No 36 (2015)

ИСТОРИЯ МОНИКИ

ON THE OCCASION OF THE 145 ANNIVERSARY OF OPHTHALMOLOGY DEPARTMENT OF MONIKI

Ryabtseva A.A., Grishina E.E., Yugay M.P.

Abstract

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Almanac of Clinical Medicine. 2015;(36):6-8
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SURGICAL TREATMENT OF OPHTHALMOPATHY

ANATOMO-TOPOGRAPHIC AND HYDRODYNAMIC PARAMETERS OF THE EYE AFTER CATARACT PHACOEMULSIFICATION

Yugay M.P., Ryabtseva A.A., Shirinova U.A.

Abstract

Background: Removal of the native lens alters spatial relationships between anterior eyeball structures and results in fluctuations in intraocular pressure. Intraocular pressure control is important for the prevention of early postoperative complications. 

Aim: To study anatomic, topographic and hydrodynamic changes of the eyeball after uncomplicated cataract phacoemulsification with intraocular lens implantation. 

Materials and methods: 75  eyes of 75  patients after uncomplicated cataract phacoemulsification were studied. All patients underwent ultrasound biomicroscopy, electronic tonography and biomechanics study on ocular response analyzer (before the surgery, in 2  weeks, 1 and 3  months after the surgery). 

Results: We found significant increase in anterior chamber depth, distance trabecula-iris at 500  microns from the scleral spur, anterior chamber angle, angle between sclera and iris and angle between sclera and ciliary processes.

Preoperatively, intraocular pressure was 15.67  ± 0.85  mm Hg, in 2  weeks  – 13.22 ± 0.53  mm Hg, after 1  month  – 13.21 ± 0.55  mm Hg, after 3  months  – 12.42  ± 0.46  mm Hg. Cornealcompensated pressure before surgery was 15.91 ± 0.69 mm Hg, it increased from the first day after surgery, reached maximum  19.37 ± 1.52  mm Hg after 2  weeks and returned to preoperative values at 1  month; in 3  months, corneal-compensated pressure decreased to 14.4  ± 0.70 mm Hg. Goldmann intraocular pressure changes were similar with corneal-compensated intraocular pressure. Mean preoperative aqueous outflow easiness coefficient was 0.15 mmі/min/mm Hg, increased after 2  weeks to 0.24  mmі/min/mm Hg and stayed unchanged in 1 and 3 months after surgery (0.22 mmі/min/mm Hg).

Conclusion: Changes of anatomy and topography of anterior part of the eyeball after cataract phacoemulsification lead to decrease of intraocular pressure by 1.5–2  mm Hg in 3  months after the surgery compared to preoperative values. Further studies of the relation between eyeball anatomy and intraocular pressure are needed.

Almanac of Clinical Medicine. 2015;(36):9-12
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CHANGES OF BIOMECHANICAL PROPERTIES OF THE CORNEAAFTER CATARACT PHACOEMULSIFICATION

Ryabtseva A.A., Yugay M.P.

Abstract

Background: Cataract phacoemulsification is accompanied by changes in biomechanical parameters of the eye. Corneal hysteresis is a characteristic of viscoelastic properties of the cornea which may be studied in vivo. 

Aim: To assess the changes of corneal hysteresis in 3 months after phaco. 

Materials and methods: We studied 72  eyes of 72  patients after uncomplicated phacoemulsification with soft Intraocular lens implantation. Patients’ examination included routine assessment of corneal compensated intraocular pressure (IOP), Goldman-correlated IOP and corneal hysteresis using Ocular Response Analyzer (Reichert, USA) before the procedure, on the first 2 days, in 2 weeks,1 and 3 months after the procedure. 

Results: Corneal hysteresis decreased from 9.85 ± 0.30 mm Hg to 8.91 ±0.31 mm Hg on the first day after the procedure and to 7.97 ± 1.51 mm Hg (p < 0.05) after 2 weeks. Later, corneal hysteresis begins to grow and returned to preoperative values in 3 months after the procedure (9.68 ± 0.45 mm Hg). Directly after the procedure, IOP raised by 3–3.5 mm Hg, reached maximum in 2 weeks, then decreased to preoperative values in 1 month after phaco with consequent decrease by 1.5–2 mm Hg in 3 months after phacoemulsification. 

Conclusion: After phaco, decreased corneal hysteresis may reflect tissue response to the procedure. Return to reoperative values indicates recover of biomechanical properties of the cornea. Monitoring of corneal hysteresis may be useful for adequate clinical interpretation of the results of intraocular pressure measurement.

Almanac of Clinical Medicine. 2015;(36):13-15
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EFFICACY OF LASER PHOTOCOAGULATION IN PREGNANT WOMEN WITH DIABETES MELLITUS

Khomyakova E.N., Sergushev S.G., Ryabtseva A.A.

