Saratov JOURNAL of Medical and Scientific Research

2020, volume 16

Combined operations for cicatricial entropion of the eyelids

Year: 2020, volume 16 Issue: №2 Pages: 633-635
Heading: Ophtalmology Article type: Original article
Authors: Nuraeva А.В., Galimova V.U.
Organization: Bashkir State Medical University of the Russian Health Care, Russian Eye and Plastic Surgery Center
Summary:

The purpose of the study is to evaluate the efficiency of combined operations with the use of allogeneic biomateri-als in patients with eyelids cicatricial entropion. Material and Methods. The group under study included 45 patients (50 eyes) aged from 5 to 71 years with cicatricial entropion and trichiasis of eyelids. The patients underwent reconstructive operations with the use of the allograft for eyelid plasty, allotendinous sututres and automucous membrane of lip. The efficiency of the performed operations was evaluated according to the following criteria: the position of the eyelid margin; the width of the palpebral fissure, the degree of the eyelids closure and presence of lacrimation. Results. In the early postoperative period (up to 14 days), all patients had correct position of the eyelids margin and narrowing of the palpebral fissure (up to 7-8 mm, absence of lagophthalmus. 9 patients still had lacrimation. In the long-term follow-up period (up to 3 years), we observed complete elimination of entropion, restoration of the palpebral tissue size and complete closure of eyelids in all patients. Conclusion. The use of the allogeneic biomaterials in the reconstruction of the eyelids with cicatricial entropion allows to eliminate eyelids deformation, lacrimation and lagophthalmus; to restore anatomical position and lost functions of the eyelid. The results of the study showed that it is possible to use the combined surgical intervention with simultaneous use of allogeneic grafts and automucous membrane of lip for complex cases of eyelids entropion.

Keywords: Alloplant biomaterials, cicatricial entropion of the eyelid

Analysis of the results of implanting intraocular lens with low-addition power and asymmetric optics

Year: 2020, volume 16 Issue: №2 Pages: 628-632
Heading: Ophtalmology Article type: Original article
Authors: Nenasheva Yu.V., Fabrikantov O.L.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

The purpose of the study is to analyze clinical and functional treatment outcomes and usefulness of visual rehabilitation in patients implanted with IOL Lentis Comfort. Material and Methods. 64 patients were examined. Patients of group one underwent cataract phacoemulsification with IOL Lentis Comfort implantation, patients of group two were implanted with IOL Acrysof Restor. Non-corrected and corrected distance visual acuity, for intermediate distance (70 sm) and near visual acuity (30-40 sm) were examined on the 2nd day, in a month and in 6 months postoperatively. In 6 months after surgery subjective assessment of patients' satisfaction with the quality of vision was conducted using a questionnaire. Results. High distance visual acuity was revealed in both groups, visual acuity for intermediate distance was significantly higher in patients of group one, near visual acuity was higher in patients of group two. According to the questionnaire results patients of both groups did not experience difficulties in working and driving during the day, at night, patients of group two were much more likely to report difficulties in driving a car and undesirable light phenomena. Conclusion. Implantation of IOL with low-addition power and asymmetric optics provides high quality vision at various distances. The low level of undesirable light phenomena contributes to rapid adaptation of patients in the postoperative period.

Keywords: cataract, Lentis Comfort, multifocal IOL, phacoemulsification

Experimental muscle reinnervation by allogeneic biomaterials as an example of interlevel relationship restoration in the system

Year: 2020, volume 16 Issue: №2 Pages: 623-627
Heading: Ophtalmology Article type: Original article
Authors: Musina L.A., Shangina O.R., Nigmatullin R.T., Muslimov S.A.
Organization: Russian Eye and Plastic Surgery Center
Summary:

