Surgical treatment of epirethinal fibrosis: a current state of the problem

S.A. Kochergin, D.G. Alipov Russian Medical Academy of Continuous Professional Education, Moscow This review discusses different approaches of surgical treatment of epiretinal fibrosis in detail. The introduction briefly describes the risk factors and causes of the disease. Each type of operation is analized as well as all the possible options. The results of 25 and 27G vitrectomy are compared, also in this review you can find the comparison of membrane removal without vitrectomy and after subtotal vitrectomy. When ERM is removed without vitrectomy, the risk of cataract appearing, retinal detachment, appearance of visual field defects decreases, but the risk of recurrence of the disease increases. In this article are also given the advantages and disadvantages of ILM-removing during the operation. In particular, the data of meta-analysis is described, that shows that patients’ who ERM was removed together with ILM visual acuity is higher 6 months after surgery, but after 18 months the situation becomes reverse. The possibilities for visualization of ERM during the operation are described. The article describes the features for visualization of ERM during surgery and a comparison of the results of operations involving ERM staining with ILM-Blue and MembraneBlue-Dual. The role of OCT in the diagnostics and treatment of ERF is shown. The possible surgery complications, such as hemophthalmia, retinal perforation, cataract, ocular hypertension, visual field defects are analized. This material does not include information about treatment of full macular hole. Key words: epiretinal fibrosis, epiretinal membrane, vitrectomy, optical coherence tomography, internal limiting membrane, complications, intraocular hemorrhage, retinal detachment, cataract, ocular hypertension, dyes, visual field. For citation: Kochergin S.A., Alipov D.G. Surgical treatment of epirethinal fibrosis: a current state of the problem //&nbsp;RMJ “Clinical ophthalmology”. 2018;1:55–59.<br

Удаление эпиретинальных мембран без витрэктомии

Цель. Оценить эффективность и безопасность удаления эпиретинальных мембран без витрэктомии. Материал и методы. Проведена оценка результатов хирургического лечения 20 пациентов (20 глаз), которым эпиретинальная мембрана (ЭРМ) удалялась без витрэктомии. Удаление ЭРМ проводилось по следующей методике: установка двух 25G-портов, удаление эпиретинальной мембраны единым блоком с внутренней пограничной мембраной (ВПМ) без окрашивания. Проводился контроль остроты зрения, внутриглазного давления, толщины сетчатки в центральной зоне, а также толщины слоя нервных волокон сетчатки в различных секторах перипапиллярно, также проводился контроль экскавации ДЗН с помощью ОКТ. Светочувствительности макулярной зоны сетчатки определялась при помощи микропериметра Maia, а периферических зон - при помощи компьютерного периметра Humpfrey. Пациенты обследованы до операции, а также через 1, 3, 6 и 12 мес. после операции. Результаты. Средний возраст пациентов в исследуемой группе составил 67,7±11,4 года. Средняя продолжительность хирургического вмешательства составила 8 минут. Статистически значимое увеличение остроты зрения было зафиксировано уже через месяц (0,378 против 0,286 до вмешательства, p=0,041), и в дальнейшем значение данного показателя продолжило нарастать, достигнув к концу периода наблюдения величины 0,63 (дина мика за 12 мес. +0,344). Светочувствительность макулы возросла за 12 мес. на 2,21 дБ (p=0,008). Толщина сетчатки прогрессивно снижалась в течение всего периода наблюдения (с 462,4 мкм исходно до 363,9 мкм через 12 мес., p=0,01). Изменения других показателей были незначимыми. У 6 пациентов из 20 был зафиксирован рецидив мембраны в сроки от 3 до 6 мес. Данное осложнение, по всей видимости, может быть связано с неполным удалением внутренней пограничной мембраны при удалении эпимакулярной мембраны единым блоком с ней и при отсутствии окрашивания. Выводы. Удаление эпимакулярной мембраны без витрэктомии эффективно (значительный рост остроты зрения, улучшение светочувствительности центральной зоны сетчатки, снижение толщины сетчатки), не оказывает негативного влияния на светочувствительность периферической сетчатки и внутриглазное давление, однако сопряжено с рецидивированием, что связано со сложностью выполнения и в определенной степени ограничивает применение данного метода

Improving effectiveness of glaucoma screening during prophylactic medical examinations: current approaches

