Clinical case of diagnosis of primary open-angle glaucoma in a patient after previously performed anterior radial keratotomy

The article describes a clinical case of diagnosis and detection of primary open-angle glaucoma (POAG) in a patient after previously performed anterior dosed radial keratotomy (ADRK). The reasons that hampered the primary diagnosis of POAG in the presented patient at an outpatient appointment with an ophthalmologist were: inadequate assessment of the ratio of the state of the lenses and low vision; a falsely underestimated level of tonometric intraocular pressure (IOP), as well as the absence of an in-depth ophthalmoscopic assessment of the condition of the optic nerve head, failure to comply with the mandatory perimetric examination in such cases. It should be especially remembered that there is a high likelihood of underestimation of applanation tonometry indices after performing ADRK, therefore, the assessment of its results should be treated with caution, identifying other clinical signs characteristic of glaucoma. This will make it possible to diagnose glaucoma in time and prescribe pathogenetic treatment in a timely manner. Key words: anterior dosed radial keratotomy, primary open-angle glaucoma, intraocular pressure.

Correction of refractive disorders in the surgical treatment of keratoconus by MyoRing implantation

Keratoconus is a progressive degenerative disease in which, due to the weakening of the biomechanical strength of the cornea, its cone-shaped deformation occurs, leading to the development of induced myopia and astigmatism, as well as to a decrease in corrected visual acuity. Treatment of this disease consists in achieving stabilization of the process by strengthening the structure of the cornea, as well as in correcting refractive disorders caused by corneal deformation. Purpose. The purpose is to evaluate the effectiveness of correction of refractive disorders by implanting a closed MyoRing ring in the corneal stroma of patients with keratoconus. Material and methods. The data of 98 MyoRing implantation operations using CISIS technology using the PoketMaker ultraceratom for stage 3-4 keratoconus were analyzed. The observation period is up to 9 years. The initial myopia averaged -9.23 D ±3.82, astigmatism-6.13 ±2.51. Results. Stabilization of the refractive effect occurred usually within 3-6 months after surgery. On average, the following correction of refractive disorders was achieved: myopia-8.14 D ± 2.67 and astigmatism-4.28 D ± 2.12. Keratometry indicators also in most cases stabilized within 3-6 months after surgery and remained unchanged throughout the entire follow-up period. Conclusions. Implantation of a closed MyoRing ring in keratoconus makes it possible to significantly correct refractive disorders and prevents further progression of the disease. Key words: keratoconus, MyoRing, SISI, ring implantation in keratoconus.

Comparative analysis of ultrasound biomicroscopy between femto-assisted and ultrasound cataract removal in case of lens subluxation

Purpose of the study to carry out a comparative analysis of the state of the zonular fibers before and after surgery on UBM between femtolaser assisted and classical ultrasound cataract removal. Material and methods. 19 patients (38 eyes) with age-related cataracts. 22 eyes were with pseudo-exfoliative syndrome. All patients were examined with grade 1 lens subluxation. The first group of 19 eyes underwent cataract femto-phacoemulsification. The second group included 19 eyes without using a femtolaser. The state of the fibers was determined on the UBM on the fifth day after the operation at the end of antibiotic therapy. Results. The data showed the presence of a statistically significant difference between the group with femto-assistance and the group without it. In the first group, UBM analysis showed that the state of the zonular fibers remained in the same state in 16 of 19 eyes. In the second group, 11 of 19 eyes required ring implantation with suturing to the sclera and 3 required IOL implantation with seamless fixation to the sclera and vitrectomy. Conclusions. The appropriate path to surgery depends on the most accurate objective assessment of the condition of the lens ligaments, since the position of the IOL is one of the main factors for a good result expected by the patient after surgery. Reducing the «trauma» of the eye with lens surgery has been a key success factor and femtolaser guidance provides valuable assistance in obtaining it. Key words: lens subluxation, femtosecond laser, UBM.

Results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema

Objective. To evaluate the results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema. Material and methods. A retrospective study of the complicated cataract surgery with IOL implantation results was performed in 38 patients (38 eyes) with neovascular glaucoma. The first stage was Lucentis intravitreal injection, then after 2 weeks intraocular pressure (IOP) under combined medical therapy was determined: 1) if IOP was <25 mm Hg, then phacoemulsification was performed; 2) if IOP remained >25 mm Hg, the second stage was transscleral cyclophotocoagulation, and 2 weeks later – cataract phacoemulsification. Results. All patients with neovascular glaucoma had significant increase of the best corrected visual acuity from the initial level on the 1st day, 1- and 3-months post-op. IOP values under medical treatment corresponded to the range of the average statistical norm. There was no recurrence of neovascularization or IOP increase. Conclusion. The application of Lucentis intravitreal injections as well as IOP lowering to the average statistical norm range under medication or laser surgery provide the basis for an effective and safe complicated cataract surgery with IOL implantation in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or post-thrombotic macular edema. Key words: cataract, neovascular glaucoma, phacoemulsification.

