Eye Microsurgery Federal State Institution Research Articles

Токсическое поражение зрительной системы при непреднамеренном отравлении салициланилидом

The patient complained of a severe, yet painless, reduction in vision of both eyes after an accidental intramuscular injection of Klozantrem with a dose of 4.0 ml in S. Fedorov Eye Microsurgery Federal State Institution. The standard ophthalmological examination was performed (OU visual acuity was counting fingers at a distance of 10 cm, OD intraocular pressure was 10mm Hg, OS intraocular pressure was 9 mm Hg, eye movement unremarkable). Biomicroscopy showed both eyes were calm, pale pink conjunctivae, transparent cornea, medium depth anterior chamber, transparent lens. OU ophthalmoscopy showed the optic disc was discolourated, its boundaries were indistinct, arteries and veins were narrowed, macular area of the retina without a visible physical pathology. Perimetry showed the correct light projection. A reduction in the thickness of the external and internal layers of the retina was observed as a result of the OCT of the macular zone OU. OCT showed the thickness of the layer of nerve fibres in the upper and lower nasal segments. OS has the prominence of the optic disc in the vitreous body. The threshold of the electrical sensitivity OU was 300 mkA by electrophysiological research; the electrical latency was not defined. During the MRI scan, the fascinated changes of the cerebral cortex have not been found. Acute optic neuropathy of toxic genesis was diagnosed in both eyes. A course of complex conservative treatment was prescribed: anti-inflammatory, nootropic, metabolic, vitamin therapy, as well as magnetotherapy, electrical stimulation and electrophoresis. As a result of the reported case by patient due to unintentional application of Closantel, we found that toxic damage of the ganglion cells of the retina was initially occurring, resulting in a reduction of the central visual acuity, followed by the development of the optic nerve atrophy. Care must be exercised when dealing with medicines. Potentially, any medicines are toxic and, if used improperly, may cause a number of side effects from the visual and central nervous system.

Применение контактных методов исследования у пациента после радиальной кератотомии (клинический случай)

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Современные возможности хирургии возрастной катаракты в практике Хабаровского филиала ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России

Современные возможности хирургии возрастной катаракты в практике Хабаровского филиала ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России

Анализ деятельности дневного стационара в Хабаровском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России за 2018–2019 гг.

Анализ деятельности дневного стационара в Хабаровском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России за 2018–2019 гг.

Анализ работы врачебной комиссии в Хабаровском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России за 2018–2019 годы

Анализ работы врачебной комиссии в Хабаровском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России за 2018–2019 годы

Screening of cadaver cornea donor for infections in the eye bank of the Fyodorov Eye Microsurgery Federal State Institution

Objective : to analyze negative laboratory results of cadaver cornea donor screening during preparation of corneas for transplantation according to data from the internal registry of donors of the eye bank (EB) of the Fyodorov Eye Microsurgery Federal State Institution and the European Eye Bank Association (EEBA) from 2011 through 2015. Materials and methods . Data analysis was carried out using the internal registry of EB donors and the EEBA annual directories. The analyzed data included the number of eyeballs obtained, the frequency of incomplete tests (hemolysis for EB) and positive serological results for human immunodeficiency virus (HIV-1 and HIV-2), viral hepatitis B, viral hepatitis C and syphilis. Results . In just 5 years, the EB received 3,479 eyeballs. After hemolysis of donor blood samples, 13.9% (n = 486) of corneas were excluded from the EB. EEBA recorded fewer inconclusive tests during the same period. After hemolysis and positive serological tests, 19.4% (n = 676) of corneas were excluded from the EB. Overall, the number of positive serological tests in EBs was far higher than in the EEBA data. Frequency of positive HIV tests (HIV-1 and HIV-2) and syphilis in EB showed low variability annually, while incidence of hepatitis B increased in 2015. For the analyzed period, positive serology for hepatitis C was found to be prevalent among EB donors. Mixed infections were quite often recorded in blood samples. Conclusion . Based on analysis conducted, positive serology and hemolysis were the main contraindications and led to exclusion of 33.3% (n = 1162) of cadaver donor corneas received in EB. Frequency of positive serological tests for indicated infections in EB was higher than in the EEBA data, with significant predomination of hepatitis C.

Femtosecond laser-assisted anterior and posterior capsulotomies in children with persistent hyperplastic primary vitreous.

