THE ROLE OF MICROTRAUMA IN THE DEVELOPMENT OF BACTERIAL CORNEAL ULCERS

Purpose: To study the role of corneal  microtrauma in the development of complications, leading to bacterial ulcers. Performed clinical assessment, conservative therapy, and surgical  interventions for 236 patients with the  complication  of microtrauma, mainly related to  the  prolonged  presence of foreign bodies  in the  cornea (86.1% they  had  a  metallic  nature). Methods included  ophthalmologic investigations  and  laboratory  procedures, which revealed  the  presence of bacterial corneal  ulcer  in 97 cases (41.1%), recurrent erosion  — 62  cases (26.3%), traumatic keratitis — 25 cases (10.6%) and  deep  cornea’s infiltrate  — 52  cases  (22.0%). The development of complications was  due to the  later  removal  of FB (in some  cases more  than  1 month  after  the  trauma), incomplete removal of foreign bodies,  non-compliance  with aseptic and antiseptic rules  during in the removal of FB’s without follow up of patients. Streptococcus,  staphylococcus, pneumococcus, and  isolated  cases of Pseudomonas aeruginosa and  Escherichia  coli were  mainly diagnosed. Conservative therapy  included specific, pathogenetic, symptomatic and antiallergic medications. Nitric oxide (NO) in the gas stream was used  to accelerate the reparative processes, weakening  of the inflammatory exudation and cellular proliferation.  Surgical interventions  were  performed for  preserving  of eyes,  prophylactic  and  therapeutic purposes in the  form  autoconjunctiveal  plast y, deep  lamellar  and  penetrating keratoplast y  (preserved  and  fresh  corneas) and  amniotic  membrane transplantation. According  to the results of treatment of 236 patients with the corneal  erosion  completed with elimination of inflammatory reaction, restoration of corneal  transparency; 52 patients with corneal  infiltrate -development  of opacities  in the stromal cornea layers;  patients with keratitis –formation of corneal  leucoma  and 52%  — keratoplast y were  performed. In cases of corneal  ulcer process ended  with the formation of a  rough  leucoma  in 30 patients (30.9%), surgical  interventions  with a  partial  improvement of visual function  were  observed  in 62 patients (63.9%), the removal of the eye were  done in 5 patients (5.2%)

Psychological aspects rehabilitation of patients with anophthalmia

This work deals with the psychological rehabilitation of patients with anophthalmia having eye protesis as the main role on the problem. Stages of psychological reaction after eye lost and also the difficulties of adaptation of fellows with both eyesight lost is widely discussed. In order to help practitioners, recommendations on dealing this kind of patients has been given

Corneal puncture wounds: characteristics of the course and surgical treatment

A clinical case is presented of a patient with a corneal puncture wound. The clinical course and treatment tactics are discussed. 1.5 months after primary surgical care during which the wound was sutured, the damaged area of the cornea was covered by an amniotic membrane abd a soft contact lens, the patient developed sharp thinning of the forming scar, threatening perforation: this was caused by incomplete sealing of the wound in the anterior chamber area. The patient was re-hosipitalized and given an additional through-and-through suture; autologous blood was infused into the anterior chamber, which resulted in stromal defect elimination. In cases when punctured wounds with corneal tissue deficit are accompanied by lysis and stromal thinning, through-and-through suturing and infusion of autologous blood into the anterior chamber is the operation of choice // Russian Ophthalmological Journal, 2017; 1: 81-4. doi: 10.21516/2072-0076-2017-10-1-81-84

Bionomics and medicine. Intercommunication

In article the problems of a common and medical bionomics are presented. the modern problems of a state of an environment and health of the population stipulated by a sharp amplification of relative (mutual) negative influence of the man and the environment lighted. the place of diseases of an eye in a plane of ecological medicine surveyed. the number of the unfavorable ecological factors influential in health of the medical workers is parsed

