Implantation of the First IMT Macular Lens in Age-Related Macular Degeneration (Literature Review)

This review presents the characteristics and results of clinical studies of patients with age-related macular degeneration implanted with the developed for this purpose first macular IOL – intraocular macular telescope (IMT). This lens was designed specifically for patients with the most severe or terminal form of age-related macular degeneration and is designed for monocular implantation to provide central vision while maintaining peripheral vision of the paired eye, which is important for maintaining the balance and orientation of patients. This device allows patients to see both in dynamic and static situations in the near, intermediate and far ranges. The disadvantages of this lens are a decrease in the visual field and depth of focus (which excludes its bilateral implantation), the need for a large (10–12 mm) incision for implantation, which can cause an increase in corneal astigmatism and the risk of complications, in particular, the pupillary block with an increase in intraocular pressure. There are also difficulties in the study of the fundus after its implantation to assess the small changes in the macula or to identify possible postoperative complications after cataract surgery (macular oedema, etc.). Also after the implantation of this lens, there is need for special programs of visual rehabilitation. The patient’s commitment to the rehabilitation measures for the adaptation of the central visual field of the operated eye with the peripheral vision of the second eye is crucial for success of the IMT macular telescope implantation procedure

Two-stage treatment of ametropia in patients with keratoconus and cataracts

Keratoconus (KC) is a progressive degenerative corneal disease, leads to the aberration of biomechanical and optical properties and thinning of the cornea, causes astigmatism and decreases visual acuity.Materials and methods. 33 patients (35 eyes) with stages II–III of non-progressive keratoconus and concomitant cataracts of various stages of maturity were operated on. The average age of the patients was 46.5 ± 2.7 (41–63) years old. The operations were performed according to our proposed two-stage method of treating ametropia in patients with KC and cataracts (Patent of the Russian Federation No. 2748634 of 28.05.2021). The first stage was the implantation of FERRARA intrastromal corneal ring segments (ICRS) with thickness from 150 to 350 μm. To correct residual refractive error in 5–7 months after stage 1, patients underwent stage 2: cloudy lens was removed and replaced with toric posterior chamber intraocular lens (TIOL) – AcrySof IQ Toric (Alcon, USA), T-fl ex Toric RayOne (Rayner, UK).Results and discussion. After stage 1 of the operation (ICRS implantation), the uncorrected visual acuity (NCVA) was 0.2 ± 0.03, the best corrected visual acuity (BCVA) was 0.4 ± 0.02. In 1 month after stage 2 (phacoemulsifi cation + TIOL) NCVA was 0.64 ± 0.11 and BCVA was 0.74 ± 0.12. During the entire follow-up period after the surgery visual functions, refraction, and rotational stability of TIOL were stable.Conclusions. Conducting a two-stage surgical intervention in patients with keratoconus and cataracts allows to stop the progression of the disease and effectively correct the ametropia concomitant with keratoconus

Современные возможности профилактики избыточного рубцевания после антиглаукомных операций с использованием антиметаболитов

Postoperative excessive scarring of the eye tissue at the surgical site is known to be the main reason of postoperative IOP increase. This review presents an analysis of local and foreign literature on the problem of excessive scarring management in glaucoma surgery by means of anti-metabolites (5-fluorouracil and mitomycin C). It gives an evaluation of their practical efficacy and presents various methods of their application and particular complications. The article also recounts alternatives to anti-metabolites and steroids as well as current means of affecting the process of excessive scarring. The author concludes that currently antimetabolites and, in a lesser degree, steroids present the only viable clinical possibilities of an effective postoperative drug correction of excessive scarring.Основной причиной повышения внутриглазного давления (ВГД) является послеоперационное избыточное рубцевание тканей глаза в зоне хирургического вмешательства. Существует множество факторов риска: молодой возраст пациента, предшествующие оперативные и лазерные вмешательства, интраоперационные осложнения (гифема и др.), исходно высокое ВГД, наличие псевдоэксфолиативного синдрома, развитая и далеко зашедшая стадии глаукомы, длительное применение некоторых местных гипотензивных средств (особенно с консервантами или комбинации нескольких препаратов), сопутствующая хроническая терапевтическая патология, которые осложняют и ухудшают благоприятный исход операции.В обзорной статье представлен анализ отечественной и зарубежной литературы по проблеме борьбы с избыточным рубцеванием в хирургии глаукомы с использованием антиметаболитов (5-фторурацила и Митомицина С). Дается оценка эффективности при использовании их в клинической практике, представлены различные способы их применения и возможные интра- и послеоперационные осложнения. Приводятся альтернативные антиметаболитам и стероидам современные подходы к воздействию на избыточное рубцевание. Авторы де- лают вывод о том, что реальные клинические возможности эффективного использования медикаментозной коррекции для эффективной послеоперационной профилактики избыточного рубцевания на сегодняшний день, за исключением антиметаболитов, пока ограничены