Abstract

Background: In the modern world, diabetes mellitus is a disease that is growing in epidemic proportions. Numbers of women of childbearing age with this disease are also increasing. 

Aim: To develop a dose-defining algorithm for laser photocoagulation treatment of diabetic retinopathy and diabetic macular edema in pregnant women ensuring optimal efficacy and sustained effects. 

Materials and methods: 12 pregnant women with type I diabetes decompensation before and during pregnancy (НbА1с > 8 %, group 1), 10 women with compensated type I diabetes before and during pregnancy (НbА1с 4.5–6%, group 2), 10 women with type I diabetes decompensation before pregnancy and compensation of diabetesachieved during the 1st  trimester (НbА1c  6.5%, group 3) were enrolled. In all patients, routine  ophthalmological examination and optical coherent tomography were performed. 

Results: 39 eyes were treated with laser photocoagulation of the retina including 3 panretinal,  16 focal and 20 grid laser procedures. In the group 1, stabilization of the funduscopic picture was observed during the 3 trimester and in the longtermafter the laser treatment. During the 3rd  trimester, additional laser procedure was required in 4 eyes (16%) in the group 1 and in 2 eyes (10%) in the group 2.

Conclusion: Laser photocoagulation results in significant improvement of visual acuity. Visual function changes are dependent from diabetes compensation status, presence of macular edema and volume of the procedure.

Almanac of Clinical Medicine. 2015;(36):16-21
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CHARACTERISTICS OF MACULAR REGION AND VISUAL ACUITY IN GLAUCOMA PATIENTS AFTER PHACOEMULSIFICATION CATARACT SURGERY

Mityaeva E.N., Loskutov I.A.

Abstract

Background: To improve safety of phacoemulsification cataract surgery, innovative technologies have been developed. Assessment of macular region status after the use of routine and innovative phaco technologies is of great interest. 

Aim: To compare effects of different phaco technologies on macular retina, visual acuity and intraocular pressure in patients with compensated glaucoma after uncomplicated phaco with intraocular lens implantation. 

Materials and methods: Phacoemulsification of immature cataract was performed in 52  patients (52 eyes) using Oertli machine and uniform method. Patients were divided into 3 groups. Group 1 included 20  patients (20  eyes) with simple (primary) openangle glaucoma (POAG) after phaco using easyPhaco technology. Group 2 included 20  POAG patients (20  eyes) after phaco using routine technology. Group  3 included 12  patients without glaucoma after routine phaco. EasyPhaco technology involves using of the new Oertli machine parameters, phaco tip with new geometry, flow rate/vacuum setting of 1:10. Preoperatively, in all 40 patients with glaucoma, normal values of intraocular pressure were achieved using antiglaucomatous therapies. Visual acuity, intraocular pressure and macular thickness by optical coherent tomography were measured before the surgery, in 1 and 6 weeks after the procedure.

 Results: Increase of macular thickness (by 12–30  mcm compared to baseline) was observed postoperatively in patients with and without glaucoma. After 1 week, mean macular thickness was significantly less in the easyPhaco group compared to routine phaco groups with and without glaucoma (221.5±15.4;238.3 ± 11.5 and 229.3 ± 16.9 mcm,respectively, p < 0.05). In the groups 1 and 3, macular thickness returned to preoperative values after 6 weeks (group 1: 210.5 ± 13.8 and 209.7 ± 16.3 mcm; group  3: 211.1 ± 14.4 and 211.1 ± 15.8  mcm,respectively). By contrast, after routine phaco technology in POAG patients, macular edema persisted after 6  weeks (mean macular thickness 228.2 ± 13.5  mcm compared to 208.2 ± 17.6  mcm preoperatively). 

Conclusion: In patients with glaucoma, use of easyPhaco technology is associated with less effects on the retina and less risk of macular edema after the surgery.

 

Almanac of Clinical Medicine. 2015;(36):22-25
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ANALYSIS OF EFFECTIVENESS OF DIFFERENT SURGICAL METHODS AND EARLY POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH PSEUDOEXFOLIATION GLAUCOMA

Datskikh E.O., Konovalova O.S., Mal’tsev N.G.

Abstract

Aim: To study the effectiveness of several surgical methods in patients with pseudoexfoliation glaucoma (PEG); to assess frequency of early postoperative complications.

 

Materials and methods: We analyzed hospital medical records of 554 patients with verified diagnosis of PEG; the patients underwent surgical treatment in the State-Financed Health Institution of the Tyumen Region “Regional Clinical Hospital No. 1”.

