Regional blockade for prolonged anesthesia in enucleation and evisceration

Regional anesthesia is widely used in ophthalmology both as an independent method and in combination. Retrobulbar anesthesia has risks of complications and is undesirable in the surgical treatment of choroidal melanoma due to the risk of metastasis of tumor cells when it is performed. Therefore, it is necessary to search for alternative methods of regional blockades in order to create prolonged anesthesia. Purpose. To develop and evaluate the clinical efficacy of pterygopalatine blockade as a component of combined method of anesthesia for evisceration or enucleation of the eyeball. Methods. A comparative analysis of the effectiveness of intraoperative anesthesia and the course of postoperative period was carried out in patients of two clinical groups formed depending on the method of anesthesia. Results. Intraoperative monitoring of hemodynamics in the groups did not differ. The nature of pain in the patients of the compared groups in the postoperative period had significant differences in presence and intensity of pain on the scale of verbal sensations. Discussion. Use of pterygopalatine blockade with levobupivacaine in combination with dexamethasone as an adjuvant allows getting a prolonged analgesic, anti-inflammatory and decongestant effect. This makes it possible to avoid the use of opioid analgesics in the early postoperative period, that is, to avoid such systemic side effects as nausea, dizziness, and in rare cases vomiting, which generally improves the quality of the postoperative period. Conclusions. Use of pterygopalatine ganglion blockade with local prolonged-acting anesthetic levobupivacaine and dexamethasone as an adjuvant based on inhaled anesthesia with sevoflurane provides safe and effective anesthesia in patients with evisceration or enucleation of the eyeball, both in the intra- and postoperative period. Key words: enucleation; evisceration; pterygopalatine blockade; dexamethasone.

Features of diagnostics and treatment of pvcrd in children

Purpose. To identify the clinical course of the «risk-forms» of peripheral vitreochorioretinal dystrophy (PVCRD) depending on sex, age, type and degree of refraction in children, as well as to establish the characteristics of the diagnosis and treatment of PVCRD in childhood. Methods. A retrospective analysis of medical records of pediatric patients who underwent peripheral prophylactic laser retinal coagulation (PPLRC) regarding the «risk-forms» of PVHRD at the ophthalmology department of MAUZ Children’s Clinical Hospital No. 1 from 2017 to 2019 was performed. 241 childr (293 eyes) aged 7 to 17 years (mean age 14.1 ± 2.4 years) were operated. Results. PVCRD in children is asymptomatic and it is detected at the age of 7 to 17 years, regardless of gender, the peak of occurrence is 10–14 years. The most common type of PVCRD is «lattice» dystrophy. PVCRD is predominant in low degree myopia. Quite a lot of cases of PVCRD detected in emmetropic refraction, as well as in hyperopic refraction and combined astigmatism. Conclusions. A thorough examination of the periphery of the fundus is necessary in all children, regardless of age and refraction. The parameters of laser coagulation in children differ from those in adults. Given the characteristics of childhood, the success of the operation depends on the correct preoperative preparation, including psychological preparation, contact of the surgeon with the child during the operation. Key words: peripheral dystrophy; ophthalmoscopy; mydriasis; laser coagulation; children. vitreochorioretinal

Possibilities of modern visualisation of helminthic chorioretinitis

Purpose. To present a rare clinical case of helminthic chorioretinitis in a child and to demonstrate the informative value of a comprehensive analysis of optical coherence tomography (OCT) in identifying the etiological nature of the disease. Methods. The results of clinical, laboratory and instrumental examination of a patient with chorioretinitis caused by ascaris. Results. After etiotropic therapy, the patient had an increase of visual acuity from 0.8 to 1.0 and a two-fold decrease of paracentral scotoma. Conclusion. The presented case shows high informative value of combination of standard analysis of retinal maps and sagittal scans with the complex reconstruction of three-dimensional image and analysis of frontal scans obtained in OCT-angiography (OCTA) mode. Key words: chorioretinitis; helminthiasis; OCT-angiography.

