№3, 2021, volume 17

The review is devoted to the most promising technologies that are important for the development of ophthalmology. The article provides an overview of the latest trends, focused on improving the quality of diagnosis and treatment of diseases of the visual system. Printed publications and electronic editions were analyzed. The depth of the literature search was 12 years. The review is based on the study of 26 foreign and 4 domestic sources obtained from international medical databases PubMed, Cochrane and e-Library for 2008-2021. The analysis of modern data concerning the development of algorithms for the diagnosis of retinal pathology, new approaches to the implantation of a visual prosthesis and the use of robotic devices and technologies in ocular surgery.

Purpose: increasing the effectiveness of therapy in patients with primary open-angle glaucoma (POAG) by developing combined magnetic and laser exposure. Material and Methods. 199 patients diagnosed with POAG I (n=66), II (n=68), III (n=65) stages were examined. Patients of the main group (n=103) underwent rotational laser magneto-stimulation in the projection of the eye drainage system using the AMO-ATOS-ICL treatment; control group patients (n=96) received local antihypertensive therapy. Ophthalmological examination, intraocular blood flow examination, electrophysiological examination were carried out; determined the level of monocytic chemoattractive protein (MCP-1), vasculoendothelial growth factor (VEGF) in blood serum. Results. Rotational laser magnetostimulation is most effective in the treatment of patients with early glaucoma changes, which is confirmed by the following indicators: increase in the amplitude of the P100 peak by 24.1 %; decrease in latency by 10.2%, p<0.001; an increase in the coefficient of ease of outflow by 13.3%; decrease in true intraocular pressure by 7.6%, p<0.001; increase in the minimum diastolic blood flow velocity by 9.7%, p=0.003; decrease in the resistance index in the posterior short ciliary arteries by 16.4%, p=0.001. Conclusion. The developed and tested in clinical practice technique of rotary laser magnetostimulation of the eye drainage system turned out to be effective in the immediate and long-term follow-up of patients.

Purpose: to assess the definition of surgical intervention in visually stressed patients with monocular cataracts, depending on the magnitude of visual acuity. Material and Methods. The study involved 22 volunteer test subjects (men) aged 30-35 years with emmetropic refraction. Experimental evaluation was performed by the plus spherical glass method. The indicator of the quality of accompanying tracking was used as a criterion for the level of visual performance. Results. In the range of optical modeling, a decrease in visual acuity to 0.6-0.9 visual performance was noted at a high level, amounting to 94.8-99.0% of the control values. A further decrease in visual acuity (from 0.5 to 0.3) led to a pronounced statistically significant decrease in visual performance to 74.3-80.6% of the control values (p=0.004-0.036). Conclusion. Surgical treatment of monocular cataract in visually strenuous labor patients should be considered from the standpoint of an earlier surgical intervention, which is confirmed (under conditions of optical-physiological modeling of a decrease in visual acuity) by the limiting value of the maximally corrected distance visual acuity (0.6), revealed in this work, below which there is a pronounced statistically significant deterioration in the level of visual performance.

Purpose: to assess the state of intraocular microcirculation in patients with primary open-angle glaucoma (POAG) before and after surgical treatment using optical coherence tomography angiography (Angio-OCT). Material and Methods. The study involved 30 patients (30 eyes) diagnosed with POAG stage lb (group 1) and 25 people (31 eyes) without ophthalmic pathology (group 2, control group). All patients with POAG underwent sinustrabeculectomy. Results. Patients with POAG revealed a decrease in the density of blood vessels (up to 18.10±0.53) and blood flow density of the optic nerve disc (up to 33.77±0.65). After surgical treatment, the vascular density increased to 19.06±0.32, the blood flow density to 37.74±0.32. After 6 months, the hemodynamic and morphofunctional parameters of the optic nerve disc head remained the same in comparison with the data obtained after the operation. Conclusion. After antiglaucoma operation, a significant increase in the hemodynamics of the optic nerve disc was observed, which lasted for 6 months and was accompanied by the stabilization of the morphofunctional indices of the optic nerve disc. The results of the optic nerve disc Angio-OCT can be used as an additional criterion for the stabilization of the glaucomatous process.

