Methodological Principles for the Development of a Questionnaire “Quality of Life” in Patients with Computer Visual Syndrome

Purpose: scientific substantiation and development of methodological principles of the “quality of life” (QOL) assessment questionnaire in patients with symptoms of computer visual syndrome (CVS).Material and мethods. As part of the first stage of the study, an individual interview was carried out (according to the standard developed methodology) with 100 patients with visually strenuous labor, according to the results of which the entire spectrum of complaints arising during prolonged work with a computer was determined (44 complaints in total). As part of the second stage, a special questionnaire was developed, in which the identified complaints were transformed into questions. The study involved 96 ophthalmologists aged 32 to 62 years with an average of 17.3 ± 1.4 years. The task of an expert ophthalmologist was to assess the relevance each of the questions in terms of the influence degree on the patient’s QOL, as well as the “severity” of the complaint in terms the of occurrence frequency.Results. The development of the questionnaire was based on the sequential implementation of five stages (development of a conceptual framework; development of a preliminary version and confirmation of validity content; additional modification; scaling procedure development; psychometric properties determination). The results obtained made it possible to form the questionnaire (22 questions) the final version, which (according to the analysis) meets the requirements of meaningful and constructive validity (specificity, reflection of questions and scales of significance for the patient, the results of an expert assessment by ophthalmologists of the psychometric response scale) with the weight coefficients development, the required values correlation coefficients (according to Pearson) between the relevance assessment of the question from the points according to the symptom severity, as well as the high level of consistency according to the “Cronbach-α” indicator.Conclusion. The main direction of the assessment QOL improving of a patient with GLC is active participation in the ophthalmologist’s questionnaire development. Our results determine that the expert assessment provides a mathematically confirmed choice of the most significant (in terms on QoL impact) subjective manifestations, which (in conjunction with the development of each patient’s possible responses expert assessments, in points) provides the required level of the questionnaire meaningful and constructive validity. The developed questionnaire can be recommended for further clinical testing.

Evaluation of the Antioxidant Effectiveness in Reduction of the Dry Eye Syndrome among Patients with Relevant Toxicoallergic Component and a Severe Case of Corneal-Conjunctival Xerosis

Currently the ophthalmologists meet with corneal-conjunctival xerosis more often in their daily practice. The objective of this research is identifying a new alternative method of treatment of the dry eye syndrome of different severity. In this work there will be a demonstration and the results of usage of BAA Delphanto® in treatment of different cases of the dry eye syndrome. The data collected from a dynamic research of groups of patients reveals the effectiveness of the comprehensive therapy with the use of BAA Delphanto®. Consequently, the research results demonstrate an improvement of the initial data from the biomicroscopy, OSDI index, Schirmer-1 test and the tear break up time. The statistically significant results were received reveal the effectiveness of the use of BAA Delphanto® with a significant improvement of the quality of life. It can be used widely by ophthalmologists for the treatment of corneal-conjunctival xerosis of different severity.

A Clinical Case of Two-Stage Visual-Functional Rehabilitation of a Patient with Postinfectious Central Corneal Opacity in Combination with Mixed Astigmatism Using Laser Keratorefractive Surgery

Introduction: to evaluate the clinical and functional results of two-stage treatment in a patient with post-infectious Central corneal opacity combined with mixed astigmatism.Patient and methods. Patient N., 19 years old with postinfectious (postherpetic) Central corneal opacity, mixed astigmatism was examined and operated using two-stage corneal laser treatment. To determine the possibility of surgical treatment of the patient, a complex of General ophthalmology was performed (checking visual acuity near and far in natural conditions and in conditions of drug-induced mydriasis, IOP measurement, autorefractometry, examination of visual fields, A- and Bscanning, ophthalmoscopy with examination of the Central and peripheral areas of the fundus), as well as special (keratopography and Scheimpflug camera examination, optical coherence tomography (OCT) of the anterior segment of the eye with analysis of the epithelial map, quantitative assessment (Schirmer test-1) and qualitative (tear film rupture time) lachrymal products, assessment of the epithelium state when stained with vital dyes and infrared meibography) research methods. To determine the activity of herpetic infection, PCR diagnostics were performed. The follow-up period was 2 years.Results and discussion. To achieve high visual-functional rehabilitation while preserving the native lens, a two-stage treatment algorithm was developed using technologies of laser corneal refractive surgery. At the first stage, in order to regularize the ocular surface and eliminate Central corneal opacity, an inverted topographically oriented PRK was performed; at the second stage, residual refractive errors were corrected using topographically oriented FemtoLASIK technology.Conclusion. According to the results of a literature search and analysis of Internet resources, there were no previously recorded and published works using a similar two-stage method. Therefore, the described clinical case justifies the relevance and novelty of the goal and has an evidence-based Foundation for the use of a two-stage laser keratorefractive treatment system in the ophthalmological practice of visual and functional rehabilitation of patients with Central corneal opacity in combination with mixed astigmatism or hypermetropic refraction. The two-year postoperative follow-up period showed stable and high visual-functional results with no recurrence of the inflammatory process.

