2020, volume 16

The purpose is to perform clinical assessment of neurodegenerative and inflammatory changes in the visual organ in patients with advanced open-angle glaucoma and to identify the relationship between the degree of neurodegenerative and inflammatory changes. Material and Methods. Prospective examination of 26 patients with advanced open-angle glaucoma and 22 patients without changes in eye hydrodynamics with determination of TGF-p and MMR-9 concentrations in lacrimal and anterior chamber aqueous humor. Results. There was a statistically significant decrease in the concentration of MMR-9 in patients with glaucoma by 1.62 times in the lacrimal fluid (p<0.01) and by 2.17 times in the anterior chamber aqueous humor (p<0.05) in comparison with the control group. There was a statistically significant inverse relationship between MMP-9 in the lacrimal and the indicator characterizing a clinical picture of inflammatory reaction of the conjunctiva (p=0.02) and direct interdependence of the concentration of MMP-9 in the lacrimal and the thickness of the nerve fiber layer (p=0.02). Conclusion. The study revealed correlations between the degree of severity of the conjunctival inflammatory response, neurodegenerative changes, and the content of MMR-9 in the lacrimal and aqueous humor of the anterior chamber of patients with open-angle glaucoma.

The purpose of the study is to analyze morphometric parameters of the optic disc, peripapillary retina and ganglion cells complex of the retinal macular area in eyes with different disc area. Material and Methods. 150 patients (294 eyes) aged 62.1 ±9.6 years old were examined (male — 69, female — 81). The eyes were divided into two groups according to the optic disc area (OD): eyes with average disc area (1.63-2.43 mm2) and eyes with small disc area (less than 1.63 mm2). Analysis of the morphometric structure of the OD, peripapillary retina and ganglion cells complex of macula was performed with Heidelberg laser retinal tomography HRT-3 and optical coherence tomography RTVue-100 (Optovue, USA). Computed perimetry of the central visual field was conducted using Carl Zeiss (USA) device with HFA30-2 software. Results. In the group of eyes with small discs according to HRT we revealed the significant difference in the OD parameters (cup area, rim area, cup/disc area) between normal eyes and eyes with preperimetric glaucoma, as well as in the group with average discs (p<0.001). We detected a significant difference of the peripapillary retina parameters (RNFL) between all stages of glaucoma, including normal limits, preperimetric and advanced stages of glaucoma in the group with small discs according to OCT. Conclusion. Both HRT and ОСТ have identical capability in early diagnosis of glaucoma, however, HRT evaluates the optic disc parameters better, while the ОСТ is preferable at peripapillar retina parameters evaluation. Preperimetric glaucoma, being the principal part of diagnosing glaucoma suspect, provides for accumulation of structural alterations of the optic disc and thus early detection of glaucoma.

The purpose of the study is to evaluate major accommodation disorders in patients with ametropy. Material and Methods. Analysis of the accommodation and hydrodynamics eye state was carried out on 235 people (235 eyes) with myopia (1 group) and 52 people (52 eyes) with hyperopia. The age of patients ranged from 18 to 35 years. Results. Accommodation disorders were observed in 82% of myopia cases; they were expressed through weakness of accommodation (49.2%), habitual excess tension of accommodation (HETA) (18.6%), and combined disorders (14.2%). Accommodation disorders were observed in 86.5% of hyperopia cases, which were expressed through accommodation weakness (51.9%), combined disorders (23.1 %), and HETA(11.5%). At myopia, ophthalmic hypertension was observed in 16.4% of cases with HETA and combined accommodation disorders. Ophthalmic hypertension was detected in 5.4% of hyperopia cases against the background of accommodation weakness. Conclusion. HETA and weakness of accommodation are more often observed with an increase in myopia degree, the rigidity values of the corneoscleral membrane and corneal hysteresis decrease. Weakness of accommodation is more often observed with an increase in the hyperopia degree, the rigidity values of the corneoscleral membrane and corneal hysteresis increase.

The purpose of the study is to estimate the efficacy of polymer micro-shunt Reper-NN in combined glaucoma and cataract surgery. Material and Methods. The examination group consisted of 34 patients (34 eyes) with cataract and glaucoma of different stages. All patients were divided into 2 groups: 1)16 patients underwent micro-shunt Reper-NN implantation with simultaneous phacoemulsification with IOL implantation; 2) 18 patients underwent micro-invasive non-penetrating deep sclerectomy with simultaneous phacoemulsification with IOL implantation. The diagnosis was made based on the anamnesis and data of objective and instrumental examinations. Preoperatively all patients underwent examination of visual acuity, intraocular pressure, perimetry, ophthalmometry, ultrasound scanning. Results. Intraocular pressure was normalized in all patients. Conclusion. Combined cataract and glaucoma surgery using polymer micro-shunt Reper-NN is an effective and safe method of treating open-angle glaucoma and cataract.

The purpose of the study is to investigate the clinical effectiveness of prophylactic treatment of women who have previously undergone preeclampsia and are a part of the risk group for the formation of vascular retinal pathology. Material and Methods. The main group consisted of 40 women aged 24 to 43. The selection criterion was presence of a risk of vascular retinal pathology formation. Women of the main group were prescribed periodic courses of preventive treatment for a period of time of 3-4.5 years. The comparison group consisted of 51 women, who underwent preeclampsia, and also had a risk of forming vascular retinal pathology and did not receive preventive treatment. Results. Systematic conduct of preventive treatment courses with antiplatelet agents and antioxidants to women who have undergone preeclampsia and are at risk of vascular retinal pathology formation have been effective. Conclusion. Frequency of vascular retinal pathology formation in the main group decreased to 15% against 34% in the comparison group (p<0.05).