Эпидемиологические характеристики глаукомы в Республике Башкортостан

PURPOSE: The purpose of the research is to study glaucoma prevalence in the Republic of Bashkortostan (RB) over the 20-year period (1999-2018 years).METHODS: This research was conducted using the data from statistic annual reports of ophthalmologists from various cities and regions of RB, the Ufa Eye Research Institute with assistance from the Head Office of Medical and Social Examination Service in RB.RESULTS: In 2018 there were 33 727 people with glaucoma in RB (81.5% with primary open-angle glaucoma — POAG). 73.8% of them were over the age of 60 and 83.3% patients had mild or moderate glaucoma. During periodic health examination there were 1.2% patients with suspected glaucoma and 0.6% with an established diagnosis. During the period from 1999 to 2018 there was a 112.8% increase in patients registered in dispensaries, a 77.4% increase in prevalence and morbidity from POAG, while there was a decreasing trend in the number of blind people and people primary identified as disabled associated with glaucoma.CONCLUSION: The 20-year period analysis (1999-2018) showed that there was more than a two-fold increase in the number of officially registered patients with glaucoma in the Republic of Bashkortostan: from 15 852 to 33 727. But despite the progressive growth of glaucoma incidence, particularly primary open-angle glaucoma (from 9.3 to 16.5 per 10 000 people over the age of 40) there was a 30% reduction in blindness prevalence over the last 9 years (since 2010) — from 17.3 to 13.0 and a 37% reduction in absolute number of people with glaucoma-related disability — from 346 to 218. It was a complex result of high level of check-ups and periodic health examinations in Republic followed by an increasing number of identifications of patients with early glaucoma, active and wide use of topical medicines and a persistently high surgical activity.ЦЕЛЬ. Изучение эпидемиологических показателей глаукомы в Республике Башкортостан (РБ) за 20 лет (1999- 2018 гг.).МАТЕРИАЛЫ И МЕТОДЫ. Данные исследования проведены на основе данных годовых статистических отчетов офтальмологов городов и районов РБ, ГБУ «Уф НИИ ГБ АН РБ» при содействии ФКУ «Главное бюро МСЭ по РБ».РЕЗУЛЬТАТЫ. В 2018 г. на диспансерном учете в республике с глаукомой состояло 33 727 человек (с первичной открытоугольной глаукомой (ПОУГ) — 81,5%), из них 73,8% пациентов были в возрасте старше 60 лет, а 83,8% имели начальную или развитую стадии заболевания. На профосмотрах доля пациентов с подозрением на глаукому составила 1,2%, с установленным диагнозом — 0,6%. С 1999 по 2018 гг. наблюдалось увеличение на 112,8% больных, состоящих на диспансерном учете, на 77,4% — распространенности и заболеваемости ПОУГ на фоне устойчивой тенденции к снижению доли слепых и количества первичных инвалидов вследствие глаукомы.ВЫВОДЫ. Анализ за 20-летний период (1999 и 2018 гг.) показал, что число пациентов с глаукомой, официально находящихся на учете в Республике Башкортостан, за исследуемые годы увеличилось более чем в 2 раза: с 15 852 до 33 727 человек. На фоне прогрессирующего роста заболеваемости глаукомой, в частности первичной открытоугольной ее формой (с 9,3 до 16,5 на 10 тыс. населения старше 40 лет), отмечено уменьшение доли слепых на один и оба глаза за последние 9 лет (с 2010 г.) на 30% — с 17,3 до 12,0, а также абсолютного числа первично освидетельствованных инвалидов вследствие глаукомы на 37% — с 346 до 218. Этому способствовали высокий уровень обследования и профосмотров в республике, что привело к увеличению числа выявленных больных в начальных стадиях заболевания, активное и все более широкое использование эффективных местных медикаментозных средств, а также стабильно высокая хирургическая активность

