№1, 2020, volume 16

The purpose is to analyse the safety of radio-wave strabismus surgery using the FOTEK device. Material and Methods. The results of surgical treatment of strabismus were analysed in 283 patients. Results. The duration of the procedure using the FOTEK device was 12±0.5 minutes for operations on 1 muscle and 18±0.3 minutes for operations on 2 muscles involved, М±ст In the control group the duration of the operation was 16±0.4 and 25±0.5 minutes, M±a Intraoperative bleeding was recorded in the control group, which worsened the visibility of the surgical field and required additional time to stop the bleeding. Conclusion. The FOTEK device reduces the probability of hemorrhagic complications during surgical treatment of strabismus and shortens the duration of the operation.

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.

The purpose of the study is to analyze the possibilities of color duplex scanning in assessing the state of ocular blood flow at various stages and forms of active retinopathy of prematurity (ROP). Material and Methods. A study of blood flow in the vessels of the eye and orbit was performed in 16 children (30 eyes) with various stages of active ROP at 6-10 weeks of life (post-conceptual age 36-38 weeks). A study of the blood flow in the vessels of the eye and orbit was performed by using the duplex scanning method in the modes of color Doppler mapping and pulsed Doppler ultrasound. The control group consisted of 9 premature infants without signs of ROP. Blood flow was evaluated in the ocular artery (OA), central retinal artery (CRA), central retinal vein (CRV), medial and lateral posterior short ciliated arteries (PSCA). The Doppler frequency shift spectrum (DFSS) was recorded and quantitative blood flow parameters were determined in these vessels, i. e. the maximum systolic rate (V ), the final diastolic rate (Vdiast), and the index of resistance or peripheral resistance (Rl). Results. The first and second stages of ROP were characterized by decreasing V in the orbital artery. A significant increasing V was detected in children with the third stage of ROP. Values of V in the orbital artery at all stages of ROP were significantly reduced if compared with the control group. The decrease of blood flow velocity index in the central retinal artery was detected in children with ROP. At the same time, a dependence of a greater extent on the type of pathological process than on the stage was found. We observed a significant increase in the Vsyst during the fourth stage. Analysis of blood flow in the posterior short ciliary arteries revealed the decreasing V during the first, second and third stages of ROP. The increase of the resistance index was revealed in all vessels under study. Conclusion. Presence of varying severity of hemodynamic disturbances of ROP was established. Color duplex scanning has significant diagnostic potential in assessing the hemodynamic parameters of the eyeball and orbit vessels, it is highly reproducible and objective.

The review is devoted to minimally invasive methods of surgical treatment of keratoconus. Typical clinical manifestations of keratoconus are patients' young age and progressive course of the disease. Therefore, the problem of increasing keratoconus treatment effectiveness, especially at the early stages using minimally invasive techniques, does not lose its relevance, that determines the variety of the proposed methods and technologies and their modifications. Scientific literature review showed high activity of researchers aimed at developing new and improving the existing minimally invasive methods for surgical treatment of keratoconus. A significant number of publications is devoted to intrastromal keratoplasty (ISKP) with implantation of corneal segments. The ongoing studies touch upon both ways of forming the intrastromal tunnel, and the design of new models of the corneal segments, as well as the comprehensive analysis of their clinical application results. Special attention should be paid to the precision of performing ISKP to achieve high functional results and patient satisfaction with the quality of vision. In our opinion, this direction of research is especially promising and requires further development.

The article covers the main aspects regarding prevalence, pathogenesis, diagnosis and treatment of progressive, degenerative, non-inflammatory corneal disease, i. e. keratoconus. Characteristic features of this pathology affect people of a young and working age, and cause high rates of visual disability. Keratoconus is a multifactorial disease that requires individual approach in each clinical case. Existing methods of diagnosis and treatment allow to achieve stabilization of the ectatic process at an early stage and increase the visual functions of the patient. New methods of this disease treatment are alternative and high-tech methods that allow to expand the arsenal of corneal surgery without donor material use.

The purpose of the study is the clinical-functional evaluation and development of intrastromal keratoplasty using a digital marking device in patients with keratoconus. Material and Methods. 60 patients (60 eyes) diagnosed with second degree keratoconus were included in the study. The patients were from 19 to 35 years old. 30 patients (30 eyes) were included in the main group and underwent femtolaser intrastromal keratoplasty controlled by the Verion Digital Marker digital marking device (Alcon, USA). 30 patients (30 eyes) were included in the control group and underwent standard femtolaser intrastromal keratoplasty. Results. By the end of the observation period we recorded an increase in uncor-rected visual acuity from an average of 0.25 to 0.6, as well as corrected visual acuity from an average of 0.5 to 0.7 in the main group. Visual acuity was lower in control group, which was probably due to the fact that cyclotorsia was not taken into consideration during surgery. In the course of dynamic observation, we recorded a decrease in keratometry indices in the main group in the course of 3 months, next, in the following 12 months their stabilization was observed. In the course of dynamic observations in the main group, we recorded a decrease in keratometry indices in the course of 3 months, next, in the following 12 months their stabilization was observed. Conclusion. Application of Verion navigation system during intrastromal keratoplasty using a femtosecond laser with consideration of eye cyclotorsia has shown high efficiency in achieving precise positioning of the corneal segments.

