A clinical case of a combined method for correcting postkeratoplastic astigmatism of a high degree in a patient with cataract

Background. Performing penetrating keratoplasty in 100 % of cases leads to the occurrence of induced postkeratoplasty astigmatism, which can be more than 12,0 D. If cataracts occur in this category of patients, performing cataract phacoemulsification with implantation of a toric intraocular lens (tIOL) does not completely solve the problem. The use of the method of implantation of intrastromal corneal segments at stage I before cataract phacoemulsification makes it possible to reduce the degree of postkeratoplasty astigmatism and create optimal conditions for additional correction of residual postkeratoplasty astigmatism due to the implantation of tIOL during cataract phacoemulsification.The aim. To analyze the clinical and functional indicators of correction of regular high-grade postkeratoplasty astigmatism in a patient with cataracts using a combined method, including first implantation of intrastromal corneal segments and subsequent cataract phacoemulsification with implantation of toric intraocular lens using the example of a clinical case.Material and methods. A 55-year-old patient with cataracts, who had a history of  undergoing penetrating keratoplasty, contacted us. According to the keratotopogram data, a regular postkeratoplasty astigmatism of 18.68 D was diagnosed. The patient underwent a combined method. At stage I, intrastromal corneal segments were implanted into the corneal graft, then after 6 months stage II was performed – cataract phacoemulsification with implantation of tIOL.Results. Six months after intrastromal corneal segments implantation, the patient’s keratometric data stabilized, and corneal astigmatism decreased to 8.98 D. Then the patient underwent cataract phacoemulsification with tIOL implantation. After 1 month, the spherical component of refraction was 0.5 D, the cylindrical component of refraction was –0.5 D, visual acuity increased to 1.0.Conclusions. A combined method for correcting regular high-grade postkeratoplasty astigmatism in a patient with cataracts showed high refractive results, stability and safety in the long-term postoperative period

Comparative analysis of the correction of irregular postkeratoplastic astigmatism with scleral lenses and intrastromal ring implantation

Background. Many patients after penetrating keratoplasty (PK) experience induced postkeratoplastic astigmatism, which is often irregular and causes an increase in corneal aberrations that reduce visual acuity and quality. The aim of the study. To conduct a comparative analysis of the effect of rigid gas permeable scleral lenses and the MyoRing implantation method on clinical and functional parameters in patients with IPA. Material and methods. The clinical study included 60 patients (60 eyes). The age of patients with IPA was from 25 to 42 years. All patients underwent penetrating keratoplasty. All patients were divided into two groups depending on the method for irregular postkeratoplastic astigmatism correction. Group I included 30 patients (30 eyes) who were fitted with rigid gas permeable scleral lenses. Group II consisted of 30 patients (30 eyes) who underwent implantation of the MyoRing into a penetrating corneal graft. The observation period was 1 year. Results. After 12 months of observation, there was a greater increase in uncorrected visual acuity by an average of 3 lines, in corrected visual acuity – by 2 lines; a greater decrease in corneal aberrations in photo- (root mean square (RMS) of total aberrations (RMS total) by 0.30 ± 0.08 µm, RMS of higher order aberrations (RMS HOA) – by 1.01 ± 0.24 μm) and mesopic conditions (RMS total – by 0.33 ± 0.09 μm, RMS HOA – by 0.08 ± 0.03 μm) in patients wearing rigid gas permeable scleral lenses compared with patients after MyoRing implantation into a penetrating corneal graft. Conclusion. Patients of group  I, wearing rigid gas permeable scleral lenses, showed a greater improvement in visual acuity and a decrease in corneal aberrations in  photo- and mesopic conditions compared to the patients of group  II (after MyoRing implantation) at a follow-up period of 12 months

Our experience of combined treatment of chronic central serous chorioretinopathy using laser exposure of different wavelengths

