№3, 2021, volume 17

Purpose: to present a series of clinical cases demonstrating the spectrum of ophthalmic pathology in patients who have undergone coronavirus infection (COVID-19). COVID-19 can potentially provoke or aggravate the course of autoimmune ophthalmopathology, infectious diseases, vascular occlusions. The considered clinical examples show the most common types of ophthalmopathology that develop on COVID-19 background. The information of the study confirms the importance of a multidisciplinary approach for the management of COVID-19 patients, regardless of the disease severity. The variety of ophthalmic diseases in COVID-19 patients indicates that the changes caused by the virus or accompanying this infection are due not only to its direct action, but also to the activation of latent diseases associated with hereditary or other predisposition. Taking into account the data of modern literature and our experience, we believe that the recognition of COVID-19 as the etiological factor of a number of eye diseases without convincing evidence can lead to misdiagnosis and inappropriate treatment. COVID-19 should be considered as the main etiological factor after excluding all other possible causes of eye diseases.

Purpose: to analyze the results of laser treatment of children with retinopathy of prematurity (ROP). Material and Methods. Surgical laser treatment of 32 children (61 eyes) with threshold stages of ROP was carried out on an Iridex 532 nm laser device using a Skepens head-on binocular ophthalmoscope. Preoperative preparation fortranspupillary laser coagulation of the retina (TPLC) included examination by a pediatrician and anesthesiologist, instillation of means for pupil dilation, and connection of vital functions monitoring sensors. Endotracheal anesthesia was used. Parameters of coagulation were selected individually: power from 150 to 200 mW, exposure time 0.1-0.3 second. The number of coagulates depended on the area of the avascular zones: from 480 to 1100 (per eye). Results. Evaluation of the results of TPLC was carried out 7 days after the operation. Signs of ROP regression were noted during the first postoperative examination in 20 children (34 eyes). Additional laser treatment was required for 8 children (13 eyes). When examined 7 days after the last TPLC for the entire analyzing period, only 4 children (5 eyes) needed vitreoretinal surgery due to the progression of ROP, increased vitreoretinal proliferation, onset of retinal detachment due to the presence of ROP stages 4a and 4b. Conclusion. During the study period, 76 operations were performed. Laser coagulation is the only treatment for active progressive ROP.

Purpose: to evaluate the effectiveness of using radiosurgery with the use of various types of plastic for the treatment of eyelid tumors. Material and Methods. In the study 149 adult patients with eyelid tumors were examined. Research methods included: cytological examination before surgery and morphological examination after surgery. All patients underwent radio excision of neoplasms (Surgitron EMC) using a specific method of defect replacement (combined flap, tarsoconjunctival flap, skin autograft, displaced flap, closure of the defect with local tissues). Results. Out of 149 patients, 84 cases of benign lesions and 65 cases of malignancy were identified. The structure of malignant tumors revealed: basalioma — 75% (49 patients), squamous cell carcinoma — 18% (12 patients), adenocarcinoma — 5% (3 cases), melanoma of the eyelid skin — 1.5% (1 case). In all cases, a good engraftment of the transplanted tissues was obtained. Conclusion. Radiosurgical treatment with an individual selection of types of eyelid defect replacement allows achieving good results in restoring the structure and function of the eyelids and an acceptable cosmetic effect.

Purpose: to analyze the results of penetrating optical keratoplasty in various corneal pathologies. Material and Methods. 86 patients (86 eyes) with corneal pathologies in need of keratoplasty were examined. Depending on the etiology of the disease, patients are divided into four groups. Group 1: patients with post-burn haze (7-20-year-old injury) at the age of 47±12 years (n=22); maximally corrected visual acuity (MCVA) before surgery 1/°° pr. I. certae. Group 2: patients with bullous keratopathy caused by the dislocation of the pre-camera intraocular lens, with artifaction at the age of 71±2 year (n=14); MCVA before surgery 0.02±0.01. Group 3: patients with haze after suffering a corneal ulcer at the age of 50-72 years (n=31); MCVA before surgery 1/°° pr. I. certae. Group 4: patients with epithelial and endothelial corneal dystrophies (hereditary nature) aged 55±9 years (n=19); MCVA before surgery 0.02±0.01. Results. In all four groups of patients, after optical penetrating keratoplasty surgery, there was a positive trend in the form of an increase in MCVA. In groupl, the MCVA after surgery increased to 0.3±0.02. In group 2, the MCVA after surgery increased to 0.3±0.07. In group 3, the MCVA after surgery increased to 0.4±0.1. In group 4, MCVA after surgery increased to 0.5±0.1. Thanks to the monitoring of the graft condition using optical coherence tomography (ОСТ), it was possible to promptly correct the medical follow-up of keratoplasty in the postoperative period. Conclusion. The results of the operations performed for various pathologies of the cornea make it possible to conclude about the effectiveness of through optical keratoplasty. The results of the operations performed forvarious corneal pathologies make it possible to conclude about the effectiveness of optical penetrating keratoplasty.

