Eye Microsurgery Federal State Institution Research Articles

Клинический случай поэтапного лечения ребенка с анизометропической амблиопией и гиперметропией, сочетающейся с расходящимся косоглазием

Case study A clinical case of staged treatment in a child with anisometropic amblyopia and hyperopia combined with divergent strabismus I.L. Kulikova, K.A. Aleksandrova, S.M. Pikusova, A.V. Kuzmina S. Fyodorov Eye Microsurgery Federal State Institution, Cheboksary Branch, Cheboksary, Russian Federation Postgraduate Doctors’ Training Institute, Cheboksary, Russian Federation A clinical case of a child with anisometropic amblyopia, hypermetropia and divergent strabismus is considered. Clinical and functional results of staged treatment, including refractive laser surgery and surgical correction of strabismus, are presented. This treatment makes it possible to create optimal conditions for the more effective treatment of amblyopia and preservation of orthotropia in children with anisometropic amblyopia, hypermetropia and divergent strabismus. Key words: amblyopia, hyperopia, exotropia, FS-LASIK

Интраоперационная профилактика децентрации роговичного кольца в ходе интрастромальной имплантации при центральном кератоконусе

Original article Intraoperative prevention of corneal ring decentration during intrastromal implantation for central keratoconus A.V. Tereshchenko, E.N. Vishnyakova, I.G. Trifanenkova, S.K. Demyanchenko S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation Medical Institute of Kaluga Tsiolkovski State University, Kaluga, Russian Federation Purpose. To develop a method for intraoperative prevention of decentration of the corneal ring manufactured by NEP Eye Microsurgery LLC during intrastromal implantation for stage 2 central keratoconus. Material and methods. This work included 5 patients (6 eyes) from 32 to 42 year old diagnosed with stage 2 central keratoconus in combination with high myopia, who required implantation of rings manufactured by NEP Eye Microsurgery LLC from 200–250 microns with an internal diameter of 5 mm. The parameters of the intrastromal ring were calculated using the data from nomograms for MyoRing rings and nomograms for calculating intrastromal segments for the spherical component. A femtosecond laser, Femto LDV Z8 (Ziemer, Switzerland) was used to form an intrastromal channel. Capsulorhexis program for centering on the visual axis was used to perform digital marking of the cornea using the Verion system. Results. In 6 months, in all cases there was an increase in visual acuity, a decrease in the spherical and cylindrical components of refraction, a decrease in keratometry data, and the thickness of the cornea remained stable. All patients had a marked decrease in keratometric parameters. Keratotopography results had a specific appearance, corresponding to the central location of the ring. Not a single case of ring displacement or decentration was identified. Conclusion. Developed technique ensures precision implantation of an intrastromal corneal ring with precise centering along the visual axis, reducing risk of decentration of the ring in the postoperative period. Further studies are needed on larger clinical material and over a longer observation period. Key words: primary corneal ectasia, keratoconus, intrastromal keratoplasty, intrastromal corneal ring

Роль федерального учреждения МНТК «Микрохирургия глаза» в работе региональной детской офтальмологической службы.

One of the main tasks of the children’s ophthalmological service in any region is to ensure the availability of high-tech medical care, however, personnel and technological shortages can negatively affect this indicator. Using the resources of a federal specialized clinic at the regional level can help resolve this issue. The goal is to reflect the participation of the federal specialized clinic in the work of the regional children’s ophthalmological service. Material and methods. The data used to assess the state of provision of ophthalmological care to children was taken from the electronic database of medical records of patients who received ophthalmological care at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from 2017 to 2023. Results. In 2005, a pediatric surgical department was organized at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. The work of the department’s ophthalmologists is primarily aimed at providing modern surgical treatment for children with various ophthalmological diseases. The leading scientific and practical direction is retinopathy of prematurity. To ensure optimal accessibility of specialized medical care, implementation of a system for early diagnosis and monitoring of the vision status of children, in the fall of 2020, a Children’s Ophthalmological Diagnostic Center (DOC) was opened within the structure of the Kaluga branch of the MNTK. The priority direction of the DOC is the introduction into clinical practice of innovative medical technologies aimed at early detection and formation of stages in the treatment of eye diseases in children and adolescents, and the determination of recommendations for preventive measures. From 2017 to 2023, the volume of ophthalmological care provided by the Kaluga branch of MNTK was within the range of 1,400–3,000 operations per year. Every year, ophthalmological care is provided directly to more than 1000 children at the Children’s Center. In total, over the entire period of operation of the center, conservative treatment was carried out in 3552 cases of amblyopia, myopia and other forms of ametropia, including severe forms. Using the new treatment method, 809 courses of treatment have been carried out at the Amblyokor complex since September 2020. During the work of the Center, 1908 orthokeratology lens sets were selected and issued. In addition to accepting patients living in the Kaluga region, we are actively accepting children from other regions. Conclusion. Thanks to the work of the branch of the MNTK «Eye Microsurgery» in the Kaluga region, the shortage of highly qualified medical personnel is compensated, the effective use of complex and unique diagnostic and treatment equipment is concentrated and implemented, the widespread introduction of progressive treatment methods into practice is ensured, the optimal route for patients is developed, taking into account the structure of medical organizations, participating in the implementation of the program of state guarantees of providing free assistance to the population. It should be noted that ophthalmological care for the children’s population through the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution is largely provided at the interregional level, affecting the territories of neighboring regions.