 

Results: The majority of patients were > 70 years old (mean age was 67.5 ± 21.5 years old). Types of surgical treatment were as follows: sinus trabeculectomy (STE) with posterior scleral trepanation in 73.1% of the cases (n = 405), non-penetrating deep sclerectomy (NPDS) – in 23.8% (n = 132); STE + posterior scleral trepanation and use of silicone drainage Repegel-1 (STE + drainage) – in 3.1% (n = 17). After primary STE, postoperative complications were found in 20% (n = 31) of the patients; after repeated STE – in 76.8% (n = 119); after STE + drainage – in 3.2% (n = 5). Early postoperative complications of STE were diagnosed in 28% (n = 155) of the patients including hyphema in 45% (n = 70) of cases, postoperative hypertension in 31% (n = 48), absence of filtering bleb in 20% (n = 31) and others in 4% (n = 6) of cases. After repeated STE, early postoperative hypertension

was found only in patients with hyphema (in 99.2% (n = 118) of cases, p < 0,05).

 

Сonclusion: Analysis of the results of several surgical methods of treatment for pseudoexfoliation glaucoma demonstrated inefficiency of NPDS; on the contrary, STE and STE + drainage are regarded as methods of choice. Concomitant cardiovascular diseases contribute to the progression of PEG and increase the risk of early postoperative complications.

Almanac of Clinical Medicine. 2015;(36):26-28
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INTRAOCULAR PRESSURE REDUCTION IN OPEN-ANGLE GLAUCOMA AFTER SEGMENTARY DILATION OF SCHLEMM’S CANAL USING IN-HOUSE SECOND GENERATION INTRACANAL EXPANDER

Kumar V., Frolov M.A., Dushina G.N., Bozhok E.V., Bezzabotnov A.I.

Abstract

Background: Schlemm’s canal collaps and increased trabecular (especially juxtacalanicular) resistance play an important role in the development of glaucoma. Dilation of Schlemm’s canal and moderate trabecular extension promote restoration of natural aqueous outflow pathways. Previously we had developed first generation Schlemm’s canal expander (SKE-1) and proved its efficacy in decreasing intraocular pressure in open-angle glaucoma. Though, inappropriate size of the expander results in traumatic implantation. Thus, we developed second generation Schlemm’s canal expander (SKE-2) characterized by smaller length and diameter. 

Aim: To evaluate effectiveness of SKE-2 in decreasing intraocular pressure in open-angle glaucoma. 

Materials and methods: 25 patients (25 eye) were included. 13 patients (13 eyes) in the intervention group underwent glaucoma surgery with SKE-2 implantation. The results were compared with SKE-1 implantation in the control group (12 patients, 12 eyes). The groups were age-, sex and glaucoma stage-matched (p > 0.05). The patients were followed for 1 year. Outcome measures included intraocular pressure changes, complication rate, need for additional hypotensive therapies and repeat surgery. 

Results: Intraocular pressure changes, need for additional hypotensive therapies frequency of intra- and postoperative complications didn’t differ between the groups. Trabeculopuncture with yttrium aluminum garnet (YAG) laser as a second step procedure was needed in 2 cases (16%) in the control group and in 5 cases (38%) in the intervention group (p = 0.002). 

Conclusion: SKE-1 and SKE-2 are equally effective in reducing intraocular pressure in open-angle glaucoma. Though, after SKE-2 implantation, YAG laser goniopuncture is more frequently needed as a second step procedure.

Almanac of Clinical Medicine. 2015;(36):29-33
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VISUAL OUTCOMES OF IMPLANTATION OF MULTIFOCAL INTRAOCULAR LENS WITH ASYMMETRICAL LIGHT DISTRIBUTION

Mityaeva E.N., Loskutov I.A.

Abstract

Background: The results of implantation of refractive intraocular lenses (IOL), especially with an inferior segmental near add are of great interest due to advantages of the new lenses over more frequently used diffractive multifocal IOL. 

Aim: To assess the ocular optical performance of eyes implanted with a new IOL Lentis Mplus. 

Materials and methods: 78 patients (100 eyes) aged > 50 years were implanted with 100 IOLs Lentis Mplus. Preoperative examination included measuring uncorrected and corrected distance visual acuity, uncorrected and corrected near visual acuity. Postoperatively, uncorrected and corrected distance visual acuity, uncorrected and corrected near visual acuity (distance 33 cm) were estimated along with intermediate vision measurement using near-vision charts (60 cm). 

Results: On the day 3 after the procedure, distance visual acuity was good, and patients were able to near-reading of medium-size fonts. In 1 year, uncorrected visual acuity was 0.8–1.0 in two thirds of patients. 25% of patients needed distance visual correction from (-)0.5 to (-)0.75 D. Corrected visual acuity improved to 0.9–1.0. In 1 year, near visual acuity was 0.5 or more and intermediate visual acuity was 0.4 or more in all patients. In 78% of patients, 60 cm visual acuity was 0.5. 