Choosing the optimal method for preoperative risk assessment of dry eye syndrome development in patients with myopia

Aim. Comparative analysis of the effectiveness of keratotopography methods and classical Norn’s test in assessing the stability of the tear film (TF) in patients with myopia before photorefractive surgery. Methods. The study involved 26 patients. All of them were planned for keratorefractive surgery to correct myopic refraction and astigmatism. Their age averaged 32.5±14.5 years (18-47 years). The stability of pre-corneal tear film was assessed using computed keratotopography and Norn’s test - the tear film rupture time (TFRT) was determined. A standard questionnaire was also used to assess the severity of symptoms of dry eye syndrome (DES). A comparison was made of the indicators of tear film, stability obtained by the methods of keratotopography and Norn’s test, with their subsequent comparison with the data of the questionnaire. Results. In 17 patients (65.4 %), TFRT index corresponded to the age norm. In the remaining 9 people (34.6 %), indicators of tear film stability were reduced both by keratotopography (12±4 sec) and by Norn’s test (13.5± 4.5 sec), and there were also subjective signs of dry eye syndrome according to questionnaire data. The data turned out to be comparable. Conclusion. The incidence of impaired stability of the TF and subjective manifestations of DES among patients planned for keratorefractive surgery for myopia and myopic astigmatism was significant and, according to our data, made 34.6 %. To prevent complicated postoperative course of photorefractive surgery, it is necessary to assess the condition of the ocular surface immediately before refractive surgery, to identify the risk group for DES development. Key words: dry eye syndrome; tear film; keratotopography; Norn’s test; tear film rupture time.

Evaluation of the technical features of vitreoretinal surgery for proliferative diabetic retinopathy in young patients

Aim. To investigate the technical difficulties of performing the stages of vitreoretinal surgery, the peculiarities of the surgical technique in young patients with the proliferative stage of diabetic retinopathy (DR). Methods. Twelve patients (12 eyes) with type 1 diabetes mellitus (DM) were selected. Their average age was 26±2 years (from 19 to 30 years). There were 4 men and 8 women. All patients had DM since childhood. Selection criteria: presence of indications for vitreoretinal surgery for proliferative DR, age of patients with type 1 DM not more than 30 years, onset of DM in childhood. Results. Initially, the clinical manifestations of proliferative DR in young people with type 1 DM were distinguished by the severity of neovascular and fibrous growths, a tendency to hemorrhages, and the complexity of preoperative preparation in the form of panretinal laser coagulation, at least partial. Surgical removal of vitreoretinal adhesions and elimination of neovascularization zones differed in technical difficulties associated with their higher density and the area of retinal tissue lesion. Conclusion. Surgical treatment of proliferative DR in young patients has a number of technical difficulties associated with the density and length of fibrovascular vitreoretinal growths, the difficulty of separating them due to the high tendency of newly formed vessels to hemorrhages. Key words: proliferative diabetic retinopathy; endovitreal surgery; type 1 diabetes mellitus; young age.

The incidence of dry eye syndrome depending on the duration of antihypertensive drops use in patients with primary open-angle glaucoma

Aim. To conduct a clinical assessment of the incidence of dry eye syndrome (DES) in patients with primary open-angle glaucoma (POAG), depending on the timing of the use of local antihypertensive therapy. Methods. The main group included 45 patients (45 eyes) with POAG. Inclusion criteria - use of local antihypertensive therapy for at least one month; absence of previous laser and microsurgery operations, systemic pathology that can cause DES (thyroid lesions, diabetes mellitus, autoimmune and rheumatoid diseases). The patients’ age averaged 61.2±8.7 years (from 47 to 82 years). There were 29 men and 16 women. The design of the work consisted of a comparative assessment of the frequency of DES formation in the studied groups and subgroups, as well as the degree of its severity. Results. The results of the study showed that with an increase in the duration of the use of local antihypertensive drugs by patients with POAG the incidence of DES development increases. Moderate changes in the studied functional parameters of the ocular surface were recorded as early as 1-3 years from the start of antihypertensive therapy. Especially often DES was formed in the 3rd subgroup and proceeded in more severe clinical forms. Conclusion. The initial statistically insignificant changes in the indicators of the state of the ocular surface in patients with POAG using local antihypertensive therapy took place at the time of their instillation from 1 to 3 years. Most often, according to our data, DES developed in patients with POAG after three years of using antihypertensive drugs (9 out of 15 patients). Key words: dry eye syndrome; glaucoma; antihypertensive therapy.

