Methods of Screening for Meibomian Gland Dysfunction

The relevance of the modern diagnosis of meibomian glands dysfunction (MGD) increases daily. Firstly, it is caused by changing of the perception about the prevalence of this disease, according to various data it is from 40 to 71% of the population in different age groups. Considering the increasing number of patients suffering from MGD, there is the need to develop screening methods for diagnosis of this disease. Screening methods should be available not only for specialists involved in the treatment of xerosis keratoconjunctival in specialized ophthalmology clinics, but also in out-patient sector. An important aspect in the diagnosis of the severity of the functionaldisorders of the meibomian glands is the assessment of morphological status that determines the further choice of therapy. To evaluate the morphological and functional state of the meibomian glands proposed to use biometrics of meibomian glands. A slit lamp is used for examination. Furthermore, objective data characterizing the morpho-functional state of the meibomian glands, can be obtained by carrying out meibography. Authors used not only white light but also infrared light for the visualization of meibomian glands during meibography. The multifunctional ophthalmic devices equipped with infrared lighting can be used for lighting. For example, specialized slit lamps, corneal topographs, Sheympflyug camera, the fundus camera and others. We applied nonmidriatic fundus camera TOPCON TRC-NW300, using for fotoregistration of the ocular fundus. A feature of the proposed method — meyboskopy — was simplicity and absence of necessity of the investigator skills by scanning with the fundus camera of the inner surface of the eyelid. Meiboskopy doesn’t require  additional equipment and software of the fundus camera and allows to receive objective quality video of meibomian glands, it opens new diagnostic possibilities. Extending of the range of diagnostic capabilities in detecting of MGD based on the screening methods will allow time to assess the severity of this disease and to appoint pathogenetically substantiated therapy

The efficiency of tear substitute therapy at dysfunction tear basic secretion

Purpose: to evaluate the efficiency and tolerance of drops replacing tear with hyaluronic acid 0.15% (Hylabak, thea, France) for the treatment of tear film diseases, in particular blepharoconjunctival form of dry eye syndrome.Methods: 32 patients (range 38 to 72 years) with blepharoconjunctival form of dry eye syndrome were treated lubricant Hylabak 2-4 times a day during 7-30 days.Results: After treatment was detected the elimination of complaints in 30 of 32 people, increasing the stability of the tear film (increasing values of the samples Norn test from 7.3 ±0.5 to 10.1±0.6 seconds), as well as normalization of Schirmer test (from 8.8±0.4 to 15.2±0.5 mm).Conclusion: the study was showed high efficacy of lubricant Hylabak and subjective tolerability at blepharoconjunctival form of dry eye syndrome