Conclusion: Implantation of multifocal IOL Lentis Mplus produced good distance visual acuity and satisfactory (working) near and intermediate visual performance.

Almanac of Clinical Medicine. 2015;(36):34-36
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INFLAMMATORY AND DEGENERATIVE EYE DISEASES

PRIMARY OPEN-ANGLE GLAUCOMA IN ONCOLOGIC PATIENTS

Ryabtseva A.A., Grishina E.E.

Abstract

Background: Glaucoma-induced visual impairment negatively influences quality of life of oncologic patients. Yet, tumor in itself and methods of its treatment may promote glaucoma progression. 

Aim: To study characteristics and course of primary open-angle glaucoma in oncologic patients. 

Materials and methods: We analyzed case reports of 19 oncologic patients after primary open-angle glaucoma-related sinus trabeculectomy (34 eyes) and laser cyclopexy (1 eye). Diagnosed malignancies included colorectal cancer in 5 patients, uterine body and cervical cancer in 4 patients, chronic lymphocytic leukemia in 1 patient, renal cell carcinoma in 1 patient, adrenal cancer in 1 patient, prostatic cancer in 1 patient, breast cancer in 1 patient, vulvar cancer in 1 patient, tongue root cancer in 1 patient. Antiglaucomatous surgery was accomplished during the first 5 years from the diagnosis of tumor in 14 patients. In 9 patients, chemotherapy or hormone therapy was continued by the time of surgery. Follow-up of the patients was undertaken in 4–12 months after the antiglaucomatous operation; it included routine ophthalmological examination and dry eye syndrome functional tests. 

Results: Duration of postoperative period was 4 months or more. All patients had uveitis postoperatively. During late postoperative period, choroidal detachment was diagnosed in 4 patients. Bleb scarring was found in 2 patients. All patients received hypotensive treatment postoperatively including selective and non-selective beta-adrenergic blockers. Conjunctival and corneal xerosis was observed in all patients. 

Conclusion: In oncologic patients undergoing antiglaucomatous surgery, long-term (4 months or more) postoperative anti-inflammatory therapy is needed along with monthly ophthalmological follow-up during the first year after the operation. In patients with ongoing cytostatic drug treatment, artificial tear should be administrated.

Almanac of Clinical Medicine. 2015;(36):37-39
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COMPARISON OF DIFFERENT METHODS OF PHYSIOTHERAPY TREATMENT IN THE MANAGEMENT OF PRIMARY OPEN-ANGLE GLAUCOMA

Kamenskikh T.G., Veselova E.V., Kamenskikh I.D.

Abstract

Background: Therapeutic action of physical therapy aims at the recovery of conductibility of optic tracts, improvement of microcirculation and hemodynamics, stimulation of regulatory brain structures and improvement of psycho-neurological status of patients. 

Aim: To assess efficacy of transcranial magnetic therapy, contemporary transcranial magnetic therapy/electrostimulation and magnetic sympathocorrection in the treatment of primary open-angle glaucoma. 

Materials and methods: 397 patients (634 eyes), aged 58–76 years, with verified diagnosis of stage I, II or III primary open-angle glaucoma, received transcranial magnetic therapy (group 1, 182 eyes), contemporary transcranial magnetic  herapy/electrostimulation (group 2, 258 eyes) and magnetic sympathocorrection (group 3, 194 eyes). All patients underwent routine ophthalmological examination, visual evoked potential recording and assessment of ocular circulation. 

Results: In patients with initial stage of glaucoma, most prominent changes of electrophysiological parameters was demonstrated in the group 2: visual evoked potential amplitude increased from 8.4 ± 0.4 to 11.3 ± 0.2 mcV, latency decreased from 77.6 ± 1.3 to 70.4 ± 2.1 ms. Maximal improvement of ocular circulation (decrease of resistance index of posterior short ciliary arteries from 0.69 ± 0.02 to 0.51 ± 0.03) was registered in the group 3. In patients with evolved glaucoma (stage II), significant increase of P100 amplitude of visual evoked potentials (from 7.5 ± 0.2 to 9.8 ± 0.3 mcV) was found in the group 2; latency period decreased from 84.6 ± 1.5 to 74.8 ± 2.1 ms. In stage II glaucoma patients, prominent increase of systolic blood velocity was demonstrated in groups 3 and 2: from 11.26 ± 0.8 to 13.64 ± 0.63 cm/s and from 10.5 ± 0.2 to 13.9 ± 0.7 cm/s, respectively. Resistance index decreased from 0.76 ± 0.05 to 0.52 ± 0.02 and from 0.75 ± 0.02 to 0.65 ± 0.02 in groups 3 and 2, respectively. In advanced glaucoma (stage III), most prominent increase of P100 amplitude of visual evoked potentials was demonstrated in group 2: amplitude of visual evoked potentials increased from 6.5 ± 0.2 to 8.1 ± 0.2 mcV, latency decreased from 87.5 ± 2.3 to 80.1 ± 2.1 ms. Maximal improvement of ocular circulation (increase of systolic blood velocity from 9.2 ± 0.72 to 11.2 ± 0.6 cm/s) and decrease of resistance index (from 0.84 ± 0.04 to 0.66 ± 0.03) was found in patients with stage III glaucoma in the group 3. 

