Saratov JOURNAL of Medical and Scientific Research

2020, volume 16

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.

Keywords: iris-lens diaphragm, optical reconstructive surgery, tumor progression

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.

Keywords: endothelial dysfunction, endothelin-1, preeclampsia

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.

Keywords: subthreshold micropulse laser treatment, platelet autoplasma

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

Year: 2020, volume 16 Issue: №2 Pages: 658-662
Heading: Ophtalmology Article type: Original article
Authors: Sosnovskii S.V., Boiko E.V., Oskanov D.H.
Organization: Military Medical Academy n.a. S. M. Kirov, North-West State Medical University n.a. I.I. Mechnikov, Department of Neuropathology Assistant Professor, Candidate of Medical Science, S. Fyodorov Eye Microsurgery Federal State Institution
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.

Keywords: age-related macular degeneration, angiogenesis inhibitors, choroidal neovascularization, RPE — choroid graft trans-location, subretinal surgery

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.

Keywords: implantation of “reverse” intraocular lens, high myopia

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.

Keywords: calculation of square of iris defect, grid palette, iridoplasty, iris-lens diaphragm implantation, post-traumatic aniridia

Flash visual evoked potentials and psychophysi-ological indicators of the visual system with visual acuity "hand motion"

Year: 2020, volume 16 Issue: №2 Pages: 647-652
Heading: Ophtalmology Article type: Original article
Authors: Sirotkina I.V., Gareev Е.М., Mikhaylova G.M., Shakirova E.R., Koshelev D.I.
Organization: Russian Eye and Plastic Surgery Center
Summary:

The purpose of the study is to investigate the distribution of the amplitude and time parameters of visually evoked potentials and their relationship with the psychophysiological indicators of the visual analyzer in visual acuity "hand motion". Material and Methods. Data from 85 eyes were analyzed: 36 eyes with predominant impairment of retinal functions, 36 eyes with predominant impairment of the optic nerve, and 13 eyes with the predominant impairment of the optical media of the eye. The LED flash response was registered on the Neuro-MVP-4 device. The severity of detection was assessed using the CAMEL software. The threshold of electrical sensitivity was measured on the ESOM-Comet device. Results. All the parameters under study had a significant variation. The latency of flash VEP components had statistically significantly higher values in the group with predominant dysfunction of the optic nerve (p<0.01). The amplitude of the VEP was significantly higher in the group with the impairment of the transparency of optical media of the eye (p<0.01). There were no close correlations between the amplitude-time parameters of the flash VEP and the psychophysiological parameters of the visual system (т<0.20, p>0.05). Conclusion. The methods under study can be used with different efficiency in monitoring the functional state of the visual analyzer. The obtained data indicate the need for comprehensive assessment of visual functions in the non-visible area for effective monitoring of residual visual functions.

Keywords: blindness, detection acuity, electric sensitivity threshold, flash VEP, “hand motion”

Indocyanine green angiography: perspective on use for identifying the malignant vascula-ture of choroidal melanoma (review)

Year: 2020, volume 16 Issue: №2 Pages: 642-646
Heading: Ophtalmology Article type: Review
Authors: Samkovich Е.М., Panova I.E.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

Choroidal melanoma refers to malignant tumors characterized by high aggressiveness in terms of local distribution, the occurrence of loco-regional and distant metastasis, which determines its high social value. The risks of metastatic disease depend on the size of the tumor, timing of observation, clinical and morphological characteristics and genetic factors. This review presents data on the study of aspects of the development and growth of choroidal melanoma, in terms of neoangiogenesis and the phenomenon of vasculogenic mimicry, the capabilities of indocyanine green angiography in identifying abnormal vascular network of the tumor. The relevance of this question is determined by the characteristics of the development of choroidal melanoma, which can occur as de novo or by malignant transformation of pigmented nevi and the critical point for its development is the tumor thickness of more than 2 mm, which starts the process of neoangiogenesis. Indocyanine green angiography, which is aimed at the identification of vascular network of choroidal melanoma plays an important role not only in the differential diagnosis of this pathological condition, but is of considerable practical interest in planning treatment, assessing its effectiveness and predicting the risk of metastatic process development. Methods used to find, select, obtain information and synthesize data: search for information on the Internet: Google Scholar, PubMed, eLibrary. The number of sources is 39 (from 1974 to 2019).

Keywords: choroidal melanoma, indocyanine green angiography, neoangiogenesis, ophthalmooncology, uveal melanoma, vasculogenous mimicry

Analysis of six formulas for intraocular lens optic power calculation precision in eyes with axial length of 20-22 mm

Year: 2020, volume 16 Issue: №2 Pages: 638-642
Heading: Ophtalmology Article type: Original article
Authors: Pershin K.B., Pashinova N.F., Likh I.A., Tsygankov A.Yu.
Organization: Ophthalmological clinics «Eximer»
Summary:

The purpose of the study was to conduct comparative analysis of the accuracy of IOL optical power calculation for eyes with an axial length of 20-22 mm and 22-24 mm. Material and Methods. 147 eyes of 104 patients were included in the study. The study group (I) included 56 patients (81 eyes) with short eyes (average axial eye length 21.17±0.56 (20.02-21.98 mm). Comparison group (II) consisted of 48 patients (66 eyes) with a normal axial length of 22.75±0.46 (22.0-23.77) mm. The IOL optical power was calculated using the SRK/T formula, and the retrospective comparison was made using the Hoffer-Q, Holladay 2, Olsen, Haigis and Barrett Universal I formulas. Results. Group I was characterized by statistically insignificant (p<0.05) differences in the average estimation error for Holladay 2, Hoffer-Q, SRK/T, Olsen and Barrett Universal II formulas (0.19±0.14, 0.23±0.08, 0.15±0.09, 0.21±0.13 and 0.17±0.21 D respectively). When using the Haigis formula, the smallest average estimation error was obtained (0.11±0.02), the differences are significant at the trend level (0.05

Keywords: formula for calculating IOL, hyperopia

The vitreoretinal interface pathology and anti-VEGF therapy of macular edema in diabetic angioretinopathy

Year: 2020, volume 16 Issue: №2 Pages: 635-638
Heading: Ophtalmology Article type: Original article
Authors: Oskanov D.H., Sosnovskii S.V., Boiko E.V.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to assess the effect of vitreoretinal interface changes in patients with diabetic macular edema as far as the effectiveness of anti-VEGF therapy is concerned. Material and Methods. The study included 198 patients (198 eyes) with diabetic macular edema (DME). Two groups were formed: group 1 — patients without pathological changes in vitreoretinal interface (VRI); group 2 — patients with pathological changes in VRI. We studied the best-corrected visual acuity according to the Snellen table, central retinal thickness and VRI condition according to optical coherence tomography before the intravitreal administration and 1 month after. Results. Significant differences in best-corrected visual acuity were observed before and 1 month after intravitreal administration in both groups (p<0.05). A significant decrease in central retinal thickness in both groups was revealed (p<0.001). A statistically significantly larger average decrease in the thickness of the central retinal in group 1 was obtained (p<0.001). Conclusion. Improvement in visual acuity is significant in anti-VEGF therapy of DME with normal VRI, while with the pathological VRI it is not significant. The degree of improvement in average visual acuity and the degree of decrease in the average thickness of the central retina during anti-VEGF therapy of DME is significantly lower in the presence of VRI pathology. Presence of the vitreoretinal interface pathology reduces the effectiveness of antiangiogenic therapy of DME.

Keywords: antiangiogenic therapy, diabetic angioretinopathy, vitreoretinal interface