Saratov JOURNAL of Medical and Scientific Research

2021, volume 17

Protracted herpetic keratitis in a patient with coronavirus infection (clinical case)

Year: 2021, volume 17 Issue: №4 Pages: 701-704
Heading: Ophthalmology Article type: Case report
Authors: Latypova Е.А., Zagidullina A.Sh., Mukhamadeev T.R.
Organization: Bashkir State Medical University of the Russian Health Care
Summary:

Purpose: a clinical case study to analyze features of herpetic keratitis course in a patient with coronavirus infection. The presented case demonstrates the herpesvirus infection activation of the body influenced by acute coronavirus infection with damage to the cornea. It resulted in the dendritic keratitis developed for the first time in a patient's life. In the initial stage of the disease, herpetic keratitis proceeded subacutely in the course of the antiviral COVID-19 treatment, including hormones, and severely intensified after the completion of the therapy course. Clinically, herpetic keratitis was complicated by edema and infiltration of the dendritic cornea focus. New ulcerated infiltrates emerged along with the previous focal area. The cornea became vascularized, and the infection spread into its deep layers, with the anterior segment of the choroid involved in the inflammatory process. The patient's vision deteriorated to 0.02-0.01, with a protracted course of the disease. It was managed to arrest the inflammatory process in the eye with the antiherpesvirus therapy (Aciclovir orally and topically). The keratitis ended in the formation of cloudy opacities in the central cornea. The patient's vision improved to 0.5. This clinical observation indicates the need for a specific therapy for coronavirus infection complications and standard COVID-19 treatment.

Keywords: coronavirus infection, dendritic keratitis, herpesvirus, herpetic keratouveitis

A comparison of effectiveness of various marking methods of toric intraocular lens implantation during cataract surgery

Year: 2021, volume 17 Issue: №4 Pages: 697-700
Heading: Ophthalmology Article type: Original article
Authors: Alnoelaty Almasri M.A., Stebnev V.S.
Organization: Samara State Medical University
Summary:

Purpose: to evaluate the effectiveness of isolated manual marking, manual marking using a cell phone and digital marking using the VERION system during implantation of toric intraocular lens (IOL) during phacoemulsification. Material and methods. An observational study was conducted, including 70 patients (100 eyes) with diagnosed senile cataract and corneal astigmatism >0.75 D. Isolated manual marking was performed in a sitting position on a 6-hour limbus (manual axis — 90°) using a slit lamp. Manual marking using a cell phone was carried out through the Android application iToric Patwardhan. The digital marking was carried out in the prone position on the external screen using the digital overlay of the VERION axis and was taken as the reference axis. Results. The average absolute angular deviation between the axis of the mobile program and the VERION axis was 1.97°, which is significantly lower than that of the isolated manual marking axis (3.8°) (p=0.05). The correlation coefficient between the axis parameters for mobile marking and the VERION axis parameters was 0.85. Conclusion. Manual marking using a mobile application demonstrates significantly greater accuracy and efficiency than isolated manual marking. The VERION digital system is recognized as a reference method for marking the corneal axis during implantation of a toric IOL.

Keywords: astigmatism, cataract, phacoemulsification, toric intraocular lens

Comprehensive assessment of the results of rehabilitation of older patients with chronic sensorineural hearing loss

Year: 2021, volume 17 Issue: №4 Pages: 691-696
Heading: Otolaryngology Article type: Original article
Authors: Daikhes N.A., Vladimirova T.Yu., Bulgakovа S.V., Sapozhnikov Ya.M., Machalov A.S., Kuznetsov A.O., Kurenkov A.V., Martynova A.B.
Organization: National Medical Research Center of Otorhinolaryngology of the Federal Medico-Biological Agency of Russia, Samara State Medical University
Summary:

Purpose: to evaluate the results of rehabilitation of patients of the older age group with chronic sensorineural hearing loss (SNHL) during auditory training and in the long-term period. Material and methods. 78 patients took part in the study (mean age 77.6±10.4 years), the indices of speech and spatial hearing were assessed. Results. Auditory training improved the accuracy of determining the target signal and the response time in the elderly (group I) and elderly patients and long-livers (group II). An increase in interhemispheric interaction with dichotic listening was revealed: speech intelligibility in group I increased by 5.7 % by 1 month, in group II — 3.6 %, the indicator approached the pre-training level in group I by 6 months and in group II by 3 months. According to SSQrus-12, the average score in group I by month 1 became 6.4 % higher due to the Hearing Quality and Spatial Hearing scales, in group II — by 10.4 % due to the Hearing Quality scale with retention for six months. According to the SF-36 questionnaire, the stability of a positive result was revealed for 6 months for both groups: the total score for group I was 88.1±7.4 points, for group II — 84.8±3.7 points. Conclusion. The assessment of auditory rehabilitation allows us to recommend the need for a repeated course of auditory training for people over 75 years old with a frequency of every 3 months, for elderly patients every six months.