Anterior and posterior capsulotomies were performed in 12 eyes of 12 patients (age range 3 months to 6 years) with congenital cataracts and primary persistent hyperplastic primary vitreous (PHPV) syndrome using a femtosecond laser. The procedure was performed in 8 eyes with PHPV severity level 1 and 4 eyes with severity level 2 (Sudovsky classification). Surgeries were performed at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Russia. Postoperative follow-up was between 8 months and 36 months. The use of a low-energy femtosecond laser-assisted posterior capsulotomy in this pediatric population provided safe and predictable results with a reduced number of intraocular manipulations, and reduced the risk for complications.

Эффективность применения комплексной терапии в лечении частичной атрофии зрительного нерва различного генеза

Regional drugs injection is а promising method of partial optic atrophy treatment. The therapy involves the introduction of drugs into the microcirculation region on the side of the affected organ, in the area corresponding to the topographic projection of the lymph node. Purpose: To evaluate the effectiveness of treatment of partial optic atrophy of various origins using regional combination therapy. Material and Methods: Complex therapy was applied in hospital environment of The S. Fyodorov Eye Microsurgery Federal State Institution in treatment of 38 patients (38 eyes) with partial optic atrophy of various origins. The patients were divided into two groups: group I (27 eyes), diagnosed with partial optic atrophy of glaucomatous origin, group II (11 eyes), diagnosed with partial optic atrophy of mixed genesis. Before and after treatment, all the patients passed standard ophthalmological examination, as well as optical coherence tomography (OCT).The parameters of the optic disk were assessed using Cirrus 5000 retinal tomograph by Carl Zeiss Meditecinc (Germany). Results: After 12 months of complex treatment, administered 2 times a year and included injections in the pterygopalatine fossa and submastoid region, in patients of group I the following indices were registered: an increase in visual acuity by 0.1-0.2, a decrease in relative scotoma number by13%, stability of the nerve fiber layer thickness and excavation of the optic disc. Total visual field expanded up to 220-335. After 12 months of treatment, administered 2 times a year in patients of group II the following indices were registered: an increase in visual acuity by 0.1-0.3, a decrease in relative scotoma number by 9%, stability of the nerve fiber layer thickness and excavation of the optic disc. The total visual field after treatment expanded up to 310-450. Conclusion: the application of complex therapy in treatment of patients with partial optic atrophy of various origins has positive effect on visual function.

Natural course of lamellar macular holes

To study natural course of LMH and to develop criteria of their progression. The study analyses retrospective data of patients with LMH observed in S. Fyodorov Eye Microsurgery Federal State Institution from 2013 to 2018 who were examined by optical coherence tomography (OCT) at least 2 times with an interval between the initial and last examinations of at least 6 months. The examinations were carried out to evaluate the types of LMH and epiretinal membrane, the ellipsoid zone of photoreceptors and vitreoretinal interface, as well as calculate the changes in the quantitative parameters of the LMH. One hundred and three patients with LMH were identified; data of 65 patients (65 eyes) was studied in detail. The follow-up lasted 20.5±12.9 months on average. Statistically substantiated criteria for the progression of tractional and degenerative LMH were developed, taking into account the OCT changes most significant for each type of LMH. According to the proposed criteria, signs of marked progression were found in 2 (5.3%) of 38 patients with tractional and 4 (14.8%) of 27 patients with degenerative LMH. Moderate progression was detected in 2 (5.3%) patients with tractional and 2 (7.4%) patients with degenerative LMH. In two patients who were not included in the groups for calculating the criteria for progression, the formation of a full-thickness macular hole has occurred. One of the variants of the natural course of LMH can be its progression up to transition into a full-thickness macular hole. The proposed statistically substantiated criteria allows identifying dangerous progression of LMH, which should be taken into account when determining the treatment tactics.