Use of various keratometry data (ring and zone) in trifocal IOL calculation

Purpose. To compare the results of trifocal IOL calculation using various corneal tomographic data (ring and zone). Methods. This retrospective study involved 46 patients (46 eyes), underwent cataract surgery with trifocal IOL implantation (AcrySof IQ PanOptix). The calculation was performed using Tomey OA-2000 according to 2 formulas (Barrett II Universal, Olsen). Keratometry values included Km (the average of two main meridians of a cornea) provided by Pentacam HR Power Distribution Apex map, which describes total corneal refractive power (TCRP) with diameter of 3.0, 4.0 and 5.0 mm on a ring and zone. Mean (MAE) and median (MedAE) predicted postoperative refraction errors were assessed after surgery. Results. Mean Km value on 3 mm zone and ring was: 42.75±1,46 D and 42,91±1,43 D, respectively (p<0,0001). Mean Km on 4 mm zone and ring was: 42.6±1.5 D and 43.3 ± 1.5 D, respectively (p <0.005). Mean Km value on 5 mm zone and ring was: 43,09±1,5 D and 43,55±1,48 D, respectively (p<0,0001). Calculations using the Barrett II Universal formula revealed significant difference between MAE and MedAE of the predicted postoperative refraction on 5mm zone and ring (p=0.045). When using the Olsen formula in the calculations, significant difference was revealed using the Km data with a diameter of 3 mm and 5 mm (p=0.001 и p=0.009, respectively). The calculation on 3 mm ring was more accurate than for 3 mm zone. With a 5 mm diameter, the calculation is more accurate according to the zone data. Conclusion. Mean Km value on Power Distribution Apex map according to ring is significantly greater then according to zone. 1) The calculation of the trifocal IOL based on the TCRP zone data is reliably more accurate than the ring data according to both formulas (Barrett II Universal and Olsen) with a diameter of 5 mm. 2) According to the Olsen formula with a diameter of 3 mm, the calculation of the optical power of trifocal IOL based on TCRP ring data is more accurate. Key words: IOL calculation, Trifocal IOL, corneal topography

Possibilities of scleral lenses for visual rehabilitation of patients with corneal scars

Purpose. To analyze the efficacy and safety of SCL in patients with corneal cicatricial changes and other concomitant conditions. Material and мethods. The study included 19 patients (20 eyes) with cicatricial deformity of the cornea of various etiology, who were fitted with scleral contact lenses. Results and discussions. The use of SCL is possible in post-traumatic pathology, such as corneoscleral scars with or without aphakia, as well as after keratitis with an outcome in cicatricial deformity, cicatricial changes after a burn. A significant increase in visual acuity compared with spectacle correction has been proven. Depending on the topography of the scar, it is possible to select scleral lenses such as Oblate and Prolate, as well as with different versions of the support zone: both toric and quadratic. Conclusion. Scleral lenses can be successfully used for optical correction in patients with cicatricial changes in the cornea and other concomitant post-traumatic conditions of ineffectiveness of other methods of visual rehabilitation. Key words: cornea, lenses, vision correction, contact lenses, visual rehabilitation, scleral lenses, corneal scars, post-traumatic astigmatism, aphakia, keratitis, toric lenses, quadratic lenses, astigmatism, irregular cornea, regular cornea, regular astigmatism, irregular cornea, irregular astigmatism, prolate, oblate.

Assessment of changes in the biomechanical properties of the cornea after FemtoLASIK surgery

Purpose. The aim of the study is to investigate the biomechanical properties of the cornea before and after FemtoLASIK in patients with myopia. Material and methods. 24 patients (42 eyes) underwent refractive vision correction using the FemtoLASIK method. The Oculus CORVIS ST ® device (Oculus, Germany) was used to assess the biomechanical properties of the cornea. Results. A statistically significant decrease in the rigidity and strength of the cornea was noted after keratorefractive surgery. Conclusion. Refractive surgery using FemtoLASIK technology leads to a decrease in the rigidity of the cornea, and therefore to a reduction in its framework properties. Key words: refractive surgery, FemtoLASIK, myopia, laser correction, biomechanical properties of the cornea, Oculus CORVIS ST ®.