The Myopia Progression in School-Age Children after Home Quarantine Due to COVID-19

Myopia is an actual health issue in the world. The World Health Organization estimates that 50 % of the world population may be myopic by 2050. In response to the coronavirus disease 2019 (COVID-19) outbreak, the Russian government started a nationwide school closure as an emergency measure to prevent spreading of the infection since the 23rd of March 2020. The present study was organized to investigate prevalence of myopia in school-aged children during the COVID-19 home confinement in Moscow. The studied group included school-age children: pupils of 1, 5, 11th classes. The inclusion criteria were: myopia — refraction above –0.5 D in conditions of cycloplegia. The results of survey 523 pupils from Moscow schools, the proportion of patients with myopia was 20.1 %, while the proportion of patients with myopia among 1st class pupils was only 8.3 %. In 5th class, the rate was 16 %, in the 11th grade reached 42.1 %, i.e. increased more than 5 times. The trend with an increase in the number of children with myopia in the learning process is explained by the increased visual load of the high school curriculum. Home confinement during the COVID-19 pandemic appeared to be associated with a significant myopic shift for children aged 6 to 8 years due to the visual load increase in and a decrease in time spent outdoors. Further research is needed to evaluate these results and long-term follow-up of these children.

To Evaluate the Effectiveness of Plasmapheresis as a Method for the Graft Disease Prevention in Patients with Keratoplasty

Purpose: to evaluate the effectiveness of plasmapheresis as a method for preventing and treating the graft rejection reaction in corneal transplantation.Patients and methods. The study involved patients with surgical pathology of the cornea, who underwent a prophylactic course of plasmapheresis procedures and underwent penetrating keratoplasty (Main group); and patients with surgical pathology of the cornea who underwent penetrating keratoplasty, but did not undergo plasmapheresis (Comparison group), whose data were analyzed retrospectively. The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group.Results. Patients with keratoplasty who received a course of therapeutic plasmapheresis in the perioperative period demonstrated a statistically significant increase in the number of cases of a decrease in the level of C-reactive protein and a statistically significant decrease in the median values of the mean stimulated cytochemical index and the mobilization coefficient. Depending on the risk group for keratoplasty, the patients showed different dynamics of the levels of the studied interleukins after the course of plasmapheresis and keratoplasty. In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24 %) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn’t demonstrate any cases of graft disease. In patients of the Comparison group (in total for two subgroups), the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. At the same time, the patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease (in both subgroups).Conclusion: the obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.

The Species Composition of Microbiota and Biological Properties of Dominant Bacterial Species in the Lacrimal Fluid in Patients with Endogenous Uveites

The purpose: to study the species composition of the lacrimal fluid microbiota in patients with endogenous uveitis and the biological properties of dominant species of bacteria.Patients and Methods. A bacteriological study of the lacrimal fluid of 107 patients (114 eyes) with endogenous uveitis and 28 practically healthy persons (control) was carried out. The research was performed using the conventional methods. The isolated microorganisms were identified up to the species. We studied the main biological properties of bacteria — the presence of persistence and virulence factors of isolated dominant species.The results. 43 strains of various types of bacteria were isolated from the lacrimal fluid of patients with uveitis, bacteria of the genus Staphylococcus prevailed, S. aureus was isolated in 23.3 % of cases, and the remaining strains were representatives of coagulase-negative staphylococci. The species composition of the bacteria isolated from practically healthy individuals did not differ in essence. Isolated strains of S. aureus had a significant set of virulence factors. All isolates lysed sheep red blood cells, 80 % of the cultures had lecithovitellase and 60 % — DNA-se activity. Representatives of coagulase-negative staphylococci were characterized only by hemolytic activity. In the study of persistence factors, it was found that all the studied strains of S. aureus and the vast majority of representatives of coagulase-negative staphylococci isolated from tears were resistant to lysozyme. Biofilm formation was more typical for S. aureus strains 90 % versus 34.4 % for representatives of coagulase-negative staphylococci (t = 2.194, p = 0.034). Similar patterns were found in relation to complement resistance, 90 % of S. aureus cultures and 37.5 % of coagulase-negative staphylococci (t = 2.055; p = 0.046).Conclusion. Among the microorganisms isolated from the lacrimal fluid, Staphylococcus bacteria prevailed, from which S. cohnii was most often isolated. S. aureus to a greater extent than coagulase-negative staphylococci had a certain set of virulence and persistence factors. The microbiocenosis of the lacrimal fluid of patients with endogenous uveitis did not differ from practically healthy individuals. The presence of S. aureus in lacrimal fluid is a risk factor for the development of endogenous uveitis in cases of chronic oral and ENT organ diseases.