Purpose: comparative analysis of the effectiveness of VEGF inhibitors in the treatment of patients with neovascular age-related macular degeneration (nAMD) with different activity of choroidal neovascularization (CNV). Material and Methods. A retrospective study was carried out in 30 nAMD patients (30 eyes) with active CNV and 30 nAMD patients (30 eyes) with an inactive form of CNV. The examination included visometry, ophthalmobiomicroscopy and optical coherence tomography angiography (ОСТА) of the retina. All patients were injected intravitreally aflibercept in the amount of 2 mg. Results. Patients with active CNV as a result of treatment revealed a significant increase in visual acuity from 0.16±0.04 to 0.57±0.12, a decrease in the number of neovascular diseases, an increase in vascular density from 15.7±2.6 mirr1 to 18.9±2.5 mm1 and the perfusion density of the internal retinal capillary network from 0.37±0.06 to 49±0.06. In patients with inactive CNV, there was no positive dynamics of these indicators. Conclusion. Early diagnosis of nAMD and the timely use of VEGF inhibitors with active CNV can significantly improve the visual functions of patients.

Purpose: to estimate the effectiveness of intravitreal aflibercept (IA) in the treatment of diabetic macular edema (DME) in patients with varying degrees of compensation for carbohydrate metabolism. Material and Methods. The study involved 63 patients (63 eyes) with proliferative diabetic retinopathy complicated by diabetic macular edema. Two groups were formed. In group I (n=43), the level of glycated hemoglobin (HbA1c) remained within the normal range during the entire observation period (HbA1c<7.5%). In group II (n=20), the HbA1c level was increased during the year (HbA1c>7.5%). During the initial examination, there were no significant differences between groups I and II in terms of maximum corrected visual acuity (MCVA) and retinal thickness in the center (RTC) (p=0.1).The patients received five intravitreal injections of aflibercept (2 mg). Optical coherence tomograph Spectralis ОСТ (Heidelberg Engeneering, Germany) was used to determine the thickness of the retina. Results. After the fifth IA, significant differences were found between MCVA(p=0.02) and RTC (p=0.03) among groups I and II. Group I patients showed an increase in MCVA from0.22±0.08to0.53±0.21; in group II from 0.18±0.2to 0.32±0.18, and a decrease in MCVAfrom456±112to 304±92 in group I and 480±109 to 376±98 in group II. Conclusion. The results of the study confirm the clinical efficacy of IA in the treatment of DME. Due to the treatment, visual acuity improves, the thickness of the retina decreases, and the outflow of intraretinal fluid is activated. In patients with impaired carbohydrate metabolism, the dynamics of a decrease in RTC and an increase in MCVA are less pronounced.

Purpose: comparative assessment of temporal indicators of simultaneous binocular (BPhEC) and monocular (MPh-EC) phacoemulsification of cataract. Material and Methods. An analysis of 15 BPhEC and 30 MPhEC (according to the standard method) was carried out, during which the operating room load for one operation and the total time spent by the patient in the clinic were assessed. All patients were operated on by one surgeon. Results. Analysis of the clinical examination of patients after BPhEC and MPhEC indicates the absence of postoperative infectious complications. A significant (by 47.4 min, p<0.001) excess of the total time spent by a patient undergoing BPhEC compared to MPhEC was found. It is noteworthy that the total operating room load time during MPhEC and BPhEC practically did not differ and amounted to 26.3±0.9 and 26.2±0.8 minutes, respectively (p>0.05). Conclusion. The main principle that should be adhered to when performing BPhEC is to consider each eye operation as individual and autonomous. The correctness of this principle is confirmed by the data obtained in this study, indicating that the total operating room load time in the cases of BPhEC and MPhEC practically did not differ.

