the power depending on the height of the swelling region of the retina, thereby gaining coagulates strictly necessary for the specific case of intensity, will enable to increase the efficiency and safety of laser treatment.

Prolonged hypotensive effect in the postoperative period is one of the main tasks of modern glaucoma surgery. In connection with this, the aim of our study is to develop a surgical method of prevention of scarring during the classical sinustrabeculectomy. Material and Methods. The operation was performed in 13 patients (13 eyes) with primary open angle glaucoma (POAG) ll-lll (B-C) in steps aged 50-70 years. The duration of observation up of 2 year. Results. After 9-12 months of hypotensive efficacy was 100% (13 eyes) in 20-24 months — 98% (12 of 13 eyes). The result was confirmed using standard methods of examination (visometry, tonometry, computerized perimetry, tonography et al.), in the early postoperative period was performed optical coherence tomography of the anterior segment, then — ultrasound biomicroscopy. Conclusions. Developed a new version of the surgical treatment of glaucoma a long-acting hypotensive effect.

Purpose: to analyze the results of microinvasive surgical treatment of children with post-traumatic endophthalmitis. Patients and Methods. Under our observation there were 5 children aged 9-13 years with penetrating wounds of the cornea. All children referred to the clinic with clinical manifestations of endophthalmitis. Visual acuity was reduced from 0,01 up to light perception with the correct projection. Results. Lensvitrectomy allowed to visually detect foreign bodies in vitreous and to remove them through the corneal access. Finished the operation by the intraocular introduction of antibiotics and corticosteroids. Criteria of efficiency of treatment: relief ofthe infectious process, the transparency of optical media, lack of subatrophy ofthe eyeball during the observation period of 3-5 months. Conclusion. Timely primary surgical rehabilitation of children with post-traumatic endophthalmitis appropriate, despite the severity of the injury.

The purpose of the study was to investigate the efficiency of nistagmus treatment method using videooculography in a long-term observation. Material and methods. 288 patients were examined. The nystagmogram had been record-ering at the time of the patient's admission, every day after the treatment and after the entire course of treatment. The video image had been recordering for 1 minute at the sight of the patient directly. Based on the diagnostic results, there had been determining the following parameters: the main nystagmus frequency, the amplitude of the nystagmus (maximum deviation from the central position). The treatment procedure had been carrying out for 7-10 minutes in average, depending on the degree of decrease in the amplitude of the nystagmus. It is necessary to correct the frequency of light stimulus when the main nystagmus frequency changes. Results. Suppression of nystagmus in patients after a single treatment procedure persisted for different times (from several seconds to several minutes), after which the gradual recovery of the nystagmus occurred before the values of the amplitudes less than before the start of the treatment procedure. The result of repeated procedures was a further decrease in nystagmus amplitudes and an increase in the time of preservation of the suppression effect. One course included 7-10 treatment procedures. On average, for 2 courses of treatment per year in 60% of patients the amplitude of nystagmus decreased by 40-85%, in 30% of patients the amplitude of nystagmus did not change more than 8-12%, in 10% of patients there were no significant changes. Conclusion. The developed method using videooculography is effective in the diagnosis and treatment of nystagmus, as it allows to reveal the frequency of nystagmus of each patient with further treatment by light stimulus of the patient at this frequency and the possibility of its correction.

Objective: to evaluate the effectiveness of orthokeratological correction in the treatment of progressive myopia in children. Material and methods. A retrospective study correction of myopia orthokeratology lenses of 100 patients (178 eyes) with an established diagnosis of myopia of an average degree, undergoing treatment at the Clinic of eye diseases of SSMU. Group I consisted of 50 patients who received OK-correction lenses "Emerald" by Euclid Systems Corporation (USA). The wear time is 2 years. Group II included 50 people (87 eyes), using spectacle correction during the same time. Patients underwent visual acuity testing, biomicroscopy, refractometry, determination of reserves of accommodation, ultrasonic biometry (IOL-Master, CarlZeiss) is a measurement of the size of the front-sadayoshi eyeball, survey after 2 years of using the selected correction. Results. Comparative analysis showed that the use of OK lenses for patients with myopia of an average degree resulted in a significant reduction in the rate of progression of myopia. In the background wearing OK lenses for 2 years has been the increase PZO, PZO dynamics were 0.09±0.05 mm. For the correction of progressive myopia spectacle lens changes were more significant, the dynamics of early school leaving amounted to 0,36±0,11 mm. Conclusion. The identified inhibitory effect of OK-lenses on myopia progression, confirmed by the indices of refraction and ultrasound biometry within 2 years of the study. The data allow us to recommend OK-therapy, as an effective tool for progressive myopia.

The objectives of the study are to establish the occurrence of uveitis in patients with rheumatic diseases, to assess the features of the uveitis in rheumatic disease in children and adults, and to analyze the effectiveness of theirtreatment. Materials and Methods. The study included 670 people with RH (stage I) and 35 patients who had uveitis and / or rheumatic fever who agreed to undergo additional ophthalmologic bleeding (stage II), including a standard ophthalmological examination including visiometry, biomicroscopy of the anterior segment, ophthalmoscopy of the posterior segment of the eye, refractometry, optical coherence tomography in angiomode(tomograph-angiograph CIRRUS HD-OCT MODEL 5000 (Carl Zeiss, Germany), dopplerography of the vessels of the eye. Results. The prevalence of uveitis in rheumatic diseases was established in 21%, which is higher than that in the general population. Uveitis in rheumatic diseases is recurrent and well-treated condition with frequent and complete improvement of visual acuity, and angiographycal features of uveitis, p <0,05 for all parameters. Conclusions. The high incidence of uveitis and relapsing their course in rheumatic diseases lead to necessity of an ophthalmologist's examination every 6 months. It is desirable to perform a comprehensive angiographic examination of uvea for the timely detection of erased and subclinical forms of uveitis.