Femtosecond laser-assisted cataract surgery in eyes with Fuchs endothelial corneal dystrophy

Purpose. The purpose of this comparative study was to assess the efficiency and safety of the Femtosecond Laser Assisted Cataract Surgery (FLACS) and the conventional manual phaco in eyes with Fuchs endothelial corneal dystrophy. Material and methods. The study included 72 patients (72 eyes) with Fuchs endothelial dystrophy which were divided into 2 groups. The patients of the group 1 (n=33) underwent the FLACS procedure (using the Victus B&L laser and the Infinity Alcon inc. phaco-device), the conventional manual phaco-surgery (the Infinity Alcon inc. device) was performed in the group 2 (n=39). The endothelial cell density was evaluated in the center and at 6 areas in the mid periphery of the cornea (using the Tomey EM 3000 device) preoperatively, and 1 day, 1 week, 1 month after the surgery. Results. The mean endothelial cell loss comparison in all potentially assessed points showed a significantly lower loss in the group 1 (FLACS) for all the analyzed follow-up periods (p<0.05). Conclusions. For a preservation of endothelial integrity, the FLACS proves to be a safer procedure

ИЗМЕНЕНИЯ МИКРОЦИРКУЛЯТОРНОГО РУСЛА КОЖИ И ОРГАНОВ, СОПУТСТВУЮЩЕГО ГОРМОНАЛЬНО-БИОХИМИЧЕСКОГО ФОНА У КРЫС ЛИНИИ ВИСТАР ПРИ МОДЕЛИРОВАНИИ САХАРНОГО ДИАБЕТА

Spasm of arterioles (thickening of the smooth muscle cell layer), endothelial desquamation and neutrophilic perivascular infiltration are often observed in the microvasculature on the background of diabetes mellitus. Microangiopathies of the skin and internal organs develop in parallel and are comparable in nature with morphological changes. The level of renin significantly increases in diabetes mellitus, which indicates an early involving of mechanisms of renal pathology and development of arterial hypertension. Osteocalcin reduces in diabetes mellitus, which is associated with severe (possibly irreversible) metabolic disorders of bone tissue and osteoblast death. На фоне сахарного диабета в сосудах микроциркуляторного русла чаще всего наблюдается спазм артериол (утолщение слоя гладкомышечных клеток) и десквамация эндотелия, нейтрофильная периваскулярная инфильтрация. Микроангиопатии кожи и внутренних органов развиваются параллельно и сопоставимы по характеру морфологических изменений. При сахарном диабете происходит достоверное повышение уровня ренина, что свидетельствует о раннем включении механизмов развития почечной патологии и формирования артериальной гипертензии, и снижение остеокальцина, что сопряжено с выраженным (возможно, необратимым) нарушением метаболизма костной ткани и гибели остеобластов.

Optimizatsiya tekhniki vitrektomii pri pozdnikh stadiyakh proliferativnoy diabeticheskoy retinopatii

Цель. Оценить способность субтенонового введения Авастина ингибировать ретиновитреальный неоангиогенез, а также индуцировать отслойку ЗГМ в комплексном хирургическом лечении пролиферативной диабетической ретинопатии. Материалы и методы. В исследование было включено 20 пациентов (28 глаз) с сахарным диабетом 1 типа (СД 1) при наличии развитой пролиферативной диабетической ретинопатии на обоих глазах. Всем пациентам были выполнены стандартные клинические исследования. За 7 дней до запланированного хиургического лечения всем пациентам в субтеноновое пространство вводили 5 мг Авастина. Результаты. Субтеноновое введение 5 мг Авастина приводило во всех случаях к значительному регрессу новообразованных сосудов на ЗГМ. Отслойка сетчатки после удаления силикона произошла через 6 месяцев на 3 глазах. Два пациента из этой группы не могли быть оперированы по соматическим противопоказаниям (декомпенсация диабета). Острота зрения после хирургического вмешательства зависела от наличия дооперационной отслойки макулы. Заключение. Субтенонеальное введение 5 мг Авастина приводит к значительному регрессу ретиновитреальной неоваскуляризации у пациентов с пролиферативной диабетической ретинопатией. При поздних стадиях диабетической пролиферативной витреоретинопатии с тракционной отслойкой сетчатки полное удаление ЗГМ возможно только в водной среде. Тампонада витреальной полости ПФОС до полного удаления ЗГМ в водной среде приводит к прогрессированию пролиферации и рецидивам отслойки сетчатки