Comprehensive Treatment of Noninfectious Uveitis Accompanied by Macular Edema with the Use of Autologous Platelet-Rich Plasma

Background. A common cause of visual impairment in patients with non-infectious uveitis is macular edema, developing in 38–84 % of cases. Plasma enriched with platelets is widely used in various branches of medicine, the effectiveness of its use in the treatment of non-infectious uveitis, accompanied by macular edema, has not been sufficiently investigated. Aim: To evaluate the effectiveness of autologous platelet-rich plasma in the complex treatment of non-infectious uveitis accompanied by macular edema.Material and methods. The study was conducted on the basis of the academician S.N. Fyodorov Eye Microsurgery Federal State Institution in the period from 2016 to 2018, which included 123 people (176 eyes) from 18 to 50 years with non-infectious uveitis, accompanied by macular edema: 46 men, 77 women. Patients were divided into 2 groups. The main group consisted of patients receiving autologous platelet-rich plasma and anti-inflammatory treatment; the comparison group consisted of patients receiving anti-inflammatory treatment. The results of visual acuity, intraocular pressure, biomicroophthalmoscopy, optical coherence tomography of the macular zone, microperimetry, ultrasound examination on the side of the affected eye were evaluated. Statistical processing of the data was carried out in the program Statistica 10.Results. Maintenance of autologous platelet-rich plasma contributes to a statistically significant improvement in visual acuity on the 10th day of treatment by 64.2 %, a decrease in the thickness of the retina in fovea by 36.3 % and an increase in retinal photosensitivity by 34.6 % compared to the group of patients receiving only anti-inflammatory treatment. Conclusions. The use of autologous platelet-rich plasma in the complex treatment of non-infectious uveitis allows to accelerate the natural mechanisms of tissue regeneration, contributing to the reduction of macular edema, and improve visual performance.

Паралитический лагофтальм: оценка клинических результатов оперативного лечения в Оренбургском филиале МНТК «Микрохирургия глаза»

Паралитический лагофтальм: оценка клинических результатов оперативного лечения в Оренбургском филиале МНТК «Микрохирургия глаза»

Мышца Мюллера верхнего века: патогистологическая картина при врожденном и приобретенном птозах

Мышца Мюллера верхнего века: патогистологическая картина при врожденном и приобретенном птозах

EFFICACY OF THE INDICATORS IN THE SYSTEM OF INTERNAL CONTROL AND MANAGEMENT OF THE QUALITY AND SAFETY OF MEDICAL ACTIVITY IN S. FYODOROV EYE MICROSURGERY FEDERAL STATE INSTITUTION

The purpose of the study was to evaluate the efficacy of quality indicators in the system of internal control and management of ophthalmic activities at S. Fyodorov Eye Microsurgery Federal State Institution (Institution). Material and methods. The values of quality indicators were determined and compared in dynamics over the last 5 years of the Institution (indicators of structure, indicators of technological processes, and indicators of results). The actual values of the indicators are calculated using statistical data of accounting principles on the structure, medical processes and results achieved. Target values were established on clinical recommendations results of best practices, based on the introduction of modern technologies in medicine. Results. Analysis of changes in the indicators of structure reflects a positive dynamics of realization of the potential of the Institution medical-industrial activity (over a 5 years period reduced staff turnover, increased the number of doctors and medical sisters having certification category). Indicators of medical technological processes demonstrate the stable increase of the technological level of the Institution (the proportion of implantation of toric multifocal intraocular lenses, microinvasive endovitreal interventions 25–27 G, femtosecond stages of corneal and cataract surgery were introduced). After the comparative analysis of target and actual indicators of the result, the dynamics of indicators over 5 years was evaluated and showed their growth. Conclusion. The effectiveness of quality control and safety of medical assistance in the Institution with the use of dynamic assessment system and analysis of indicators has been proven by the increase in the quantitative-qualitative indicators of health activity for the last 5 years.

