Features of the Postoperative Period in Patients with Chronic Dacryocystitis and Type 2 Diabetes Mellitus after Endoscopic Endonasal Dacryocystorhinostomy Depending on the Degree of Compensation of Diabetes Mellitus

The aim. To identify the features of the postoperative period in patients with chronic dacryocystitis and type 2 diabetes mellitus (DM2) after endoscopic endonasal dacryocystorhinostomy (DCR), depending on the degree of compensation of DM. Materials and methods. The study involved 30 DM2 patients with chronic dacryocystitis who underwent endoscopic endonasal DCR according to standard methods. The patients were divided into groups according to the degree of compensation of DM2: 6 patients with compensated, 7 patients with subcompensated and 17 patients with decompensated DM2. The results of the operation were evaluated after 2 months, 6 months and 2 years. In addition to standard methods, ophthalmic examination included nasolacrimal duct probing, lacrimal duct lavage, and endoscopic examination of the nasal cavity. Results and discussion. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months (58.8 ± 11.9 % of patients) on average was 1.4 times, and after 6 months (52.9 ± 12.1 % of patients) and 2 years (41.2 ± 11,9 % of patients) – it was 1.5 times less than that in subcompensated and compensated DM2 (p < 0.05). In patients with decompensated DM2, tearing was observed in 41.2 ± 11.9 % of patients after 2 months, in 47.1 ± 12.1 % of patients after 6 months and in 58.8 ± 11.9 % of patients after 2 years post-op, which was, on average, 2.7 times, 2.1 times and 1.5 times more often than that in subcompensated and compensated DM2, respectively (p < 0.05); there were no significant differences between the values (p > 0.05). Conclusions. Features of the postoperative period in patients with chronic dacryocystitis after endoscopic endonasal DCR depend on the degree of compensation of DM2. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months is on average 1.4 times, and after 6 months and 2 years it is 1.5 times less than that in subcompensated and compensated DM2. Keywords: type 2 diabetes mellitus, degree of compensation of diabetes mellitus, chronic dacryocystitis, efficiency of endoscopic endonasal dacryocystorhinostomy, features of postoperative period.

Comparison of Hypotensive Effect of Endotrabeculoectomy and Selective Laser Trabeculoplasty

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p < 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p < 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

Analysis of the Results of Reconstructive and Restorative Operations in Post-Traumatic Orbital Defects by Computer Simulation

Treatment of patients with post-traumatic orbital defects is relevant problem of ophthalmology and maxillofacial surgery. Residual diplopia or dislocation of the eyeball leads to disability, social maladaptation and development of psychoemotional disorders in patients. In this paper, we present an evaluation of treatment of patients with posttraumatic orbital wall defects based on the retrospective comparative analysis of CT data by computer simulation before and after reconstruction. When comparing the volume of the injured orbits before and after the operation (average volume difference was 2.7 ± 0.9 cm3), a significant improvement was found in terms of recovery of the orbital volume. The factors influencing the treatment effectiveness were determined based on the calculation of the volume of the orbits on the healthy and injured side in the software environment before and after the reconstruction. The causes of the detected cases of incomplete recovery of the orbital volume were analyzed. The solution to the problem of restoring the orbital volume is in the plane of restoring the geometry of the orbit because previous adaptation of the shape of the standard plate to its anatomical structure with overlapping defect on the stereolithographic model provided the best end result. Conclusions. Personalized adaptation of the implants to the shape of the orbit or individual production thereof can increase the accuracy of the orbital volume restoration, which can increase the effectiveness of eliminating complications such as enophthalmos and diplopia. The effectiveness of treatment of post-traumatic orbital defects by traditional methods directly depends on the severity of the damage, the degree of which determines the magnitude of the change in the orbital volume. However, the greater is the volume of the orbit changes as a result of the injury, the worse is the prognosis for its recovery. Development of the ways to individualize implants and evaluate their effectiveness is an important area for further research. Keywords: post-traumatic orbital defects, reconstructive surgery, computer simulation.

Peculiarities of the Anterior Surface of the Eye in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

The aim. To conduct an analysis of the anterior surface of the eye in patients with the newly diagnosed primary open-angle glaucoma in order to choose treatment with or without preservative. Materials and methods. We evaluated the front surface of the eye in 46 patients (92 eyes) diagnosed with primary open-angle glaucoma: 20 men and 26 women aged from 58 to 80 years. The anterior surface of the eye was examined using an analyzer of the anterior eye. Results. The signs of previously diagnosed dry eye syndrome (DES) with various manifestations of dysfunction of meibomian glands and complaints about dry eyes, foreign body sensation, lacrimation and blurred vision were reported in 39 patients (85%). Based on the examination results, preservative-free topical hypotensive medications were recommended for these 39 patients. Conclusion. In order to preserve visual functions and quality of life in patients with newly diagnosed POAG, it is advisable to conduct a preliminary assessment of the condition of the anterior surface of the eye when prescribing drug therapy in order to rationalize the choice of first-line drugs with or without preservative in accordance with the European recommendations of Diagnosis and Treatment for glaucoma. Keywords: preservative-free medications, dry eye syndrome, primary open-angle glaucoma.