A Differentiated Approach to the Complex Treatment of Cornea Ulcers

Ulcerative lesions of the cornea in 17–21 % lead to functional and up to 8 % to anatomical death of the eye depending on the severity. The aim of the work was to develop an algorithm of surgical treatment of patients with corneal ulcers. Comprehensive examination, treatment and outcomes in the dynamics of ulcerative lesions was performed in 126 patients, 86 patients of them received surgical intervention (with the threat of corneal perforation or present) for emergency indications and in 40 cases combined treatment was carried out with the use of a crosslinking (CRL) in corneal ulcer and ulcer a corneal transplant. Surgical intervention included autoconjuctival plasty (AUC), the transplantation of amniotic membrane in combination with blepharorrhaphy (TAM + BR), lamellar keratoplasty (PKP), penetrating keratoplasty (PK), reconstructive keratoplasty (RCP). The most favorable outcomes with relief of inflammation were achieved in RCP and PC. In cases of delayed epithelialization of the cornea and graft (herpesvirus infection and trophic disorders), the most resonant ones were TAM and TAM + BR. CRL treatment was carried out in 3 variants: 1-as the main method of treatment, 2 — CRL in combination with TAM + BR, 3 — CRL + keratoplasty ( 5–7 days after surgery). As a treatment result, epithelialization of ulcerative-destructive process and partial increase in visual acuity were observed in all patients. Based on the results of patient’s treatment the algorithm of complex surgical care was created. It takes into account the etiology, localization, depth and severity of the inflammatory process, the area of ulcerative lesions of the cornea and of the graft, reduced terms of treatment inflammation and rehabilitation period

Crosslinking in the complex treatment of corneal ulceration and corneal grafting

Purpose: to study the impact of crosslinking (CL) on the healing of corneal ulcers of various etiologies. Materials and methods. Treatment results of 15 patients with corneal and transplant ulcers by CL and its combination with other surgical interventions were analyzed. Results. For the first time three options of combined treatment of corneal ulcers were proposed: 1) CL as an independent method; 2) CL combined with transplantation of amniotic membrane (ТАМ) and temporary tarsorrhaphy; 3) corneal grafting combined with CL. The main diagnostic technique of treatment result evaluation was OCT of the anterior segment of the eye. Results. CL was found to contribute to the cleaning of the bottom and the edges of the ulcer surface, to promote the resorption of the hypopyon and the edema, leads to rapid healing of the ulcer and the reduction of the corneal syndrome and increases visual acuity. Conclusion. The obtained data indicate the need for further study of the impact of CL on the healing process of corneal and transplant ulcers. For citations: Chentsova E.V., Verigo E.N., Makarov P.V., Khazamova A.I. Crosslinking in the complex treatment of corneal ulceration and corneal grafting. Russian ophthalmological journal. 2017; 10 (3): 93-100. doi: 10.21516/2072-0076-2017-10-3-93-100 (in Russian)

Fungal canaliculitis: diagnostics, treatment, prevention

Up to 2.4 % of primary patients seeking ophthalmological care are cases of canaliculitis. Purpose: to systematize the methods of diagnosing, treatment and relapse prevention of fungal canaliculitis on the basis of the authors’ experience. Material and methods. The results of diagnosing, treatment and relapse prevention are systematized based on the analysis of examination of 57 patients aged 46 to 89 with tear duct disorders of micotic origin. Results. Canaliculitises of fungal etiology are characterized by chronic course of the disease and complications caused by late diagnosis and prolonged inadequate treatment. Practical ophthalmologists should be aware of the fact that this pathology develops primarily in senior females suffering from chronic conjunctivitis and inflammatory disorders of ocular adnexa within the tear duct area that are resistant to antibiotics. A plan of diagnostic examination is recommended based on the analysis of the clinical picture, determination of patency of lacrimal passages during washing and probing, and canalicular and nasolacrimal assays. We also used bacteriological methods of study and X-ray contrasting of tear ducts. The main technique of treatment of fungal canaliculitis is surgical dissection of lacrimal canaliculi, removal of their content with subsequent instillations and washing of tear ducts with antiseptics and antifugal preparations. In the follow-up period spanning 2 months to 5 years no relapses of the process were observed. Conclusion. The use of special diagnostic methods based on the analysis of clinical picture and surgical treatment combined with antimicotic preparations is necessary for relapse prevention and rehabilitation of patients with fungal diseases of lacrimal canaliculi // Russian Ophthalmological Journal, 2016; 4: 74-9. doi: 10.21516/2072-0076-2016-9-4-74-79

Ultrasound scan of the orbit with an immersion protection in patients with subatrophy and anophthalmos