Purpose: to develop an additional criterion for assessing the neovascular membrane activity in order to provide a more balanced approach to the appointment of angiogenesis inhibitors in the treatment of wet neovascular age-related macular degeneration (nAMD). Material and Methods. Sixty-one patients (61 eyes) with nAMD were examined. The average age is 69±7 years. Two groups were formed: The 1st group included 35 patients (35 eyes) with an active neovascular membrane; the 2nd group consisted of 26 patients (26 eyes) with an inactive neovascular membrane. All patients underwent optical coherence tomography using a REVO NX apparatus. Results, как отношение площади новообразованных сосудов, занимающих выделенную область неоваскулярной мембраны, к площади самой неоваскулярной мембраны The coefficient as the ratio of the area of newly formed vessels, which occupy the selected domain of the neovascular membrane, to the area of the neovascular membrane itself (F/V) has been developed. When comparing the average values of the F/V ratio in the 1st and 2nd groups, significant differences were obtained (p=0.01). In the absence of neovascular membrane activity, the value of this indicator significantly increased (p=0.01). Conclusion. The obtained coefficient can be considered an additional criterion for assessing the neovascular membrane activity.

Purpose: to assess the clinical effectiveness of various methods for studying the quality of life (QOL) of visually strenuous work (VSW) patients with symptoms of computer visual syndrome (CVS). Material and Methods. 78 patients aged 24-36 years were examined, whose professional daily activities were characterized as VSW associated with electronic information display systems. Each of the patients underwent a single examination of 28 indicators of the functional state of the visual analyzer. The original (main: KZS-22) and traditional (control: ESAR, CVS-Q, OSDI) questionnaires were used as methods for assessing QOL. The analysis of the results was carried out on the basis of an assessment of the Spearman rank correlation coefficient (CC) between QOL and visual indicators. Results. The obtained data of the comparative assessment indicate that the value of the average CC is significantly (by 0.14-0.26 relative units) higher in the main questionnaire in comparison with the control ones. Along with this, in relation to the questionnaire KZS-22, a lower frequency of occurrence of weak (by 14.3-32.2%) and moderate (by 14.3-25.0%) and a higher frequency of occurrence of a noticeable (by 25,0-32.2%) of communication density according to the Chaddock Scale. Conclusion. The original method (KZS-22) for assessing the QOL of a patient with symptoms of CVS is characterized (in comparison with the traditional: ESAR, CVS-Q, OSDI) by a significantly higher level of clinical effectiveness.

Purpose: to assess the position of the intraocular lens (IOL) in patients with secondary membranous cataract before and after Nd: YAG laser capsulotomy according to optical coherence tomography (ОСТ) of the anterior part of the eye. Material and Methods. The patients are divided into two groups. In the 1st group (n=105), the weakness of the lens ligaments was excluded; in the 2nd group (n=36) patients with concomitant ophthalmopathology were considered. All patients underwent standard ophthalmological examination, YAG laser discision of secondary cataract, and dynamic ОСТ of the anterior part of the eye. Results. After surgery, the visual acuity of patients in thelst group increased from 0.19±0.1 to 0.81±0.09 (p=0.01), in the 2nd group from 0.08±0.1 to 0.72±0.08 (p=0.02). There was no significant change in the position of the IOL after the operation in patients of thel st group. In some patients of the 2nd group, in the long-term period, an increase in the distance between the posterior surface of the cornea and the anterior surface of the IOL was revealed. In tow cases, the developed IOL dislocation required surgical intervention. Conclusion. Nd: YAG laser capsulotomy is a highly effective and low-trauma surgery for secondary cataract. In patients with Nd: YAG lens ligament weakness, laser capsulotomy may be a factor in the progression of IOL dislocation into the vitreous body. ОСТ allows you to assess the position of the IOL, the state of the ligamentous apparatus, the presence and progression of IOL dislocation.