Genetic Predictors of Vascular Regulation of Glaucoma Optic Neuropathy Progression in Patients With Primary Open-Angle Glaucoma

Glaucoma is regarded as a heterogeneous group of diseases with a specific change in biomechanics of the anterior and posterior chambers of the eye, resulting in the increased production and decreased outflow of the aqueous humor. Progressive degeneration of retinal ganglion cells, microglia, astrocytes, Mueller cells leads to chronic damage, thinning of the neuroretinal layer and narrowing of visual field. In this study we investigated primary open-angle glaucoma (POAG). According to many American Optometric Association studies, POAG is the most common type of glaucoma (accounting for up to 72–96 % of cases) characterized by asymptomatic course with gradual decrease in peripheral vision. The reason for this abnormal condition is the optic nerve damage, inefficiency of eye drainage system with fluid accumulation and increased intraocular pressure. Investigation of POAG occurrence and progression becomes more and more relevant each year. Epidemiological studies for the past 50 years showed progressive increase in the incidence of glaucoma. In 5 % of cases, glaucoma is a monogenic disease with Mendelian inheritance. A significant proportion of cases POAG are genetically determined and have a clear hereditary predisposition, which according to various estimates determines from 20 to 60 %. NOS3 gene polymorphism is of considerable scientific interest due to its influence on the development of endothelial dysfunction. Of great scientific interest is determination of the relationship between the rs1799983 and rs2070744 polymorphisms with the development and progression of POAG. Literature review was performed in following database of scientific literature: Web of Science, Google Scholar, PubMed, Scopus etc. Keywords: prevalence of glaucoma, glaucoma epidemiology, gene polymorphism, NOS3 gene, endothelial dysfunction.

Analysis of the Cytokine Balance in Tear Fluid of Diabetic Patients with Bacterial Keratitis Depending on the Severity of the Disease

The aim. To analyze the cytokine balance of tear fluid in patients with bacterial keratitis at presentation depending on the severity of the disease and the presence of diabetes mellitus (DM). Materials and methods. The analysis was performed through the comparison of the level of pro- and anti-inflammatory cytokines in the tear fluid of 17 patients with type 1 DM and bacterial keratitis and 15 patients with bacterial keratitis without DM at presentation. Data from 14 healthy individuals of the appropriate age were also used for comparison. The patients with bacterial keratitis were divided into subgroups according to the severity of bacterial keratitis. The levels of IL-1β, IL-6 and IL-10 in the tear fluid of the sick and the contralateral eye were determined by quantitative colorimetric enzyme-linked immunosorbent assay. Results and discussion. At presentation, patients with bacterial keratitis, both with and without DM, showed increased levels of proinflammatory cytokines, namely IL-1β and IL-6, in the tear fluid of the sick eye, which correlated with the severity of the disease, and also increased level of anti-inflammatory cytokine IL-10 in the tear fluid of the contralateral eye. In addition, the concentrations of proinflammatory cytokines IL-1β, IL-6 in the tear fluid of the contralateral eye in DM patients were increased at all degrees of severity of bacterial keratitis. Conclusions. In patients with bacterial keratitis, the cytokine balance of the tear fluid of the sick and the contralateral eye depends on the severity of the disease and the presence of DM. Keywords: diabetes mellitus, bacterial keratitis, severity of keratitis, cytokines, interleukins.

Comprehensive Treatment of Dry Eye Syndrome in Patients with Sjogren’s Syndrome by Using Preservative-Free Drops Containing 0.4 % Sodium Hyaluronate and a Complex of Nutraceuticals

The aim. To increase the effectiveness of treatment of dry eye syndrome in patients with Sjogren’s syndrome with preservative-free drops which contain 0.4 % sodium hyaluronate and nutraceutical complexes nutraceuticals. Materials and methods. The study was conducted on the basis of the Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine. The study included 64 patients aged 34 to 58 years (128 eyes) with dry eye syndrome accompanied by Sjogren’s syndrome. Examination of patients included: assessment of complaints, visometry, refractometry, bacterial culture of the conjunctiva and nasopharynx, biomicroscopy, ophthalmoscopy, Schirmer and Norn tests, assessment of "comfort of application of drops" on the questionnaire. This study is an extension of the study previously conducted at the premises of the Filatov Institute of Eye Diseases and Tissue Therapy of The National Academy of Medical Sciences of Ukraine on the effectiveness of preservative-free eye drops containing 0.4 % hyaluronic acid in the treatment of Sjogren’s syndrome. Results. Prior to the appointment of comprehensive treatment with instillations, the Norn test showed 6.55 s (SD 1.57) with a minimum of 3 s, a maximum of 9 s, and a median of 6.5 s. After 3 months of treatment the Norn test score in the 1st group averaged 14.66 (SD 1.07) vs. 13.86 (SD 1.07) in the 2nd group, but the difference was not statistically significant (p=1.0). The mean number of required instillations per day was 4.1 (SD 1.04) in the 1st group and 5.27 (SD 1.11) in the 2nd group. Conclusion. Instillations of preservative-free drops containing sodium hyaluronate 0.4 % (in a bottle with an innovative ophthalmic squeeze dispenser (OSD)) in combination with a nutraceutical complex in the treatment of dry eye syndrome in patients with Sjogren’s syndrome is effective and allows achieving a stable and long-term effect. Keywords: Sjogren’s syndrome, hyaluronic acid, nutraceuticals, artificial tear, Schirmer test, Norn test, dry eye syndrome, tear film.

