Features of Surgical Correction of Spontaneous Luxation of the Complex “IOL Posterior Chamber – Capsular Bag”

Luxation of intraocular lens in capsular bag several years after cataract surgery leads to a decrease in visual function and requires surgical treatment.Aim: to determine effectiveness of various types of surgical treatment of late spontaneous dislocations of IOL in capsular bag.Methods. Analysis of 123 case histories of patients with late IOL dislocation, operated in 2013–2015, was made. First group included patients with replaced IOLs dislocated into pupillary lens. Second group consisted of patients who underwent reposition and suture of IOL to iris. Examination was made before operation and 6–12 months after operation. Results. The average term from moment of IOL implantation to its luxation was 8.78 ± 4.85 years. II degree of dislocation was detected in 74 % of patients, III degree of dislocation – in 10 %, and IV degree – in 16 % of patients.Uncorrected visual acuity was reduced to 0.15 ± 0.16; best corrected visual acuity to 0.31 ± 0.26. In 83.7 % of patients a pseudoexfoliation syndrome was detected. In 62.6 % of patients IOL luxation was accompanied byhydrodynamic disturbances. Best corrected visual acuity in period from 6 to 12 months after surgery was 0.40 ± 0.24, and after IOL reposition – 0.49 ± 0.22. In addition, after IOL replacement a significant increase in postoperative astigmatism was noted from –0.44 ± 0.84 to –1.96 ± 1.60 D (p < 0.001).Conclusion. As a result of surgical treatment of late spontaneous IOL dislocations in both groups increase in distance uncorrected and best corrected visual acuity was noted. Insufficient visual functions after surgical treatment were caused by concomitant pathology as well as increased postoperative astigmatism

Assessment of the degree of restoration of the retinal structure and chorioretinal blood flow after surgical treatment of large-diameter macular holes

The aim: to evaluate the restoration features of the structural relationships of the retina and chorioretinal blood fl ow after surgical treatment of large-diameter macular hole (MH) using a modifi ed technology.Material and methods. A prospective study of 14 patients (14 eyes), 13 women and 1 man, with medium-and large-diameter MH was conducted. The mean age of the patients was 67.7 ± 5.38 (55–80) years. The study included patients with endto-end MH of the 3rd–4th stage according to the classifi cation of J. Gass. All patients underwent surgical treatment of macular rupture according to the proposed method of inverted fl ap of the internal limiting membrane (ILM) and fi lling it into a “pocket” formed between the retina and the ILM.Optical coherence tomography (OCT) was performed along with traditional research methods. The obtained images were used to measure manually the parameters of retinal MH, the thickness of the choroid in the projection of the rupture and the fovea zone before the operation and 1, 3 and 6 months after the operation. In the angio-mode, the foveal avascular zone (FAZ) was evaluated, as well as the density of capillaries of the superfi cial and deep retinal plexus in four quadrants, with the exception of the central zone.Results. In all patients, it was possible to achieve MH blocking. Visual acuity in the eyes with MH varied from 0.02 to 0.3, while in the comparison group, the best corrected visual acuity was from 0.3 to 1.0 (p = 0.002). An increase in the diameter of large choroidal vessels, as well as a pronounced decrease in the diameter of the posterior short ciliary artery, attracted attention. However, despite the improvement in visual acuity, patients retained a signifi cant expansion of the FAZ, which by 6 months exceeded the FAZ area of the paired eye by 25.8 % (p = 0.01).Conclusion. The results obtained indicate that the achievement of an anatomicalreconstructive effect and even a moderate improvement in visual acuity during surgical treatment of macular holes by the modifi ed inverted flap technology of the internal limiting membrane does not determine the restoration of retinal perfusion in full

