Цель — разработать комбинированную методику предварительной ИАГ-лазерной фрагментации и фемтолазерного воздействия на приборе CATALYS и оценить её роль в уменьшении временных и энергетических параметров хирургии катаракты высокой степени плотности. Материал и методы. В исследование были включены 118 пациентов (118 глаз) с возрастной катарактой 3-й и 4-й степени плотности ядра хрусталика. В основной группе перед факоэмульсификацией катаракты (ФЭК) с фемтолазерным сопровождением и имплантацией интраокулярной линзы (ИОЛ) проводили предварительную ИАГ-лазерную факофрагментацию ядра хрусталика. В первой контрольной группе выполняли ФЭК с фемтолазерным сопровождением и имплантацией ИОЛ. Во второй контрольной группе — ФЭК с имплантацией ИОЛ. Результаты. Достигнуто снижение энергии фемтолазерного воздействия на 35 % при 3-й степени плотности ядра хрусталика и на 40 % — при 4-й степени по сравнению с проведением ФЭК с фемтолазерным сопровождением без предварительной ИАГ-лазерной факофрагментации; снижение кумулятивной энергии ультразвука на 38 % при 3-й степени плотности ядра хрусталика и на 42 % — при 4-й степени по сравнению с изолированной ультразвуковой ФЭК. Заключение. Предложенная модификация методики комбинированного ИАГ-лазерного и фемтолазерного воздействия позволяет достичь полноценной фрагментации ядра хрусталика высокой степени плотности в ходе хирургии катаракты, способствует минимизации риска осложнений и быстрой послеоперационной реабилитации пациентов.
Introduction. Strabismus is the deviation of one eye from a common fixation point, associated with impaired of binocular vision. The eye’s position in horizontal and vertical directions looking straight determines the t ype of strabismus. Despite numerous reports of surgical interventions on the vertical action muscles, there is no a differentiated approach to the treatment of patients with this pathology. The search for the optimal methods and principles of surgical treatment of vertical strabismus caused by hyperfunction of the inferior oblique muscle, testifies to the relevance of developing new approaches to eliminate hypertropia depending on its severit y. The purpose — to develop a method of dosing the degree of anterior transposition of the inferior oblique muscle in the surgical treatment of vertical strabismus caused by hyperfunction of the inferior oblique muscle depending on severit y, and to evaluate its clinical efficacy. Patients And Methods. In the period from January 2013 to October 2015 60 children (96 eyes) aged from 3 to 17 years with a vertical strabismus caused by hyperfunction of the inferior oblique muscle were followed-up. All patients underwent a complete pre — and postoperative examinations. All patients received surgical treatment — weakening of the inferior oblique muscle through its anterior dosed transposition. Results. There were no intraoperative complications and specific complications t ypical for weakening surgeries on the inferior oblique muscle. Overcorrection wasn’t registered neither in the case of surgical treatment of large vertical angles of strabismus, no small vertical deviations. Restriction of mobilit y of the eyeballs wasn’t recorded throughout the observation period in any patient. Residual hyperfunction of the inferior oblique muscle was in 3 patients (5%). It did not exceed the value of the vertical, with the fusion and did not require additional surgical treatment. Conclusion. The technology will significantly improve the efficiency and safet y of treatment, reduce the risk of complications and the duration of surgery and anesthesia, the number of surgical treatment stages, to create optimal conditions for the rehabilitation of visual functions in children.
Purpose : to evaluate the effectiveness of the posterior sclerectomy with the use of corneal trepan of a uveal effusion syndrome. Material and methods : patient 1. The man, 61 years, addressed with complaints to a blindness of the right eye and the progressing decrease in vision of the left eye. On the basis of these conducted examinations the diagnosis is established: uveal effusion syndrome, detachment of the choroid, exudative retinal detachment, the complicated cataract of both eyes. Patient 2. The man, 62 years, addressed with complaints to low vision of the right eye and blindness of the left-hand eye. Diagnosis : uveal effusion syndrome, detachment of the choroid, exudative retinal detachment, the initial complicated cataract of the right eye. Subatrophy, operated retinal detachment, complicated cataract, silicone into the vitreal cavity of the left eye. Both patients underwent trepanation posterior sclera. Results : the patient 1. At the time of the last inspection, the patient noted significant improvement of vision in both eyes. When testing visual acuity with correction was: OD 0.2, OS is 0.3. Intraocular pressure was normal, showed improvement of electrical sensitivity and lability. On ultrasound examination of the retina belonged, remained moderate swelling of the choroid. Patient 2. At the time of the last inspection visual acuity was 0.1 + 3.0 D. According to the ultrasonic B-scan of the right eye retinal detachment decreased to 3.8 mm, remained moderate swelling of the choroid. According to the OСT showed detachment of the neuroepithelium in the macula to 60 μm. In ultrasonic biomicroscopy marked circular, ciliochoroidal detachment to 0.15 mm. Conclusion : in the example described clinical cases, we confirmed the almost complete recovery of patients with the uveal effusion syndrome. Holding sclerectomy with the use of corneal trepan is a technically simple procedure and helps to define the path of the outflow suprachoroidal fluid subtenon space.