Nailfold capillaroscopy in diabetes mellitus. literature review

Nailfold capillaroscopy is currently one of the highly informative methods for assessing the state of microcirculation. The advantages are ease of implementation, non-invasiveness, accessibility of the research object, instant visualization of the microvasculature, painlessness. The object of the study is the nailfold capillaries of the fingers or toes, due to their horizontal position in relation to the surface of the body, which makes it possible to evaluate the capillary throughout. Many authors have shown pronounced microvascular anomalies in type 1 and type 2 diabetes mellitus: tortuosity and dilation of capillaries, a decrease in their density, microhemorrhages, avascular zones, ectasias and aneurysms, newly formed capillaries; a relationship with the duration and compensation of diabetes mellitus as well as the severity of diabetic retinopathy was revealed. Thus, nailfold capillaroscopy can be used as a method for diagnosing and predicting diabetic retinopathy in patients with diabetes mellitus with the aim of early detection of initial changes in the microvasculature and timely retinopathy treatment. Key words: capillaroscopy; nailfold; diabetes mellitus.

Submicroscopic characteristics of the lacrimal fluid in vitreomacular traction syndrome, diabetic retinopathy compared with the norm

Study of the lacrimal fluid (LF) as a constant microenvironment of the anterior part of the eye which is the only atraumatically accessible substrate for the diagnosis and research of ophthalmic diseases, such as vitreomacular traction syndrome (VMTS), diabetic retinopathy (DR), makes it possible to study it using electronic microscopy methods. All studied LF samples contain cells and cell fragments; exosomes which are vesicles (40–100 nm) localized in multivesicular bodies, transmitting signals between cells and carrying markers of many diseases. Analysis of the samples revealed changes in the occurrence of these structures in VMTS and DR in comparison with healthy subjects. In this work, the components of the LF were visualized and their changes were established in DR and VMTS, which proves the value of the LF as a diagnostic substrate and determines the need for further research in order to formulate clear criteria for the diagnosis of these diseases in the early stages. Key words: lacrimal fluid; electronic microscopy; vitreomacular traction syndrome; diabetic retinopathy.

Use of modern energetic methods of bone tissue removal during endoscopic dacryocystorhinostomy

The article presents the results of surgical treatment of 22 patients with chronic dacryocystitis accompanied by proximal obstruction of the nasolacrimal duct. A new method of nasolacrimal anastomosis bone window during endonasal endoscopic dacryocystorhinostomy using ultrasound bone dissection is described. The questions of operation technique using SONOCA 185 ultrasound bone dissector and specific features of postoperative treatment are discussed. The obtained data allow to conclude that low temperature process of bone dissection with ultrasound cavitation gives a possibility of adequate bone window formation, reduces surgical trauma of bone structures, surrounding soft tissues and nasal cavity vessels as well as reduces the risk of bleeding and operation time needed for its stopping. It also enables better healing of soft tissues in shorter terms, provides anatomical and functional success of operation in 91 % of cases. Key words: chronic dacryocystitis; endonasal endoscopic dacryocystorhinostomy; ultrasound bone dissection; dacryostoma.

Formation of retinal pigment epithelium rupture in a patient with wet form of macular degeneration against the background of anti-vegf therapy

Purpose. To present possible complications of anti-VEGF therapy in patients with high pigment epithelial detachment on the basis of a clinical case. Methods. A clinical case of pigment epithelium rupture formation in a patient on the background of anti-VEGF therapy with aflibercept. Results. The presented clinical case clearly demonstrates the significance of OCT-signs of high risk of pigment epithelium rupture formation. The question of anti-VEGF therapy continuation in case of detection of these signs in a patient with continued activity of the process, as well as the choice of the drug, remains open. Key words: wet macular degeneration; pigment epithelium detachment; pigment epithelium rupture; aflibircept; ranibizumab.