Role of Color Perimetry and Visocontrastometry in Diagnosis of Optical Neuritis

The most sensitive method for assessing changes in visual functions in patients with optical neuritis is chromatic computer perimetry with a red mark on a green background.Aim. To evaluate the effectiveness of clinical and functional diagnostic methods for optical neuritis. Material and methods. A cross-sectional, non-randomized, comprehensive examination of 53 patients aged 19–48 years (31.65 ± 4.88), the ratio M : W = 1 : 1.2 with optic neuritis was performed. Of these, 43 cases are patients with multiple sclerosis. The control group consisted of 37 people with high visual acuity, somatically healthy, corresponding to the clinical group by sex and age.Results. Retinal sensitivity in patients with optic neuritis according color contrast perimetry was below the norm by 21.96 %. The depth of blindspots at optical neuritis, differed in significant variability and was in the range from to 2.6 to –19.64 dB. The level of visual field defects depended on the severity of the inflammatory process and, on average, exceeded the indices of the control group by 4.64 times. The area of scotoma in optical neuritis exceeded the values of the control group by 1.81 times.Conclusion. The most sensitive method for assessing changes in visual functions in patients with optical neuritis is chromatic perimetry with a red mark on a green background. Chromatic and achromatic visocontrastometry makes it possible to reveal a significant decrease in indices only in the high frequency range, which characterizes the state of the macular area, which generally indicates the predominant involvement of the retinal ganglion cells in the pathological process.The most sensitive method for assessing changes in visual functions in patients with optical neuritis is chromatic perimetry with a red mark on a green background

Diagnostic Criteria for Macular Edema Associated with Venous Occlusions

Background. Macular edema is considered as a risk factor for a significant decrease in the visual acuity and quality of life of the patient, regardless of its cause. The search for the causes of macular edema in some cases should include an interdisciplinary approach and laboratory studies to correctly determine its etiology and management tactics for such patients. Therefore, the differentiation of the etiology and pathogenesis of macular edema at the stage of diagnosis determines the possibility of preserving not only visual functions, but in some cases the patient's life.Aim: to present clinical cases of macular edema associated with central retinal vein thrombosis of various etiologies. Materials and methods. A prospective study of individual patients with macular edema associated with thrombosis of central retinal vein or its branches was conducted in real clinical practice. All patients underwent a standard ophthalmological examination, as well as optical coherence tomography, and a patient with suspected macroglobulinemia underwent a biochemical blood test.Results. In the first clinical case, macular edema was associated with an exudative form of retinal arterial macroaneurysm. The patient underwent direct laser coagulation of retinal arterial macroaneurysm. 6 months after direct laser coagulation of macroaneurysm, the best corrected visual acuity of the left eye was 1.0. The fundus - macroaneurysm, retinal edema, solid exudates are not ophthalmoscopic. In the second clinical case, macular edema, thrombosis of central retinal vein is associated with Waldenstrom disease. Follow-up and treatment of the underlying disease by a hematologist were recommended.Conclusion. Thus, macular edema proceeding against the background of central retinal vein thrombosis and its branches, having atypical symptoms in the form of ring-shaped deposition of hard exudates, exudative retinal detachment, the presence of a bilateral process, as well as resistance to anti-VEGF therapy require a careful collection of the patient's medical history and the presence of other ophthalmic vascular pathology

Mathematical modeling of the refractive effect of SMILE surgery in high degree myopia correction