In order to create an experimental model of toxic corneal erosion in rabbits we have studied clinical and functional condition of the cornea (with use of confocal microscopy and quantitative calculation of the area of desquamated epithelium) and comparative assessment of the effect by instillation surface-active 0.1 % solution of benzalkonium chloride (experimental group) four times a day for 7 days, and saline solution (control group) on the rabbit cornea. It was shown that instillation of 0.1 % benzalkonium chloride for 7 days induced toxic corneal erosion, which is perspective for further development of new methods for treatment and prevention of this nosology.
The purpose of researcher is clinical and morphological substantiation of biodegradable implant safety during it’s anterior chamber and intravitreal injection. The research was performed on 60 (120eyes) rabbits chinchilla. Clinical examination, electroretinography and histology with light microscopy were performed after 1,3,7,14,21,30 days. To assess the status of intraocular structures prior to implantation and in the dynamics underwent ophthalmic examination: biomicroscopy, photographic registration of fundus images, electroretinography. The results of the study indicates the safety of the intraocular injection of unsaturated and saturated dexamethasone implants.
Purpose : is to develop a technique for local subretinal injection of xenogeneic stem cells labeled with magnetic particles and to prove experimentally its effectiveness. Material and methods: We used a line of stem cells HEK-293 GFP, labeled with magnetic particles. The study was made on 84 eyes of 42 chinchilla rabbits 6 months of age, the weight were from 2.5 to 3.5 kg. All right eyes were experimental (42 eyes) and all left eyes (42 eyes) were the control group. In the experimental group we used original complex of polymer elastic magnetic implant (PEMI) with laser probe and fixed it to the sclera, then we made a median vitrectomy and injected HEK-293 GFP under the retina using a specially designed dispenser. In the control group PEMI was not fixed. We examined animals using biomicroscopy, ophthalmoscopy, ultrasound scanning, optical coherence tomography OCT), computer tomography (CT), morphological study (cryohistological sections) in 1, 3, 5, 7, 14 day and 1 month after surgery. Results: According the results of biomicroscopy in observation periods up to 3 days the vascular injection was visualized in the area operation. According the results of ophthalmoscopy and ultrasound scanning in 1 day the local retinal detachment was visualized in the area of local injection of the stem cells, which was not visualized in terms of further observations. CT helped us to confirm the local place of PEMI fixation. The morphological study results showed that cells were located in the subretinal space up to 14 days in the experimental group, and only up 3 days in the control group. Conclusion: The suggested surgical technique enables to control the injection of cells into the subretinal space, reduces the risk of tissue damage and exit cells in the vitreous space. The suggested methodology allows the fixing of the cellular material in the local place of the injection and enables to predict cells`s movement.
The aim of the work was to determine the possibilities of the method fluorescent angiography (FAG) in the diagnosis and prediction of the flow of retinopathy of prematurity (ROP). FAG was performed 48 prematurely born children with different stages of active ROP. The survey was conducted on pediatric retinal digital video system RetCam-3, equipped with a built-in power for FAG. As a result, found that the most characteristic feature of the retinal circulation at different stages of ROP are expressed unlike vascularized from avascular retina and clearly visualized boundary between them.
To determine the morphometric parameters of retinal vessels in the central zone of the fundus and on the periphery of each type during the active phase of retinopathy of prematurity (ROP) were examined 155 premature infants (310 eyes) with I, II and III stages of ROP, with the division into types 1 and 2 course of the disease. The result was determined by a clear increase in the diameter of the retinal vessels, arterial tortuosity factor in the central zone of the fundus on the periphery when compared to the type 2 with type 1 ROP in each stage. The data obtained can serve as clear criteria for determining high and low risk of progression of ROP within each stage.