Глазной тканевой банк и фемтотехнологии как основа развития кератопластики

Abstract Eye tissue bank and femtotechnologies as fundamentals for keratoplasty development E.V. Boiko, I.E. Panova, A.V. Titov, Ya.I. Masian, A.A. Varavka, D.R. Mirsaitova, O.D. Yagmurov S. Fyodorov Eye Microsurgery Federal State Institution, Saint Petersburg Branch, Saint Petersburg, Russian Federation I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation Saint Petersburg State University, Saint Petersburg, Russian Federation Bureau of Forensic Medical Examination, Saint Petersburg, Russian Federation Purpose.To evaluate development of keratoplasty in the St. Petersburg branch, taking into account eye tissue bank opening and femtotechnologies intergation. Material and methods. A retrospective analysis of the structure and quantity of keratoplasty in combination with femtosecond laser was carried in Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution. Data were analyzed regarding 2-time intervals: from 1990 to 2019 and from 2019 to 2022. Results.Between 1990 and 2019, 1367 corneal transplantations were performed (an average of 46 transplantations per year). Penetrating keratoplasty had a leading position in the structure – 1159 operations (84.8%). At the same time, the lamellar keratoplasty segment took only 15.2% (208 operations), and femtosecond laser was used only in 1% of operations (14 operations). In the period from2019 to 2023, 674 keratoplasty were performed, percentage of penetrating keratoplasty decreased to 50.8% (343 operations), and number of lamellar keratoplasty cases increased to 49.2% (331 operations). Femtosecond laser was used in 73.4% of operations (495 operations). Conclusion.Based on the results of a retrospective analysis, the advantages of eye tissue bank opening and a femtosecond laser integration into the work of the St. Petersburg branch were determined. Key words:eye tissue bank, femtosecond laser, keratoplasty

Эволюция транспупиллярной лазерной коагуляции сетчатки в лечении активной ретинопатии недоношенных: от режима одиночного импульса до навигационного сопровождения

Abstract Evolution of transpupillary laser coagulation of the retina in the treatment of active retinopathy of prematurity: from single pulse mode to navigational support A.V. Tereshchenko, I.G. Trifanenkova, Yu.A. Sidorova, V.V. Firsova, V.V. Shaulov S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga branch, Kaluga, Russian Federation K.E. Tsiolkovski Kaluga State University, Kaluga, Russian Federation Purpose. To present the development stages and results of 18 years of experience in laser technologies application for the treatment of premature infants with active ROP in the Kaluga branch of S. Fyodorov Eye Microsurgery Federal State Institution. Material and methods. Transpupillary laser coagulation of the retina (LCR) was performed in 1583 children (2537 eyes) with active ROP for the period from 2004 to 2021. LCR was carried out with various stationary laser ophthalmocoagulators. Stages 2 and 3 of active ROP with an unfavorable disease course, stage of early clinical manifestations, manifestation of aggressive posterior ROP were indications for laser treatment. Results. Transpupillary LCR began to be performed for children with active ROP with a stationary ophthalmic coagulator for the first time in Kaluga branch of the S. Fyodorov Eye Microsurgery in 2004. The technology of patterned LCR in active ROP was applied for the first time at domestic and international clinical practice, in the Kaluga branch of Eye Microsurgery in 2009. Pattern LCR began to be performed on the Integre Pro Scan device in 2016. Pattern with the most dense and uniform arrangement of laser applications – hexagonal – was identified. In 2021 transpupillary LCR of the avascular zone of the retina was performed in automatic mode with navigation support on the Navilas 577s laser system. It was possible to perform LCR of the avascular zone of the retina up to the dentate line in all cases. Regression of disease was achieved in 100% of cases. Conclusion. Evolution of laser technologies and the experience of their use demonstrate the high efficacy, safety and predictability of the results of laser treatment of active ROP. Modern pattern laser techniques are highly effective, safe, dosed and tissue-saving, which can serve as the basis for standardization of retinal laser coagulation technology in the treatment of active ROP. Key words: retinopathy of prematurity, unfavorable type of course, laser coagulation of the retina, hexagonal pattern, navigation system

