2020, volume 16

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.

The purpose of the study is to investigate the optic disk and peripapillary retina parameters using SD-OCTA in people of an older age group. Material and Methods. 31 patients (62 eyes), 12 males and 19 females, mean age 57.1 ±9.6 were examined. All patients underwent SD-OCT and SD-OCTA examination (RTVue XR, Optovue), by using protocol HD Angio Disk 4.5*4.5 mm. SD-OCT and SD-OCTA were used to measure the radial peripapillary capillaries (RPC, %) and retinal nerve fiber layer thickness (RNFL, urn), rim area, disc area, cup volume. Results. Mean value of the RNFL thickness was 109.7±11.1 urn. The lower value of the RNFL thickness was observed in "Tempo Inferior" and "Tempo Superior" segments. Rim area was 1.66±0.33 mm2, disc area 1.87±0.28 mm2. The mean value of RPC density in peripapillary retina was 52.2±2.3%. The lower value of the RPC density was in "Nasal Inferior" and "Superior Nasal" segments, 48.9±3.2 and 49.9±3.1 %, respectively. Conclusion. The reference values of the optic disk and peripapillary retina parameters for senior Russian citizens, which were developed with RTVue XR Avanti (Optovue Inc., USA) device, can be used as diagnostic criteria for neuroophthalmological pathology.

The purpose of the study was to analyze corneal topography in patients with cataract after previous anterior radial keratotomy Material and Methods. A total of 118 patients (118 right eyes) with a cataract and history of previous anterior radial keratotomy were examined. The average age of patients was 55.8±6.7 years (from 41 to 72). A comprehensive ophthalmological examination was performed, including the topography of the cornea using a Pentacam HR apparatus (Oculus, Germany) with the determination of elevation points of the anterior cornea. Results. The regular post keratotomy profile was revealed in 105 patients (89%), with flattening of the cornea in the central zone by an average of -10.40±3.31 urn (from-48.40 to 12.80 urn). The wrong profile with irregular flattening zones outside the optical center was detected in 13 patients (11 %). In most cases, patients with wrong profile had surgery for retinal detachment and anti-glaucoma surgery in (61%), while in the group with the correct profile it was observed only in 17% of cases. Conclusion. Corneal topography allows to establish the pattern of the post keratotomy corneal deformation, to identify its irregular zones, and to determine features of the central optical zone. Patients within correct cornea profile were older at the time of radial keratotomy. Cornea in patients with a complicated medical history is exposed to additional bio-mechanical loads, which negatively affects keratotopography.

The clinical case demonstrates high refractive efficacy and safety of photorefraction keratectomy in final correction of residual myopia and complex myopic astigmatism after MyoRing implantation.

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.

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.

The purpose of the study is to analyse myopic progression in association with orthokeratological (OK) correction. Material and Methods. We studied medical histories of 416 patients (832 eyes) with mild, average and high myopia in association with OK correction. Apart from routine ophthalmic examination, all patients underwent optical biometry on the IOL-Master (Carl Zeiss) device before OK lens fitting and every year of wearing the lens (maximum 5 years). Treatment results of patients with visual acuity 0.9-1.0 and 0.7-0.8 in association with OK correction were compared separately. Results. We noted an increase in the axial length of the eye (АРА) in the majority of patients. Significant differences of the annual gradient of myopic progression were revealed: it was significantly lower in patients with visual acuity 0.9-1.0 in association with OK correction in comparison with patients with hypocorrection and visual acuity 0.7-0.8. Conclusion. In cases when OK lenses are fitted to slow down myopic progression, it is necessary to achieve full myopic correction and maximum visual acuity (0.9-1.0).

The article presents a clinical case of successful treatment of a premature baby with congenital essential esotropia. The diagnosis was made in the sixth month of life. The patient was recommended spectacle correction taking into account the parameters of ametropia and constant alternating occlusion. In connection with the subsequent increase in horizontal esodeviation and the appearance of a paretic component, a bilateral recession of the internal rectus muscle by 5 mm was carried out in combination with an injection of Botox in a volume of 2.0 IU. After the first stage of surgical treatment, a stable decrease of horizontal esodeviation and an increase of the amount of abduction were achieved. Bilateral combined weakening of medial rectus muscles (classical recession and chemorecession) allows to achieve predicted good results in cases of large strabismus angles, combined with limitation of abduction.