Retrospective analysis of long-term clinical and functional outcomes of implantation of domestically produced posterior chamber PIOL

Introduction. The use of phakic intraocular lens (PIOL) for the correction of high ametropia is reflected in the works of both domestic and foreign ophthalmologists. In spite of this, there are very few publications which are devoted to the long-term outcomes of the use of domestically produced models of PIOL such as RSK-1(3) and RSK-3.Purpose. The main aim of this work is to assess the clinical and functional outcomes of the use of domestically produced models of PIOL such as RSK-1(3) and RSK-3.Material and methods. A retrospective analysis of the long-term results of PIOL implants performed at the Fyodorov Eye Microsurgery Federal State Institution was carried out from 1994 to 2001. The analysis involved 122 eyes of 84 patients with high myopia from who were implanted with posterior chamber negative PIOL with two haptic elements (RSK-3) and PIOL with thr ee haptic elements (RSK-1(3). Results. Analysis of the dynamics of postoperative refractive data in compare with preoperative parameters showed us that in all cases there was a significant increase in uncorrected and corrected visual acuity. Long-term outcomes of implantation were found in 25 patients (43 eyes). The average duration of PIOL in the eye was 14.30±1.3 g (from 2 to 30 years). In all cases, the reducing cell density of the corneal epithelium did not exceed 4.0% in the early postoperative period. At the same time, the main complication in the distant postoperative period was the development of subcapsular cataracts.Conclusions. This method of ametropia correction can be recommended to young patients, who are not suitable for keratorefraction interventions

Comparative clinical and functional outcomes of implantation of «reverse-M» and «reverse-M1» IOL in patients with high myopia in the long-term postoperative period

The formation of secondary cataracts in patients with high myopia remains the main cause of vision loss in the long-term postoperative period. In view of that fact, the Fyodorov Eye Microsurgery Federal State Institution has developed a soft model of posterior chamber “reverse” IOL, which allows reducing the development of secondary cat aracts.Purpose. Comparative analysis the clinical and functional outcomes of «reverse-M» and «reverse-M1» IOL implantation in patients with high myopia in the long-term postoperative period.Material and methods. Clinical research has been carried out on 140 eyes of 97 patients with high myopia aged from 42 to 83 years (on average, 64.24±0.79 years) after phacoemulsification with IOL implantation in high myopia. The main group consisted of 57 eyes of 40 patients who were implanted with «reverse-M1» IOL, the control group consisted of 83 eyes of 57 patients who were implanted with “reverse-M” IOL. Before the surgery, the uncorrected visual acuity in any patient did not exceed 0.01, and the best corrected visual acuity was no more than 0.2 (80%). The follow-up period was up to 5 years.Results. Visual functions in most patients increased and remained stable throughout the postoperative period, amounting to 0.55±0.04 in the main group, and 0.54±0.03 in the control group. In the late postoperative period, dissection of the posterior lens capsule with «reverse-M» IOL was performed in 11 eyes of 13 patients (13.2%). In the main group, YAG laser dissection of the posterior capsule was required in 2 patients with 3 eyes (5.3%).Conclusion. «Reverse-M1» IOL implantation is safe, predictable and allows to reduce the incidence of secondary cataracts by more than 2 times in comparison with the «reverse-M» IOL

The hesperidin inhibits the butyrylcholinesterase from serum of human

Hesperidin shows a variety of pharmacological effects and is potentially promising for the treatment of neurodegenerative diseases. Literature review and in-house QSAR analysis showed that hesperidin also displays the various biological and pharmacological properties, including antiinflammatory, antineoplastic, antidepressant and antioxidant activity. Molecular docking of hesperidin into the active site of BChE allows to assume the existence of the inhibition effect. Hesperidin inhibits the BChE by mixed mechanism. Further comprehensive research in this area is relevant with aim of further development of drugs for the treatment of neurodegenerative diseases

Myopic shift of clinical refraction following cataract phacoemulsification with IOL implantation in an avitreal eye

Purpose: Propose a correction of IOL power calculation for the cases of cataract phacoemulsification after preceding subtotal vitrectomy.Methods: The study enrolled 32 cases (32 patients) cataract phacoemulsification with IOL implantation after subtotal vitrectomy.Patient age averaged 48±3 years. In all cases, the elastic IOLs were implanted with the value of the constant A from 118.0 to 119.0. Termevaluation of clinical refraction after phacoemulsification surgery was on average 3 months. A retrospective analysis was performed of refractive outcomes using the inverse method of calculation.Results: In a retrospective analysis, the error calculated IOL power by an average of 0.8 D, which leads to a shift in clinical refraction towards myopia. IOL after surgery avitreal eye on the average is closer to the top of the cornea by 0.5 mm, relative to the standard situation. Conclusion: For preoperative IOL power calculations after subtotal vitrectomy A-constant can be modified as follows: Am = A-0.9

Calculation of contact transscleral diode laser cyclophotocoagulation parameters on the basis of ciliary body original state assessment using ultrasound biomicroscopy in terminal glaucoma patients