Ocular manifestations in patients who underwent COVID-19 in the early stages after Phaco surgery with implantation of IOL

Purpose. To study the ocular manifestations in patients with pseudophakia who underwent COVID-19 during the rehabilitation period after surgery. Material and methods. 46 patients with Phaco with implantation of IOL who underwent COVID-19 in the period from 1 week to 2 months after surgery. Of the examined patients, there were 28 men (61%), 18 women (391%). The average age of the patients was 63±1,2 years. Results. In 78% of cases, vascular pathology of the anterior and posterior segments of the eyeball was observed in patients who underwent COVID-19 in the early postoperative period after Phaco with implantation of IOL. Conclusions. The main ocular symptoms from the anterior segment of the eyeball in patients in 17% of cases were the occurrence or intensification of previously existing manifestations of the «dry eye» syndrome, as well as inflammatory phenomena from the anterior part of the uveal tract. From the posterior segment of the eye, in 70% of cases, there was a progression of vascular disorders, as well as the appearance of complications associated with manifestations of hypercoagulation syndrome and systemic vasculopathy. Key words: Covid-19, cataract phacoemulsification, pseudophakia.

Evaluation of changes in corneal biomechanics in eyes with keratectasia

Purpose. To make a comparative analysis of topographic, tomographic and biomechanical values, measured by Pentacam HR and Corvis ST, in healthy multirefractive cohort versus patients with keratectasia of various severity. Material and methods. The prospective study comprised 237 patients aged from 18 to 47 years, subdivided into three groups. The first group included 174 healthy persons with various refraction (174 eyes). The second and the third group embraced 63 patients with keratoconus: 36 patients (36 eyes) with keratoconus of the I degree and 27 eyes with keratoconus of the II and III degrees. Besides the conventional comprehensive ocular examination the following studies were performed in all the patients: evaluation of topographic, tomographic and biomechanical corneal properties with application of Pentacam HR and Corvis ST (OCULUS Optikgerate GmbH; Wetzlar, Germany). Results. It was revealed that the following biomechanical values, assessed by means of Pentacam HR and Corvis ST, exhibited statistically significant changes (p<0,001) in all degrees of ketatoconus: a relative corneal thickness by Ambrosio, inverted radius of applanation curvature (IntRadius), DA Ratio Coefficient, values of corneal rigidity – SP-A 1 and SSI. Conclusion. The detected parameters may be applied as indicators, allowing to evaluate corneal biomechanics, to define early features of ectatic process, to assess effectiveness of the performed corneal collagen crosslinking and intralamellar keratoplasty with implantation of corneal segments. Key words: keratoconus, corneal biomechanics, pachymetry, index of pachymetric progression, corneal viscoelasticity.

Study of peculiarities of intra- and postoperative state of the interface «intraocular lens - posterior capsule» in phacoemulsification of senile cataract

Presence of full contact of interface «intraocular lens (IOL) – posterior capsule (PC)» ensures the transparency of the latter in the early period after phacoemulsification (PE) of senile cataract (SC). The main reasons for absence of full contact of IOL with PC are: the presence of residuals of viscoelastic (VE) in the capsular bag, uneven tension of the capsule by the haptic elements of the IOL, and the incommensurability of the size of the IOL with the capsule. Purpose. To study the features of the intra- and postoperative state of interface «IOL – PC» during PE SC. Material and methods. Dynamic observation of 42 patients (42 eyes), who operated on immature senile cataracts, was carried out. All operations were performed using OPMI LUMERA 700 surgical microscope (Carl Zeiss Meditec AG, Jena, Germany) with integrated intra-operative OCT, state of interface «IOL – PC» was examined. 2 hours after and on the 1st day after the operation state of interface «IOL – PC» was studied in all eyes by OCT on Optovue RTVue-100 (Optovue, Inc., US) with module for anterior segment examining to protocols «Cornea Line» and «Cornea Cross Line». Results. During the operation, the presence of contact between IOL and PC was observed only in 9 eyes (21.4%). 2 hours after surgery, 40 eyes (95.2%) had absence of contact between lens and capsule. On the 1st day after surgery, the optimal interface between IOL and PC was observed in 32 eyes (76.2%). Conclusion. Studies have shown that state of interface «IOL – PC» on the 1st day does not depend on its characteristics revealed intraoperative and 2 hours after the operation. The main reason for absence of contact between IOL and PC is residues of VE, and the using «impulse-irrigation» technique allows completely removing VE from the central zone of the capsule in all cases. Key words: cataract, phacoemulsification, intraocular lens, lens capsule, viscoelastic, interface «IOL – PC».