2021, volume 17

Purpose: to present a clinical case of a rare long-term postoperative complication of scleroplasty performed for progressive myopia. One of the methods of surgical treatment of progressive axial myopia is scleroplasty — strengthening the posterior pole of the sclera with grafts. The operation is simple to perform, does not require special equipment and rarely causes postoperative complications. The clinical case demonstrates a complication that appeared in the long-term period after scleroplasty — the darkening of the dislocated graft. It developed after hemosiderin imbibition of the graft material based on the subconjunctival hemorrhage caused by a blow to the eye. The graft was removed and replaced with a new one. Three months after the operation, it retains its correct position and color. This clinical case focuses on the interrelated complications of a technically simple operation: a change in the color of the graft due to subconjunctival hemorrhage occurred due to its displacement to the area of frequent localization of the hyposhagmus.

Objective: using clinical examples, to analyze the connections and features of the course of ophthalmic pathology in COVID-19 patients. We observed changes on the part of the visual organ in patients who had previously been ill with COVID-19 in various degrees of severity who sought ophthalmological help. The report is illustrated by the most striking clinical examples, on the basis of which we proposed the following mechanisms of the effect of coronavirus infection on the eye tissue: 1) activation and generalization of viral infections of the eyes, in particular herpetic, adenovirus, mollusk contagious; 2) ocular vascular disorders in the form of hemophthalmos, cavernous sinus thrombosis with corresponding ophthalmological manifestations; 3) oculomotor disorders due to neuropathy (we present a case of the development of non-friendly strabismus); 4) aggravation of chronic diseases; 5) visual disorders against the background of asthenic syndrome; 6) side effects from the organ of vision against the background of therapy for COVID-19. Based on the demonstrated examples, it is shown that the functional and organic disorders of the visual organ caused by COVID-19 are quite diverse.

Objective: to study the microflora of the conjunctival cavity in adults in normality and in different inflammatory diseases of the anterior eye segment of patients in the Kirov region. Material and Methods. In the course of experimenting, two groups were identified: the first group consisted of 24 people (25 eyes) who were treated for different infectious and inflammatory pathologies of the ocular surface. The control group (the second group) consisted of 29 people (29 eyes) without infectious and inflammatory pathology of the organ of vision. The material was taken and then seeded on nutrient media. Results. The composition of the microflora in the patients was the same, but in different proportions. The exception was a patient who was seeded with a single microorganism that caused conjunctivitis, Proteus vulgaris; in two patients, the only microorganism in a concentration of more than 105 CFU/ml was Anaerococcus prevotii. In the first group, the most frequently isolated microorganisms were Candida sp., Staphylococcus aureus, Streptococcus pyo-genes, Peptostreptococcus, Propionibacterium granulosum, Klebsiella sp., Staphylococcus epidermidis, Escherichia coli. In the second group, microorganisms were more common: Candida sp., Klebsiella sp., Staphylococcus aureus, Propionibacterium granulosum. Conclusion. In general, the composition of the microflora in the patients was the same, but in different proportions, which indicates the conditional pathogenicity of the microflora of the conjunctival cavity. Most of patients have a high frequency and large concentrations of Candida sp., which can be explained by the peculiarities of the conjunctival microflora of the residents of the Kirov region and the impact of the COVID-19 pandemic.

Purpose: to evaluate the safety and effectiveness of the myopia correction by corneal lenticule refractive extraction. Material and Methods. A prospective study included 24 patients (24 eyes) (26.8±4.6 years old) who were operated at the S. Fedorov Eye Microsurgery Federal State Institution for myopia correction by corneal lenticule refractive extraction. Results. One week after the operation, there was an improvement in visual acuity (VA) (up to 0.9 (0.7; 1.0)), which remained throughout the observation period. After a month, the uncorrected VA was 1.0 (1.0; 1.0). There were no in-traoperative or postoperative complications. Loss of the maximum corrected VAwas observed in 20.8%. There was a decrease in the average corneal thickness from 555.9±28.2 urn before surgery to 464.8±26.9 urn a week after surgery (p<0.05). The cost of tissue per 1 diopter was 17 microns. Conclusion. Correction of myopia by the method of corneal lenticule refractive extraction meets modern concepts about the effectiveness and safety.