Aim. To analyze the initial atrophy of ciliary body in patients with painful terminal glaucoma using ultrasound biomicroscopy (UBM) and the progression of ciliary body atrophy following transscleral diode laser cyclophotocoagulation (TSCPC) considering total laser energy used.Materials and methods. 56 patients (92 eyes) with terminal painful glaucoma were examined. In these patients, TSCPC with total laser energy ranged from 43.2 to 86.4 mJ was performed. Total laser energy parameters for TSCPC were determined according to the presence and degree of ciliary body atrophy of the affected eye as compared withhealthy one. Additionally, 5 terminal glaucoma eyes with clinically apparent eye globe sub-atrophy following previous TSCPC with total laser energy above the level used in this study were examined.Results. In all terminal glaucoma patients, various degrees of ciliary body atrophy was revealed using UBM. This atrophy was diagnosed by ciliary body thinning as compared with healthy eye by 28.37 %. Post-op reaction degree following TSCPC depends on total laser energy. Total laser energy parameters selection depending on initial ciliarybody atrophy reduces pain syndrome, minimizes post-op complications, prevents further ciliary body atrophy progression and decrease IOP to sub-compensated level.Conclusion. Mathematical analysis of ciliary body thickness changes depending on laser energy used was assumed as a basis of nomogram construction that provides individual calculation of maximum allowable and minimally required total laser energy

THE MORPHOLOGICAL AND BIOCHEMICAL CHANGES IN THE SCLERA AFTER EXPOSURE TO THE LASER DIODE. EXPERIMENTAL STUDY

Purpose. To investigate the morfologicl and biomechanical changes in the sclera after exposure to diode laser in the experiment.Material and methods. The study included 12 isolated fragments of human cadaver sclera of 12 eyes aged 60 to 70 years. [Axial length (AL) is 23.56±3.06mm (20.05-26.62)]. Exclusion criteria were: eye injuries, surgical interventions before, as well as the general anamnesis of medical illness. Samples of sclera were cut out with a microsurgical blade from the posterior pole of the eye, then the scleral fragments were exposed to the diode laser ALOD-1 (Russia) (energy E=900mJ, exposure time 5sec). Fragments of the sclera treated earlier by the laser were cultivated in the medium and then transported to a laboratory for biomechanical testing on an Instron testing machine, and morphological studies using electron microscope Quanta 200 3D.Results. The study of biomechanical properties of posterior pole of sclera after the exposure to diode laser showed an increase in strength and indices Jung’s modulus (JM) in all tissue samples regardless of the refraction of the eye. The morphological studies using the electron microscope Quanta 200 3D. diode laser exposure leads to pronounced morphological changes in the scleral tissue.Conclusions. Strength properties of samples of scleral tissue after the exposure to the diode laser increased by 30% in all persons (regardless of the refraction of the eye), which may be relevant for the development of new methods in treatment of glaucomatous optic neuropathy. The lowest biomechanical characteristics are detected in the fragments of the myopic type sclera that causes pronounced changes in the biomechanical status initially in comparison with other types of refraction. Modeling of the biomechanical properties (JM, strength) in the most prognostically dangerous areas (the posterior pole of the eye), enables a future development of a method of invasive impact on the fibrous membrane of the eye in open-angle glaucoma

OPTIMIZATION OF THE IOL OPTICAL POWER CALCULATION IN PATIENTS WITH COMPLICATED CATARACT AND PSEUDOEXFOLIATIVE SYNDROME

Background. In recent years the phacoemulsification with IOL implantation (PHACO+IOL) is a «gold» standard for cataract surgery. This requires high refractive outcomes that depend upon a number of reasons. One of those is a change in the IOL position in the eye, which can be caused by dystrophic lesions of the zonular system of lens associated with the pseudoexfoliative syndrome (PEХ).Purpose. To increase the accuracy of IOL power calculations in patients with complicated cataract and pseudoexfoliative syndrome.Material and methods. A comparative analysis of refractive results in phacoemulsification with IOL implantation PHACO+IOL was performed in 57 cases of cataract with PEХ. All clinical materials were divided into two groups based on bio-microscopic characteristics: with initial and advanced PEX symptoms. All patients underwent standard examinations. A comparative analysis of refractive outcomes in the study groups was carried out using the «reverse calculation» method that consists in a recalculation of IOL power based on post-operative examination data in both groups.Results. There was no necessity in any amendments to the IOL power calculation in patients with cataract and initial PEX stage. An error of the calculated IOL power was detected in patients with advanced PEХ stage on an average 0.37±0.12D.Сonclusion. The detected error of the calculated IOL power in patients with advanced PEX stage requires an amendment amendment for A constant Am=A+0.3