LMI-SI and Scharioth Additional Intraocular Lenses for Age-Related Macular Degeneration. Review

Currently, the treatment of neovascular age-related macular degeneration (AMD) includes: intravitreal injections (bevacizumab, ranibizumab, aflibercept, pegaptanib, etc.), photodynamic therapy, surgical treatment (subretinal surgery, recombinant tissue plasminogen activator + gas, macula translocation) and etc. Rehabilitation of these patients is carried out using special optical tools (glasses, magnifying lenses, loupes, electronic devices). Classic external devices for the correction of very poor eyesight are not convenient to use: they are often lost or forgotten at home, not adapted for constant wear, people are embarrassed to use them in public places. This review presents the characteristics and clinical results of the implantation of two intraocular lenses, the Lipschitz Macular Implant (LMI-SI) and the Scharioth Macula lenses, in patients with age-related macular degeneration (AMD). These IOL can be implanted during standard phacoemulsification with the implantation of usual posterior chamber IOL or years after the cataract extraction, which makes them unique among other lenses that are implanted only during the cataract extraction procedure. The Lipschitz Macular Implant (Israel, 2013) is a rigid IOL made of polymethyl methacrylate (PMMA), implanted in a capsular bag, it requires an incision up to 6 mm. A positive feature of the Scharioth Macula lens (1stQ GmbH, Germany, 2017) is the smallest incision needed for implantation — no more than 3 mm. This lens consists of a biocompatible hydrophilic acryl with a UV filter, the peripheral zone of the lens is optically neutral, the square design excludes its free rotation. Also, this lens can be used as therapy for progressive macular dystrophy of various etiologies. The additional macular IOLs do not affect peripheral vision, reduce binocularity when reading, and require complex visual rehabilitation

Surgical options for cilio-choroidal detachment prevention and treatment

Purpose: the current study was designed to improve drainage options of suprachoroidal space for cilio-choroidal detachment (CCD) prevention and treatment after glaucoma surgeries and to assess their clinical efficacy. Material and methods. A double cross-shaped sclerotomy was proposed to increase the effectiveness of CCD intraoperative prevention and to reduce intervention consequences. It was performed in 49 patients (49 eyes) aged 54-77 years with POAG simultaneously with the main fistulizing surgery within the same area. The control group consisted of 42 patients (45 eyes) who underwent fistulizing surgeries without preventive sclerotomy. For CCD treatment, posterior scleracyclostomy was designed, which was applied to 24 patients (24 eyes) with POAG, aged 52 to 84, who developed CCD aftera fistulizing surgery. The control group of 18 patients (18 eyes) received traditional posterior sclerectomy to treat CCD. Results. Double cross-shaped sclerotomyreduced CCD frequency after fistulizing surgeries by 4.4 times - from 26.7 % to 6.1 %, while the need for surgical treatment of retinal detachment dropped from 50.0 % to 33.3 %. Posterior sclera cyclostomy eliminated CCD in 100 % of cases, in which no relapse occurred, while in the control group the detachment showed a relapse in 16.6 % of cases. Conclusion. The proposed technique of preventive sclerotomy is effective, technically simple, and low traumatic. The designed surgical technique of CCD treatment, posterior sclera cyclostomy, proved to be a more effective way to prevent CCD relapses than conventional posterior sclerectomy // Russian ophthalmological journal. 2017; 10 (2): 5-9. doi: 10.21516/2072-0076-2017-10-2-5-9

Results of modified sinustrabeсulotomy in patients with primary openangle glaucoma