Central serous chorioretinopathy is a disease that occurs in young people and causes a significant decrease in visual functions. In some cases, the pathological process acquires a chronic course, the treatment of which remains an urgent problem. Unfortunately, the available methods of conservative treatment of this problem do not have proven effectiveness, and laser treatment methods do not always lead to rapid and persistent remission and do not guarantee the absence of relapses of the disease.The aim of this study. To evaluate the effectiveness of the treatment of this pathology using a combined treatment method: a combination of transpupillary thermotherapy of the optic nerve disc with micropulse laser exposure to the retinal neuroepithelial detachment zone in the treatment of patients with chronic central serous chorioretinopathy.Patients with chronic central serous chorioretinopathy were divided into two groups: patients who were treated with simultaneous application of laser exposure in micropulse mode (wavelength – 577 nm) with a single session of transpupillary thermotherapy on the optic nerve disc area (wavelength – 810 nm); and patients whose treatment consisted in laser exposure in micropulse mode (wavelength – 577 nm). In patients of the combined laser treatment group, there was an improvement in visual acuity after a month and a half from the start of therapy in 84 % of cases, whereas in patients who received only micropulse laser exposure it happened in 57 % of cases. A noticeable improvement in the linear blood flow rate in the posterior short ciliary arteries according to the ultrasound triplex examination of the eye vessels was also observed in the combined treatment group: the blood flow rate increased by 36 %, in the other group the blood flow rate did not significantly change. Also, in the combination therapy group, only 1 relapse of the disease was detected within 24 months, while in the second group, relapses were observed in 8.7 % of cases. Subjectively, patients from the combined treatment group noted a faster disappearance of complaints of visual discomfort

AGE-RELATED CHANGES IN REFRACTION AND ACCOMMODATION IN JUNIOR SCHOOL AGE CHILDREN

The myopia incidence in children and teenagers for the last 10 years increased by 1.5 times, the most widely spread it received among graduates of lyceums and gymnasiums (50%).Purpose. To reveal the dynamics of changes in refraction, accommodation and viscoelastic properties of the cornea in schoolchildren within 3 years.Material and methods. The dynamics of myopia progression was investigated in 323 children (182 children with emmetropia and 141 – with myopia). The examined children were divided into 2 groups: the group 1 included children with emmetropia; the group 2 – children with mild to moderate myopia (mean spherical equivalent: -1.65±1.07D) aged from 7 to 12 years (mean age: 8.52±1.00). The period of follow-up was 3 years. The study carried out an estimation of axial length (AL), refraction, accommodation.Results. During 3 year follow-up the axial length steadily increased: within the first year – most intensively in the group 2, in the second and third years – in both groups. In the examination of refraction of the eye a gradual increase in the quantity of myopic children was noted in the group 1 with the initial emmetropia, reaching to the end of the 3rd year 82 children (34.7%). During the study, lower indices of reserve of relative accommodation were detected in the group 2 that remained during the entire period of follow-up.Conclusions. 1. Children with myopia have lower reserves of relative accommodation compared with healthy pupils. 2. Children with myopia have a higher gradient of AL growth compared with children of the same age group with the initial emmetropia. 3. The increase of myopia in 8-year schoolchildren is related to the intensive visual load, provoking habituallyexcessive accommodation tension

ELECTRON MICROSCOPY OF THE CORNEAL STROMA AFTER THE STANDARD CROSS-LINKING AND USING FEMTOSECOND LASER IN EXPERIMENT

Purpose. The study and comparison of the corneal tissues condition after the standard corneal collagen cross-linking (CXL) and femto-cross-linking in experiment.Material and methods. The study used 9 male Chinchilla rabbits (18 eyes) weighing 2-3kg, which were divided into 3 groups depending on the type of surgical intervention: femtocross-linking, standard CXL and the control group where the femtolaser formation of pocket were performed without the crosslinking procedure. Rabbits were taken out of the experiment at 1 week, 1 and 3 months. The eyes were enucleated, cornea was excised using a 9.0mm trephine. The corneal discs were examined by the transmission electron microscope JEOL 1200 EX (Japan).Results. Analysis of microscopic pictures from the transmission electron microscopy after the femto-cross-linking and the standard CXL revealed an equal quantity of cross-links in collagen fibers. After the standard CXL the changes in the basal membrane and basal epithelial cells were visualized with signs of polymorphism and increased intercellular spaces.Conclusion. In the electron-microscopic images of ultrastructure in the corneal stroma the comparable changes were found in the standard group and femto-cross-linking that suggests an identical efficiency of both techniques. The detected changes in the basal membrane a week after the standard CXL suggests a traumatism of the stage of epithelium removal in contrast to an atraumatic formation of stromal pocket using the femtosecond laser