The purpose of the study is to reveal the morpho-functional relationship dynamics of allografts and the recipient's nervous system based on the experimental model of the mimic musculature reinnervation. Materials and Methods. The experiments were carried out on Chinchilla rabbits (n=36). Facial nerve transection has been performed on all animals. No other manipulations were performed in the control group (n=9); in the 1st experimental group (n=12) an autograft fragment of the masseter muscle with a neurovascular bundle was fixed to the denervated cheek muscle. In the second experimental group (n=15) a complex of allogeneic biomaterials namely, "Regeneration stimulator" and "Vasculogenesis stimulator" was inserted between specified muscles. The animals were removed from the experiment on the 10-th, 30-th, 60-th and 180-th days. Tissue pieces from the operation zone were analysed with the use of transmission electron microscopy method. Results. It was established that compensatory-restorative processes in the control and 1st experimental group ended in scarring of the border zone and contracture of the mimic muscles. In the second experimental group we revealed a mimic musculature revascularization, as well as ingrowth of axons into the muscle and restoration of the neuromuscular synapses. Conclusion. Allogeneic biomaterial transplantation creates adequate conditions for restorations of the organic vascular bed and innervative apparatus of the denervated mimic muscles. The obtained results of the experiment can be regarded as one of the examples of the interlevel relationship restoration in the system following the use of allogeneic biomaterials.

Keywords: allotransplantation, biomaterials, muscle reinnervation

Deep anterior keratoplasty in the treatment of keratoconus

Year: 2020, volume 16 Issue: №2 Pages: 619-623
Heading: Ophtalmology Article type: Original article
Authors: Lev I.V., Fabrikantov O.L.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

The purpose of the study is to estimate the results of deep anterior keratoplasty in the treatment of keratoconus during the period of time from 2016 to 2020 based on Tambov branch data. Material and Methods. The main group included 26 patients (28 eyes) diagnosed with III-IV degree keratoconus and undergone deep anterior lamellar keratoplasty (DALK). The control group included 11 patients (12 eyes) with penetrating keratoplasty (PK). All patients underwent ophthalmologic examination before and after surgery, including routine and special (keratotopography, keratopachym-etry, endothelial biomicroscopy) methods of examination. Results. The prevalence of keratoconus in Tambov region is 0.59%, moreover keratoconus occurs in men 2 times more often than in women. Transparent engraftment of the transparent cornea was obtained in 100% of DALKs and only in 84% of PKs. In the group of patients with PK all changes in corrected visual acuity were statistically insignificant, while in the group of patients with DALK they were significant at all stages of examination. One year after surgery the corrected visual acuity was 0.64±0.23 and 0.57±0.27 in the main and control groups correspondingly (p<0.05). The endothelial cell loss one year after surgery was 10.5 and 5.1% following DALR and PK correspondingly (p<0.05). Conclusion. The analysis of DALK and PK outcomes in patients with keratoconus shows that DALK is characterized by shorter period of rehabilitation, absence of rejection reaction, stable visual acuity restoration, and lower rate of endothelial cell loss.

Keywords: deep anterior lamellar keratoplasty, endothelial cell density, keratoconus, visual acuity

Morphological aspects of restoring a rat's eye socket defect with elastin-based biomaterial

Year: 2020, volume 16 Issue: №2 Pages: 614-618
Heading: Ophtalmology Article type: Original article
Authors: Lebedeva A.I., Nigmatullin R.T., Kutushev R.Z.
Organization: Bashkir State Medical University of the Russian Health Care, Russian Eye and Plastic Surgery Center
Summary:

The purpose of the study is to identify morphological aspects of replacement of xenogenic decellularized elastin matrix (DXEM) transplanted into a bone defect of the upper wall of the rat's eye socket. Materials and Methods. The experiment was performed on 60 Wistar rats, which produced a 7x4 mm defect in the upper edge of the orbit. DXEM was placed in the defect zone, in the experimental group (n=30). The size was similar to the defect and was fixed with a suture material-silk 50 microns. Soft tissues were sutured in layers in the control group (n=30). Tissue excision was performed after 1, 3 and 12 months. Histological, immunohistochemical and electron microscopic methods were used. Results. DXEM was gradually replaced by bone tissue against the background of a pronounced reaction of CD68+/MMP-9+ macrophages. This indicated its resorption and lysis. Osteogenesis occurred endesmally, periostally, which was preceded by centripetal migration of endothelial kidneys with subsequent differentiation into hemocapillaries and growth of loose fibrous connective tissue with progenitor cells. The microenvironment could contribute to differentiation of progenitor cells in the osteogenic direction and osteogenesis represented by reticulin fibers, TGFb, sulfated glycosaminoglycans in the control group, the defect remained open throughout the experiment. Conclusion. Decellularized biomaterial based on elastin matrix has osteoconductive and osteoinductive characteristics and can serve as an adequate biomimetic for bone defects restoration.

Keywords: eye socket bones, regeneration, transplantation, xenogenic elastin biomaterial

Anatomical and biomechanical substantiation of the transplant for reconstructive surgery of the orbit bone walls

Year: 2020, volume 16 Issue: №2 Pages: 610-614
Heading: Ophtalmology Article type: Original article
Authors: Kutushev R.Z., Nigmatullin R.T., Musina L.A., Pervushin Yu.S., Gizatullina E.R.
Organization: Bashkir State Medical University of the Russian Health Care, Russian Eye and Plastic Surgery Center, Ufa State Aviation Technical University (USATU)
Summary:

The purpose is to study biomechanical parameters of elastin biomaterial's (BM) fibroarchitectonics. Material and Methods. For the study we usedxenogenic biomaterial made on the basis of the ligamentum nuchae (L. n.)) Bos taurus taurus, L. 1758. For histological examination of BM (n=24), we used electron microscopy (Jem-1011 microscope) and reflected light microscopy of histotopographic sections in the three planes, taking into account the orientation of elastic fibers (EF). Sections were stained with oreina, as well as according to Mallory and Van Gizon, they were impregnated according to Fut method. The mechanical properties of the material were studied on 11 samples with a size of 10x8x16 mm using a Zwick/Roell Z010 breaking machine, which allows for compression deformation. The strength of the suture fixation was determined by the tensile load (Pmax). To characterize the elastic properties of BM, the Young's modulus was calculated. Results. In the elastic deformation zone, the Young's modulus was 1.74±0.1 N/mm2. Subsequent loading of the BM led to deformations with stratification and formation of lamellar fragments. After removing the load, the BM restored its shape and size. BM fibroarchitectonics provides high strength of suture fixation. Conclusion. The BM fibroarchitectonics and the set of its structures form a single elastic-collagen complex. The results allowed us to develop structurally modified BM with osteoinductive properties.

Keywords: elastin biomaterial, osteoinductive biomaterials

Effect of solar activity and gestational age on the development of retinopathy of prematurity

Year: 2020, volume 16 Issue: №2 Pages: 605-609
Heading: Ophtalmology Article type: Original article
Authors: Kutimova E.Yu., Fabrikantov O.L., Matrosova Yu.V., Shutova S.V.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin
Summary:

The purpose of the investigation is to analyze prevalence and progression of retinopathy of prematurity depending on gestational age and solar activity at the time of birth. Material and Methods. 229 cases of premature babies born from 2017 to 2019 were randomly selected. They were divided into two groups: group I — children with retinopathy of prematurity (1, 2 and 3 degree) and group II —without any retinopathy (pre retinopathy). The disease outcome was taken into account in children with retinopathy of prematurity: children undergone laser coagulation (LK) and spontaneous regression. Based on the date of birth all children were divided according to seasons (winter, spring, summer and autumn) and periods of solar activity: reduced (winter-autumn) and increased (spring-summer) solar activity. Results. The study revealed a strong direct relationship between the outcome of retinopathy and gestational age and seasonal solar activity. Conclusion. In children born in spring and summer, the rate of spontaneous regression of retinopathy is significantly lowerthan in children born in the winter-autumn period. Reliable correlations were obtained: the longerthe gestational age and birth weight, the less likely it is to require laser coagulation.