ANALYSIS OF SELECTIVE LASER TRABECULOPLASTY EFFECTIVENESS

Purpose of the study was to investigate the effectiveness of selective laser trabeculoplasty (SLT) in various forms of glaucoma, in the initial, advanced and far-advanced stages of the disease. Material and methods . An analysis of the effectiveness of the treatment of 132 eyes (132 patients), who were examined and treated in the department of glaucoma diagnostics and treatment of Ekaterinburg Center of Eye Microsurgery Federal State Institution, has been performed from 2016 to 2018. The study included a group of patients with primary open-angle, pseudoexfoliation, pigment, and combined forms of glaucoma previously not operated. Laser iridotomy was previously performed in patients with pigmented and combined glaucoma. The efficacy of SLT was assessed by the level of intraocular pressure (IOP) before SLT, after three days, 1, 6 and 12 months, using the perimetric MD index and according to the need for repeated surgical interventions during the observation period. Results. By the end of the observation period after SLT in patients with initial glaucoma IOP decreased by 5.1 mm Hg (by 20.7 %), with advanced glaucoma – by 6.3 mm Hg (by 25.7 %), with far-advanced glaucoma – by 6.8 mm Hg (by 31 %) compared to baseline values. Analysis of SLT effectiveness depending on the form of the disease showed that 12 months after surgery IOP in patients with primary open-angle glaucoma decreased by 5.5 ± 1.32 mm Hg (23 %) compared with baseline figures, and in patients with combined glaucoma – by 5.5 ± 1, 5 mm Hg (22.8 %). In the follow-up period from 6 to 12 months after SLT, 88 % of patients with pseudoexfoliation glaucoma, 64 % of patients with pigmentary glaucoma and 34 % of patients with combined glaucoma underwent non-penetrating deep sclerectomy, 15 % of patients with primary open-angle glaucoma underwent repeated SLT. Conclusion. SLT is the safe and effective method of glaucoma treating. In all forms and stages of glaucoma, target IOP was obtained, as evidenced by stabilization of retinal sensitivity by automated perimetry, but the hypotensive effect after SLT in patients with pseudoexfoliation glaucoma and pigmentary glaucoma lasted less than 1 year.

Эндофтальмиты после катарактальной хирургии в Чебоксарском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

Эндофтальмиты после катарактальной хирургии в Чебоксарском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

Методология развития телемедицинских и информационных систем ФГАУ «МНТК «Микрохирургия глаза» им. акад. С. Н. Фёдорова» Минздрава России на примере Новосибирского филиала

The article summarizes the experience in the development of information technology and telemedicine at the Novosibirsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution within an improvement of the administrative-management, medical-diagnostic and scientific-educational activities. The article presents ways to improve their use in accordance with the approved decisions on the telemedicine development in the Russian Federation.

Организация работы и возможности повышения пропускной способности диагностического отделения Хабаровского филиала ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России

Организация работы и возможности повышения пропускной способности диагностического отделения Хабаровского филиала ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России

A DIFFERENTIATED APPROACH TO ENERGY PHACOFRAGMENTATION IN AGE-RELATED CATARACTS SURGERY

Aim. Analysis of complications arising in the process of fragmentation of the lens nucleus, by various methods the energy of the impact in the surgical treatment of age-related cataracts. Material and methods. The study included 550 patients (677 eyes) operated for cataract in the period from 2015 to 2017 in the Krasnodar branch of the S. Fedorov Eye Microsurgery Federal State Institution. According to the method of energy crushing of the lens nucleus, all patients were divided into 3 groups. For group 1 – ultrasound technology (bimanual phacoemulsification of cataract (FCE) was used; for group 2 – Nd: YAG-laser with a wavelength of 1,44 μm technology of laser cataract extraction (LCE) was used; group 3 – infrared femtosecond laser technology (femtosecond laser support phacoemulsification (FFCE) was used. Results. When using FFCE minimum percentage of complications in comparison with the FCE and LCE in cases of uncomplicated age-related cataracts was observed. In has been proved that in the presence of complicated cataracts, combined with a defect or weakness of the ligamentous apparatus of the lens, a pronounced syndrome, irido-ciliary dystrophy (IFIS-syndrome), bad expanding pupil; as well as in cataract with high degrees of density of nuclei, and in agitated patients, both FCE and LCЕ can be used. In our opinion LCE is preferable. Conclusion. Differentiated approach to the choice of the optimal method of phacofragmentation results in minimum intra – and postoperative complications, as well as better outcome for the patients.

Система управления эффективностью и качеством медицинской помощи в ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России

The system of management in efficiency and quality of medical care, developed at the S. Fyodorov Eye Microsurgery Federal State Institution, provides a constant growth of quantitative and qualitative indicators of the medical activities of the Institution that ensures for patients receive high-quality ophthalmic care services. The developed organizational and methodological principles of management in efficacy and a quality of medical care, methods of audit, a reasoned approach to the organization and remuneration of medical staff may be useful in the practice of health care facilities of ophthalmic profile and other specialized areas of medicine.

The S. Fyodorov Eye Microsurgery Federal State Institution – a national heritage

The S. Fyodorov Eye Microsurgery Federal State Institution – a national heritage