Двухэтапное хирургическое лечение регматогенной отслойки сетчатки, осложненной выраженной пролиферативной витреоретинопатией, с применением первичной круговой ретинотомии и отсроченной эндолазеркоагуляцией сетчатки в уменьшенном объеме

Abstrakt Primary retinotomy in the surgical treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy D.O. Shkvorchenko, B.E. Malyugin, A.Yu. Kornienko, E.S. Khrisanfova, O.B. Klepinina S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To develop a method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy (stage C) using primary circumferential retinotomy, short-term perfluorocarbon liquid (PFCL) endotamponade and deferred laser endophotocoagulation in a reduced volume. To evaluate the effectiveness of the developed method in the treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy. Material and methods. 12 patients (12 eyes) with the diagnosis of rhegmatogenous retinal detachment with severe proliferative retinopathy were operated using developed method of two-stage surgical treatment with a reduced volume of laser endophotocoagulation. All 12 patients had a concomitant diagnosis of complicated cataract. Results. A new method of two-stage surgical treatment with reduced volume of laser endophotocoagulation was developed in the S. Fyodorov Eye Microsurgery Federal State Institution. After the follow-up period of 12 months retina was attached in all 12 cases, best corrected visual acuity (BCVA) was 0.38±0.08; 5 eyes had silicone oil endotamponade, in 7 cases silicone oil was removed. Conclusion. Primary 360-degree retinotomy is an effective method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy. The most preferable in these cases is to carry out surgical treatment in several stages with short-term PFCL tamponade, which allows to achieve maximum adaptation of the retina. Laser retinopexy in the PFCL environment during the second stage of surgery allows it to be carried out fully and at the same time in a minimal volume. Key words: retinal detachment, proliferative vitreoretinopathy, primary retinotomy, circumferential retinotomy, perfluorocarbon liquid, laser endophotocoagulation

Прогностические критерии функциональных исходов хирургического лечения идиопатического эпиретинального фиброза, основанные на оптической когерентной томографии

Abstrakt Prognostic criteria of epiretinal membrane surgery functional outcomes, based on optical coherencetomography A.A. Shpak, A.S. Zhuravlev, S.V. Kolesnik, A.I. Kolesnik, F.A. Avakyan, E.A. Shikhalieva S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Relevance. Surgery for epiretinal fibrosis is currently a routineprocedure in vitreoretinal surgery. However, in some cases, the functionalresults of the surgery are unsatisfactory. With the widespread introductionof optical coherence tomography (OCT) into clinical practice, manyprognostic criteria for the functional outcomes of surgery for thispathology have been proposed, the description of which is the purposeof this review. Purpose. To describe prognostic criteria of idiopathicepiretinal fibrosis surgery functional outcomes based on opticalcoherence tomography data. Material and methods. To perform thisreview, clinical studies were searched through the eLibrary, PubMed, andScopus database, using the keywords «epiretinal fibrosis», «prognosticcriteria», «optical coherence tomography» (in the eLibrary database),«prognostic criteria», «epiretinal membrane» and «optical coherencetomography» (in the PubMed and Scopus databases). A total of 39 articlesrelevant to the topic of the review were selected. Results. A large numberof OCT criteria have been proposed to predict functional outcomes ofepiretinal membrane surgery, some of which remain understudied. Conclusion. Сone outer segment tips and ellipsoid zone appear to be the most informative and easy-to-use prognostic criteria. Further studiesare needed to determine the best set of prognostic parameters. Key words: optical coherence tomography, epiretinal fibrosis, epiretinalmembrane, classification, prognostic criteria

Изучение вязкоэластичных свойств роговицы у пациентов с субклиническим кератоконусом