Keywords: gestational age, preventive, retinopathy of prematurity

Modern view on the problem of optic neuritis (systematic review)

Year: 2020, volume 16 Issue: №2 Pages: 602-605
Heading: Ophtalmology Article type: Review
Authors: Krivosheeva M.S., loyleva Е.Е.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, State Budgetary Healthcare Institution of the Moscow Region «Sergiev Posad District Hospital»
Summary:

The review discusses modern concepts of etiopathogenesis, clinic, diagnosis, treatment and preventive measures for optical neuritis, as well as the position of modern ophthalmology on the principles of management of patients with optical neuritis of various etiologies. The review includes 14 sources over the past 25 years from Russian (Elibrary CyberLeninka) and international (PubMed) databases.

Keywords: microperimetry, optic nerve,, optic neuritis, spectral optical coherence tomography

Method for intraocular lens reposition with suture fixation in the ciliary sulcus (clinical case)

Year: 2020, volume 16 Issue: №2 Pages: 599-602
Heading: Ophtalmology Article type: Case report
Authors: Kislitsyna N.M., Sultanova D.M., Dibirova S.M., Kurakina E.S.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to provide a method for repositioning intraocular lens (IOL) with suture fixation to the sclera in the projection of the ciliary furrow based on the example of a clinical case. The article presents the method for suture fixation of IOL dislocation (T-26 model). It describes a method of IOL reposition with suture fixation into the ciliary sulcus. Procedure stages: this method of IOL suture fixation is performed using two needles connected by a thread of polypropylene 10-0 (MANI sutures polypropylene 10-0). Using a guide needle 30G through the paracentesis, the needles are inserted above and below the IOL haptic element at the 6 o'clock position. The formed thread loop fixes the IOL in the projection of the ciliary sulcus to the sclera. Visual acuity on the first day after surgery was established at 0.7; IOP 19.0 mm Hg. At the control check-up after 7 days, visual acuity is 0.9 without additional correction; IOP 18 mm Hg. The proposed method of IOL reposition with suture fixation in the ciliary sulcus is associated with atraumatic, simple implementation and allows to achieve good functional and anatomical results in the treatment of patients.

Keywords: ciliary sulcus area, intraocular lens dislocation, intraocular lens reposition, transscleral fixation

Comparative characteristics of operational access during surgical treatment of strabismus

Year: 2020, volume 16 Issue: №2 Pages: 595-599
Heading: Ophtalmology Article type: Original article
Authors: Gorbenko V.M., Zakharova I.A.
Organization: Medical Diagnostic Centre «Sokol» LLC, S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to conduct comparative analysis of the two types of surgical approaches used in strabismus surgery: vertical and limbal L-shaped. Material and Methods. Analysis of surgical treatment of strabismus in 137 (205 eyes) patients aged 4 to 15 years was performed. During surgery, access to the surgical field was carried out by a vertical conjunctival incision in 143 cases (69.8%), by limbal incision — in 62 cases (30.2%). Results. Duration of hyperemia and edema in the group with limbal access is significantly shorter than in the group with vertical conjunctival access (12.2±0.14 and 24.5±0.15 days, respectively) (p<0.001). Reactions to suture material in the group with limbal access were shown only in 2 cases (3.2%), and in the group with vertical access — in 23 cases (16.1%) (p<0.01). Conclusion. An individual approach must be taken for each patient, taking into account the goals and scope of the procedure. When performing surgery on two adjacent muscles, preference should be given to conjunctival access, and when working on one muscle, to limbal access. For operations of the reinforcing type, it is preferable to use limbal access, and for weakening operations, it is more advisable to conduct conjunctival access. In children of a younger age group and in patients with a history of allergic reactions, it is better to conduct operations with limbal access.

Keywords: operational access during treatment of strabismus, strabismus