New Possibilities of Antibiotic Therapy for Blepharoconjunctivitis in Children

The problem of drug therapy for bacterial eye infections in children has remained relevant for many years. The greatest interest of ophthalmologists in recent years is associated with the use of fluoroquinolones in the treatment of inflammatory eye diseases of the bacterial etiology. At the same time, new ophthalmic dosage forms of fluoroquinolones that have appeared in recent years naturally require additional research on their effectiveness.Objective: to study the clinical efficacy of the antibacterial drug Oftocypro (0.3 % cyprofloxacin in ophthalmic ointment) in the treatment of chronic blepharoconjunctivitis in children.Materials. The study involved 38 children aged 3 to 18 years (mean age 10.3 ± 2.7 years) with clinical manifestations of blepharoconjunctivitis. All patients were divided into 2 groups of equal size: 18 children (36 eyes) — with bacterial blepharoconjunctivitis and 20 (40) — with chlamydial blepharoconjunctivitis. The diagnosis was verified based on the clinical picture of blepharoconjunctivitis and laboratory data: detection of pathogenic microflora in the conjunctival cavity of patients of the first group and chlamydia antigen — in epithelial cells in scraping material from the conjunctiva by immunohistochemical analysis.Results. The analysis of the data obtained during the examination and treatment of children with blepharoconjunctivitis of bacterial etiology (group I), a reliable dynamics of controlled clinical and laboratory parameters was established. There was a significant positive dynamics of all controlled parameters of the clinical course of chronic bacterial blepharoconjunctivitis against the background of the drug Oftocipro ophthalmic ointment 0.3 % use. All children with chronic chlamydial blepharoconjunctivitis with the background of treatment with Oftocypro, ophthalmic ointment 0.3 %, showed a steady tendency towards relief of the estimated clinical signs of the disease. According to the results of laboratory studies, it was found that on the 28th day of treatment with Oftocypro chlamydia in the cells of the epithelium of the conjunctiva was re-detected in 4 out of 20 patients (20 %).Conclusion. The high efficacy of the drug Oftocypro ophthalmic ointment 0.3 %, in combination with the absence of pronounced side effects, makes it possible to recommend this drug for wider practical use.

The Myopia Control in Real Clinical Practice: The Results of an Expert Study

The article presents expert study results about myopia control. The study was conducted by Russian eye care practitioners in 2019.Purpose. to summarize the views of eye care practitioners on the problem of myopia control in Russia.Methods. The study was conducted by mailing (sending) questionnaires to practitioners. The questionnaire contained 9 questions. Base questionnaire was developed by British Contact Lens Association (BCLA) for global study, translated into Russian and updated with items of interest to Russian practitioners.Results. 356 questionnaires were received and processed. Concern increasing frequency of pediatric myopia was highest (9.0 ± 0.08 on a 10 point scale). Orthokeratology was perceived to be the most effective method of myopia control, followed by myopia control soft contact lenses and increased time outdoors. Perceived effectiveness rated as percentage was 50.7 ± 1.6 %, 44.9 ± 1.8 % и 42.9 ± 1.7 % respectively. Perifocal spectacles correction was perceived to be the most effective method in the Southern area of Russia (56.8 ± 11.1 %), atropine — in the Northwestern Federal District (39.5 ± 7.1 %), scleroplasty — in the Far East (55.1 ± 7.6 %). Under-correction was perceived to be the least effective method in all areas (11.6 ± 1.0 %). Increased time outdoors was a priority for most practitioners (on average 94.0 ± 7.8 prescriptions per month by one practitioner). Practitioners prescribed single vision spectacles as the primary mode of correction for myopic patients (47.2 ± 3.6 prescriptions per month by one practitioner). Phenylephrine instillation was used often (49.4 ± 3.6 prescriptions per month by one practitioner). This trend was in most areas. Vision therapy was used most frequent in Siberia and the Urals and in the Far East (70.4 ± 11.5 и 20.0 ± 5.2 prescriptions per month by one practitioner respectively). The most common reasons practitioners gave for not adopting myopia control strategies were: they were felt to be uneconomical (42.1 %); they considered there to be inadequate information about the modalities (22.2 %). 45 % practitioners from the Far East called the last reason the main one. 42.9 % practitioners from Northwestern Federal District did not believe that these are any more effective methods then single vision correction.Conclusion. The active promotion and introduction into everyday clinical practice of myopia control methods that have proven to be highly effective could help reduce the frequency of progressive and degenerative myopia

