2021, volume 17

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.

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.