Abstrakt Corneal viscoelastic properties in patients with subclinical keratoconus I.V. Dutchin, E.L. Sorokin, Yu.V. Kutuzova, Ia.E. Pashentsev Fyodorov Eye Microsurgery Federal State Institution, Khabarovsk Branch, Khabarovsk, Russian Federation Far-Eastern State Medical University, Khabarovsk, Russian Federation Purpose. To evaluate corneal viscoelastic properties in subclinical keratoconus (SKC), analysis of its association with corneal thickness, and degree of risk of iatrogenic corneal ectasia. Material and methods. The main group consisted of 21 patients with signs SKC according to Pentacam (Oculus, Germany). The control group consisted of 21 patients without signs of subclinical SKC. In both groups, moderate myopia prevailed; groups were comparable in age and gender. A comparative statistical analysis of parameters of topography system Pentacam and corneal viscoelastic properties using the Corvis ST (Oculus, Germany) was carried out. Results. In the main group, the values: Corneal Applanation Velocity1, the Deformation Amplitude, and the Tomographic and Biomechanical Index (TBI) were statistically significantly higher compared to the control group. The values of the radius and the corneal central thickness, on the contrary, had statistically significantly lower values than in the control group. According to the values of the TBI (from 0 to 0.28), in the control group there was a «no obvious risk» of postoperative ectasia. In the main group, the average value of the TBI (0.43) was much higher than in the control group, which indicates weakened protective frames of cornea and risk of iatrogenic corneal ectasia in case of refractive surgery. There was no relationship between corneal thickness and TBI in the main group: r= –0.34 (p=0.13). Despite the signs of SKC in the main group, according to Pentacam, in 74% of eyes the corneal viscoelastic properties had sufficient rigidity for keratorefractive surgery. Conclusion. When selecting patients for keratorefractive surgery, along with assessing the parameters of corneal topography, it is also necessary to evaluate the corneal viscoelastic properties. Key words: subclinical keratoconus; fruste keratoconus; corneal viscoelastic properties, corneal biomechanical properties; iatrogenic corneal ectasia

Анализ ОКТ-предикторов анатомических и функциональных результатов aнтиангиогенной терапии отслойки пигментного эпителия при неоваскулярной возрастной макулярной дегенерации

Abstract Analysis of OCT predictors of anatomical and functional results of anti-VEGF therapy of pigment epithelium detachment in neovascular age-related macular degeneration E.V. Kozina, S.N. Sakhnov, V.V. Myasnikova, E.V. Bykova S. Fyodorov Eye Microsurgery Federal State Institution, Krasnodar branch, Krasnodar, Russian Federation Kuban State Medical University Ministry of Health of Russia, Krasnodar, Russian Federation Purpose. Analysis of optical coherence tomography (OCT) biomarkers for anatomical results prediction of anti-angiogenic therapy (antiVEGF) of pigment epithelial detachments (PED) in neovascular macular degeneration (n-AMD). Material and methods. Primary tomograms of 260 patients with PED higher than 200 µm were analyzed. The shape, height, length of the detachment and subpigmentary space reflectivity were assessed. After anti-VEGF injections, reattachment of PED according to OCT was observed in 114cases (44%) – 1st group; in 111 cases (43%) OCT showed PED resistance – 2nd group; in 35 cases (13%), the pigment epithelium tear (RPET) of 3–4 degrees was happened – 3rd group. In each OCT were studied of the following biomarkers: the ellipsoidal zone and RPE integrity, intra – and subretinal fluid, the drusen under RPE around PED, hyperreflective foci in retina. Results. A statistically significant difference was revealed between 1st and 2nd groups in the height and length of pigment epithelium detachment: PED height (506.2±204.3 µm) and length (3206.2±722.1 µm) have a tendency to reattachment during anti-VEGF therapy (р<0.05). High PED with neuroepithelial detachment has a higher risk of RPET (р<0.05). Presence of RPE defects and large hyperreflective foci in the retina can be considered as a predictor of the PED reattachment (р<0.05). Low PED with reflectivity subpigmentary space is a predictor of PED resistance (р<0.05). Conclusion. Patients with high PED, with neuroepithelial detachment, should be given antiVEGF therapy with great caution. Lower PED with hyperreflectity under PED tend to be anatomically resistant to therapy. Biomarkers of the adherence of the PE can be RPE defects and large hyperreflective inclusions in the internal layers. Key words: retinal pigment epithelium detachment, pigment epithelium tear, OCT biomarkers, hyperreflective foci, antiangiogenic therapy