Purpose: clinical case of intraocular electrochemical lysis technique at the stage of endoresection for large choroidal melanoma. Methods : Endoresection with intraoperational intraocular electrochemical lysis (ECL) was performed in one patients (1 eyes) with large choroidal melanoma T3N0M0 (tumor thickness — 10 mm, base diameter — 13,7 x 15,4 mm, juxtapapillary localization). The original method of two platinum electrodes (extrascleral anode and intraocular cathode) combined positioning was used for ECL during endoresection. Removed material was examined morphologically. Results: The tumor was removed completely. The anatomical retinal reattachment was reached. Morphological examinations testified ECL efficacy for both tumor and tumor cells destruction. Material removed during endoresection corresponded to tumor fragments in pathomorphism. There were different necrosis extensive fields: acellular detritus with tumor parenchyma complete destruction, tumor parenchyma lixiviation; coagulation necrosis with destroyed parenchyma and compacted tumor stroma. An absence of viable tumor cells and tumor fragmentation did not allow to verify histologic tumor structure. Conclusion: New vitreoretinal technologies and new intraocular methods that destroyed tumor tissue could make the endoresection perspective and reassuring organ-safe treatment mode.
The article is aimed to develop a differentiated approach to laser treatment for active stages of retinopathy of prematurity using pattern retinal photocoagulation and evaluate its effectiveness. The study was conducted at 1158 eyes 613 premature infants. In the main group pattern retinal photocoagulation (Pascal) was performed, in the control in single pulse regime. Pattern photocoagulation advantages as compared with standard are the significant reduction in the duration of the intervention (not less than 2 times) and high dosage of impact.
The purpose was to determine the most accurate linear and angular parameters of anatomo-topographical ratios of anterior segment structures by ultrasound biomicroscopy (UBM) in preterm infants with retinopathy of prematurity (ROP). UBM was performed on 217 eyes of 122 premature infants with different stages of ROP. As a result, it is found that the most informative method of UBM has the study III, IV and V of active ROP stages. These data may be used for optimizing exposure settings and laser surgery.
Dynamic assessment of diameters of renal vessels in fundus central zone, 2 nd order vessels, and peripheral vessels, and central zone arteries tortuosity index during II and III ROP stages regressing after laser treatment is performed. The given data may be used for determination of optimal follow-up to define early a probability of ROP progressing after the lasercoagulation and to decrease a quantity of diagnostic examinations if ROP regressing.
Aim. To describe the dynamics of vascular endothelial growth factor (VEGF) immune expression in the retina using the model of photoinduced branch retinal vein occlusion (BRVO) and to establish the terms of neovascularization appearance. Materials and methods. BRVO was modelled on 21 chinchilla rabbits (21 eyes) weighing 1.5‑2 kg (fellow eyes served as controls). Photosensitizer «Fotoditazin» (2.5 mg / kg) was injected intravenously. 15 min later, transpupillary laser irradiation of branch retinal vein near the optic nerve head was performed. Irradiation energy density was 200 J / cm2. Histological analysis and immunohistochemistry of the retina was performed following 30 min, at days 1, 2, 3, 7, 14 and 30. Results. Maximum VEGF accumulation in photoinduced BRVO model was observed on day 2. From day 3, direct neovascularization was confirmed. VEGF levels were stably high throughout the follow-up to the day 30 inclusive. Conclusion. VEGF immune expression in the retina using the model of BRVO induced by photodynamic exposure was explored for the first time. These data can serve as the basis for future studies in order to define optimal anti-VEGF agent, its dosage and terms to manage this condition.
Purpose . To develop the vitrectomy technique under the air medium in case of progressive retinopathy of prematurity (ROP) after the laser treatment with a formation of local traction retinal detachment. Material and methods. The clinical material consisted of 30 ROP patients (42 eyes) aged 7-11 weeks of life (post-conceptual age – 37-43 weeks), in which 2-3 weeks after laser treatment for the ROP stage III (29 eyes) and aggressive posterior ROP (13 eyes) signs of further progression of the disease was observed, that was expressed in increased vascular activity in the posterior pole of the eye, intensity of retinal edema in the fovea area, the growth of fibrovascular tissue along the shaft and into the vitreous body with the formation of vitreoretinal tractions, the formation of local tractional retinal detachment with extent not more than 4-hour meridians. All patients underwent an early lens-sparing 3-port vitrectomy using the 25g systems of the Constellation device (Alcon, USA). Results . In the postoperative period the anatomic results of the early vitrectomy was estimated by the retinal attachment. The full retinal attachment was achieved in 40 eyes (95.2%), partial – 2 (4.8%). The regression of the disease was characterized by the absence of extra-renal proliferation. Positive dynamics of the process was confirmed by a fixed and statistically significant normalization of morphometric criteria. During the analysis of surgical treatment results the indications for an early vitrectomy were determined when signs of ROP progression after retinal coagulation. Conclusion . In accordance with the obtained data, it was found that the optimal period to carry out the early lens-sparing vitrectomy is 2-3 weeks after laser coagulation of the retina in case of signs of disease progression, which ensures a maximum efficiency of surgical treatment.