Purpose: based on the data of clinical and immunological studies, to optimize the diagnosis of uveitis in patients with rheumatic diseases. Material and Methods. The study involved 70 people (70 eyes): group I — patients with acute uveitis (33 people, 66 eyes); group II — patients with uncomplicated chronic uveitis (37 people, 74 eyes). The control group (III) consisted of 40 people (80 eyes). All patients underwent a general ophthalmological examination, biochemical, immunological blood tests, ultrasound dopplerography (USDG) of the arteria ophthalmica (АО) and its branches: the central retinal artery (CRA) and posterior short ciliary arteries (PSCA). Results. In patients of group I, an increase in systolic and diastolic blood flow velocity, a decrease in the pulsation index in АО (0.53±0.04), CRA(0.51±0.14), PSCA (0.58±0.004), an increase in the index of resistivity in АО (1.66±0.21) were revealed. In patients of group II: a decrease in systolic and diastolic blood flow velocity, an increase in the pulsation index in АО (0.79±0.57), CRA (0.76±0.11), PSCA(0.76±0.11) and index resistivity in АО (1.59±0.15), CRA(1.59±0.15), PSCA(1.63±0.26). Group III: no changes in hemodynamics were found. In patients of groups I and II, there was an increase in the levels of cytokines IL-1 (3, IL-6, in all nosological forms of anterior uveitis on rheumatic diseases background. Conclusion. Uveitis is characterized by a diagnostically significant disturbance of blood flow mainly in the АО and its branches according to the results of Doppler ultrasound. In rheumatic uveitis, an increase in the level of proinflammatory cytokines was found, to a greater extent in the acute phase of inflammation.

Purpose: to analyze the results of treatment of diabetic macular edema (DME) using intravitreal administration of anti-VEGF drugs and dexamethazone implant after vitrectomy. Material and Methods. The study involved 64 patients (64 eyes) with proliferative dibetic retinopathy and type 2 diabetes mellitus. Group 1 included 34 patients (34 eyes) with chronic DMO after vitrectomy. All patients received loading doses of an anti-VEGF drug (5 aflibercept injections) 1 month after vitrectomy (VE), followed by the introduction of a dexamethasone implant into the vitreous cavity. Patients of group 2 (16 patients (16 eyes)) received a dexamethasone implant immediately 1 month after surgery (VE). Results. The maximally corrected visual acuity (MCVA) in the 1st group increased from 0.07±0.03 to 0.36±0.12 (p=0.01)6 month after administration, the retinal thickness decreased from 487±45 to 276±29 mkm (p=0.01). In the 2nd group the visual acuity against the background of the treatment increased from 0.09±0.04 to 0.53±0.13 mkm (p=0.01) 6 month afterthe introduction of the dexamethasone implant, the thickness of the retina in the macula decreased from 499±76 to 268±16 (p=0.01). Conclusion. The use of a dexamethasone implant and anti-VEGF drugs for the treatment of DMO after VE has a positive effect.

Purpose: optimization of vitrectomy technique in order to improve functional and anatomical results in surgery for myopic traction maculopathy Material and Methods. A total of 64 patients with myopic traction maculopathy were examined. All patients (three groups) underwent a standard 3-port 25G vitrectomy. In group 1 (n=25), the epiretinal membrane was removed and the internal border membrane (IBM) was peeled. In the case of rigid IBM, the vitreous cavity was not tamponed. In group 2 (n=15) membrane peeling was performed, the vitreous cavity was plugged with a gas-air mixture. In group 3 (n=24), the IBM was removed, platelet mass was injected, and the vitreous cavity was tamponed with a gas-air mixture in 20 patients; in 4 patients of the 3rd group, the technique of the inverted flap of the IBM was used due to the large diameter of the rupture (more than 900 urn). Results. In all three groups of patients, a positive anatomical and functional effect of treatment was achieved. In all patients, according to results of optical coherence tomography, the thickness of the retina decreased, there was no traction effect on the retina, and in the 3rd group of patients, complete closure of the macular gap was achieved. Subjectively, patients noted a decrease or disappearance of metamorphopsias and an increase in the maximum corrected visual acuity (MCVA). Conclusion. In all cases examined by us, vitrectomy led to elimination of traction syndrome, closure of macular hole, and improvement of MCVA.