Conclusion: Use of different methods of magnetic therapy especially in combination with electrostimulation activates ocular hemodynamics and stimulates bioelectric activity of visual cortex and may prevent visual functions impairment in glaucoma.

Almanac of Clinical Medicine. 2015;(36):40-46
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ASSESSMENT OF COLOR VISION FOR DIAGNOSIS AND DYNAMIC MONITORING OF MULTIPLE SCLEROSIS

Kuchina N.V., Yakushina T.I., Kotov S.V., Lapitan D.G., Andryukhina O.M., Ryabtseva A.A.

Abstract

Background: Multiple sclerosis is regarded as the most frequent cause of neurological disability. Visual disturbances are common and may be due to pathology of retina, optic nerve and cerebral conduction tracts (optic tract). Routine methods of assessment of visual function are insufficient in diagnosing some visual problems including color vision disturbances. Aim: To assess color vision in patients with multiple sclerosis. 

Materials and methods: We examined 110 patients (age > 18 years old) with previously diagnosed multiple sclerosis. Neurological status was assessed using functional scales; results of neuroimaging, medical records and history were taken into account. Color vision was examined using Farnsworth dichotomous test. Control group included 20 healthy volunteers (8 men, 12 women, mean age 29.1 ± 1.4 years old). 

Results: In patients with multiple sclerosis, color vision defects were significantly more prevalent compared to the control group (89.1% vs. 65%, p < 0.05). Deuteranopia was found in 18.6% of patients with multiple sclerosis, protanopia in 17.3%, tritanopia in 7.3% of patients. Significant color vision defects positively correlated with disability level of the Expanded Disability Status Scale (EDSS) and were independent of disease duration and history of retrobulbar neuritis. 

Conclusion: In patients with multiple sclerosis, color vision defects were associated with the activity of pathological process. Severity of neurological disability level estimated by EDSS positively correlated with visual disturbances. Thus, Farnsworth dichotomous test may be recommended for dynamic monitoring of multiple sclerosis.

Almanac of Clinical Medicine. 2015;(36):47-52
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MONITORING OF OPHTHALMOLOGICAL INDICATORS IN PATIENTS WITH MULTIPLE SCLEROSIS

Andryukhina O.M., Ryabtseva A.A., Kotov S.V., Yakushina T.I., Kuchina N.V.

Abstract

Background: According to the literature data, more than 70% of patients diagnosed with multiple sclerosis with disease duration > 5 years and absence of retrobulbar neuritis, have visual analyzer involvement manifested by decreased thickness of peripapillary nervous fibers. 

Aim: To assess interrelations between retinal/optic nerve changes and clinical signs of multiple sclerosis; to estimate prognostic value of optic coherence tomography in the monitoring of patients with multiple sclerosis. 

Materials and methods: We studied 132 eyes of 66 patients (41 women, 62.12%, and 25 men, 37.8%, age 20–57 years old) with verified diagnosis of relapsing-remitting multiple sclerosis. All patients underwent routine ophthalmological examination and optical coherence tomography every 3 months during 2 years. 

Results: Significant correlations were demonstrated between disability severity (Expanded Disability Status Scale, EDSS) and changes of total thickness of peripapillary nervous fibers (r = -0.362, p = 0.042), mean thickness of superior temporal peripapillary nerve fibers (r = -0.373, p = 0.046), mean thickness of inferotemporal peripapillary nerve fibers (r = -0.504, p = 0.005), optic disc volume (r = -0.645, p = 0.001), total retinal thickness at the posterior pole of the eyeball (r = -0.470, p = 0.010), and total retinal volume (r = -0.453, p = 0.012). Demonstrated relations were independent of the history of retrobulbar neuritis. 

Conclusion: Changes of visual analyzer demonstrated in optical coherence tomography reflect the severity of diffuse neurodegenerative process in the brain and correlate well with disability and disease progression.