Correction of postkeratoplastic astigmatism by intrastromal corneal segments implantation using a femtosecond laser

Background. After penetrating keratoplasty, mild to high induced corneal astigmatism was observed in each case. The existing choice of correction of postkeratoplastic astigmatism is aimed at fi nding an individual approach in order to compensate for it and not weaken the biomechanical properties of the corneal graft.The aim: to analyze the clinical, functional, and morphological results of postkeratoplastic astigmatism correction by implantation of intrastromal corneal segments using a femtosecond laser.Methods. 22 patients were examined before and 1 year after surgery. The operation was performed under local anesthesia: stage I – an intrastromal tunnel was formed using a femtosecond laser “Femto Visum” 1 MHz (Optosystems, Russia); stage II – the intrastromal corneal segments were implanted. The results were assessed using standard and special research methods using optical coherence tomography Visante OCT (Zeiss, Germany), keratotopography (Tomey-5, Japan), optical corneal analyzer ORA (Reichert, USA), laser tindalemetry FC-2000 (Kowa, Japan) and confocal microscope Confoscan-4 (Nidek, Japan).Results. Before the operation, uncorrected visual acuity averaged 0.09 ± 0.05, after a year – 0.50 ± 0.16; best corrected visual acuity – 0.30 ± 0.12 and 0.60 ± 0.05 respectively; cylindrical component of refraction – –10.29 ± 3.12 and –2.20 ± 0.64 D respectively; mean keratometry value – 43.59 ± 2.14 and 38.56 ± 1.75 D respectively; corneal hysteresis – 7.92 ± 1.22 and 8.95 ± 1.05 mm Hg respectively; corneal resistance factor – 7.01 ± 1.81 and 8.44 ± 1.44 mm Hg respectively; protein fl ux in the moisture of the anterior chamber – 2.97 ± 0.28 and 3.04 ± 0.24 f/ms respectively; endothelial cell density – 1521 ± 327 and 1475 ± 419 cells/mm2 respectively.Conclusion. Intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has efficiency and safety method in correcting postkeratoplastic astigmatism

Some aspects of examination of children with combined spine and pelvis pathology living in an industrial city

The aim of the study was to analyze the peculiarities of combined spinal and pelvic pathology in children living on the industrial area of the Irkutsk Region. To perform the analysis we carried out the clinical-roentgenological research, and when making orthopedic examination we took into consideration ecological factors and used the chart of multivariative analysis. It was found that in the structure of combined pathology, pelvis asymmetry ranks first, scoliosis ranks second, Legg - Calve - Perthes disease ranks third. According to the assessment of age structure of combined pathology we can conclude that at the equal manifestations of scoliosis, Spina bifida, retrospondylolisthesis, pelvis asymmetry, children of 11-15 y.o. more often have Legg - Calve - Perthes disease, children of 16-21 y.o. - coxarthrosis. In its turn relative share of Legg - Calve - Perthes disease cases in children living within a radius of 5 km from the industrial center is the largest (21 из 28 cases). It's important to mention that Legg - Calve - Perthes disease was registered in all examined boys and only in 35.5 % of girls. I and II degrees of manifestation of clinicoroentgenologic disorders of combined spine and pelvis pathology prevail (77 and 43 cases correspondingly) over the disorders of the III degree (15 cases)

Эндоскопическая лазерная циклопластика в лечении закрытоугольной глаукомы с плоской радужкой