Importance of ophthalmological examination in pregnancy

Obstetricians interest to the eye pathology is connected with the choice of tactics while looking after women expecting babies and the way of their childbirth if the pregnant patients have any eye pathology. Nowadays this question is opened to discussion, according to the literature. The frequency of performing Caesarian section reaches 10-30% if expectant mothers have any eye disease. Nevertheless, the reason for surgical childbirth is retinal detachment or its threat in most cases. The most frequent reason for retinal detachment is vitreochorioretinal retinal dystrophy, that about 14,6% of women at childbearing age are often ill. In this article the facts concerning ophthalmologic inspections of pregnant women have been systematized. All the women expecting babies must be examined by ophthalmologist before 28-30 week of pregnancy and must be examined using ophthalmoscopy in condition of the highest possible medical midriatic. If retinal tears or retinal detachment are found, laser photocoagulation is strongly recommended. If pregnant women have from high to medium myopia, they must be examined every 3 months. The next ophthalmologic examination is recommended during 32-36 week of pregnancy . After that ophthalmologist makes the final conclusion about the choice of way of childbirth considering ophthalmologic indications. Despite the fact, that ophthalmologist makes the conclusion about the preferred method of childbirth, the decision in each specific case must be made advisory together with obstetrician-gynecologist, who supervises the pregnant woman.Интерес акушеров-гинекологов к глазной патологии связан с выбором тактики ведения беременности и способа родоразрешения при наличии офтальмопатологии. В настоящее время по данным литературы вопрос о способах родоразрешения беременных с патологией органа зрения остается дискутабельным. Частота проведения операции кесарева сечения при наличии глазных заболеваний достигает 10-30%. При этом в большинстве случаев причиной оперативного родоразрешения служит наличие отслойки сетчатки или ее угрозы. В свою очередь, наиболее частой причиной отслойки сетчатки является периферическая витреохориоретинальная дистрофия, которая у женщин фертильного возраста достигает 14,6%. В работе были систематизированы данные, касающиеся офтальмологического обследования беременных. Все беременные должны быть своевременно осмотрены офтальмологом на не позднее 28-30-ой недели беременности с обязательным проведением офтальмоскопии в условиях максимального медикаментозного мидриаза. При обнаружении разрывов или отслойки сетчатки показано проведение отграничивающей лазерной коагуляции. При наличии миопии средней и высокой степени беременных необходимо осматривать в каждом триместре. Повторный осмотр офтальмологом показан на 32-36-й неделе беременности, при этом делают окончательное заключение о выборе метода родоразрешения по офтальмологическим показаниям. Несмотря на то, что офтальмолог дает заключение о предпочтительном способе родоразрешения, решение в каждой конкретной ситуации следует принимать консультативно совместно с акушером-гинекологом, курирующим беременную

EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research

Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given

ВОЗМОЖНОСТИ ХИРУРГИЧЕСКОЙ КОРРЕКЦИИ ТРОМБОЗА ВНУТРЕННЕЙ СОННОЙ АРТЕРИИ У ПАЦИЕНТОВ С ОСТРЫМ ИШЕМИЧЕСКИМ ИНСУЛЬТОМ

Objective. To estimate the efficacy of surgical treatment of internal carotid artery (ICA) thrombosis in patients suffered from acute ischemic stroke (AIS).Material and methods. Author operated 25 patients suffered from AIS and ICA thrombosis from 01 Feb, 2014 till 31 Aug, 2016 in Neurosurgical Department of N.V. Sklifosovsky Research Institute for Emergency Medicine. Among them, 15 patients had total thrombosis of ICA and were operated on, 10 patients had partial mural thrombosis or floating thrombus (6 patients were operated on). There were 7 thrombectomies with the removal of intima, 13 superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses, 1 ICA stent installation.Results. The excellent outcomes were seen in 7 (33.4%) patients, good outcomes — in 11 (52.3%) and satisfactory outcomes were observed in 3 (14.3%) patients. The improvement of functional deficit in the early post-operative period was 4.85 scores according to NIHSS, 1.2 scores according to Rankin scale and 2.3 scores according to Rivermead mobility index. The regress of neurological deficit was more significant among patients with severe focal disturbances; better outcomes were among patients operated on within first 3 days from an onset of the disease. There was no significant improvement among non-operated patients at the moment of discharge from hospital. Thrombectomy with the removal of intima performed in 2 (40%) patients with partial mural thrombosis was complicated by repeated thrombosis of ICA. The improvement of cerebral blood supply was verified in 16 (76.2%) operated patients according to the data of cerebral perfusion examination.Conclusions. The early surgical treatment is indicated for patients with acute total thrombosis of ICA. It is possible to perform STA-MCA bypass in case of inability to perform endovascular thrombextraction or open thrombectomy with the removal of intima. The conservative treatment is indicated for patients with partial mural thrombosis while urgent operation is necessary among patient with floating thrombus to decrease the risk of cerebral embolism. Цель. Оценить эффективность хирургического лечения тромбоза внутренней сонной артерии (ВСА) у пациентов с острым ишемическим инсультом (ОИИ).Материал и методы. В период с 1.02.2014 по 31.08.2016 гг. в нейрохирургическом отделении НИИ СП им. Н.В. Склифосовского пролечены 25 пациентов с ОИИ и тромбозом ВСА. У 15 больных выявлен полный тромбоз (все 15 оперированы), у 10 — неполный пристеночный или флотирующий тромб (6 оперированы). Выполнено 7 тромбинтимэктомий (ТИЭ), 13 экстра-интракраниальных микроанастомозов (ЭИКМА), одно стентирование ВСА. Результаты. Отличные исходы получены у 7 (33,4%), хорошие — у 11 (52,3%), удовлетворительные — у 3 (14,3%) больных. Снижение функционального дефицита в раннем послеоперационном периоде состави- ло 4,85 балла по шкале NIHSS, 1,2 балла по шкале Рэнкина и 2,3 балла по индексу мобильности Ривермид. Регресс неврологического дефицита был более выражен у пациентов со значительными очаговыми нарушениями; лучшие исходы имели пациенты, оперированные в первые 3 сут заболевания. У неоперированных пациентов достоверного улучшения к моменту выписки не было. ТИЭ по поводу пристеночных тромбозов в 2 наблюдениях (40%) сопровождалась ретромбозом ВСА. У 16 оперированных пациентов (76,2%) отмечено улучшение кровоснабжения головного мозга по данным исследований его перфузии.Заключение. Пациентам с острым полным тромбозом ВСА показано проведение раннего хирургического лечения. При невозможности проведения эндовазальной тромбэкстракции или открытой ТИЭ предлагается выполнить обходное шунтирование (ЭИКМА). Пациентам с неполным пристеночным тромбозом показано проведение консервативного лечения. Больным с неполным флотирующим тромбозом и высоким риском эмболии в головной мозг показано проведение экстренной операции.

