Changes of lysozyme content in the lacrimal fluid in patients with diabetic retinopathy (pilot study)

Background. Type 2 diabetes mellitus is one of the most common metabolic disorders in humans. Diabetes mellitus can lead to abnormalities in many tissues of the eye structure, exposing patients to the risk of developing a wide range of ocular pathologies associated with changes in its anterior and posterior segments. The most common complication is diabetic retinopathy.The aim: to assess the potential clinical significance of lacrimal lysozyme as a minimally invasive biomarker of diabetic ophthalmic disorders.Material and methods. Three groups were formed during the study. Group  1 (Control, n  =  10) included conditionally healthy people with no type  2 diabetes mellitus. Group 2 (Main 1, n = 15) included patients with type 2 diabetes mellitus, but  no  diabetic manifestations in the fundus. Group  3 (Main  2, n  =  15) included patients with type 2 diabetes mellitus and manifestations of diabetic retinopathy of varying degrees. In patients of all groups, the level of tear lysozyme was assessed.Results. It was found that the concentration of lacrimal fluid lysozyme in patients with type 2 diabetes mellitus was significantly lower than in healthy patients. In patients with diabetic retinopathy of varying degrees of manifestation (non-proliferative and proliferative forms) against the background of type  2 diabetes mellitus, significantly lower values of lysozyme were observed compared to patients with type 2 diabetes mellitus, but without diabetic ophthalmic manifestations.Conclusion. It is possible that local detection of lysozyme in the lacrimal fluid may be potential biomarkers of the progression of diabetic retinopathy

Aniridia, aphakia accompanied by retinal detachment: problem and its ways of solution

Purpose: Evaluation of the results of various treatment tactics of patients with post-traumatic retinal detachment pathology combined with aniridia and aphakia.Patients and methods.The analysis of four clinical cases of surgical treatment of post-traumatic retinal detachment in conjunction with aniridia and aphakia was carried out. There was used a gradual approach of optic-reconstructive surgery: vitreoretinal stage by the standard method 23‑25 Ga with tamponade of vitreous cavity with silicone oil in two different ways. In one case, full eyeball tamponade was made, and in the other one it was made up to the diaphragm formed of polypropylene sutures. At the final stage — iridolenticular diaphragm was implanted (Reper-NN, Russia).Results. In all cases, early postoperative reaction proceeded with the phenomena of fibrino-plastic iridocyclitis, which corresponded to the severity of the initial state and the volume of surgical intervention. Periods of observation of patients in the postoperative period ranged from 3 to 12 months. In three cases where the diaphragm was formed from polypropylene sutures there was noticed full retina adaptation, wherein silicone oil, introduced in the vitreous cavity, did not penetrate into the anterior chamber during the entire period of observation. In one case, where there was a complete eyeball tamponade with silicone oil epithelial and endothelial corneal dystrophy developed. Such an outcome of a clinical case, despite high functional results, is apparently related to the severity of the initial state, the need to re-intervention for recurrent retinal detachment and relatively early stages of iridolenticular diaphragm implantation.Conclusion. Reconstructive surgery of posttraumatic aniridia and aphakia combined with retinal detachment requires a multistage approach. Reconstruction of anterior segment of the eye is preferably to carry out in long-term periods as after the trauma so after surgical treatment of retinal detachment. Choice of the method of eye cavity tamponade by silicone oil depends on the severity of the initial state, at that the formation of the diaphragm from polypropylene sutures provides longer tamponing by silicone, reduces the risk of postoperative complications.</p

Surgery of secondary glaucoma in patients with operated retinal detachment induced by emulsified silicone oil

Purpose. To evaluate the efficacy of silicone oil induced secondary glaucoma surgery using shunt-drains.Material and methods. The study included 10 patients (10 eyes) aged 38-73 years. All patients had been previously operated for rhegmatogenous retinal detachment with vitreous cavity tamponade by silicone oil. The tamponade duration ranged from 1 year or more. All patients underwent the surgery for the secondary glaucoma induced by emulsified silicone oil. Either leucosapphire explantodrains or polymer micro-shunts were implanted in these patients. The follow-up period was 6 months.Results. There were no any intra-operative complications. Ciliochoroidal detachment occurred in 5 cases, hyphema – in 2 cases. Intraocular pressure after surgery was 20mmHg within a month. Subsequently, antihypertensive drugs were prescribed for 1 patient, and another 1 patient underwent transscleral cyclophotocoagulation. Expansion of visual field limits was 7-15°, improvement of visual functions was from hundredths to tenths.Conclusion. Glaucoma in eyes with previously operated retinal detachment, and complicated by the alteration of anterior chamber angle under the influence of emulsified silicone oil, requires a more radical approach to a surgical treatment with application of drains.The leucosapphire explantodrain and polymer micro-shunt show a sufficiently high hypotensive efficiency in relatively the same surgical technique

EXPERIENCE OF SURGICAL TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY

The study included 48 vitreoretinal surgeries performed during 2014-2015 in 39 patients with advanced fibrovascular stage of proliferative diabetic retinopathy. Visual acuity before the surgery averaged from pr. l. certae to 0.01. In 7 cases patients underwent intravitreal injection of Lucentis 2-3 weeks before the surgery. The surgery was performed according to the standard 3-port 25 G vitrectomy. In some cases, short-term tamponade of vitreous cavity by fluid perfluororganic compounds (PFOS) was performed for 2-3 days. This was due to prolonged bleeding during the surgery. In these cases, fibrinolytic of direct action (hemasa) was injected directly to the blood clot. In 4 cases circular retinotomy was needed. In 35 cases tamponade was made by silicone oil 5700 cSt, in 13 - by air-gas mixture. In cases of air-gas tamponade 3 patients had a relapse. After vitreous cavity revision it was plugged with silicone oil 5700 cSt. In 17 cases visual function remained unchanged, in 18 cases the changes were imperceptible, in 9 cases visual acuity improved to 0.2, in 3 cases -visual function increased to 0.4 and in 1 patient - to 0.7. In postoperative period IOP increased in 7 cases. In 5 of these cases compensation was achieved with antihypertensive drugs. 1n one case the patient was implanted leukosapphire drainage, and in one more case transscleral cyclophotocoagulation about terminal aching glaucoma was performed. The silicone oil was removed in 6 patients at the period of 6 months up to 2 years