PURPOSE: To study efficacy and safety of endoscopic laser cycloplasty in treatment of patients with angle-closure glaucoma with plateau iris.METHODS: The study included 15 patients (23 eyes) with angle-closure glaucoma with plateau iris, 13 women, 2 men. Mild glaucoma was diagnosed in 24.7% of cases; moderate — in 34.8 %; advanced — in 30.4 %. Mean age was 69.1±8.7 years. Intraocular pressure (IOP) level before surgery with medical therapy ranged from 17 to 30 mm Hg (mean of 22±3.4 mm Hg). Mean number of hypotensive instillations used by the patients — 3.1±1.8. During the postoperative period all patients underwent tonometry, tonography, anterior segment OCT and ultrasonic biomicroscopy (UBM). Follow-up period was 3 months.RESULTS: All patients had an improvement of visual acuity during the postoperative period. In all cases we observed a decrease in IOP from 22±3.4 mm Hg (before surgery) to 19.3±2.2 mm Hg (in 3 months) and an increase of the aqueous humor outflow facility coefficient from 0.18±0.06 mm3/min⋅mm Hg (prior to the surgery) to 0.34±0.05 mm3/min⋅mm Hg (in 3 months). According to OCT data in 3 months, the anterior chamber angle remained open with a mean width of 32.6±3.5 degrees. UBM results showed an increase in morphometric values of the anterior chamber angle with a reduction in ciliary processes length from 512.1±118.6 µm before surgery to 403.3±112.4 in 3 months.CONCLUSION: Endoscopic laser cycloplasty in all the cases allowed for IOP reduction without hypotensive therapy and glaucoma progression halt due to opening of the anterior chamber angle and eliminating risk of IOP increase. ЦЕЛЬ. Изучить эффективность и безопасность эндоскопической лазерной циклопластики в лечении пациентов с закрытоугольной глаукомой (ЗУГ) с плоской радужкой.МЕТОДЫ. Исследование включает 15 пациентов (13 женщин, 2 мужчин, 23 глаза) с ЗУГ с плоской радужкой. В 24,7% случаев наблюдалась I стадия глаукомы, в 34,8% — II, в 30,4% — III стадия. Средний возраст пациентов составлял 69,1±8,7 года. Уровень внутриглазного давления (ВГД) до операции на фоне гипотензивной терапии колебался от 17 до 30 мм рт.ст. (среднее значение 22±3,4 мм рт.ст.). Среднее количество закапываний составляло 3,1±1,8. Всем пациентам выполняли тонометрию, тонографию, оптическую когерентную томографию (ОКТ) переднего отрезка и ультразвуковую биомикроскопию (УБМ). Срок наблюдения составил 3 месяца.РЕЗУЛЬТАТЫ. У всех пациентов отмечено улучшение остроты зрения в послеоперационном периоде. Во всех случаях наблюдалось снижение уровня ВГД с 22±3,4 до операции до 19,3±2,2 мм рт.ст. через 3 месяца и повышение коэффициента легкости оттока с 0,18±0,06 мм3/мин⋅мм рт.ст. (до операции) до 0,34±0,05 мм3/мин⋅мм рт.ст. через 3 месяца. По результатам ОКТ, через 3 месяца угол передней камеры (УПК) открыт, средняя ширина его составляет 32,6±3,5°. При проведении УБМ наблюдалось увеличение морфометрических показателей передней камеры на фоне уменьшения средней длины цилиарных отростков с 512,1±118,6 до операции до 403,3±112,4 мкм через 3 месяца.ЗАКЛЮЧЕНИЕ. После проведения эндоскопической лазерной циклопластики во всех случаях наблюдалось снижение уровня ВГД без применения гипотензивной терапии и открытие УПК, что позволило избежать развития приступов повышения ВГД и прогрессирования глаукомного процесса