Purpose: to determine the effectiveness of selective laser trabeculoplasty in the complex treatment of open-angle glaucoma. Material and Methods. Study group: 47 patients (53 eyes), mean age 70.0±9.1 (Cl 69.8-73.1) years; men 44.7% (n=21), women 55.3% (n=26). Patients with stages 1-3 of open-angle glaucoma underwent tonometry, computed perimetry and ОСТ of the optic nerve disc at the beginning of the study and at least 6 months after the SLT Decrease in IOP was defined as the difference between the pressure obtained within at least 6 months of observation and the initial level of IOP. Results. IOP before SLT was Me=24.0 mmHg (Q1-Q3: 21.0-28.0 mmHg), after Me=20.0 mmHg (Q1-Q3: 17.0-21.0 mmHg). Decrease in IOP was Me=4.0 mmHg (Q1-Q3: 3.0-8.0 mmHg). IOP after SLT significantly decreased (p<0.05) in 88.7% of cases. There was no statistically significant association between the variable "IOP decrease" and the stage of glaucoma (p=0.215), as well as between the decrease in IOP and previous glaucoma surgery (p=0.664). The correlation between the baseline value and the magnitude of the decrease in IOP is statistically significant (p<0.05, r =0.73). A linear dependence was obtained, at which, with an increase in the initial IOP by 1 mmHg decrease in IOP level will increase by 0.75 mmHg. Conclusion. SLT is an effective and safe method for lowering IOP, which makes it possible to recommend this procedure more often for all patients with open-angle glaucoma.

Purpose: to determine the effect of a peptides solution on the processes of pathological angiogenesis in a model of post-burn neovascular albugo of the rat cornea. Material and Methods. The study was carried out at 24 rats (48 eyes). Post-burn neovascular albugo was treated after 30 days of the formation of a chemical burn of the cornea. One eye of each animal was used as a control eye, and the other was an experimental eye. In the 1st experimental group (12 animals, 12 eyes) treatment was carried out with the total fraction of the peptide drug, in 2nd group — with a fraction of the peptide drug up to 30 kDa. Instillations of the culture medium, which is used in the production of a peptide drug, were used on control eyes. The research methods included ophthalmoscopy with photoregistration, optical coherence tomography (ОСТ) of the anterior segment of the eye, assessment of morphological changes in the corneal tissues before and after treatment. The observation period was up to 30 days. Results. Treatment of post-burn corneal albugo with a peptide drug in the experimental groups had an antiangiogenic effect. In the control group, a albugo formed, which led to a thinning of the cornea, in which there were vessels of different functional state. Conclusion. The results obtained indicate the prospects of using a peptide solution for the treatment of post-burn neovascular corneal albugo.

Purpose: to analyze the impact of the COVID-19 pandemic on the anxiety level of ophthalmologists in the Russian Federation. Material and Methods. An online survey of ophthalmologists in the Russian Federation was conducted according to the author's questionnaire, which included, in particular, 8 questions about the level of anxiety in April and October 2020. The respondents (n=582) assessed the level of personal anxiety on a 5-point scale ("very strong" — 4 points, "strong" — 3, "moderate (average)" — 2, "weak" — 1, "not at all worried" — 0). Results. Ophthalmologists have a higher level of anxiety that they will personally get sick COVID-19 in April than in October 2020 (2.13±1.27 and 1.89±1.28, p<0.05). Ophthalmologists were most worried about their family members getting sick with COVID-19 (p<0.05), in additon in April more than in October 2020 (3.01±1.07 and 2.76±1.14, p<0.05). The level of anxiety of ophthalmologists that colleagues will get sick with COVID-19 was higher in April than in October 2020 (2.25±1.11 and 2.16±1.16, p<0.05). The level of anxiety that ophthalmologists will personally infect other people COVID-19 was also higher in April than in October 2020 (2.28±1.31 and 2.10±1.29, p<0.05). Ophthalmologists were less worried about the decrease in personal financial income in April than in October 2020 (2.44±1.29 and 2.69±1.22, p<0.05). The level of anxiety that friends will get sick with COVID-19, as well as that it is more difficult to get medical care for other diseases in April, did not differ from the data for October 2020 (2.24±1.12 and 2.18±1.16 (p>0.05), 2.42±1.31 and 2.41±1.27 (p>0,05) respectively). Conclusion. The COVID-19 pandemic had a negative impact on the anxiety level of ophthalmologists in the Russian Federation.