НОВЫЕ ТЕХНОЛОГИИ В ХИРУРГИИ НЕТРАВМАТИЧЕСКИХ ВНУТРИЧЕРЕПНЫХ КРОВОИЗЛИЯНИЙ

ABSTRACT. The article is dedicated to the problem of nontraumatic intracranial hemorrhage surgery. Principal concern was given to the contemporary aspects of target and urgent diagnostics of vascular pathology of the brain, being the cause of hemorrhage, and ischemic complications detection. Modern surgical technologies applied for surgical treatment of patients with intracranial hemorrhages are described and surgical results achieved in Sklifosovsky Research Institute are represented. РЕЗЮМЕ. В статье освещается проблема хирургического лечения нетравматических внутричерепных кровоизлияний. Особое внимание уделено современным аспектам плановой и экстренной диагностики сосудистой патологии головного мозга как причины нетравматических кровоизлияний и выявлению ишемических осложнений. Описаны современные хирургические технологии, применяемые для лечения больных с внутричерепными кровоизлияниями и представлены результаты лечения этих больных в НИИ скорой помощи им. Н.В. Склифосовского.

From dry eye to team film disease

In this article, authors present the new terminology and classification one of wide-spread ophthalmologic diseases is syndromedry eye

Descemet stripping automated endothelial keratoplasty (DSAEK) with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity

Purpose: To evaluate the results of DSAEK with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity.Methods: DSAEK with thin grafts the thickness of which was 150‑70 μm was fulfilled in 47 patients (47 eyes) suffered bullous keratophaty without visible leukomas in the corneal stroma. Visual acuity prior to the operation with a maximum spectacle correction accounted for an average of 0.05±0.04. Tear film osmolarity of 20 patients (20 eyes) who participated in the research was measured. Results: In follow-up period graft kept transparency in 39 patients. Visual acuity in 3 months after the operation, on average, without correction was 0.38±0.16, with a maximum of spectacle correction is 0.51± 0.18. The spherical component varied in the range from 0 to 3.75 D, with an average of 1.63 per±1.1 D. Corneal astigmatism was from 0.5 to 4.0 D, an average of 1.8±0.98 D. At preoperative osmolarity indicators were within the normal reference for both operated and non-operated eyes — 292.3±10.4 и 279.3±3.51. In a first postoperative week osmolarity was not detected while on a non-operated eye it was 278.4±1.4. After 1, 3 and 6 months osmolarity indicators on both eyes were within normal reference. Spherical component ranged from 0 to 3.75 D, averaging 1.1±1.63 D. Corneal astigmatism ranged from 0.5 to 4.0 (D), with an average of 1.8±0.98 D 1.63 per±1.1 D.Conclusion: DSAEK with thin grafts is an effective modern methods of surgical treatment of bullous keratophaty. For old patients with severe ocular pathology — concomitant eye diseases, repeated surgery of the eye, the developed stage of the keratophaty — we have not noted the apparent correlation between the thickness of the transplant, visual acuity and the time of recovery of visual functions after keratoplasty. Osmolarity in an early postoperative period is a non-informative method of diagnostics. Restoration of osmolarity level to preoperative level is expected within one month after the surgery

