2022, volume 18

Abstract. Objective: to evaluate the reproducibility and constructive validity of the "Phacoemulsification of cataract (PEC) — 22" technique for the study of the patient's quality of life in cataract surgery. Material and methods. Two series of clinical studies were carried out. The first one was aimed at evaluation of repeatability indices of the assessed technique based on triple examination of 39 patients with unilateral cataract before and after PEC. The second series aimed to assess the indices of constructive validity based on general testing index in patients (n=33) with different maximal corrected visual acuity in far distance (less than 0.4; 0.4-0.6 and 0.9-1.0 rel. units). Results. The overall testing rate at triplicate examination of patients by the "PEC-22" method before operation varied within 1.3-1.5% (p>0.05), after operation —within 1.1-1.5% (p>0.05). Marked (by 18,3; 24,3; 47,0%, p<0,001) differences in the total testing index between groups of patients with different maximum corrected visual acuity were revealed. Conclusion. The developed "PEC-22" technique is characterized by the required level of reproducibility and constructive validity indices that ensures introduction of the given method in complex diagnostics of cataract patients both before and after surgical intervention.

Abstract. Objective: to determine the tactics of choosing a drainage device, as well as to identify early postoperative complications in the implantation of certain types of drainage. Material and methods. The patients were divided into 3 groups depending on the drainage used: group 1 —Ahmed valve (16 eyes, 24.6%), group 2 — Ex-press metal anti-glaucoma shunt (27 eyes, 42.5%), group 3 — drainage BenchmarkA-1 (22 eyes, 32.9%). Results. In 11 eyes (15%), hyphema was observed on the first day, which resolved on its own on the 3rd day. Ciliochoroidal detachment on the first day after surgery was detected in group 1 (1 eye), group 2 (5 eyes), group 3 (4 eyes). Increased intraocular pressure on the 1st day after surgery was detected in 3 eyes in patients of the 3rd group. Drainage antiglaucoma Reper A-1 is preferably implanted in eyes with primary glaucoma with an unsatisfactory result of surgery on the fellow eye and in eyes with postveal glaucoma. The Ex-press shunt has a good hypotensive effect in advanced operated high-pressure glaucoma in combination with pseudophakia. The preference for Ahmed valve implantation is given to secondary refractory uncompensated glaucoma with residual visual functions. Conclusion. The use of shunts and drainage devices is a modern approach to achieve target intraocular pressure in patients with refractory glaucoma, which will preserve visual functions, prevent disability and avoid blindness.

Abstract. Objective: analysis of the first results of glaucoma surgical treatment by micropulse transscleral cyclophotocoagulation. Material and methods. 31 patients (31 eyes) are examined and treated, 58% of them are men, 42% are women, the average age is 63±17years, with different forms of glaucoma: primary open-angle glaucoma of stages l-IV was in 83.9% of cases, secondary — 12.9%, juvenile stage III — 3.2%. The initial level of intraocular pressure (IOP) was on average 30.9±5.02 mmHg. Visual acuity in 74.2% of cases was 0.2 and higher. All patients had a history of hypotensive operations including laser. All patients took at least two kinds of hypotensive drugs (an average of 2.9). The principles of the selection of persons for treatment and the operation technique are described. The observation period is 10 months. Results. No intraoperative complications were noted. Postoperative complications: short-term pain syndrome was in 9.6% of cases, IOP rise above preoperative — 9.6%, persistent hypotension —6.4%, ectopia of the pupil — 16.1%. The target IOP level of 87.2% has been reached. On average, IOP was 18.7±7 mmHg (p=0,04). The number of hypotensive drugs used decreased by 28%. Visual acuity was preserved in 94% of cases. Conclusion. The first experience of using micropulse transscleral cyclophotocoagulation has demonstrated an effective result in reducing the IOP level and the number of hypotensive drugs used. The safety of using this method and a small number of complications are shown.

Abstract. Objective: to assess the thickness of the choroid in children with myopia of various degrees. Material and methods. We examined 28 children (56 eyes) with myopia of varying degrees aged 9 to 11 years, 16 girls, 12 boys. Four groups have been formed. Group I (n=12 eyes) consisted of children with progressive mild myopia. Group II (n=22 eyes) consisted of children with progressive moderate myopia. Group III (n=14 eyes) consisted of children with progressive high myopia. Group IV was the control group, it (n=8 eyes) consisted of children with hyperopia. To determine the subfoveolar thickness of the choroid (TC), an optical coherence tomograph REVO NX (Optopol Technology, Poland) was used, and an apparatus ZEISS IOL Master 700 was used to measure the anterior-posterior axis (АРА) of the eye. Results. TC in myopia is, on average, 134.9±16.2 urn less than TC in hypermetropia. In group I, the subfoveolar TC was 290.3±30.2 urn, the АРА was 24.6±0.3 mm. In group II, TC —260.2±44.4 urn, АРА—25.3±0.6 mm. In group III, TC — 234.8±55.1 urn, АРА—26.7±0.8 mm. A significant decrease in the index of subfoveolar TC was revealed in groups II and III compared with the control group IV (p=0.03). Conclusion. With progressive moderate and high myopia, there is a significant decrease in the subfovelarTC, compared with hyperopic refraction.