Almanac of Clinical Medicine. 2015;(36):53-58
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THE ROLE OF LABORATORY EXAMINATION IN RED EYE SYNDROME

Chernakova G.M., Kleshcheva E.A., Obrubov A.S., Ovsyanko A.A., Semenova T.B.

Abstract

Aim: To analyze etiological structure of inflammatory diseases of ocular surface. 

Materials and methods: The study included outpatients (n = 49) who referred to Ophthalmological office at the Herpetic center during the period 2012 to 2014. Complaints duration was 60.65 ± 12.28 days. All patients underwent routine ophthalmologic examination; tear and/or conjunctival scraping PCR for type 1 and 2 herpes simplex viruses, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, type 6 human herpesvirus, adenoviruses, enteroviruses, ureaplasma, chlamydia; conjunctival swab microbiology; eyelash microscopy for eyelash mites. 

Results: After the examination, all patients were divided into three groups: 1) with herpesvirus infections of the eye (n = 24), 2) with non-herpetic infection of the eye (enterovirus, adenovirus, bacteria, fungi, n = 18), 3) with ocular surface lesions due to non-infectious causes (n = 7). In three cases U. urealyticum was detected, doxycycline was administrated. Identification of pathogens in the groups 1 and 2 resulted in effective causal treatment with subsequent clinical recovery. Exclusion of infection in the third group allowed to avoid inappropriate antibacterial or antiviral therapy. 

Conclusion: In patients with chronic red eye syndrome of unknown etiology, laboratory examination of tear and/or conjunctival scraping is essential for differentiating between infectious and non-infectious disease.

Almanac of Clinical Medicine. 2015;(36):59-66
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PHARMACOTHERAPY OF PRIMARY CHRONIC GLAUCOMA IN DIABETIC PATIENTS IN RELATION TO MACULAR AREA STATUS

Konovalova O.S., Brynza N.S., Ponomareva M.N., Konovalova N.A.

Abstract

Background: In diabetic patients with glaucoma, individualized pharmacotherapy of glaucoma is needed. 

Aim: To assess the effects of topographic morphometric characteristics of macular region and presence of concomitant diseases on visual acuity in patients with diabetes mellitus and glaucoma or ocular hypertension in order to provide optimal drug treatment. 

Materials and methods: 178 patients with diabetes and glaucoma or ocular hypertension were examined. 

Results: Background somatic pathology was as follows: arterial hypertension in 92.7% of the patients, ischemic heart disease in 36.2%, dyscirculatory encephalopathy in 96.1%, bronchial asthma in 5.6%, cervical osteochondrosis in 20.2%. 86.7% of the patients had primary chronic open-angle glaucoma, 1.1% – narrow-angle glaucoma, 1.1% – low pressure glaucoma, and 2.2% – secondary glaucoma. Significant diabetic macular edema was found in 85% of cases. Thickness of parafoveola was significantly negatively correlated with corrected visual acuity. Serous retinal detachment was demonstrated in 27.7% of cases, detachment of epiretinal membrane – in 41.7%, cystic changes – in 50% of the patients. 

Conclusion: In patients with diabetes and glaucoma, hypotensive therapy with prostaglandins may be contraindicated due to background changes of macular region.

Almanac of Clinical Medicine. 2015;(36):67-70
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ДИРОФИЛЯРИОЗ ПРИДАТОЧНОГО АППАРАТА ГЛАЗА И ОРБИТЫ

Grishina E.E., Ryabtseva A.A., Belova T.V.

Abstract

Background: Floppy eyelid syndrome is a rare disorder characterized by tarsal atonia, common spontaneous eversion of the upper eyelids in conjunction with chronic papillary conjunctivitis. Floppy eyelid syndrome is a frequent cause of recurrent keratitis of different severity up to corneal ulceration. 

Aim: To assess tear production, tear film and status of cornea in patients with floppy eyelid syndrome. Materials and methods: We examined 8 women aged 47–81 years (median 59 years) with clinical signs of floppy eyelid syndrome. For functional assessment, Schirmer and Norn tests were used. 

Results: All patients had dry eye syndrome due to increased evaporation and fluid loss from the ocular surface in combination with meibomian gland dysfunction. In all cases, keratitis of varied severity was diagnosed: pitted corneal erosions in 7 patients, severe keratitis on 1 patient. In this patient, untimely diagnosis of floppy eyelid syndrome and inadequate treatment resulted in the development of purulent corneal ulcer, endophthalmitis and subsequent eye enucleation. In all patients, medical treatment involved artificial tear, night gauze bandage and therapeutic eye gels. 

Conclusion: In patients with floppy eye syndrome, early diagnosis and timely treatment may prevent the development of corneal ulcer.

Almanac of Clinical Medicine. 2015;(36):71-73
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DIROFILARIASIS OF OCULAR ADNEXA AND ORBIT

Grishina E.E., Ryabtseva A.A.

