LONG-TERM RESULTS OF DIFFERENT UV-CROSSLINKING TECHNIQUES IN PATIENTS WITH PROGRESSIVE KERATOCONUS

Purpose. To compare a clinical effectiveness of different UV-crosslinking techniques in patients with progressive keratoconus.Material and methods. Randomized prospective clinical trial included 130 eyes of 117 keratoconic patients. There were created 2 equal groups of 65 eyes. In the group I patients underwent a classical UV-crosslinking technique with a complete central corneal deepithelialization, in the group II a UV-crosslinking with dosed corneal epithelium scarification was performed using a new device. The postoperative follow-up period was 24 months. Preoperatively in the group I the uncorrected visual acuity (UCVA) was 0.21±0.11, the best corrected visual acuity (BCVA) was 0.49±0.14, the central corneal pachymetry (CCP) – 469.1±23/4μm, the mean keratometry (Kave) – 46.1±1.7D, in the group II: UCVA was 0.22±0.09, BCVA – 0.48±0.12, CCP – 475.2±28.5μm, Кave – 46.7±1.4D.Results. The mean postoperative pain score was 6.9±1.3, relief on the 3-rd ±1.2 day post-op. in the group I, and 2.8±1.1 relief on the 1-st±0.4 day post-op. in the group II. All patients had a 0.1 to 0.12 visual acuity loss 7 days after the surgery that was due to a mild corneal opacification. At 3 months after operation in both groups the UCVA and the BCVA were back to their preoperative values. In the group I the UCVA increased by 0.07±0.03 (р<0.05) 2 years after the treatment, the BCVA increased by 0.11±0.04 (р<0.05). At that time in the group II the similar values were obtained: 0.08±0.02 (р<0.05), 0.1±0.04 (р<0.05) respectively. The Kave index in both groups gradually decreased during first 12 months after operation and then stabilized. At the end of the follow up it was lower by 2.6±0.5D (р<0.05) in the group I and by 2.4±0.3D (р<0.05) in the group II. According to the anterior OCT, the depth of demarcation line was 327±11μm in the group I and 318±13μm in the group II. The demarcation line was absent in all cases 12 months after surgery. In the early postoperative period 3 months after operation the CCP gradually decreased. It reduced by 3.77±0.83% (р<0.05) in the group I and by 3.17±0.88% (р<0.05) in the group II. After that the CCP slowly increased during the entire follow-up, but 24 months later it was still lower by 2.36±0.57% (р<0.05) in the group I and by 1.68%±0.75 (р<0.05) in the group II. Confocal microscopy 1 month after surgery revealed typical changes of corneal structure at the depth up to 310±9μm (290 to 335) in the group I and 300±8μm (280 to 330) in the group II. A full reinnervation and the repopulation of the cornea with keratocytes was seen 6 months after operation. The only complication (delayed corneal epithelization) was in the group with classical UV-crosslinking technique.Conclusions. The trial revealed similar clinical outcomes after classical UV-crosslinking technique and UV-crosslinking with dosed corneal epithelium scarification, however in the latter case during the postoperative period the severity and duration of pain were significantly reduced

CHONDROTOXICITY OF FLUOROQUINOLONES IN CHILDREN: YES OR NO?

Two groups of children on therapy with monofluoroquinolones were enrolled in this open research trial: 169 patients with cystic fibrosis (exacerbation period) and 55 patients with aplastic anemia (neutropenic phase); age was from 6 months to 16 years. The aim of the study was to compare tolerability (with the focus on arthrotoxicity) of ciprofloxacin, ofloxacin and pefloxacin during intermittent (15-50 mg/kg/day in cystic fibrosis patients) and prolonged continuous therapy (10-15 mg/kg/day in patients with aplastic anemia). Quinolone-induced arthropathy was reported in 7, 6% of all cases, mainly during pefloxacin therapy (31, 8%), and more frequently in patients with aplastic anemia (10, 9% vs. 7, 7%), only in pubertal children, and was fully reversible with no influens on the lineal growth. Following the monofluoroquinolones use, residual joint-related symptoms were not observed because monofluoroquinolones did not achieve chondrotoxic concentrations in cartilaginous structures

Complex treatment of Pellucid Marginal Degeneration (a case report)

Purpose. To assess the results in a step-by-step complex treatmentof a patient with pellucid marginal degeneration (PMD) of cornea and cataract.Material and methods. Patient N., male, 52 years old, who complained on a low and deteriorating vision was diagnosed with pellucid marginal degeneration, cataract and lens subluxation in both eyes. Patient’s examinations included visometry, keratometry, anterior optical coherence tomography, corneal topography, and confocal microscopy. Then the step-by-step procedures in the left eye of the patient were performed including intrastromal keratoplasty with implantation of PMMA corneal ring segment, followed by UV cross-linking (after 3 months) and then phacoemulsification with toric IOL implantation 6 months later.Results. Both the uncorrected visual acuity (UCVA) and the best corrected visual acuity (BCVA) increased, accompanied by flattening of the central cornea, increasing flat and lowering steep corneal meridians. The BCVA became 0.6, and astigmatism decreased from 11.0D to 4.0D 3 month after intrastromal keratoplasty. The BCVA (sph -4.0 cyl -3.5 ax 115º) after UV cross-linking was unchanged while the final UCVA after toric IOL implantation was 0.8.Conclusion. The step-by-step approach including consecutively intrastromal keratoplasty with implantation of PMMA corneal ring segments, UV cross-linking, provided a stabilization of ectasia and an astigmatism decrease, phacoemulsification with toric IOL implantation allowed to increase considerably visual functions and to achieve the complete visual r ehabilitation

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

MICROFLORA OF THE RESPIRATORY TRACT IN PATIENTS WITH CYSTIC FIBROSIS AND SENSITIVITY TO ANTIBIOTICS BASED ON A 15-YEAR FOLLOW-UP (2000–2015 YEARS)

Chronic lower respiratory tract infection in patients with cystic fibrosis (CF) is the major factor determining the severity of the clinical course and prognosis of the disease. The purpose of the study was to investigate the prevailing respiratory microflora in patients with CF and changes in the activity of antibacterial medicines (ABM) during the period 2000–2015 in order to optimize guidelines for antibiotic therapy. Bronchial secretion was evaluated in CF patients from 2000 till 2015. 9774 samples were studied, 16.703 microbial strains were obtained. In 2000–2015, P. aeruginosa (smooth and mucoid morphological types) was the most widespread gram-negative strain. Typical strains of P. aeruginosa were isolated more often than mucoid morphotypes. In 2000–2015, isolation rates for P. aeruginosa decreased from 41.2 to 20.0% (p <0.001). The proportion of B. cepacia complex increased from 1.1 to 7.3%, up to 11.3% in 2008–2011, and a rise in the proportion A. xylosoxidans was registered from 2.9 to 4.9% (p <0.001). During the follow-up period, the diversity of isolated species has grown.ABM such as colistin (active against 100% of strains), carbapenems (imipenem is active against 70.3–72.2% of strains, and meropenem against 75.8 and 78.9%) remain active against P. aeruginosa. The effect of piperacillin/tazobactam is similar to that of carbapenems. Cefepime is less effective than ceftazidime. Fluoroquinolones and tobramycin also remian active