ALLERGIC EYE DISEASES IN CHILDREN. MODERN VIEW ON PATHOGENESIS AND TREATMENT

The prevalence off allergic diseases has  been  significantly increased among  adults  and children during last 30-40 years. International study has  shown  that  the  frequency  of atopy  in developed  countries, including Russia,   is higher  than  in developing.  Often atopic dermatitis, started in infancy, can develop into an “allergic march”  — food allergy, followed by the formation of allergic rhinitis, allergic conjunctivitis and  other  allergic diseases. The problem  of prophylaxis and  treatment of allergic pathology  becomes actual  for these reasons. An opinion according some  preventive  measures has  changed in recent. It was  noted  that  in families  with many children, where  children  were  often  sick  with respiratory infections,  the  incidence  of allergic  diseases was  lower  than  among  rarely sick children.  It is explained by the  “hygienic theory” — insufficient “training” of the  Th1 response in rarely sick children.  Allergic diseases, which are  based on IgE-mediated inflammation,  have a common  pathogenetic nature and,  consequently, general  principles of therapy, in which, as  is well known,  antihistamines take  a significant  place.  This is cased by the  mandatory involvement of histamine  in the mechanism of development of the main symptoms of allergic diseases. Current  capabilities  of local ophthalmologic  antiallergic therapy includes medicines  with multiple action mechanisms, such as mast cell stabilizers, antihistamines, combined  agents, steroids and nonsteroidal anti-inflammatory effects. The latest generation antihistamine drug — olopatadine hydrochloride  0.2% is a new form of the molecule of olopatadine, which is intended  to increase the duration  of the action.  The article considers the main modern directions in prevention  and treatment of allergic diseases, including allergic eye diseases, which are  a manifestation of the underlying disease and have a common  pathogenetic nature to all atopic diseases, based on the IgE-mediated inflammation reaction

PROGNOSTIC SIGNIFICANCE OF THE VNTR POLYMORPHISM INTRON 4 OF THE GENE OF NITRIC OXIDE ENDOTHELIAL SYNTHASE IN CHRONIC HEART FAILURE PATIENTS

Aim. To analyze the prevalence of VNTR-polymorphism intron 4 (4b/4b and 4a/4b) carriage of the gene of endothelial nitric oxide synthase (eNOS) in chronic heart failure patients (CHF) of ischemic origin according to ejection fraction of the left ventricle (LVEF) and the disease stage.Material and methods. Totally, 280 CHF patients studied, selected to groups in accordance with LVEF (by echocardiography) and the disease stage. Then, within the study, genetic test specimens were collected with further typing of the gene alleles 4b/4b and 4a/4b of eNOS gene polymorphism.Results. By the prevalence analysis, 4b/4b and 4a/4b polymorphism of eNOS gene and the rate of various CHF stages in carriers, the predominance was found of 4a/4b carriers in IIА to III stages of the disease in both preserved and low LVEF. The increase of absolute risk was found, and of odds ratio of carriage of genotype 4а/4b in CHF patients with IIB-III stages.Conclusion. Genetically associated predisposition revealed to CHF progression in all patients with 4а/4b polymorphism of eNOS gene carriage and protective role of the carriage of 4b/4b eNOS polymorphism