Закрытоугольная глаукома с плоской радужкой

The article is a review of Russian and foreign literature on the problem of angle-closure glaucoma with a plateau iris, methods of its diagnostics and treatment. More than 80 sources of Russian and foreign literature about the problems of diagnostics and treatment of angle-closure glaucoma (PACG) with a plateau iris were analyzed. There are differences in the classification of this disease in foreign practice, namely the differentiation of plateau iris configuration and plateau iris syndrome, which influences the choice of treatment. The analysis pointed out the specifics of diagnostics of this form of glaucoma. The prevailing majority of authors note that patients with PACG with plateau iris have an average depth of the anterior chamber. However, there are studies that prove the opposite. The review also reveals features of the structure and position of the ciliary body and its processes based on the results of anterior segment optical coherence tomography and ultrasonic biomicroscopy. As for the treatment methods, in case of PACG with a plateau iris, hypotensive medication cannot be considered the therapy of choice. Preference is given to laser and surgical methods of treatment. However, at present, there is no consensus on the most effective and safe methods leading to the anterior chamber angle opening and intraocular pressure level stabilization.Статья представляет собой обзор отечественной и зарубежной литературы по проблеме закрыто- угольной глаукомы (ЗУГ) с плоской радужкой, методам ее диагностики и лечения. Было проанализировано более 80 источников отечественной и зарубежной литературы, касающихся проблем диагностики и лечения ЗУГ с плоской радужкой. Отмечены различия в классификации этого заболевания в зарубежной практике, а именно выделение отдельно конфигурации плоской радужки и синдрома плоской радужки, что оказывает влияние на выбор способа лечения. В ходе проведения анализа обзора выявлены особенности диагностики данной формы глаукомы. Подавляющее большинство авторов указывает на наличие средней глубины передней камеры у пациентов с ЗУГ с плоской радужкой. Однако встречаются работы, доказывающие обратное. Также выявлены особенности строения и положения цилиарного тела и его отростков по результатам проведения оптической когерентной томографии переднего сегмента и ультразвуковой биомикроскопии. Что касается методов лечения, то в случае ЗУГ с плоской радужкой назначение медикаментозных гипотензивных препаратов не является терапией выбора. Предпочтение отдается лазерным и хирургическим методам лечения. Однако в настоящее время нет единого мнения о наиболее эффективных и безопасных способах, приводящих к открытию угла передней камеры и стабилизации уровня внутриглазного давления

One week of levofloxacin plus dexamethasone eye drops for cataract surgery: an innovative and rational therapeutic strategy

Background: Cataract surgery is the most common operation performed worldwide. A fixed topical corticosteroid-antibiotic combination is usually prescribed in clinical practice for 2 or more weeks to treat post surgical inflammation and prevent infection. However, this protracted schedule may increase the incidence of corticosteroid-related adverse events and notably promote antibiotic resistance. Methods: This International, multicentre, randomized, blinded-assessor, parallel-group clinical study evaluated the non-inferiority of 1-week levofloxacin/dexamethasone eye drops, followed by 1-week dexamethasone alone, vs. 2-week gold-standard tobramycin/dexamethasone (one drop QID for all schedules) to prevent and treat ocular inflammation and prevent infection after uncomplicated cataract surgery. Non-inferiority was defined as the lower limit of the 95% confidence interval (CI) around a treatment difference >\u201310%. The study randomized 808 patients enrolled in 53 centres (Italy, Germany, Spain and Russia). The primary endpoint was the proportion of patients without anterior chamber inflammation on day 15 defined as the end of treatment. Endophthalmitis was the key secondary endpoint. This study is registered with EudraCT code: 2018-000286-36. Results: After the end of treatment, 95.2% of the patients in the test arm vs. 94.9% of the control arm had no signs of inflammation in the anterior chamber (difference between proportions of patients = 0.028; 95% CI: 120.0275/0.0331). No case of endophthalmitis was reported. No statistically significant difference was evident in any of the other secondary endpoints. Both treatments were well tolerated. Conclusions: Non-inferiority of the new short pharmacological strategy was proven. One week of levofloxacin/dexamethasone prevents infection, ensures complete control of inflammation in almost all patients and may contain antibiotic resistance