Укрепление бельма аутотрансплантатом височной фасции при кератопротезировании

Abstract Dependable covering of keratoprosthesis with temporal fascia autograft M.G. Kataev, A.V. Golovin, O.N. Nefedova, I.Yu. Trofimova S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To propose a surgical technique to secure keratoprosthesis from protrusion by covering the plate with temporal fascia autograft. Material and methods. This study included 17 patients (17 eyes) with corneal leucoma, who underwent surgery of covering the leucoma with temporal fascia autograft at the first stage of keratoprosthesis implantation (6 eyes), or transplantation of corneal-prosthetic complex (4 eyes) or protrusion of the keratoprosthesis supporting plate (7 eyes). 4 cm long skin linear incision was performed, temporal fascia autograft 15–18 mm in diameter was harvested and placed on cornea, fixed to the sclera by 8 peripheral not absorbable sutures. Flaps of Tenon’s capsule was undermined in the intermuscular quadrants and sutured together by purse absorbable suture covering the autograft. Conjunctiva was closed by running absorbable suture. Eyelids were secured together by one blepharorrhaphy stich. Patients were examined before surgery, 7–10 days and 6 months after surgery. The follow-up period was on average 18 months. Results. The depth of the keratoprosthesis supporting plate at least 6 months after surgery was on average 1141 µm. The following postoperative complications were noted: in 6 (35.3%) cases the optical cylinder of keratoprosthesis became overgrown. In one case (5.9%) the optical cylinder was opened by a local excision of the conjunctiva. In 5 cases (29.4%) the optical cylinder was replaced with a higher one. In one case (5.9%) protrusion of the keratoprosthesis supporting plate occurred and the leucoma was re-covered with temporal fascia autograft. In other cases, the keratoprosthesis supporting plate was tightly fused with the underlying tissues of the leucoma and its position was stable. Conclusion. The use of a temporal fascia autograft is an accessible and effective method of dependable covering of leucoma in the prevention of protrusions during the simultaneous first stage of keratoprosthesis, transplantation of the corneal-prosthetic complex and at the beginning stage of keratoprosthesis protrusion. Key words: keratoprosthesis, keratoprosthesis protrusion, temporal fascia, leucoma covering

Первичный задний капсулорексис: исторические аспекты и современное состояние вопроса

Abstract Primary posterior capsulorexis: historical aspects and the current state of the issue E.V. Egorova, A.O. Direev, S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation Purpose. The paper analyzes the data of modern literature (published from 2008 to 2023) on the history and technique of primary posterior capsulorexis (PPC). The fields of application, variations, effectiveness and safety of the procedure are considered. Material and methods. A search for research on the subject of work from 2008 to 2023 was carried out. The search was carried out using Google Academy electronic databases (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm. nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/) and foreign and domestic journals devoted to ophthalmology. Results. An analysis of the literature has shown that performing PPC provides high visual results both in comparison with standard cataract surgery and in the case of primary fibrosis of the posterior capsule. The key points of the PPC method are: intact anterior hyaloid membrane, continuous tear-resistant edge of capsulorexis and its size, which allows the preserved part of the PC to provide adequate support for the IOL and form a circular capsule barrier along the edge of its optical part. However, some studies have shown the possibility of partial or complete «closure» of the capsulorexis area by proliferating epithelial cells of the lens (ECL) in adult patients. In pediatric practice, it is well known that posterior hyaloid membrane (PHM) can act as a matrix for the migration of ECL, and the frequency of opacity of the optical axis after PPC reaches 60%. Therefore, in a number of clinics, the standard algorithm for cataract surgery in children includes not only PPC, but also anterior vitrectomy, although this complex approach is not always effective. As a solution to the problem of opacity of the optical axis after PPC, the technique of «capturing the optics» of the IOL was proposed, which permanently eliminates the opacity of the optical axis behind the IOL and significantly reduces fibrosis, especially in combination with polishing the anterior capsule. Conclusion. A large number of studies analyzing the clinical results of the PPC method, performed over several decades with various types of IOLs, leaves no doubt that performing posterior capsulorexis is a well-controlled method that significantly reduces the frequency of secondary cataracts, adding a «second line of defense» without reducing the barrier effect along the optical edge. Key words: anterior hyaloid membrane, Berger’s space, continuous curvilinear capsulorhexis, posterior optic capture

Зависимость частоты спонтанной люксации комплекса капсульный мешок-ИОЛ от материала и массы линзы

