Comparative analysis of ultrasound and femtolaser-assisted phacoemulsification in patients with primary endothelial Fuchs corneal dystrophy

Comparative analysis of ultrasound and femtolaser-assisted phacoemulsification in patients with primary endothelial Fuchs corneal dystrophy

Dynamics of interhemispheric relations as a result of functional treatment in children with non-paralytic operated strabismus

Purpose. To study the dynamics of interhemispheric interactions in children with friendly strabismus as a result of functional treatment. Material and methods. The study included 135 children aged 6 to 8 (average 6.8±0.1) years with convergent non-paralytic operated strabismus in combination with hypermetropic refraction and 96 children of the same age in the control group (average 7.1±0.1 years) without ophthalmic pathology. In children with strabismus, the leading hand and dominant eye were determined before and after functional treatment. Characteristics of spatial perception were evaluated by copying of complex geometric shapes which were Taylor's (right-handed) and Ray-Osterritz's (lefthanded). Results. After functional treatment in the group of children with non-paralytic strabismus, along with improved binocular functions and improved performance of the Taylor and Ray-Osterritz tests, there was an increase in the number of ambidextrous children and a significant decrease in the number of left-handers (p<0.001). Conclusion. The increase in the number of symmetrical lateral phenotypes against the background of improved binocular functions and spatial perception characteristics as a result of functional treatment of children with non-paralytic strabismus indicates an improvement of their interhemispheric interactions and can be an additional criterion for the ef fectiveness of treatment. Key words: lateral phenotypes, interhemispheric asymmetry, functional treatment of strabismus

Prismatic correction in the presence of acutely acquired esotropia with diplopia

Purpose. To analyze changes in binocular vision functions in patients with acutely acquired esotropia after preoperative correction by prisms. Material and methods. The study included 16 patients with acutely acquired esotropia with diplopia. Depending on the tactics of preoperative case management, two groups were distinguished. Eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years old (mean age, M±sd – 17.5±1.9 years). This group underwent preoperative prismatic correction of diplopia and the deviation angle, as well as eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years (18.5±1.9 years). Patients in this group underwent surgery without prior prismatic correction. Fresnel prisms were used to select and assign prismatic correction. The patients were monitored dynamically. Results. In the course of treatment 1 group (prismatic correction followed by surgical correction) according to the indicator of Worth's four-dot test color test, revealed a statistically significant increase in the frequency of value of the binocular single vision (p=0.041), the frequency of the presence of stereovision according to the Fly-test (p=0.013), fusion amplitude in the distance by 1.11 times (p=0.033) and near fusion amplitude by 1.15 times (p=0.003). Significant differences between the groups were observed only in the frequency of stereovision presence according to the Fly-test after treatment, which was 2.0 times higher in group 1 (p=0.041). Conclusion. Prismatic correction in combination with surgical treatment had better curative benefits than surgery itself in improving both binocular and stereoscopic visual functions. Key words: acutely acquired esotropia, diplopia, binocular vision, stereoscopic vision, Fresnel prisms

Main aspects of etiopathogenesis, diagnosis and treatment of subhyaloid hemorrhages

Purpose. To present modern literature data on the main aspects of etiopathogenesis, diagnosis and treatment of subhyaloid hemorrhages. Material and methods. To perform the review, the search for literature sources on PubMed abstract databases was analyzed by the keywords «subhyaloid hemorrhages», «posterior hyaloidotomy» according to Russian publications on the topic of the article for the period up to 2020 inclusive. Results. Subhyaloid hemorrhage is a suspension of blood in a space bounded by a mesh membrane and a detached posterior hyaloid membrane. The most common cause of subhyaloid hemorrhages are retinal vascular diseases: diabetic retinopathy of the retina (30%), Valsalva hemorrhagic retinopathy (30%), central retinal vein thrombosis (20%). Subhyaloid hemorrhages are less common in hematological diseases, eye injury, rupture of the macroaneurysm, Terson syndrome. It has been established that the main complications due to untimely or inadequate treatment of subhyaloid hemorrhages are the formation of a premacular fibrous membrane, vitreoretinal fusion, traction retinal detachment, hemophthalmos, fibrosis and retinal atrophy, which require the right tactics in treatment. Conclusion. Thus, due to the prolonged presence of blood and fibrin in the premacular subhyaloidal space, there is a danger of mechanical and toxic effects on the retinal neuroepithelium of the macular region, which can lead to an irreversible decrease in visual functions. Key words: subhyaloid hemorrhages, Nd:YAG laser, posterior hyaloidotomy