M.A.&nbsp;Kazanfarova1,2, I.B.&nbsp;Alekseev1, A.L.&nbsp;Lindenbraten3, S.A.&nbsp;Kochergin1 1Russian Medical Academy of Continuous Professional Education, &nbsp;Moscow, Russian Federation 2The International Medical Cluster Foundation, Moscow, Russian Federation 3N.A.&nbsp;Semashko National Research Institute of Public Health, Moscow, Russian Federation Background: early diagnosis of diseases in clinically healthy persons is the basis of prophylactic medical examinations. In addition to cardiovascular disorders, cancer, diabetes, and chronic lung diseases, glaucoma is one of the major causes of disability in Russian Federation. Prophylactic medical examinations for glaucoma are less addressed in domestic published data than for other diseases which results in disability and early death. Aim: to assess the effectiveness of screening for glaucoma in Russian Federation, to uncover ineffective areas, and to suggest potential solutions. Materials and Methods: the 35-item questionnaire for ophthalmologists who provide primary ocular care was developed (screening questions are addressed below). Survey responses from 126 ophthalmologists who provide primary ocular care were anonymous. Results: 37% of respondents consider prophylactic medical examinations effective while 63% consider prophylactic medical examinations ineffective. Currently, glaucoma is diagnosed more often at early stages, i.e., 34% of respondents diagnose glaucoma at early stage, 60% at early-to-moderate stage, and 6% at moderate-to-advanced stage. 71% of respondents diagnose glaucoma in patients who visit an ophthalmologist independently, 29% diagnose glaucoma in the course of prophylactic medical examinations. 46% of respondents report that IOP measurements during prophylactic medical examinations in adults result in more often diagnosis of glaucoma at early stages. 26% diagnose glaucoma more often but at later stages while 28% do&nbsp; not diagnose glaucoma more often. Conclusions: currently, glaucoma is diagnosed more often at early stages but mainly in patients who visit an ophthalmologist independently. This is the result either of poor coverage of the population by prophylactic medical examinations or their poor quality. Revision of fundamental approach to glaucoma screening is required, i.e., switch from mass screening using tonometry (which is characterized by high percentage of errors) to target screening using advanced diagnostic tools. Keywords: prophylactic medical examinations, screening, medical prevention, chronic noninfectious disorders, glaucoma, risk factors, early stage. For citation: Kazanfarova M.A., Alekseev I.B., Lindenbraten A.L., Kochergin S.A. Improving effectiveness of glaucoma screening during prophylactic medical examinations: current approaches. Russian Journal of Clinical Ophthalmology. 2019;19(3):122–127. About the authors: 1,2Marina&nbsp;A.&nbsp;Kazanfarova — MD, postgraduate student, Project Manager of the International Medical Cluster Foundation, ORCID iD 0000-0001-7401-9538; 1Igor&nbsp;B.&nbsp;Alekseev — MD, PhD, Professor, ORCID iD 0000-0002-4506-4986; 3Aleksandr&nbsp;L.&nbsp;Lindenbraten — MD, PhD, Professor, ORCID iD 0000-0003-3335-7893; 1Sergey&nbsp;A.&nbsp;Kochergin — MD, PhD, Professor, ORCID iD 0000-0002-8913-822X. 1Russian Medical Academy of Continuous Professional Education. 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation. 2&nbsp;The International Medical Cluster Foundation. 35–1, Usachev str., Moscow, 119048, Russian Federation. 3N.A.&nbsp;Semashko National Research Institute of Public Health. 12–1, Vorontsovo Pole str., Moscow, 105064, Russian Federation. Contact information:&nbsp;Marina&nbsp;A.&nbsp;Kazanfarova, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no author has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;15.04.2019. </p

Кардиомиопатии, ассоциированные с мутациями гена десмина: молекулярный патогенез и генотерапевтические подходы