Abstract Spontaneous luxation frequency dependence of the «capsule bag-IOL» complex on the material and weight of the lens A.A. Ivanov , O.P. Mishchenko , T.N. Iureva S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk Branch, Irkutsk, Russian Federation Irkutsk State Medical Academy of Postgraduate Education – branch of the FSBEI APE RMACPE, Irkutsk, Russian Federation Irkutsk State Medical University, Irkutsk, Russian Federation Relevance.Spontaneous luxation of the «capsule bag – IOL» complex in the long-term postoperative period is a serious complication. The search for regulated risk factors, the limitation of which will reduce the frequency of this complication, is relevant. Purpose. To evaluate association between frequency of spontaneous luxation of the «capsule bag – IOL» complex and the number of surgeries, taking into account the characteristics of the lens. Material and methods. 69 IOLs from 14 medical companies and 2 capsule rings were examined. The weight was determined using trusted torsion scales (accuracy ± 1 mg) under hydration conditions. IOLs were divided into 3 groups: ≤18 D; 18.5–24.0 D; ≥24.5 D. A retrospective analysis of 159 cases of spontaneous IOL luxation into the vitreous body over 13 years (2007–2020) was carried out. Comparison of IOL implantation results/luxation was carried out from 2006 to 2010, taking into account luxations from 2007 to 2020. Additionally, the number of years from IOL implantation to spontaneous luxation, the axial length of the eye, and the presence of pseudoexfoliation syndrome were evaluated. Results. A multiple excess of the weight of hydrophilic compared with hydrophobic IOLs was found in three comparison groups with a comparable refractive power (p=0.0001). Hydrophilic lenses in various groups were 1.5–1.82 times heavier than hydrophobic lenses. Spontaneous luxation of hydrophobic IOLs occurred less frequently by 11.86–49.22% compared to lenses made of hydrophilic materials. Conclusion.The weight of the IOL may play an important role in the pathogenesis of dislocation of the artificial lens. In the future, it is possible to develop recommendations to reduce the risk of luxation of the «capsule bag – IOL» complex in the long term for patients with an initial combination of non-correctable risk factors complicating the condition of the ligamentous apparatus of the lens. Key words: IOL luxation, IOL weight, lens material, hydrophilic or hydrophobic IOLs

Фотодинамическая терапия в комбинированном лечении меланомы хориоидеи

Abstract Photodynamic therapy in the combined treatment of choroidal melanoma E.V. Samkovich, I.E. Panova, E.V. Boyko, E.M. Svistunova, A.A. Bykhovskii S. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch, St. Petersburg North-Western State Medical University named after I.I. Mechnikov, St. Petersburg Purpose. To evaluate the effectiveness of the combined treatment ofchoroidal melanoma (CM) based on the use of PDT and Ru-106+Rh-106brachytherapy (BT). Material and methods. Retrospective analysiswas carried out in 48 patients (48 eyes) with CM. Distribution ofpatients according to TNM system: T1N0M0 – 2 patients, T2N0M0 – 14,T3N0M0 – 32. All patients were divided into 2 study groups: 1st group –25 patients (25 eyes) who underwent Ru/Ro-106 BT in isolation, SOD125.4±12.3 Gy; 2nd group – 23 patients (23 eyes) who underwentcombined treatment: Ru-106+Rh-106 BT (SOD 127.3±13.6 Gy) + PDT.Diagnostics was carried out on the basis of clinical and instrumentalexamination including complex ultrasound with estimation of thetumor vascularization degree. Results. Application of complex organpreservation treatment, including photodynamic therapy, followedby BT promotes acceleration of rates of tumor regression in 3, 6, 12 months (p<0.05). It was reliably found that the signs of intratumoralvascularization of CM (p<0.05) decrease after a combined treatment.A comparative analysis of the effectiveness of the two variants of organpreservation treatment of CM has shown a higher efficacy of PDT andBT, based on complete regression of the tumor and local control ina significantly larger number of patients (p<0.05). Conclusion. Theresults of application of PDT in the combined treatment of CM show theprospects of the method application to achieve a faster rate of tumorregression and a preventive measure of haematogenous metastasis dueto necrosis and blocking of vessels feeding the tumor. Key words: choroidal melanoma, photodynamic therapy, brachytherapy,uveal melanoma, ophthalmo-oncology, choroidal melanoma treatment

Анализ кератотопографических и биомеханических показателей роговицы c оценкой влияния результатов диагностики на тактику ведения пациента с миопической рефракцией

Abstract Analysis of keratopographic and biomechanical corneal indicators with evaluation of the impact of diagnostic results on myopic refraction patient management tactics D.D. Sibakin, V.A. Breev, E.G. Solodkova S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd Branch, Volgograd, Russian Federation Purpose. To analyse keratopographic and biomechanical corneal indicators with the diagnostic results assessment of the influence on the treatment tactics of myopic refraction patient. Material and methods. Keratotopographic and biomechanical parameters of the cornea in a patient with mild myopia were evaluated. Results. The Belin/Ambrosio (Enchanced Ectasia Display) – BAD keratoconus screening program was used on Pentacam AXL, which did not reveal corneal pathology. According to the results of CBI (Corvis biomechanical index) on Corvis ST (Oculus, Germany) (OD – 0.61, OS – 0.48), that was indicating poor corneal biomechanical properties and a high risk of keratectasia development. Conclusion. Ophthalmic examination, using The Corvis ST biomechanical measurements, makes possible to reveal with greater sensitivity subclinical signs of a keratectatic process at the pre-clinical stage of development. Key words: keratotopography, corneal biomechanics, keratoconus