STRABO care less traumatic strabismus surgery technique in the rehabilitation of patients with strabismus

Purpose. Comparative evaluation of patients' rehabilitation using less traumatic STRABO care technique and traditional methods of strabismus surgery. Material and methods. Sixty-two patients with esotropia were included in the study. All participants underwent medial rectus muscle recession and lateral rectus muscle plication. Patients were divided into two groups. In the main group (38 patients), the surgery was performed with less traumatic technique. Radio-wave knife was used for dissecting the connective tissues. Vicryl 7-0 was used as suture material. Traditional surgical technique was used in control group (24 patients). Scissors were used as a cutting tool and Vicryl 6-0 as a suture material. In the postoperative period conjunctival hyperemia, and width of the palpebral fissure were assessed after the surgery. Conjunctival flap edema (thickness) was measured one day after surgery by the anterior segment optical coherence tomography (AS-OCT). Results. The 1st day after surgery the median thickness of the conjunctival flap above the recession site according to AS-OCT was on average 1.5 times thinner in the main group than in the control group: 405 (351–555) µm vs. 618 (513–732) µm; p<0.001. During the entire observation period in the eyes operated with less traumatic technique, hyperemia was less expressed and palpebral fissure was wider as compared to the control group, where the standard surgical technique was used. Conclusion. Less traumatic STRABO care surgical technique allows to reduce the inflammatory response of tissues in response to surgical intervention and to facilitate the course of the early postoperative period. Key words: strabismus surgery, low-traumatic technique, radio-wave knife, oculomotor muscles, rehabilitation, STRABO care, anterior segment optical coherence tomography

Corneal graft survival analysis after penetrating keratoplasty in a retrospective cohort study

Purpose. To assess the results of penetrating keratoplasty and identify the risk factors for the graft disease (GD) development. Material and methods. Data of 582 patients after corneal transplantation performed in the period since 2011 to 2019 for keratoconus (41%), as well for corneal leucorrhoea and dystrophies (59%), aggravated by concomitant pathology, the so-called high-risk keratoplasty (HRK) were analyzed in a retrospective cohort study. We estimated the functional results and incidence of GD. The calculation of the t-criterion; cross-tabulation method; Kaplan–Meier survival analysis and multivariate analysis were applied. Results. As a result of penetrating keratoplasty, the BCVA (best corrected visual acuity) in patients with keratoconus increased by 20%; in patients with HRK – by 8%. In the general group the graft survival rate was 72%, while the 8-year successful graft engraftment in patients with keratoconus comprised 91%, with HRK – 60%. A significant relationship of the GD development with preoperative diagnosis and rekeratoplasty was determined. The risk of GD incidence was minimal in patients under 30 years of age and maximum in patients aged from 50 to 70 years. Survival rates for corneal transplants were better in men than in women. Conclusion. Penetrating keratoplasty in patients with keratoconus provides a good functional result with a minimal risk of GD development. With penetrating keratoplasty in high-risk patients, the effectiveness of surgical interventions is significantly lower (by ~30%). Key words: keratoconus, penetrating keratoplasty, corneal transplantation, survival analysis

First experience using telemedicine technologies in ophthalmology of the Far Eastern Federal District of the Russian Federation