Cardiomyopathy (CMP) is a common group of cardiovascular disorders. Genetic (primary) cardiomyopathies are related to abnormalities in more than 100 genes, including the DES gene encoding desmin protein. Desmin is an essential member of the intermediate filaments, ensuring the structural and functional integrity of myocytes. Mutations in the DES gene result in desmin-related cardiomyopathy with progressive course and poor prognosis. By now, specific therapy for cardiomyopathy has not been developed. Existing conservative and surgical treatment modalities target the rate of heart failure progression and sudden cardiac death prevention but have limited efficacy. The development of gene therapy and genome editing could allow for creating effective and specific methods of gene-based therapy for desminopathies. A  number of studies have been published on the use of gene therapy for various genetic cardiomyopathies including those caused by the DES gene mutations, while genome editing has not been used yet. However, promising results have been obtained with CRISPR/Cas9 and TALEN editing systems to correct for “gain-of-function mutations” in some other genes, such as MYBPC3 and PLN. There is also evidence of the possibility to reduce the symptoms of desmin-related cardiomyopathy up to the normal function by knocking out the mutant DES allele, and preserved protein function provided by expression of the normal allele. We believe that genome editing approaches have an open perspective into the development of specific and effective methods to treat desminopathies.Кардиомиопатия – широко распространенная группа заболеваний сердечно-сосудистой системы. Генетически обусловленные кардиомиопатии связывают с  нарушениями более чем в 100 различных генах, в том числе в гене DES, кодирующем белок десмин  – один из основных белков промежуточных филаментов, обеспечивающих структурную и функциональную целостность миоцитов. Мутации в  гене DES приводят к  развитию десминзависимых кардиомиопатий, характеризующихся высокой степенью тяжести течения и неблагоприятным прогнозом. До настоящего времени специфического лечения кардиомиопатии не разработано. Имеющиеся консервативные и хирургические подходы направлены на замедление темпов прогрессирования сердечной недостаточности и  профилактику внезапной сердечной смерти, но их эффективность ограничена. Развитие методов генотерапии и  геномного редактирования может способствовать созданию эффективных методов этиотропной терапии десминопатий. Опубликован ряд работ, посвященных применению методов генотерапии при кардиомиопатиях различной генетической природы, включая ассоциированные с мутациями в гене DES. В области терапии десминопатий методы геномного редактирования пока не используются. Тем не менее многообещающие результаты получены при использовании систем редактирования CRISPR/Cas9 и  TALEN для коррекции “gain-of-function” мутаций в  некоторых других генах, таких как MYBPC3 и PLN. Имеются данные, указывающие на возможность улучшения симптоматики десминзависимой кардиомиопатии, вплоть до бессимптомного течения после нокаута мутантного аллеля с сохранением функции белка за счет экспрессии только нормального аллеля. Мы считаем, что подходы, основанные на технологии геномного редактирования, представляют собой перспективное направление для разработки эффективных специфических методов лечения десминопатий

Senile cataract — features of development and outcomes of surgical treatment in patients with hepatitis B and C viruses

B.N. Hatsukova1, G.M. Chernakova2, S.A. Kochergin1, E.A. Kleshcheva1, E.Yu. Malinnikova1,&nbsp; K.K. Kyuregyan3, M.M. Mikhailov3 1 Russian Medical Academy of Continuing Professional Education, Moscow, Russian Federation 2 S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation&nbsp; 3 Scientific Research Center of Russian Medical Academy of Continuing Professional Education,&nbsp; &nbsp;Moscow, Russian Federation Aim: to analyze features of the clinical course and results of the surgical treatment of cataracts in patients with chronic hepatitis B and C, to search for possible relationships between the formation of cataracts and the fact of chronic infection caused by HBV/HCV. Patients and Methods: 20 patients were included in the study. The main group consisted of 10 patients with HBV and HCV. The experimental group (control group) consisted of 10 patients with the absence of diagnostically significant levels of antibodies to HBV and HCV in blood serum. All patients in both groups twice underwent a standard ophthalmologic examination, as well as optical coherence tomography (OCT) of the macular area and optic disc, Humphrey Visual Field, and visocontrastometry. Cataract extraction was performed using Laureate phacoemulsifier. All patients were implanted with a posterior chamber intraocular lens (IOL). The levels of biochemical indicators of the functional state of the liver — alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) — were determined for all patients. Results: average age of patients in the main group was 61.9±5.23 years, in the control group — 69.4±3.12. The average level of ALAT in the group with patients infected with hepatitis viruses was 44.5±4.54 U/l, and in the group of healthy people — 22.45±2.08 U/l, and the level of ASAT was 38.9±3.48 U/l, and 18.7±2.43 U/l, respectively. The difference between the average levels of ALAT and ASAT between groups is statistically significant. It was found that visual acuity in the main group prior to cataract surgery is slightly lower than in the control group. Also after the operation, in the group with patients infected with hepatitis viruses it is lower than in the group of healthy people, however, this fact did not reach the level of statistical significance. Conclusion: the study results suggest the presence of a certain relationship, if not between cataractogenesis and chronic infection with hepatitis B and C viruses, then between cataractogenesis and altered biochemical status (hyperenzymemia) with a higher probability. Key words: cataract, phacoemulsification, hepatitis B, hepatitis C. For citation: Hatsukova B.N., Chernakova G.M., Kochergin S.A. et al. Senile cataract — features of development and outcomes of surgical treatment in patients with hepatitis B and C viruses. RMJ “Clinical ophthalmology”. 2018;4:174–178.<br