Purpose: To study the short- and long-term results of modified sinus trabeculotomy (STT) in primary open-angle glaucoma (POAG).Patients and methods: We observed 42 patients (47 eyes) with POAG at 1‑3 stages aged 47‑85 (average age — 67.5 years). There were 27 women (64,3 %) and 15 men (35,7 %). The I stage of glaucoma was diagnosed in 17.0 % (8 eyes), II stage — in 44.7 % (21 eyes) and III stage in 38.3 % (18 eyes) patients. The average level of intraocular pressure (IOP) at the drug therapy was 29.2±1.5 mmHg (results obtained by pneumotonometer). All patients underwent a routine ophthalmic examination before and after surgery. Long-term results for period of 6‑24 months (13.1 months average) were assessed in 39 patients (43 eyes).Results. The most common early complications were hyphema (10.6 % patients) and ciliochoroidal detachment (6.4 % patents). Long-term results showed normalization of IOP in 93.0 % cases including 7.0 % against the background of additional therapy. Visual acuity preserved in 88.4 % cases, its reduction was observed in 11.6 % and was associated with the progression of glaucoma (7.0 %) and lens opacity (4.6 %). The field of view remained at the preoperative level in 90.7 % patients and narrowed in 9.3 %, mainly due to the progression of glaucoma process.Conclusion. Cruciate STT with anchoring of the scleral flap apex in suprauveal space in POAG in long-term results (up to 2 years) has a sufficiently high and sustained hypotensive effect (93.0 %), cataractogenic effect (4.6 %) and a relatively small number of complications (especially in case of ciliochoroidal detachment — just 6.4 %). We suggest this surgery in I‑III stages of POAG when the degree of expected postoperative scarring is small

The outcomes of refractory glaucoma surgery using collagen bio-implant

Aim. To analyze the efficacy of Ologen® Collagen Matrix Implant in refractory glaucoma surgery.Materials and methods. Classical non-penetrating deep sclerectomy (NPDS) with Ologen® implantation in the scleral bed was performed.Results. Post-op, implant was visualized underneath the conjunctiva and moved within the scleral flap. Implant was resolved in 3 months with moderate filtering bleb formation. Following 12 months, visual acuity and visual fields were stable, IOP level was 12‑17 mm Hg.Conclusion. Within 12‑months follow-up, Ologen® implantation in the course of glaucoma surgery prevents scleral conjunctival scarring, provides long-term IOP-lowering effect and preserves residual visual functions

Efficiency of fistulizing surgery of secondary refractory glaucoma

Purpose. To compare the results of traditional and modified fistulizing surgery for secondary refractory glaucoma. Material and methods. 39 patients (39 eyes) aged 25 to 79 (24 and 15 women) who received the surgery were divided into 2 groups: 17 patients of the control group underwent traditional trabeculectomy or deep sclerectomy while 22 patients of the main group received tunnel trabeculectomy with iridocycloretraction. 27 patients were followed up for up to 2 years. Results. No significant difference between the compared groups was found with regard to the incidence of early postoperative complications (hyphema, ciliochoroidal detachment). After surgery, which in some cases was supplemented by the course of additional antihypertensive therapy, IOP returned to normal in 77.8% of cases. For neovascular glaucoma, the results were worse both after modified and traditional trabeculectomy procedures (40.0%). The best sustained hypotensive and functional effect was achieved after tunnel trabeculectomy with iridocycloretraction (in 68.8% of cases), while after traditional trabeculectomy the effect was lower (45.5%). Conclusions. The obtained results show that the proposed modified operation may be considered, in some cases, as an alternative to drainage surgery in patients with refractory secondary glaucoma. Neovascular glaucoma is a contraindication to tunnel trabeculectomy with iridocycloretraction. Yet, modified trabeculectomy may be recommended also to patients with neovascular glaucoma, on condition that the procedure is preceded by effective surgery which eliminates or reduces neovascularization of the iris and the anterior chamber angle // Russian Ophthalmological Journal, 2016; 3: 5-11. doi: 10.21516/2072-0076-2016-9-3-5-11