We observed 73 patients with anophthalmos with different types of intraorbital implants, and subatrophy of the globe. For three- dimensional ultrasound image of the orbit we used a new immersion substation on the basis of compressed polyvinyl alcohol, which was placed between the probe and the eyelids, excluding «dead zone». Acoustic density of the orbital structure and orbital blood flowwere estimated

PATTERNS OF TREATMENT OF COMBINED BURN EYE INJURIES IN PATIENTS HOSPITALIZED IN BURN UNITS

The paper is focused on combined burn injuries of the eye, face and other body parts in acute care patients treated in non-ophthalmic hospital departments. Purpose: to develop patterns of actions by ophthalmologists and burn doctors at various stages of multiple burn injuries in patients treated in burn units. Materials and methods. 158 burn patients were given full clinical and instrumental examination. Group 1 included 95 patients hospitalized in the department of eye traumatology and reconstructive surgery after being treated in burn units elsewhere, while group 2 consisted of 63 patients examined and treated simultaneously by ophthalmologists and burn doctors from the start of admission to burn units. Results. The patients in Group 1 developed serious ophthalmic complications, ranging from ulceration or perforation of outer eye coats, swollen cataracts, hypopyon, cicatricial eyelid deformation, lagophthalmos etc. to eye apple atrophy, all caused by the absence of eye surgery assistance at early stages of burn treatment. Conclusion. The proposed patterns and range of surgical assistance including that given in the early stages of treatment, prevented the development of severe complications to the eye and the annexa, reduced the rehabilitation period and improved the functional prognosis of combined burn eye injuries. For citation: Chentsova E.V., Makarov P.V., Verigo Е.N., Petrova A.O., Smirnov S.V. Patterns of treatment of combined burn eye injuries in patients hospitalized in burn units. Russian ophthalmological journal. 2018; 11 (3): 37-42 (In Russian). doi: 10.21516/2072-0076-2018-11-3-37-4

Cases of Undiagnosed Open Eye Injury: Clinical Features, Diagnosis and Surgical Treatment

Open eye injury (OTG), in the structure of eye damage is up to 35.0–85.0 %, the level of disability among the working part of the male population from 26 to 55 years ranges from 25.0–47.5 %, and the removal of the eyeball due to traumatic pathology is 6.5–26.3 % of cases. The aim of the work is to demonstrate the consequences of undiagnosed cases of open injury, successfully treated in the Department of traumatology and reconstructive surgery. Attention is focused on some diagnostic techniques that contribute to the correct diagnosis, especially in undiagnosed and unoperated timely sub — conjunctival sclera ruptures that occur in 1.0–2.6 % of cases of OTG. This pathology leads to the development of severe complications with a persistent decrease in visual functions, detachment of the inner shells, with the formation of staphylomatous, cystic changes, as a rule, along the upper limb in 0.5–1.0 mm from it. There are 3 clinical cases with the description of surgical restoration of the integrity of the scleral capsule in combination with intraocular surgery, which led to good anatomical, cosmetic and functional results. In the first case, the patient with the consequence of injury with wooden shavings 6 months ago was performed a delayed revision of vascular staphyloma after separation of the conjunctiva and plastic defect sclera cadaver scleral flap. Visual acuity of OD increased from 0.4 to 0.8. The second case is the consequences of an open eye injury, dislocation of the lens under the conjunctiva. The patient underwent a delayed revision of the scleral wound with removal of the lens, microinvasive vitrectomy with removal of hemophthalmos, iris plasty and secondary IOL implantation. Visual acuity improved with pr.l.certae up to 0.7. The third case is a patient with the consequences of open trauma, staphyloma vascular, complete coloboma of the iris, traumatic cataract. Were facoaspiration traumatic cataract with IOL implantation and plasticity of the iris, delayed revision of the scleral wound plasty of the defect cadaverous sclera. Visual acuity improved with pr.l.certae to 0.2 n/K. Conclusion. Thus, thanks to the use of clinical and diagnostic methods of research and high-tech surgical technique of treatment, it was possible to achieve optimal anatomical, cosmetic results in patients with long-term consequences of complicated open eye injury. Despite the severe anatomical consequences, good functional results were obtained in all cases. In our opinion, this can be explained by the absence of damage to the choroid during the injury, which, according to the literature, mainly leads to massive bleeding into the inner shells and cavities of the eye, the development of ischemia and is the trigger for the development of vitreoretinal proliferation