Abstract

Background: Dirofilariasis is a rare helminthosis caused by nematode worms Dirofilaria repens and Dirofilaria immitis. Larvae of dirofilaria are most frequently localized subconjunctivally and are easily diagnosed. Localization of the helminth deep in eyelid or orbital tissue usually leads to false diagnosis of neoplasm. 

Aim: To describe main symptoms of dirofilariasis of ocular adnexa and orbit and to assess treatment outcomes. 

Materials and methods: 43 patients with dirofilariasis (19 men, 24 women, age 25–83 years old) were included. 

Results: Clinical symptoms of dirofilariasis were related to helminth localization and toxicoallergic reaction to its metabolic by-products. In case of subconjunctival localization, mobile (in 11 patients) or dead (in 2 patients) parasites presented as a twisted white fiber with background conjunctival injection and chemosis. In 2 patients, mobile parasites were found under the eyelid skin. In patients with dirofilaria deep in eyelid tissues (in 7 patients) or in anterior portion of the orbit (20 patients), painless mass attached to subjacent tissues was detected. Migration of the helminth was associated with exacerbated clinical symptoms: eyelid edema, eyelid skin hyperemia and increased exophthalm. After several days, eyelid and orbital edema resolved, and a new localization of helminth-induced granuloma was determined. Extraction of parasite and granuloma resulted in full recovery in all patients, no medical treatment was required. 

Conclusion: Dirofilariasis should be regarded as one more possible cause of orbital inflammation or mass. The only method of treatment of dirofilariasis is extraction of parasite and/or helminth-induced granuloma.

Almanac of Clinical Medicine. 2015;(36):74-77
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TRAUMATIC INJURIES IN OPHTHALMOLOGY

COORDIMETRY IN DIAGNOSIS OF OCULOMOTOR DISORDERS IN PATIENTS WITH ‘BLOW-UP’ ORBITAL FRACTURES: CASE REPORTS

Kokorev V.Y., Ryabtseva A.A., Stuchilov V.A., Larionov K.S., Grishin A.S.

Abstract

We report three cases of ‘blow-up’ orbital fractures before and after the surgery. Differential diagnosis of consequences and complications of orbital fractures as well as detection of oculomotor muscles damage are discussed. Restoration of function of oculomotor muscles was monitored after the surgery. To detect the causes of restricted motion of eye bulb and diplopia, coordimetry was used. Coordimetric method was useful in determining nature and localization of oculomotor muscles damage. Repeated coordimetry allowed monitoring of restoration of oculomotor muscles function during treatment and rehabilitation periods in patients with consequences and complications of mid-facial trauma.

Almanac of Clinical Medicine. 2015;(36):78-81
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COMPUTER MODELING AND LASER TECHNOLOGIES IN REHABILITATION OF PATIENTS WITH MIDFACIAL TRAUMA

Stuchilov V.A., Nikitin A.A., Sekirin A.B., Filatova E.V., Larionov K.S., Grishin A.S., Kokorev V.Y., Ryabtseva A.A.

Abstract

Aim: To assess the kind of damage of musculoskeletal apparatus of eye and orbit. To develop algorithm of laser therapy to restore orbital circulation and algorithm of transcranial laser therapy to improve microcirculation in maxillofacial muscles. 

Materials and methods: 75 patients with midfacial trauma were examined using laser spectrophotometry and computer modeling of orbital structures in frontal, sagittal, and inclined planes with SSD, MPR and VRT reconstructions (with Mimics software (Materialise, Leuven, Belgium)). To study orbital and maxillofacial microcirculation complex Spectrotest was used. Tissue oxygen concentration (SatO2) and blood filling volume index of microcirculation (Vbf) were measured. 

Results: After computer modeling, several variants of damage of musculoskeletal apparatus of eye and orbit were identified including oculomotor muscle entrapment in 60% of patients, angular deviation of muscle belly in 30%, muscle contusion – in 45%, orbital hematoma – in 18%, scarring of musculoskeletal apparatus of orbit – in 40%. During early period of trauma of orbital wall and maxillary sinus, Vbf decreased by a mean of 12.5 ± 0.5% compared to normal values, whereas contralateral microcirculation increased by a mean of 28.5 ± 0.1% compared to normal values. Abnormal blood distribution persisted in the long-term, after bone reposition: blood flow increase was found only in 10% of patients. In severe trauma and chronic scarring, local laser irradiation was associated with increase of Vbf bilaterally, but chronically and significantly increased SatO2 indicated impaired tissue trophics and high risk of inflammatory complications. 