Toric intraocular lens implantation outcomes in patients with stable keratoconus

Purpose. To evaluate the clinical and functional results of phacoemulsification with toric IOL implantation in eyes with stable keratoconus.Material and methods. This study comprised 49 patients (49 eyes) with stable keratoconus and cataract post ICRS implantation and UVcrosslinking in anamnesis. Mean age was 46±1.2 years.Depending on different corneal astigmatism constant, all patients were subdivided in clinical groups. The first one was 27 patients with corneal astigmatism from 1.25 to 4.0D (2.52±1.63D) where the phaco AcrySof IQ Toric were implanted (Alcon, USA). The second group included 22 patients with corneal astigmatism from 4.0 to 10.50D (7.43±1.81D). In that group the IOL AT Torbi 709M (Carl Zeiss Meditec, Germany) was implanted, with the possibility of astigmatism corr ection up to 12.0 D.Results. Postoperative results were evaluated after 1, 3, 6 and 12 months. By the end of the first month all patients registered a significant visual acuity improvement. The UCVA and BCVA were 0.6±0.19 (from 0.4 to 0.7) and 0.8±0.1 (from 0.7 to 0.9) in the group 1. In the group 2: 0.5±0.18 (from 0.3 to 0.6) and 0.6±0.14 (from 0.5 to 0.7). The final refractive criteria stabilization was achieved 3 months after the surgery. The objective spherical and cylindrical refraction in the group 1 was –1.5±1.58 and – 0.75±0.56D; in the group 2: –1.25±2.22 and –1.25±0.56D, respectively. In refractive results estimation a hyperopic shift was found, +0.67±0.19D (from +0.53 to +0.98D) in the group 1 and +0.98±0.21D (from +0.75 to +1.21D) i n the group 2.Conclusion. Phaco with toric IOL implantation is a safe and effective option of ametropia correction in eyes with stable keratoconus, which leads to a visual function improvement in overwhelming majority of patients, however, this method needs to capture all corneal parameters. The obtained results require a deeper further i nvestigation

Comparative assessment of daily curves in patients with cataract associated with pseudoexfoliation syndrome (PEX) before and after phacoemulsification with IOL implantation

Purpose. To perform a comparative analysis of the 24-hour control of intraocular pressure (IOP) amplitudes in patients with complicated cataract associated with PEX before and after phacoemulsification of cataract.Material and methods. The clinical study was carried out in 154 eyes of 154 patients with cataract associated with pseudoexfoliation syndrome (PEX). All patients diagnosed with cataract associated with PEX were divided into 3 groups: the group 1 included patients with normal IOP level preoperatively (n=55); the group 2 included patients with IOP ophthalmohypertension preoperatively (n=57); the group 3 included patients with primary open-angle initial glaucoma (n=42). The study of the amplitude of 24-hour fluctuations of IOP and diurnal curve of IOP before and after cataract phacoemulsification was performed. Before the PHACO+IOL the amplitude of diurnal IOP fluctuations was in the group 1: 5.22±0.49 mm Hg, and in the groups 2 and 3: 6.81±1.21 mmHg and 6.60±1.49 mm Hg, respectively.Results. Patients of the group 1 had a significant decrease in the amplitude of diurnal IOP fluctuations by 1.27±0.93 mm Hg (p<0.001). A decrease in the amplitude of diurnal IOP fluctuations by 2.34±1.26 mm Hg (p<0.001) was noted in patients of the group 2. In the group 3 a decrease in the amplitude of diurnal IOP fluctuations by 1.15±1.14 mm Hg (p<0.001) was observed. A tendency of changes in diurnal IOP curves after surgery was revealed in all cases.Conclusion. PHACO+IOL in patients with cataract associated with PEX allows to normalize the level, amplitude and type of diurnal IOP curve

FREQUENCY OF SECONDARY CATARACT DEVELOPMENT IN PSEUDOPHAKIC EYES WITH POSTERIOR CHAMBER IOL OF CURRENT DESIGNS IN CASE OF AXIAL MYOPIA

Purpose. To evaluate a frequency of secondary cataract development in different periods of postoperative follow-up after cataract phacoemulsification depending on the degree of axial myopia and the implanted IOL design. Material and methods. A retrospective analysis of secondary cataract formation in the long-term follow-up after cataract phacoemulsification with foldable intraocular lens implantation was performed in 16575 eyes out of 8722 patients with emmetropia and axial myopia. The average age of patients was 74±7 years, and the follow-up period was 5 years. The eyes with associated pathology such as glaucoma, diabetic retinopathy etc, were excluded from the study. Depending on the design of implanted IOL all eyes were divided into 3 groups. The first group included 5527 eyes with the implanted B-lens IOL (Hanita, Israel). The second group included 5629 eyes with the implanted Idea IOL (XCELENS, Switzer-land). The third group consisted of 5419 eyes with the implanted Acrysof natural, SA60AT IOL (Alcon, USA). In every case the degree of myopia was evaluated using axial length of an eye that was measured instrumentally. The incidence of secondary cataract formation was evaluated on quantity of YAG-laser posterior capsule dissection within the 5-year follow-up after phacoemulsification with IOL implantation. Conclusion. According to our results the incidence of PCO is directly dependent on the axial length of the eye, strongly increasing in eyes with high axial myopia. The design and material of implanted IOL played an important role in PCO formation too. The eyes with the Acrysof natural, SA60AT IOL (Al-con, USA) had the lowest incidence of PCO in the long-term follow-up