The aim of the study. To develop a mathematical model of changes in corneal refraction during femtosecond laser-assisted lenticule extraction through a small surgical incision and, on this basis, to propose a technology for modified calculation of surgical parameters and to prove its effectiveness. Material and methods. The study included 191 patients with high myopia. They were divided into two groups: group  1 consisted of 55  patients who  were  had  SMILE (SMall Incision Lenticule Extraction) surgery with standard calculations; group  2 included 136 patients who had SMILE surgery with a modified calculation of surgical parameters based on the developed mathematical model of the refractive effect of the surgery. Results. When assessing the refractive effect of patients who were operated using standard technology, it was found that it was possible to achieve a refraction different from emmetropia for ± 0.5 D only in 51 % of cases; in the remaining patients, the planned residual refractive effect was obtained and averaged –1.96 ± 0.29 D. In patients operated using the modified technology, a statistically significantly better refractive result was achieved already on the first day. A refractive error of more than ± 1.0 D was obtained in only 1 % of cases; a deviation from the calculated refraction of ± 0.5 D was achieved in 82 % of cases, with the average values by 1 year –0.24 ± 0.57 D. Conclusions. The developed technology of a modified calculation of the parameters of the SMILE surgery for high myopia correction makes it possible to obtain an optimal refractive effect in compliance with safety rules when the structural and functional parameters of the eye are initially unfavorable for refractive surgery

Assessment of Changes in Cyliary Muscle in Patients with Hypermetropy Using Mathematical Modeling Methods

Background. Age-related decline in accommodation in patients with emmetropia, myopia and hyperopia is characterized by multidirectional changes in the thickness of the ciliary muscle and the configuration of the inner apex of the ciliary body. The structural and functional state of the ciliary muscle and its individual components and the patterns of their change with age in patients with hyperopia remain little studied.Aim: to study the structural and functional state of the ciliary muscle and its components in patients with hyperopia using mathematical modeling methods.Methods. 110 patients (220 eyes) with axial hyperopia were examined. The first group consisted of patients aged 18–30 years – 20 people. The second group consisted of 80 patients aged 45–65 years. The control group consisted of 30 healthy volunteers aged from 18 to 30 years. All patients underwent ultrasound biomicroscopy, on the basis of which a spatial-mathematical model was created using the ImageJ software package.Results and conclusion. In patients with hyperopia, in the aging process there is a transformation of the ciliary body and the restructuring of its muscular components. Structural irido-ciliary relationships in young patients with emmetropia and hyperopia significantly differ in the location and configuration of the inner apex of the ciliary body, the degree of emphasis on the circular portion of the ciliary muscle

Differential Reorganization of Structural Elements of the Iridociliary and Perenticular Zones in the Hydrodynamic Blocks Formation

Background. The key link in the pathogenesis of angle-closure glaucoma is the formation of structural blocks that initiate a violation of hydrostatic balance. However, if the parameters of the eyeball are equal, the state of the outflow pathways, the level of intraocular pressure and the eye hydrodynamics may be different. It was suggested that the formation of hydrodynamic blocks in patients with hypermetropia may be initiated at a young age by the processes of excessive accommodation, which are aggravated by physiological aging, accompanied by the formation of presbyopia.Aim. To find out the factors that provoke and aggravate the processes of formation of pathological changes in the eye hydrodynamics in patients with older hypermetropia.Materials and methods. A comprehensive study of the anterior segment of the eye was performed in 80 patients aged 45–60 years with hypermetropic refraction. Structural deviations were evaluated using ultrasound biomicroscopy and interactive Scheimpflug registration of the anterior segment of the eye (“Pentacam HR”, Oculus, USA) with the calculation of the parameters of the anterior and posterior chambers of the eye and the Lowe coefficient. Tonometry and tonography were performed on an electronic tonograph “Mentor” (Tecnar Ophthalmic, USA).Results and conclusion. The total results of the study of 80 patients with hypermetropia were processed using cluster analysis, which revealed significant and significant heterogeneity for three clusters. Comparative and regression analysis found that the parameters transformation and intraocular structures position are  initial and under the conditions of the load test in subjects of the first and third clusters was accompanied by a violation of the eye hydrodynamics with the predominant inclusion of the lenticular or iridociliary component, respectively. The changes detected in patients of the second cluster were characterized by balanced moderate changes in structural relationships and the absence of a clinically significant intraocular pressure increase

MODERN APPROACHES TO THE ASSESSMENT OF THE COMPLIANCE OF OPHTHALMOLOGICAL SERVICE OF IRKUTSK REGION TO THE REQUIREMENTS FOR MEDICAL TREATMENT PROCEDURE