The Purpose of the study is to evaluate the condition of the anterior capsule (AC) in patients with pseudoexfoliation syndrome (PEX) after implantation of intraocular lenses (IOL) of different designs. Material and Methods. Optical coherence tomography of the anterior segment was conducted in 58 patients (70 eyes) with PEX after phacoemulsification with implantation of various acrylic lOLs: planar (52 cases) and step-vaulted (18 cases). Results. Over the long-term period we revealed differences in the relationship of AC and IOL. in most cases of planar IOL implantation, the AC after polishing adjoined the IOL surface without changing its morphology. The epithelial metaplasia was noted after implantation of planar lOLs without peeling of AC. The free edge of the AC with unchanged epithelium was observed in all cases of implantation of step-vaulted lOLs. Conclusion. Polishing the anterior capsule after implantation of planar lOLs allows avoiding significant manifestations of contraction capsular syndrome. Implantation of step-vaulted lOLs excludes contact of the anterior capsule with the IOL surface; no manifestations of epithelial metaplasia were observed.

The purpose of the study is to estimate diagnostic value of optical coherence tomography angiography (OCT-angiography) parameters in patients with diabetic retinopathy. Material and Methods. The investigation included 102 patients with diabetes mellitustype II and different stages of diabetic retinopathy and 48 clinically healthy people. Apart from routine ophthalmological examination all patients underwent optical coherence tomography of the macular area. To estimate diagnostic value of OCT-angiography, we performed ROC-analysis of the most informative parameters. Results. The most significant differences in OCT-angiography data between patients with different stages diabetic retinopathy (groups I and II) and healthy people (control group) were noted for general vascular density in all sectors (Whole image) and parafoveal zone (Parafovea) of the superficial vascular plexus. The ROC-analysis showed high sensitivity and specificity of the same zones for control group and group I, as well as for groups I and II. Conclusion. The capillary network density for Parafovea in patients with diabetes mellitus is less than 52% and for Whole image it is less than 48.5%, which indicates the presence of non-proliferative and pre-proliferative retinopathy, while the reduction of Parafovea parameters lower than 43.6% and Whole image lower than 47.5% indicates proliferative diabetic retinopathy.

The purpose of the study is to evaluate the effectiveness of surgical treatment of double perforating eye injury of different localization and length with the damage to the retina, the vascular layer and the sclera of the posterior eye segment, using platelet rich plasma, including autologous conditioned plasma, without additional scleroplasty and endolaser photocoagulation. Material and Methods. The surgery technique involves carrying out 25+ gauge vitrec-tomy, removing the foreign body, posterior hyaloid membrane, in case of central and paracentral retinal detachment it involved removing the inner limiting membrane. Pneumoretinopexy was performed. After maximum removal of liquid between the air bubble and the tear we carried out instillation of platelet rich plasma or autologous conditioned plasma in 2-3 layers, involving retina around the tear, until full repair of the scleral-choroidal-retinal tear without laser coagulation, additional scleral suturing and external scleroplasty. The study involved nine patients with visual acuity from the incorrect visual projection to 0.02. Results. In the early postoperative period the retina was reattached in all the patients, the scleral-choroidal-retinal tear was blocked. In the long-term (1-12 months) period, no recurrent depressurization of the eyeball wall and retinal detachments were recorded. In two patients the healing was accompanied by the rough chorioretinal scar formation and retinal duplicate in the scarring area. The visual acuity of the operated patients was 0.03-0.4. Conclusion. Surgical treatment of the double perforating eye injury, accompanied by retinal detachment, with the use of platelet rich plasma and autologous conditioned plasma without laser coagulation of the retina, scleral suturing of the posterior eye segment and additional scleroplasty is a method that allows to achieve total scleral and chorioretinal repair and get a good anatomical and functional result.

The purpose of the study is to analyze the structure of eye cancer, its auxiliary structures and the eye socket of Orenburg region residents over the period of time from 2016 to 2017. Material and Methods. The article presents the analysis of the archival material of 294 medical histories (form №003/y) of patients with eye and its subsystem's neoplasms from the Second Ophthalmological Department of the State Medical Institution № 1. The study was carried out on an unselected sample. Results. We obtained data on the prevalence of malignant forms that most often occur in women over 18 (62%). According to histology data, basal cell carcinomas and melanomas with predominant localization on the skin of the eyelids are more common, including adhesions (70.6%) and the vascular membrane of the eye (20%). It is shown that concomitant pathology of the eye and other organs does not significantly affect the development of eye tumors. Conclusion. For timely detection of eye neoplasms and its subsystems, it is necessary to conduct a thorough examination of women of the retirement age in medical institutions at the place of their residence.

Purpose: analysis of hemostasiological and rheological parameters of blood in elderly and mature patients with ulcerative colitis. Material and Methods. In 34 elderly patients and 32 mature patients with ulcerative colitis, we investigated the aggregation ability of platelet, antithrombogenic properties of the vascular wall, blood viscosity; erythrocyte aggregation index, erythrocyte aggregation index, erythrocyte deformability index, erythrocyte deformability index, and the efficiency of oxygen delivery to tissues were determined in comparison with similar indicators in healthy people. Results. In elderly patients with ulcerative colitis, as well as in patients of mature age, changes in the vascular-platelet link of the hemostatic system and blood rheology manifested by inhibition of anti-platelet activity of the vascular endo-thelium, changes in the functional activity of platelets and erythrocytes associated with the severity and activity of the process. Ulcerative colitis was accompanied by the development of the first (compensated) phase of the chronic form of DIC-syndrome. Conclusion. Elderly and mature patients with ulcerative colitis have disorders in the vascular-platelet link of hemostasis and blood rheology, manifested by inhibition of antithrombogenic activity of vascular endothelium, a change in platelet and red blood cell activity.