Expression of Vascular Endothelial Growth Factor in Uveal Melanoma

A prerequisite for the growth, progression and metastasis of malignant tumors of any localization is the development of its own vascular network. Newly formed vessels not only nourish the primary tumor, but also create conditions for the spread of tumor cells through the circulatory system and the formation of distant metastases. Angiogenesis is able to launch a small population of tumors from 100–300 cells that have accumulated genetic aberrations and have begun to express proangigenic molecules. The phenomenon is known as “transformation of tumor cells into angiogenic phenotype”. A tumor with angiogenic phenotype carries a high potential for proliferation and malignization. This pattern has been found in many types of cancer, but studied less in uveal melanoma. Meanwhile, in this aspect, uveal melanoma, metastasizing exclusively in a hematogenic way, with its selective, organotropic nature of metastasis, becomes an attractive model for the study of the molecular “scenario” of tumor angiogenesis studies allow us to say that, UM is subject to the general patterns of the development of malignant tumors. As with many types of tumors, VEGF is an obligate condition for the development and progression of UM. The VEGF molecule’s producers in UM are two cell populations: endothelial vascular cells and tumor cells. VEGF’s expression in UM is cyclical. The cycle is re-initiated, apparently, by increasing cell density in tumor proliferate and the development of hypoxia zones. We found no correlation between the intensity of pigmentation, necrosis, hemorrhage, germination in the corner of the front chamber, ophthalmohypertension on the one hand, and expression of VEGF in UM cells on the other. At the same time, a direct link between the expression of VEGF in tumor cells and EC vessels on the one hand and the thickness, base diameter, as well as the localization of UM, on the other hand, has been revealed. Additionally, VEGF expression in tumor cells was closely correlated with the histological structure of UM, and VEGF expression in EC correlated with the stage of the disease. Thus, the authors showed that UM, like other malignant solid tumors, is prone to transformation into angiogenic phenotype and expression of VEGF.

Features of Primary Ocular Disability in the Krasnodar Region in 2016–2018

Purpose: to study the state and dynamics of changes in primary ocular disability in the period 2016–2018 by nosological forms. A complete retrospective study was made based on the data of the MSE (medical and social expertise) Bureau’s reporting documents. The following indicators of primary disability (per 10 thousand population) were registered from 2016 till 2018: among the adult population (18 years and older) 69,0–70,7–68,6 respectively; among the able-bodied population 42,8–44,1–41,1 respectively; among the population of retirement age — 125,1–126,4–124,6 accordingly. In the structure of primary disability of the adult population by severity for the period 2016–2018, the dynamics recorded an increase in the proportion of 1 group and 3 group with a decrease in the share of disability of 2 group. In the nosological structure of primary disability of the adult population in 2016–2017–2018, eye diseases account for 3 %, 3 % and 3.2 %, respectively, of all first recognized as disabled. There has been an increase in first-time applicants to the MSE Bureau. In the nosological structure of primary disability, the percentage of glaucoma patients over the past period is 47–33–32.5 % of the total number of primary disability for eye diseases, which determines the 1st rank. There is a progressive increase in the number of people with disabilities due to glaucoma of group 1 and group 2 throughout the study period. In the nosological structure of primary disability for 2016–2018 the percentage of patients with retinal diseases is 25–23–23.8 % of the total number of primary disability for eye diseases, which corresponds to the 2nd rank. There is a progressive increase in the number of disabled people in group 2. A low proportion of persons of working age in the structure of primary ocular disability was noted. A consistently high share of primary disability and a progressive increase in severe disability combined with an increase in persons of retirement age in the Krasnodar region forms an unfavorable forecast for an increase in the number of blind and visually impaired residents of the region.