Подходы к комбинированной хирургии катаракты и глаукомы в условиях слабости связочного аппарата хрусталика

Purpose. To demonstrate the effectiveness of single-step phacoemulsification of cataracts and antiglaucoma surgery in conditions of weakness of the zonular apparatus. Methods. Patient N., 67 years old, came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) with complaints of decreased vision, increased intraocular pressure (IOP), and narrowing of the fields of view of the right eye. The diagnoses: OD Primary open-angle glaucoma 3v, Subluxation of the lens grade 1 OS Primary open-angle glaucoma 1a, OU Complicated cataract, Pseudoexfoliation syndrome. Carried out: autorefractokeratometry, visual acuity testing, computerized perimetry, biomicroscopy, gonioscopy, pneumotonometry, tonometry according to Maklakov, optical biometry. Considering the weakness of the lens zonules, the method of fixation of the intraocular lens (IOL) by optic capture technique was used. Results. Examination and evaluation one week post-operation: Visus 0.6 unc, IOP (pneumotonometry) 11 mmHg without hypotensive therapy; biomicroscopy: a calm eye with a well-expressed filtration bleb at the 12 o’clock position, well-adapted sutures, a transparent cornea of average depth, clear aqueous humor, moderate iris atrophy, round 3 mm pupil with pseudophakia at the pupil’s edge, IOL located in the capsular bag with haptics in the iridociliary groove, stable positioning. Fundus examination shows a pale optic nerve head, excavated with 0.8 cup-to-disc ratio, well-defined borders, narrowed vessels. Macular region appears normal. Conclusion. Combined cataract and glaucoma surgery in a patient with subluxated crystalline lens using the «optic capture» technique and Non-penetrating Glaucoma Surgery allowed preserving the correct and stable position of the IOL with normalization of intraocular pressure without the need for hypotensive therapy during a 1-year follow-up period. Key words: one-stage surgery, primary angle-closure glaucoma complicated by cataract, «optic capture»

Tактика хирургического лечения пациента с непроникающей травмой роговицы после ранее перенесенной операции ФемтоЛАЗИК

Abstract Tactics of surgical treatment of a patient with non-penetrating corneal trauma after previous FemtoLASIK V.A. Breev, E.G. Solodkova, D.D. Sibakin S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd Branch, Volgograd, Russian Federation Purpose. To present the tactics of surgical treatment of the patient with non-penetrating corneal trauma after previously undergone FemtoLasik. Methods. The patient, operated by FemtoLASIK for middle degree myopia, had non-penetrating corneal trauma of the right eye. When applying to the Clinic of Volgograd branch he underwent corneal flap repositioning with removal of multiple corneal foreign bodies. Before and after the operation the patient underwent standard ophthalmologic examination. Results. According to the examination data, the uncorrected visual acuity of the right eye was reduced to 0.3 due to dislocation and linear defect of the corneal flap, multiple corneal foreign bodies, corneal opacity and mixed astigmatism. In 1 month after the surgical treatment there was noted restoration of transparency, correct position and integrity of the corneal flap, absence of corneal foreign bodies and increase of uncorrected visual acuity of the right eye up to 0.5. Conclusion. The correct sequence of surgical actions after trauma against the background of previously performed FemtolASIK provides qualitative corneal flap repositioning and restoration of visual functions. Key words: non-penetrating corneal trauma, corneal flap repositioning, FemtoLASIK For citation: Breev V.A., Solodkova E.G., Sibakin D.D. Tactics of surgical treatment of a patient with non-penetrating corneal trauma after previous FemtoLASIK.

Технология предварительной радиальной ИАГ-лазерной факофрагментации в хирургическом лечении катаракты

Purpose. To represent the technology of preliminary radial YAG laser phacofragmentation in the surgical treatment of cataracts. Material and methods. The technology of preliminary radial YAG laser phacofragmentation has been used in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution since 2016. The basis of the technology is the transcorneal endocapsular formation of radial cracks of the lens core for its subsequent fragmentation during ultrasonic phacoemulsification of cataracts (FEC). The total number of pulses ranges from 95 to 150. Results. In the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, preliminary radial YAG laser phacofragmentation was performed on 9468 eyes with cataracts of 2–4 degrees of density from 2016 to 2023. After YAG laser fragmentation of the lens core, its radial separation occurs according to the «snowflake» type, which consists of 3 layers and «petals» extending from cavitation bubbles that clearly outline the core. The clinical and functional state of the eyes after preliminary YAG laser phacofragmentation indicated the absence of reactive inflammation from the anterior and posterior segment of the eye, which was confirmed by biomicroscopy and ultrasound ophthalmoscanning data. Conclusion. The technology of preliminary radial YAG laser phacofragmentation is a safe and effective method that allows you to achieve uniform separation of lens fibers along the formed fragmentation zones, which correspond to subsequent nuclear fracture zones during the nuclear fragmentation stage during ultrasonic FEC. Key words: radial YAG laser phacofragmentation, cataract, ultrasonic phacoemulsification of cataract