Abstract. Traumatic injuries of the organ of vision continue to occupy a leading position among the main causes of blindness and low vision at working age. The article presents a rare clinical case of post-traumatic formation of macular retinal duplication. As a result of the proposed method of surgical treatment, including vitrectomy, peeling of epiretinal membranes with induction of central retinal detachment by subretinal injection of BSS, followed by smoothing with a perfluoroorganic compound and replacing it with air, good anatomical and functional results have been achieved.

Abstract. The article presents variants of the course of the active phase of retinopathy of prematurity (RP). Demonstrated clinical cases indicate polymorphism of forms and outcomes of RP. Even in the case of a satisfactory outcome after treatment, residual changes in the retina are recorded. Further long-term dispensary observation and rehabilitation of patients who have undergone RP is necessary, which will reduce the number of visually impaired due to RP.

Abstract. Objective: clinical regulation of the severity of asthenopia based on the data of the questionnaire for the quality of life of patients with computer visual syndrome "CVS-22". Material and methods. Under supervision there were 204 patients with "normal" indicators of objective accommodation and not presenting asthenopic complaints, as well as with symptoms of accommodative asthenopia. All patients were once examined according to the "CVS-22" questionnaire with the calculation of the total test indicator (TTI). The basis for clinical normalization was the analysis of the indicators of sensitivity (ISEN) and specificity (ISP) with the formation of standard ROC curves. Results. The "area" under the ROC curve was 0.939, which indicates the "excellent" predictive quality of the model. At the point of maximum ISEN (83%) and ISP (86%), the value of TTI was 175 points, which determines this value from the position of "norm". The final check of the developed model showed the required and sufficiently high ISEN (82% and 87%) and ISP (83% and 86%) with differences in TTI from the "norm" to "compensation" and from "compensation" to "decompensation" of asthenopia, respectively. Conclusion. The following normative indicators of asthenopia were determined: "norm" — more than 175 points; "compensation" — less than 175, but not less than 147 points; "decompensation" — less than 147 points. At the same time, these indicators do not depend on the type of accommodative asthenopia (habitual excessive stress of accommodation or asthenic form).

Abstract. Objective: to present a clinical case of a rare pathology of the anterior segment of the eyeball —Thygeson's keratitis, diagnosed in a pediatric patient. There are isolated descriptions of this disease in the medical literature, especially in children's practice. The disease has a persistent recurrent character with an unclear etiology. This clinical case demonstrates a chronic course of the disease for three years with frequent relapses in a child from the age of 4 years and difficulties associated with the possibility of using anti-inflammatory steroids in pediatric ophthalmology. The diagnosis was based on a detailed collection of anamnesis, immunological examination of blood, features of the clinical picture of the disease and relief of the inflammatory process by prescribing dexamethasone in a dilution of 0.02%. As a result of treatment, stable positive dynamics was achieved in the form of a reduction in the number and duration of relapses and an increase in remission periods.

Abstract. This clinical case draws attention to the possibilities of studying the retina using structural and angio-OCT (optical coherence tomography) in acute posterior multifocal placoid pigment epitheliopathy. At the very beginning of the disease, according to structural ОСТ data, several cystic formations merging with each other were detected in the area of the retinal pigment epithelium in the central zone of the macula. A month later, on structural ОСТ of the right eye, foci in the RPE area remained, their caliber decreased. In the affected area, the optical permeability of the pigment epithelium increased significantly due to further damage to its structure. 2 months after the first manifestations of the disease in the right eye, persistent damage was formed in the region of the RPE. Angio-OCT studies in dynamics made it possible to indirectly monitor the formation of RPE damage. According to angio-OCT performed a year after the onset of the disease, it is obvious that RPE damage, despite the absence of a clinical picture of the disease, continues to progress during the year from the onset of the disease. Thus, the study of the retina by structural and angio-OCT makes it possible to detect initial lesions in acute posterior multifocal placoid pigment epitheliopathy. They consist in the formation of pathological foci in the RPE region, followed by the formation of zones of atrophy of the pigment epithelium. The angio-OCT method makes it possible to indirectly judge the extent of areas of RPE disorganization, as well as to track the dynamics of these changes.

Abstract. Objective: to analyze the literature data on the endophthalmitis incidence and prevention after cataract phacoemulsification. Literature search was carried out in the Russian (RSCI) and international (PubMed) databases using the keywords "cataract phacoemulsification", "endophthalmitis", "antibacterial agents", "intracameral administration of antibiotics". A total of 554 sources were analyzed with further use of systematic review filters and authors' knowledge on the topic (48 sources were selected for review). The duration of the retrospective analysis was 10 years (2013-2022). Conclusion. The incidence of endophthalmitis in the traditional use of antibacterial drugs (aminoglycosides, fluoroquinolones in drops) ranged from 0.066 to 0.206%; when using these drugs in combination with intracameral administration of antibiotics (cefuroxime, moxifloxacin) — from 0.015 to 0.035%. The data presented in the literature correspond to both traditional unilateral sequential cataract surgery and immediate sequential bilateral cataract surgery the relevance of which may be due to the complex epidemiological situation.