Purpose. Evaluation of the first experience in organizing systematic telemedicine consultations/conciliums between the national medical research center and medical organizations in the territory of the Far Eastern Federal District (FEFD) of the Russian Federation. Material and methods. The analysis of organizational and technical difficulties in creating of stable system of planned and unscheduled telecommunication events between the Khabarovsk branch of the Fyodorov Eye Microsurgery Federal State Institution (Khabarovsk branch) and assigned to it medical organizations of the 3rd level, providing ophthalmological care for patients from 8 administrative territories of the FEFD. Results. Organizational and methodological department was created in the Khabarovsk branch, which clarified and eliminated the factors that impeded of telemedicine consultations/conciliums for ophthalmologists of medical organizations of the 3rd level; a set of organizational measures was taken to register these medical organizations in the Federal Register of Medical Organizations, in the Unified State Information System in the Field of Healthcare; the equipment necessary for communication was purchased and technically prepared; methodological assistance was provided in setting up equipment in the regions, including on-site visits; backup connections of several providers have been created; an algorithm for preliminary notification of regional ophthalmologists about the knowledge transmission has been worked out; an organizational algorithm for forming a request for telemedicine consultations has been tested. For 2019–2020 the Khabarovsk branch conducted 32 knowledge transmissions, 560 telemedicine consultations on patients living in the FEFD. Conclusion. The introduction into the daily clinical ophthalmologists practice in the FEFD of system of periodic telecommunication events between the Khabarovsk branch and assigned medical organizations of the 3rd level after the elimination of organizational and technical difficulties showed a high demand, allowing consultations on patient management in accordance with modern standards of ophthalmological care. Key words: telemedicine, teleophthalmology, Far Eastern Federal District, knowledge transmission, telemedicine consultations

Surgical treatment of retinal detachment with inferior break using combined gas-air tamponade with viscoelastic

Surgical treatment of rhegmatogenous retinal detachment with an inferior break remains a challenge for ophthalmic surgeons. When using silicone tamponade, complications can develop, such as increased intraocular pressure and emulsification of silicone. In recent years, tamponade of the vitreous cavity with a gas-air mixture has been actively used, however, not all patients can observe the forced position face down, and the tamponade itself is not long-term. Purpose. The authors proposed a method for the treatment of rhegmatogenous retinal detachment with an inferior break using a combined tamponade with a gas-air mixture and viscoelastic based on sodium hyaluronate. Material and methods. A clinical observation of a patient successfully operated on with the use of the specified combined tamponade is presented. A detailed description of a new surgical technique is presented, which allows achieving a higher anatomical and functional results. Conclusion. To confirm the effectiveness and safety of the proposed method, further studies on a group of patients are needed. Key words: rhegmatogenous retinal detachment, inferior break, gas-air tamponade, tamponade with viscoelastic, sodium hyalur onate

Hemodynamic parameters in the central retinal artery in active retinopathy of prematurity and their relationship with the central retinal vein

Purpose. To analyze the main hemodynamic parameters in the central retinal artery, as well as their relationship with hemodynamic indicators in the central retinal vein, depending on the stage and type of active ROP with the use of color duplex scanning. Material and methods. The 63 premature babies with various stages of active ROP and no signs of ROP were included in the study. The 55 children with active ROP included in the study were distributed according to the stages and type of disease course. All children were at the same gestational age at the time of examination – 37–38 weeks of postmenstrual age or at 6–11 weeks of life. For all these children were performed color duplex scanning of the vessels of the eye and orbit in the modes of color Doppler mapping and pulsed Doppler. Results. The study of the hemodynamic features of the central retinal artery in premature infants with active ROP showed that the progression of the disease was accompanied by a significant increase in blood flow velocity (Vsyst and Vdiast) with each subsequent stage of ROP. A higher index of peripheral vascular resistance is recorded in comparison with the non-progressive favorable type for children with an unfavorable course of the disease.The analysis of the ratio of the maximum blood flow velocities in the central retinal artery and central retinal vein made it possible to determine in which of the vessels the hemodynamic changes are most pronounced, depending on the stage and form of active ROP. Conclusion. Thus, there are statistically significant changes in such large vessels of the retinal bed as the central retinal artery and central retinal vein during active ROP. Color duplex scanning, having a significant diagnostic potential in assessing hemodynamic parameters, made it possible to obtain reliable information about the linear blood flow velocity and the state of peripheral resistance in the central retinal artery and their relationship with the central retinal vein. This information opens up prospects for improving the accuracy of predicting the nature of the course of the disease, especially i n the early stages. Keywords: color duplex scanning, active retinopathy of prematurity, hemodynamic parameters, central retinal artery, central retinal vein

Refractory glaucoma laser treatment: together or instead?

Refractory glaucoma laser treatment: together or instead?