Conclusion: Computer modeling is of great value in the diagnosis and rehabilitation planning in patients with injuries of musculoskeletal apparatus of eye and orbital structures. Laser spectrophotometry is useful for the monitoring of microcirculation before, after the operation and during rehabilitation.

Almanac of Clinical Medicine. 2015;(36):82-89
pages 82-89 views

CLINICAL AND SOCIAL OPHTHALMOLOGY

HEALTH IN ADOLESCENTS

Ermashova A.A., Konovalova N.A., Bredneva A.A., Konovalova O.S., Ponomareva M.N., Kommer A.S.

Abstract

Background: In the past decade, significant increase of pediatric morbidity was detected. Frequency of varied functional disorders tends to increase during school years. One in three school leavers has myopia and impaired posture; one in four has cardiovascular disorder. 

Materials and methods: We examined adolescents at the age of 14, in 5 schools inTyumen city in the period October – November 2012. Patients were examined by multidisciplinary team (ophthalmologist, neurologist, endocrinologist, dentist, pediatrician), functional methods were also used. 

Results: Of 184 adolescents enrolled, 83 were boys. General examination demonstrated no changes. Functional methods showed sex-associated distribution of refraction disorders: mild and moderate myopia predominated among girls, frequency of spasm of accomodation was significantly higher in boys. Children were divided into two groups: the first group included adolescents without vision disorders (n = 115), the second group involved those who had verified spasm of accomodation or myopia (n = 66). Abnormal abdominal ultrasound data (minor dysembryogenesis anomalies – folded gallbladder) were found in 22.6% of patients in the group 1 and in 50% of patients in the group 2. Endocrine disorders were also more prevalent in the group 2 (40.9% vs. 32% in the group 1). They included underweight (24.3% vs. 20% in the groups 2 and 1, respectively), overweight (in 13.6% vs. 7.6%, respectively). Overweight and underweight predominated in adolescents with myopia. 

Conclusion: Myopia develops earlier in girls, boys are in the risk group of myopia development. There have to be the constant control for somatic health of adolescents regardless of refraction.

Almanac of Clinical Medicine. 2015;(36):90-92
pages 90-92 views

MEDICAL AND SOCIAL ISSUES OF OCCUPATIONAL REHABILITATION IN ELDERLY PATIENTS WITH VASCULAR OPHTHALMOPATHY

Razumovskaya A.M., Razumovskiy M.I., Trofimova S.V.

Abstract

Aim: To assess medical and social issues of occupational rehabilitation in elderly patients with vascular eye diseases. 

Materials and methods: The results of examination of 572 patients and disabled persons after acute occlusion of central retinal artery, central retinal vein or optic nerve ischemia with sequelae were analyzed. 

Results: The majority of patients (> 70%) with history of acute occlusion of central retinal artery, central retinal vein or optic nerve ischemia were elderly and had extensive professional background. Frequency of acute vascular eye diseases-related disability was as follows: 12.7% after occlusion of central retinal artery, 60.1% after acute occlusion of central retinal vein and 27.2% after acute optic nerve ischemia. 

Conclusion: Key determinants of occupational abilities in patients with vascular eye diseases are: visual function, positive motivation for work, compensation status of background vascular condition and adequate working environment.

Almanac of Clinical Medicine. 2015;(36):93-96
pages 93-96 views

EXPERIMENTAL STUDIES

DEPRIVATION AND STRABISMIC AMBLYOPIA: ABNORMALITIES IN GENICULOCORTICAL VISUAL PATHWAYS

Alekseenko S.V., Shkorbatova P.Y.

Abstract

Background: There are inconsistent data on the changes of functional performance in subcortical structures of visual system caused by early binocular vision impairment.

 

Aim: To study neuronal functional activity of the dorsal lateral geniculate nucleus (LGNd) in monocularly deprived cats and strabismic cats.

 

Materials and methods: 4 cats with monocular convergent strabismus, 7 cats with monocular divergent strabismus, 3 monocularly deprived cats and 4 intact cats were studied. Histochemical method was used to detect cytochrome oxidase – the mitochondrial enzyme of respiratory chain correlating with neuronal functional activity. Optical density in ocular-specific layers A and A1 was measured on the images of stained LGNd sections, and the contrast was calculated.

 

Results: Relative reduction of functional activity in the layers innervated from deprived and squinted eyes was demonstrated in LGNd bilaterally. In strabismic animals, the changes were observed only in the projection of the central part of the visual field, whereas in monocularly deprived animals the changes were in the projection of the whole visual field.

 

Conclusion: These findings indicate differences between the mechanisms determining the development of strabismic and deprivation amblyopia. Thus, in amblyopia, preservation of peripheral stereoscopic vision is possible.

Almanac of Clinical Medicine. 2015;(36):87-100
pages 87-100 views

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