Objective: to compare anatomical and functional outcomes of operations in patients with through macular holes of different diameters. Material and Methods. 33 patients with different diameters macular holes were examined. The optical coherence tomograph Spectralis HRA-OCT (Heidelberg Engineering, Germany) was used in the study. The patients were divided into two groups: group 1 included 9 patients with holes of average diameter from 250 to 399 urn; group 2 contained patients with large-diameter holes. Group 2 was divided into subgroups A and B, depending on the size of the macular hole and the use of different techniques for closing the holes: group 2A consisted of 17 patients with a holes diameter from 400 to 600 urn; group 2B included 7 patients with holes from 670 to 1100 urn. All patients underwent vitrectomy using the STELLARIS and Eva systems. In group 1, peeling of the internal limiting membrane (ILM) was performed, using PRP (platelet-rich plasma); in group 2A, ILM peeling of a larger diameter was performed, air tamponade and PRP were used. During vitrectomy in group 2B, ILM peeling with the formation of a flap to close the macular hole and air-gas tamponade were performed. Results. Closure of the macular hole was achieved in all patients; only one patient required reoperation with additional ILM peeling and gas tamponade to close the hole. In group 1, the maximum corrected visual acuity (MCVA) increased from 0.1±0.04 to 0.5±0.1; in group 2Afrom 0.08±0.03 to 0.3±0.1. In group 2B, the MCVA increased from 0.06±0.02 to 0.08±0.03. Conclusion. There is a significant dependence of the functional results of vitrectomy on the macular hole diameter. The use of the inverted flap technique and the use of platelets increase the likelihood of closing the macular hole.

Purpose: to evaluate the effectiveness of AT TORBI plate tactile toric intraocular lens (IOL) (Carl Zeiss Meditec AG, Jena, Germany) and AcrySof loop tactile toric IOL (Alcon Laboratories, Inc., Fort Worth, Texas, USA) forthe correction of astigmatism >0.75 D in patients after phacoemulsification surgery in terms of visual and functional results and rotation stability. Material and Methods. A prospective randomized controlled trial was conducted. This study involved 100 patients (200 eyes) with cataracts and pre-existing astigmatism of 0.75 D or more for implantation of plate tactile-toric (AT TORBI) or loop tactile-toric (AcrySof) lOLs. Depending on the type of implanted lens, the patients were randomly divided into two groups, each of which included 50 people (100 eyes). Postoperative examination was performed on the 3rd day after surgery, after 1 week, 1 month and 3 months. The effectiveness of each IOL in both groups was evaluated by measuring uncorrected visual acuity at a distance (UDVA), the best corrected visual acuity (VA) and the position of the IOL. Results. Three months after surgery, the average logarithmic UDVA index was 0.21 and 0.18 in groups I and II, respectively (p=0.7), the average residual cylindrical refractive error in the group I was 035 D, and in the group II was 0.4 D (p=0.64). It was found that the average rotation of the IOL in 3 months after surgery in group I was 3.42°, and in group II was 2.03° (p=0.25). Conclusion. The effectiveness of both lOLs is recognized as equally high when eliminating uncorrected VA, as well as when correcting pre-existing astigmatism in the range of 0.75-5 D. Both lenses also demonstrated resistance to rotation.

Objective: to identify in patients with cardiovascular diseases (CVD), who underwent COVID-19, dynamic changes in clinical, laboratory and psychological manifestations of the disease one month after their recovery. Material and Methods. A survey was conducted among 54 CVD outpatients with confirmed COVID-19. One month after their recovery, the following was carried out: a survey about the persisting clinical manifestations; physical examination; laboratory and instrumental diagnostics; testing according to the HADS scale and the Beck scale. 34 patients agreed. Results. People aged 45-82 years were most often ill. A month after treatment, there is a decrease in the number of patients with symptoms of respiratory system damage, but symptoms of damage to other systems persist: 41.2% — destabilization of blood pressure, 52.9% — sleep disorders, 58.8% — memory loss, 94.1 % — decreased exercise tolerance. When assessing the mental properties of a person, it was found that 29.4% of respondents have subclinical and clinically severe depression. Conclusion. Within one month after treatment, there are fewer patients with cough, shortness of breath, congestion and chest pain, but they still have manifestations from the nervous and cardiovascular systems. Some individuals, after recovery, developed new symptoms: shortness of breath on exertion or at rest, swelling of the lower extremities, tachycardia, hair loss, unsteadiness or "unsteadiness" when walking.