Combined topical and intracameral injection of Amphotericin B versus topical Amphotericin B in management of fungal keratitis in MOC, Egypt

Fungal keratitis is a sight threatening condition which is widespread in tropical and subtropical countries. This study aimed to evaluate the efficacy of a combination of topical and intracameral injections of amphotericin B in the treatment of severe fungal keratitis. Patients and methods. This prospective, comparative study included 40 patients of culture proved fungal keratitis recruited from outpatient clinic of Mansoura ophthalmic center, faculty of medicine Mansoura University, Egypt, in the period from January 2017 to December 2018. Pregnant and lactating women, Children < 12 years of age, One-eyed patients, Patients with concurrent sclera involvement and Patients with impending perforations, elevated intraocular pressure were excluded from the study. The patients were randomly divided into 2 groups: Group A: underwent only topical amphotericin B. Group B: underwent combined topical & intracameral injection of antimicrobials. Patients were followed up at 1 day, 1 week, weekly till the end of the first month after injection then every 2 weeks for another month after then monthly till the 6th month. Results. Both groups were sex and age matched. Trauma was the most common risk factor recorded. Aspergillus was the commonest causative agent (85%) in group A, the size of corneal ulcer improved from 32.44 ± 19.37 to 29.71 ± 17.16 at 1st week to 18.81 ± 10.04 in the 1st month, in group B the ulcer size decreased from 30.24 ± 16.09 to 21.81 ± 11.04 (p<0.001) in the 1st week the ulcer achieved complete healing within 3 months. In group A the hypopyon level was 2.46 ± 1.23 mm which was fixed at the same value at 2nd day then decreased to 1.36 ± 0.43 ml at 1st month then to 0.90 ± 0.31 mm and 0.37 ± 0.17 mm at 2nd and 3rd months. In group B, the base line of hypopyon level was 3.22 ± 2.09 mm decreased to 1.45 ± 0.62 mm (at 1st week) decreased from 1.02 ± 0.61 mm at 2nd weeks to 0.33 ± 0.19 mm at 6th weeks. In group A, the reported complications were staphyloma (2 cases), thinning (6 cases), hyphema (2 cases) and Atrophia Bulbi (1 case). In group B the complications showed mild variations in distribution as follows; staphyloma (1 case), thinning (3 cases), hyphema (3 cases) and Atrophia Bulbi (1 case). The mean duration for the complete healing in group A, was 48.82 ± 5.31 days while the mean duration in group B, that was 29.59 ± 3.24 days (p< 0.001). Conclusions. Intracameral Amphotericin B injection is safe and effective technique in treatment of fungal keratitis.

Relationship of Juvenile Diabetic Retinopathy with Thyropathies, Lipid Exchange and Melatonin Production

Progression of diabetic retinopathy is associated with a large number of risk factors, and hyperlipidemia is one of the most common. The work is focused on peculiarities of the progression of juvenile diabetic retinopathy (JDR), depending on the presence of concomitant distyroidism in patients with juvenile diabetes mellitus (JDM), the state of lipid metabolism and melatonin production. The aim. To determine the features of the JDR progression depending on the type of concomitant dysthyroidism, the state of lipid metabolism and production of the hormone melatonin. Materials and methods. The examination of three groups of patients was carried out: group 1 (152 patients) included patients in whom JDM proceeded without thyropathy; group 2 (99 patients) included patients with JDM in combination with autoimmune thyroiditis (AIT); group 3 (111 patients) included patients in whom JDM was accompanied by an increased level of thyroid-stimulating hormone (TSH). Results. It was found that the frequency of proliferative diabetic retinopathy (PDR) in the group with JCD and elevated TSH (21.6%) was 2.7 times higher than the frequency of PDR in the group with JDM and AIT (8.1%) and 3.7 times exceeded the frequency of PDD in JDM without distyroidism (5.9%). The greatest violations of all links of lipid metabolism were found in patients with JDM with an increased level of TSH, which contributes to a more pronounced progression of JDR than in patients without thyropathy or concomitant AIT. The average daily excretion of the hormone melatonin (M) among the studied groups was the lowest in patients with PDD with JCD in combination with increased TSH (38.4 ± 2.7 nmol/day) compared with patients with PDD with JCD without thyropathy (48.3 ± 3.8 nmol/day; p <0.01) and with AIT (42.5 ± 5.6 nmol/day; p <0.01), and compared with the control indicator (52.7 ± 5.8 nmol/day; p <0.001). Conclusions. Based on the results obtained it can be concluded that the combination of type 1 JDM with elevated TSH is accompanied by significant disorders of lipid metabolism and melatonin production and this is a risk factor for accelerated progression of JDR. Keywords: juvenile diabetic retinopathy, thyropathy, melatonin production, lipid metabolism.