Purpose: comparative analysis of aphakia correction by differents models of intraocular lenses when using a sili-cone tamponade of the vitreal cavity. Material and Methods. Studies were conducted on 16 eyes with aphakia and pathology of the vitreal cavity. Depending on the use of the type of intraocular lenses (IOL), all patients were divided into 2 groups. Patients of the 1st group underwent the first stage of transscleral IOL fixation. Then a 25G vitrectomy was performed with silicone oil (SO) tamponade of the vitreal cavity. Patients of the 2nd group underwent an anterior chamber IOL, iridotomy, and then vitrectomy 25G with tamponade of the vitreal cavity by SO. Results. When using anterior chamber IOL, the presence of ophthalmic hypertension was revealed in 75% of cases, which is 2.0 times higher than when using transscleral IOL fixation. In 37.5% of cases, the SO output to the anterior chamber is determined, in contrast to the group where transscleral IOL fixation was used. A higher percentage of SO migration to the anterior chamber of the eye in 2nd group is due to a violation of the anatomy of the anterior chamber barrier and the vitreal cavity. Conclusion. In patients who underwent transcleral IOL fixation, visual acuity was 2.1 times higher than in patients who had an anterior chamber IOL implanted. Transscleral fixation of the IOL can form the necessary barrier between the anterior and posterior chambers of the eye, and it is also the most physiological method of correcting aphakia.

Purpose: to assess blood supply disorders at the level of the vessels of the eyeball, intracranial vessels and verte-brobasilar basin in patients with central serous chorioretinopathy (CSC) and to compare the revealed changes with the clinical picture of the disease. Material and Methods. An ophthalmological examination of 10 patients with CSC was performed: in addition to standard methods, it included optical coherence tomography (ОСТ) of the optic nerve disc, ultrasound B-scanning of the eyeball, perineural and retrobulbar space. Four patients additionally underwent magnetic resonance imaging (MRI) of the brain and cervical spine, ultrasound Dopplerography of extra- and intracranial vessels. Results. An ОСТ of the optic nerve disc revealed an expansion of the subarachnoid space. According to the ultrasound B-scan data, patients with CSC showed a moderate expansion of the perineural space of the optic nerve and a significant expansion of the orbital vessels. The MRI showed signs of internal hydrocephalus. Based on ultrasound Dopplerography of extra- and intracranial vessels, a conclusion was made about the signs of intracranial venous hypertension. Conclusion. Disorders of blood flow in the eye veins, vertebral arteries, along the transverse sinuses were revealed, signs of external and internal hydrocephalus were found. The role of pathological changes of central genesis in the development of CSC has been established. Interdisciplinary research and extended therapeutic measures are required.

Purpose: to evaluate the effectiveness of combined ranibizumab and sulodexide use in treatment of macular edema (ME) cause by retinal vein occlusion (RVO). Material and Methods. During the study, we examined 40 patients with ME cause by RVO, not exceeding 1.5 months ago. All patients underwent standard ophthalmological examination, optical coherence tomography (ОСТ), ОСТ angiography and electrophysiological studies. To evaluate the effectiveness of the combined use of ranibizumab and sulodexide, all patients were divided into two groups. In patients of the first group (n=21), the first intravitreal injection of ranibizumab was supplemented with a course of sulodexide. Patients of the second group (n=19) did not receive sulodexide. Results. The degree of improvement in eye functions in patients of the first group, who received sulodexide in complex treatment, is due to the best level of restoration of the retinal microcir-culation in the macula due to increase in the capillary network density in the superficial and deep capillary plexus in the retina by more than 1.2 times and decrease foveal avascularzone area in 1.5 times in comparison with the initial state. Conclusion. The results of the study showed the high efficiency of the combined use of ranibizumab and sulodexide in the treatment of ME cause by RVO and allow to recommend their use to improve hemomicrocirculation in the macular retina and enhance visual functions.