The purpose of study was to analyze the compliance of medical organizations providing primary ophthalmological care to the population to the requirements of the Federal Law N 323-Fz in maintenance of procedure of medical treatment. The article presents the results of the development and implementation of organizational approaches to the assessment of compliance of ophthalmologic service of Irkutsk region to the requirements for medical treatment procedure. The informational possibilities of offered technologies in adequacy of development of measures for improvement of the functioning of ophthalmic services are showed

THE ROLE OF GROWTH FACTORS IN THE FORMATION AND PROGRESSION OF PTERYGIUM

Purpose. To determine a role of epidermal growth factors and vasal proliferative proteins in the pathogenesis of progressive pterygium based on data of immunohistochemical and morphological studies of tissues.Material and methods. The study included a main group of patients with primary pterygium of the progressive stage III-IV (30 eyes, 28 patients), the mean age was 57±7 years. The surgical procedure the pterygium removal was performed according to the Cermak method in all cases for therapeutic purposes and for a further morphological and immunohistochemical study of pterygium tissue. The clinical assessment of postoperative condition was carried out in the early postoperative period and in 6 and 12 months after surgery. The immunohistochemical study was made with the use of monoclonal antibodies and the visualization system (the DAKO company, Denmark): CD 31 (clone JC70A), CD 34 ClassII (clone QBEnd 10), Vascular Endothelial Growth Factor VEGF (clone VG1), Epidermal growth factor EGF (clone DAK-H1-WT). The intensity of coloration of objects was estimated by colorimetric index on a 4-point scale and reflected the quantity of the studied factors. For histological examination the removed pterygium with the tissues of the cornea and conjunctiva was stained with hematoxylin-eosin with a subsequent analysis and a micro-photographing.Results and discussion. The pterygium concerning the structure and function is characterized by an impaired homeostasis of the tissues of the conjunctiva and cornea, expressed in a change of epithelial-stromal relations, disorganization of the fibrous structures of connective tissue, violations in the microcirculatory bed. As a result of the immunohystochemical research, the expression of growth factors was identified in all cases of main group. The expression of epidermal factor was diagnosed in 27 objects with the index (++) and 3 objects with the index of (+). The CD31 expression was revealed: ++++ in 28 objects, in 1 object +++, and in 1 object ++. CD34 expression was revealed: ++++ in 26 objects, in 4 objects ++. The VEGF expression was revealed: ++++ in all 30 objects. In the control group the above-described changes were not revealed, that is the expression of epidermal and vascular growth factors were determined.Conclusion. Thus, the analysis of the peculiarities of growth of the conjunctive epithelium, angioarchitectonique in the tissues of the pterygium and underlying cornea allows assuming that the starting factor of the pathological process is the primary growth of conjunctive epithelium with the accompanying growth of vasculature. The expressive level of epidermal and vasoproliferative growth factors in pterygium can serve as a prognostic sign of pterigium recurrence. The identification of VEGF expression can be a condition on the use of anti-VEGF therapy in the prevention of recurrence

ОКТ и ОКТ-ангио параметры интраокулярного кровотока у здоровых лиц зрелой возрастной группы