Keywords: auditory rehabilitation of older patients, chronic sensorineural hearing loss, virtual reality

Promising trends for the development of ophthalmology (review)

Year: 2021, volume 17 Issue: №3 Pages: 675-678
Heading: Тhematic supplement Article type: Review
Authors: Shlyapnikova O.A., Kamenskikh T.G., Roshchepkin V.V., Reshnikova L.B.
Organization: Saratov State Medical University, University Clinical Hospital №2 (Clinic of Eye Diseases)
Summary:

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.

Keywords: bionic eye, OCT-angio, robotics in ophthalmology

Analysis of the AMO-ATOS-IKL efficiency in the treatment of primary open-angle glaucoma

Year: 2021, volume 17 Issue: №3 Pages: 669-675
Heading: Тhematic supplement Article type: Original article
Authors: Filatova V.S., Kamenskikh T.G., Veselova E.V.
Organization: Saratov State Medical University, University Clinical Hospital №2 (Clinic of Eye Diseases)
Summary:

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.

Keywords: AMO-ATOS-ICL, laser therapy, magnetotherapy

Assessment of the level of visual performance depending on the magnitude of visual acuity in relation to cataract surgery

Year: 2021, volume 17 Issue: №3 Pages: 666-668
Heading: Тhematic supplement Article type: Original article
Authors: Trubilin V.N., Orlova О.М., Ovechkin I.G., Trubilin A.V., Pokrovsky D.F., Ovechkin N.I.
Organization: Academy of Postgraduate Education under the Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russia, Moscow Helmholtz Research Institute of Eye Diseases, Russian State Medical University
Summary:

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.

Keywords: cataract, visual acuity, visually strenuous work

Diagnostic capabilities of optical coherence tomography angiography in patients with primary open-angle glaucoma

Year: 2021, volume 17 Issue: №3 Pages: 662-665
Heading: Тhematic supplement Article type: Original article
Authors: Tikhonov D.A., Kamenskikh T.G., Kolbenev I.O., Veselova E.V.
Organization: Saratov State Medical University, University Clinical Hospital №2 (Clinic of Eye Diseases)
Summary:

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.

Keywords: angio-OCT, blood flow density, primary open-angle glaucoma, vascular density

Angiogenesis inhibitor in the treatment of wet age-related macular degeneration at different choroidal neovascular membrane activity

Year: 2021, volume 17 Issue: №3 Pages: 659-662
Heading: Тhematic supplement Article type: Original article
Authors: Stepanova Yu.S., Fedotov M.V., Semyonova R.R., Batishcheva Yu.S., Gileva E.V., Rusakova N.M.
Organization: Saratov State Medical University, University Clinical Hospital №2 (Clinic of Eye Diseases)
Summary:

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.

Keywords: angio-OCT, perfusion density, vascular density, VEGF inhibitors

Estimates for effectiveness of intravitreal aflibercept in the treatment of diabetic macular edema

Year: 2021, volume 17 Issue: №3 Pages: 655-659
Heading: Тhematic supplement Article type: Original article
Authors: Sinitsyna V.I., Batishcheva Yu.S., Gileva E.M., Gubareva N.N., Nugaeva N.R., Barabanova L.S.
Organization: Saratov State Medical University, University Clinical Hospital №2 (Clinic of Eye Diseases)
Summary:

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.

Keywords: aflibercept, diabetic macular edema

Comparative assessment of temporal indicators of simultaneous binocular and monocular phacoemul-sification of cataract

Year: 2021, volume 17 Issue: №3 Pages: 653-655
Heading: Тhematic supplement Article type: Original article
Authors: Pokrovsky D.F.
Organization: Russian Research Medical University n. a. N.I. Pirogov
Summary:

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.

Keywords: phacoemulsification of cataract, duration of surgery