The purpose of the study is to develop an algorithm that increases the accuracy of diagnosing initial open-angle glaucoma using Heidelberg edge perimetry and retinal tomography. Material and Methods. The study involved 624 patients (624 eyes): 236 males and 388 females. The mean age was 63.4±9.3 years old. All patients underwent routine ophthalmic examination, Heidelberg edge perimetry (HEP), and Heidelberg retinal tomography (HRT) depending on the results achieved. Results. The study revealed both direct and inverse relationships between the disease and particular HRT parameters. We established quantitative characteristics of the optic disc parameters, where pathological alterations were revealed receiver operating curve (ROC-analysis) mathematical method. We analyzed the data from the positions of attribution of a patient's individual parameters to the risk factor according to the received cut-off point limit values. Seven main parameters, which received the best evaluation of diagnostic informativity according to ROC-analysis, were assessed. Then we compared the number of risk factors and the real value of the sick/healthy characteristic. Conclusion. We have developed a new algorithm to diagnose the initial open-angle glaucoma. According to this algorithm, the most applicable diagnostic practice is to set the diagnosis in the presence of five risk factors in the individual optic disc values with 95% specificity.

The article presents the clinical case that demonstrates the result of successful single-stage safe explantation and reimplantation of the TICL Staar posterior chamber phakic intraocular lens, which confirms potential reversibility of the phakic correction method. Implantation of phakic intraocular lens makes it possible to obtain maximum visual functions and high quality of vision, in the absence of contraindications to an active lifestyle at a young age.

The purpose of the study is to evaluate the possibility of using Micropulse technology in combined treatment of refractory glaucoma, including implantation of an Ex-PRESS micro shunt and one-stage micropulse sectoral cyclophotocoagulation (mCPC). Material and Methods. The study included 25 patients with advanced stages of previously operated primary open-angle glaucoma. IOP before surgery averaged 35.3±4.4 mmHg. Surgical treatment was carried out using combined method, including implantation of an Ex-PRESS micro shunt and one-stage sectoral mCPC. Results. In 2 cases in the early postoperative period, according to the B-scan, a detachment of the choroid was diagnosed, which was treated with medication. The IOP level on the first day after surgery averaged 8.3±1.4 mmHg, after 12 months of observation 19.9±4.1 mmHg, while hypotensive drops were re-appointed in 2 cases. Before surgery all patients underwent ultrasound biomicroscopy with measurement of the ciliary body (CB) thickness, which was an average of 0.69±0.04 mm before surgery. After 12 months of follow-up, no cases of postoperative atrophy of CB were diagnosed, the CB thickness was 0.67±0.03 mm on average. Conclusion. Combined treatment of refractory glaucoma, including implantation of the Ex-PRESS micro shunt and one-stage mCPC, is an effective and safe method for IOP reduction.

The purpose of the study was to perform retrospective analysis of laser hyaloid puncture results depending on the period of its performance after the occurrence of Valsalva retinopathy. Material and Methods. Retrospective analysis of the results of laser intervention in 17 patients with Valsalva retinopathy aged 24 to 48 years at the time of the disease from 1 to 30 days (12.3±0.8) was performed. To carry out the laser hyaloid puncture, an Aura laser unit (LUMENEIS, USA) with a wavelength of 1064 nm was used. Results. All the procedures were performed without complications. Laser hyaloid puncture was carried out on 6 eyes (35.3%) within 10 days after hemorrhage, on 9 eyes (52.9%) after 11-21 days and on 2 (11.8%) after 23 and 30 days. The average increase in vision acuity 1 hour after surgery comprised 0.38±0.18. One month after the surgery, in patients operated on during the first 7-10 days after the occurrence of preretinal hemorrhage, an average visual acuity (0.93±0.07) was statistically significantly higher (P<0.05) compared with the average visual acuity of patients, who underwent the laser hyaloid puncture after 11-21 days (0.75±0.11) and 22-30 days (0.65±0.21). Conclusion. Laser hyaloid puncture performance in the early period after the occurrence of preretinal hemorrhage is pathogenetically justified and allows to restore the visual functions of patients and their working ability in the shortest period of time.