PURPOSE.To identify the relationship between the parameters of choroidal and retinal blood flow by optical coherence tomography (OCT) and OCT angiography (OCT-A), and the structural, hydrodynamic and systemic hemodynamic parameters in healthy adults.METHODS.The study included 42 male subjects aged 54.43±4.1 years without signs of local or systemic pathologies. The following parameters were evaluated on the RTVue-XR tomograph (USA): structural and microcirculatory parameters of the optic disc (OD) — peripapillary retinal nerve fiber layer (pRLNF) and radial peripapillary capillary plexus (RPCP); the macula — thickness, superficial capillary plexus (SCP), deep vascular complex (DVC), foveolar avascular zone (FAZ); the choroid — thickness, structure. Blood pressure was determined using the Riva–Rocci method; tonometry — by the Maklakov method. The parameters of bidirectional corneal applanation were evaluated, and perfusion and tolerance pressure were calculated.RESULTS.Negative correlations were revealed between intraocular pressure, pRNFL and capillary density of RCP (R= −0.58… −0.73); between choroid thickness, systemic blood flow, and tolerant pressure (R= −0.56… −0.72); between the thickness of the choroid and the volume of focal losses (FLV, %), as well as the OCT-A parameters of FAZ (area, perimeter, and density of foveolar vessels) (R= −0.45… −0.58). Positive correlations were found between perifoveal thickness (including ganglion complex) with the pRNFL (R=0.58–0.71), as well as with the thickness of the choroid (R=0.41–0.65). The confidence level was p≤0.001.CONCLUSION. The relationship of retinal, choroidal, micro hemodynamics parameters by OCT (choroid thickness) and OCT-A (RCC) (HD Angio Disc 4.5 protocol); area, perimeter, and vascular density of FAZ (Angio Retina 3.0 protocol) with  the parameters of systemic blood flow in healthy subjects can likely be considered as hemodynamic biomarkers in the diagnosis, monitoring, and evaluation of treatment effectiveness of any intraocular vascular process (including glaucoma).ЦЕЛЬ. Выявить взаимосвязи параметров хориоидального и ретинального кровотока по данным оптической когерентной томографии (ОКТ) и ОКТ-ангиографии (ОКТ-А) со структурными, гидродинамическими и системными гемодинамическими показателями у здоровых лиц зрелоговозраста.МЕТОДЫ. Обследовано 42 субъекта мужского пола в возрасте 54,43±4,1 года без признаков местной и системной патологии. На томографе RTVue-XR (США) оценены структурные и микроциркуляторные показатели диска зрительного нерва (ДЗН) — перипапиллярный слой нервных волокон (ПСНВ) и радиальное перипапиллярное капиллярное сплетение (РПКС); макулы — толщина, поверхностное капиллярное сплетение (ПКС), глубокий сосудистый комплекс (ГСК), фовеолярая аваскулярная зона (ФАЗ); хориоидеи — толщина, структура. Артериальное давление (АД) определяли методом Рива–Роччи; тонометрию методом Маклакова. Оценивали параметры двунаправленной пневмоаппланации роговицы, рассчитывали перфузионное и толерантное давление.РЕЗУЛЬТАТЫ. Выявлены отрицательные корреляции между офтальмотонусом и ПСНВ, плотностью капилляров РПКС (R= −0,58… −0,73); между толщиной хориоидеи и системным кровотоком, толерантным давлением (R= −0,56… −0,72); между толщиной хориоидеи и объемомфокальных потерь (FLV, %), а также ОКТ-А параметрами ФАЗ (площадь, периметр и плотностью фовеолярных сосудов) (R= −0,45… −0,58). Выявлены положительные корреляции толщины перифовеа (включая ганглиозный комплекс) с ПСНВ (R=0,58–0,71), с толщиной хориоидеи, а также плотностью фовеолярных сосудов (ФАЗ) (R=0,41–0,65). Уровень достоверности р≤0,001.ЗАКЛЮЧЕНИЕ. Взаимосвязи параметров ретинальной, хориоидальной микрогемодинамики по данным ОКТ (толщина хориоидеи) и ОКТ-А (РПКС, протокол HD Angio Disc 4.5); площадь, периметр, плотность сосудов ФАЗ (протокол Angio Retina 3.0) с показателями системного кровотока у здоровых субъектов с большой долей вероятности позволяют рассматривать их в качестве гемодинамических биомаркеров в диагностике, мониторинге и оценке эффективности лечения любого интраокулярного сосудистого (в том числе глаукомного) процесса.