MICROINVASIVE SURGICAL TREATMENT OF MACULAR HOLE OF STAGE I WITHOUT VITRECTOMY UNDER THE INTRA-OPERATIVE OCT CONTROL

Purpose.  To  assess  long-term results  of the  use  of mechanical separation of posterior hyaloid (PH) from foveola without vitrectomy in case of macular holes in the stages Ia and Ib.Material and methods. The study included the observations in 130 patients with macular holes in the stage Ib, operated on by the same technology by the  same  surgeon. Posterior  hyaloids membrane was separated from the foveola through 2 27Ga ports for optical fiber and a special tool.All  patients before and after surgery the following analyzes were performed: anamnesis, visometry,  standard  perimetry,  evaluation of strains on the Amsler grid, optical coherence tomography (OCT) of high-resolution using the «Cirrus» device of the Carl Zeiss Meditec company.Results.  According to the optical coherence  tomography of high resolution it was possible to separate completely the PH from foveola without a formation of penetrative macular holes in 98.5% of cases.Conclusions.   Microinvasive mechanical separation  of  PH  from foveola at the stage I of macular hole without staining and vitrectomy interrupts the disease process, preventing the development of penetrative macular hole, eliminates the cause of the disease

VITREOMACULAR INTERFACE PATHOLOGY. REVIEW OF FOREIGN LITERATURE IN QUESTIONS AND ANSWERS

The article represents a review of the foreign scientific literature dedicated to the problem of anatomical structure of the vitreomacular interface and its pathology. The review is written in the form of answers for questions about the essence of vitreomacular traction syndrome ant its manifestations: macular holes, macular edema, macular breaks and puckers

SURGICAL TREATMENT OF THE VITREO-MACULAR INTERFACE PATHOLOGY. REVIEW OF THE FOREIGN LITERATURE IN QUESTIONS AND ANSWERS

The article is a review of the foreign scientific literature dedicated to the problem of surgical treatment of the vitreomacular traction syndrome (VMTS) – the booming developing trend in vitreoretinal surgery. The review is written in the form of answers for the questions about the indications to surgery, surgical techniques for different manifestations of the VMTS, the choice of vital dyes for making visible internal limiting membrane, results and complications of the surgery

LASER PHOTOCOAGULATION OF SOFT MACULAR DRUSEN

Purpose. The assessment of morphological and functional results of the threshold photocoagulation in eyes with large soft macular drusen. Material and methods. Thirty four patients (39 eyes) were enrolled in the study. The threshold photocoagulation of soft macular drusen was performed in 23 eyes included in the treatment group. Natural history of disease was observed in 16 eyes included in the control group. All patients underwent a complete ophthalmologic examination: visual acuity, tonometry, retinal biomicroscopy, fundus photography, optical coherence tomography and microperimetry. Results. After 12 month-period of follow-up, the threshold photocoagulation of large soft macular drusen (similar to pigment epithelial detachment) leads to their complete regression in 88.9% and partial regression in 11,1%. Retinal thickness over the largest drusen increased significantly from 164±10µm to 225±8µm (рo=0.03). Retinal sensitivity was significantly increased in the treatment group compared to the control group. Сonclusions. The threshold photocoagulation of large soft macular drusen leads to their regression in 88.9%, which is accompanied by increased retinal thickness and improved retinal sensitivity. Early treatment leads to better functional results

HYDRORETINOPEXY TECHNIQUE IN CONJUNCTION WITH THE DRAINAGE OF SUBRETINAL FLUID IN THE SURGICAL TREATMENT OF PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT

Purpose. To compare anatomical and functional results of surgery extrascleral primary rhegmatogenous retinal detachment with output recovery eyes using hydroretinopexy and pneumoretinopexy.Material and methods. There were operated on 82 patients (82 eyes) with primary rhegmatogenous retinal detachment. Patients were divided into 2 groups. The first group included 44 eyes operated metered manner drainage of subretinal fluid with simultaneous administration of saline into the vitreous (hydroretinopexy). The second group included 38 eyes operated metered manner drainage of subretinal fluid with simultaneous introduction of air into the vitreous (pneumoretinopexy).Results. Patients of the first group showed on the first postoperative day a complete attachment of the retina in 43 of 44 eyes. At the same time, the total adhesion of the retina immediately after operation was noted in only 28 of 38 cases of the second group. Intraoperative complications were detected, 11.4% in the first and 7.9% in the second group, in the form of local subretinal hemorrhages in places of subretinal fluid drainage. Visual acuity one month after the surgery, in the first group was 0.5 or higher in more than 34% of patients. In the second group of patients, the visual acuity was obtained 0.5 or more only in three (7.9 %) of 38 patients. Period of hospital stay: the first group – 3 to 12 days, the patients of the second group – 4 to 24 days. Relapses of retinal detachment in patients of the first group occurred in 4 cases (9%), in the second group of patients, relapse rate was 23.7% (10 cases).Conclusions. Operation of extrascleral sealing dosed with discharging the subretinal fluid and for hydroretinopexy allows to achieve retinal attachment and to block gap with minimal impression of sclera more efficiently. This surgery allows to obtain high visual functions and requires less prolonged hospital stay. Hydroretinopexy is a more physiologic method for intraocular membranes, reducing the probability of progression in proliferative vitreoretinopathy and the frequency of retinal detachment recurrences

A Retrospective Analysis of the Results of Microinvasive Posterior Vitrectomy in the Surgical Treatment of Non-Full Thickness Macular Holes

Purpose: to study the effectiveness of the posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes on the basis of the retrospective analysis of the retina changes, identified by OCT, and functional outcomes of surgical treatment.Patients and Methods. A retrospective analysis of outcomes of posterior microinvasive vitrectomy was performed in 30 patients operated about non-full thickness macular holes. The following features were assessed: maximum diameter of the non-full thickness macular holes, the diameter at the base of the hole, the minimum thickness of the retina before and after operation, the maximum thickness of the retina before and after surgery. In addition, the configuration of the hole edges before surgery, the presence of intraretinal cysts before and after surgery, the integrity of the ellipsoid zone of the photoreceptors before and after the operation and the restoration of fovea centralis as a result of surgical treatment were assessed.Results. As a result of surgical treatment the closure of non-full thickness macular holes was reached in all cases. The most corrected visual acuity in the postoperative period was ranged from 0.1 to 1.0 (0,66 ± 0,04). The visual acuity improved in 20 cases (64.5%), remained at the same level in 8 cases (25.8%) and decreased in 3 cases (9.6%, in 1 case due to the development of cataracts). The results of correlation analysis has allowed to establish correlation between the initial BCVA and the maximum retinal thickness (R = –0.4), and residual retinal thickness in the area of the hole (R = –0.3). The increase in visual acuity after surgical treatment significantly affected the recovery of the ellipsoid zone of the photoreceptors (RD = 0.833), regression of the retinal thickness (R = 0.42). In addition, the initial diameter of non-full thickness macular holes, both external and at the base, also had an impact on the increase in BCVA (R = –0.3 and R = –0.25, respectively).Conclusion. Posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes is a highly effective method of treatment, as evidenced by the closure of the defect and improvement or stabilization of the most corrected visual acuity 90.4% cases. On the basis of the retrospective analysis it is found that the most significant increase in the most corrected visual acuity was increased in patients with low visual acuity. The recovery of the ellipsoid zone of photoreceptors, regression of the retinal thickness and the diameter of non-full thickness macular holes, both external and at the base mostly influences nn the recovery of the most corrected visual acuity