Результаты применения анти-VEGF-терапии пациентам с лучевой ретинопатией при увеальной меланоме

Relevance. Radiation retinopathy (RR) in the form of macular edema (ME) is a predictable complication of radiation therapy (RT) in uveal melanoma (UM). ME is the main reason for the decrease in visual acuity (VA) after RT. By reducing visual acuity, ME reduces the quality of life of such patients. To date, there is no standardized algorithm for the treatment of this pathology. In foreign literature, anti-vascular endothelium growth factor (anti-VEGF) are proposed as a solution to the problem, but even here their use is limited by the lack of experience of their introduction in domestic literature, the mode of administration and indications. Purpose. To present results of anti-VEGF treatment in patients with ME against the background of radiation treatment of UM. Material and methods. For the period from 2018 to 2023, at S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, anti-VEGF injection was performed in 70 patients (70 eyes) with ME, which developed against the background of radiation therapy of UM. Of these, 24 (34%) patients were men, 46 (66%) were women. The average age of patients was 54 years (from 14 to 89 years). The average maximum corrected visual acuity (VA) when MO was diagnosed was 0,37 (from 0.001 to 1.0). According to optical coherence tomography, the average value of central macular thickness (CMT) at the time of diagnosis of ME was 411 microns (from 165 to 918), the average value of volume cube (VC) – 11.5 (range from 8 to 15.9). Results. The average VA after anti-VEGF treatment was 0.43 (from 0.001 to 1.0). Based on the data of changes in VA, 22 (32%) patients had stabilization of the process, 30 (43%) showed improvement, 18 (25%) – deterioration. According to optical coherence tomography, the average CMT value after anti-VEGF was 298 microns (from 57 to 688; p<0.001), and the average VC value was 10 (from 3.6 to 13.1;, p<0.001). Conclusion. The first experience of using anti-VEGF in our country has shown its effectiveness in reducing the height of macular edema and improving visual functions, which makes their use in radiation retinopathy expedient. Key words: uveal melanoma, radiation retinopathy, macular edema, anti-vascular endothelial growth factor

АСТРОЦИТАРНАЯ ГАМАРТОМА СЕТЧАТКИ: ОСОБЕННОСТИ КЛИНИЧЕСКОЙ КАРТИНЫ

Objective: To present the clinical features of retinal astrocytic hamartoma (RAH) based on the acquired experience Methods: Medical records were analyzed on 10 patients diagnosed with RAH at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia, between 2013 and 2023. The average age of the patients was 16 years (range, 1 month – 32 years). Among these patients were 6 men, 1 woman, and 3 children (1 boy and 2 girls). The patients underwent a comprehensive ophthalmological examination, including visometry, tonometry, perimetry, biomicroscopy, ophthalmoscopy, and B-scan ultrasonography to determine the location and size of the lesion, as well as optical coherence tomography (OCT) for secondary retinal detachment Results: The average visual acuity (VA) of patients at the time of diagnosis was 0.7 (range, 0.16-1.0). VA in young children was assessed by tracking moving objects. All children were able to fixate and actively track the object. Most patients (n=8; 80%) were diagnosed with RAH based on the clinical (ophthalmoscopic) picture of the fundus, ultrasound, and OCT data. The average height of the RAH was 1.7 mm (range, 1.0 to 3.2 mm), and the average length was 4.2 mm (range, 0.4 to 7.6 mm). In all cases, the B-scan results showed lesions with hyperechogenicity of high amplitude. 4 patients displayed common signs – thickening of the neuroepithelium with optically empty spaces with a lobulated, "moth-eaten" appearance on the OCT. In contrast, the remaining patients had a homogeneous hyper-reflective thickening of the neuroepithelium in the lesion area. Two patients (20%) had cystoid macular edema in the fovea and secondary flat detachment of the neuroepithelium extending from the hamartoma to the fovea Conclusion: Differential diagnosis of RAH and retinoblastoma (RB) is crucial because, if misdiagnosed, it leads to unnecessary and aggressive treatment Keywords: Astrocytic hamartoma, differential diagnosis, clinical features, ultrasound, optical coherence tomography

Results of the 35-year medical activity of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the Far Eastern region of Russian Federation

Results of the 35-year medical activity of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the Far Eastern region of Russian Federation