Fyodorov Eye Microsurgery Federal State Research Articles

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

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

Наш опыт эндовитреального удаления внутриглазных инородных тел при выполнении хирургии тяжелых проникающих ранений глаз

Purpose. To evaluate efficiency and safety of transvitreal removal of intraocular foreign bodies (IOFB) when performing vitrectomy after penetrating eye injuries. Material and methods. 12 patients (12 eyes) with penetrating ocular trauma with IOFB were included in this study. In 2 eyes, IOFB was removed in our clinic on the same day during an emergency surgical treatment, immediately upon admission of patients: in 10 eyes – delayed. At the time of admission to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution, we registered low visual acuity or blindness in all 12 eyes: in 8 eyes – from 0.001 to 0.4; in 4 eyes – from LP to NLP. A standard three-port 25-gauge vitrectomy was performed in all patients, during which IOFB was localized. Results. In all eyes IOFB was correctly removed; in 3 eyes with retinal detachment, it was possible to achieve its total reattachment. In 7 eyes, IOFB removal was performed using intraocular forceps: 5 eyes – through the corneal tunnel – the pupillary zone – posterior capsulorhexis at the stage of phacoaspiration, 2 eyes – through the port; in 3 eyes – with the help of a vitreotom; in one eye – with the help of an magnet through the pupillary zone before implantation of the IOL RSP-3 (Russia), and in one eye – with the help of scleral forceps. Conclusion. The IOFB entry wound in 12 eyes were: corneal – 5 eyes, scleral – 5 eyes, corneoscleral – 2 eyes. In 11 eyes IOFB were metallic (9 magnetic and 2 non-magnetic), in 1 eye – non-metallic. The volume and tactics of vitreoretinal surgery in each case of IOFB removal was determined by the initial severity of eye injuries, size, and location of the IOFB, the degree of secondary trauma to the intraocular structures after their removal during the primary wound repair. Key words: ocular trauma, intraocular foreign body, penetrating eye injury, vitrectomy

Removal Large Fragment of Metal Wire from Eye Using Vitrectomy. Clinical Case

Purpose. Demonstration of non-standard clinical case of removing large fragment of metal wire from the eye. Patient and methods. Patient, 37 years old, with penetrating right eye injury with intraocular foreign body (IOFB) introduction — a fragment of metal wire. After unsuccessful attempt to remove IOFB during primary repair of eye injuries lacerations by ophthalmologist of the surgical department of the district hospital, he was sent to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. On admission: VIS OD — 0.01 uncorrected, intraocular pressure (IOP) — 16 mm Hg (noncontact tonometer TOMEY, Japan). OD — metal IOFB protrudes by 1.0 mm from the corneoscleral laceration in projection of corneal limbus at the 13 o’clock position, postoperative aphakia; according to B-scan ultrasonic data: metallic foreign body of linear shape, 14.3 mm long, about 1.5 mm thick. There is hemorrhage in the vitreous cavity. Results. Initially, conditions for visualization of the vitreous cavity were created by performing 25G vitrectomy. The course of wire location was specified: under the choroid and retina, going out through the sclera in the equatorial region. After conjunctival tweezers expanded wound edges, the embedded fragment of wire was delicately remove: 25 mm in length and 2 mm in diameter. A single retinal break was delimited by cryotherapy and laser photocoagulation. On the 2nd day: VIS OD — 0.3 with diaphragm, uncorrected; IOP — 13 mm Hg. After 3 months: VIS OD — 0.01 sph + 13.0 D = 0.7, IOP — 14 mm Hg. Silicone removal was combined with intraocular lens implantation model RSP-3 (+23D). The next day: VIS OD — 0.3 with diaphragm, 0.5 cyl — 6.0 D ax 170 = 0.5; IOP — 16 mm Hg. Conclusion. Use of 25G vitrectomy for removal IOFB localized between the inner membranes of the eye created optimal conditions for visualizing depth of its penetration, which minimized traumatic impact and avoided severe intra- and postoperative complications.

К вопросу о врожденных заболеваниях хрусталика глаза у детей

Material and methods. 110 children with congenital cataract and 16 with lens subluxation aged 1–17 years (on average 8.7±2.3) were under observation, 57 of them boys and 69 girls. All patients were examined using standard ophthalmological techniques: visometry, autorefractometry, keratometry, ultrasound biometry, an optical biometer IOL Master-500 was used to calculate IOL. Surgical treatment was required only by patients with monocular vision – with a number of 32 (45 eyes) and 6 (11 eyes). Surgical method of traetmen was presented in Saint-Petersburg brunchof S. Fyodorov Eye Microsurgery Federal State Institution. It included phacoaspiration, implantation of IOLs, including monofocal, toric and IOLs with aExtended Depth of Focus (EDOF). In cases of congenital pathology of the ligaments, an intracapsular ring (ICR) was used, including its suture fixation. Results. Children with congenital cataracts showedseveral prognostic symptoms – relatively favorable, conditionally favorable, negative and critical. Surgery of the first two of them allowed to increase monocular visual acuity (with correction) in the range from 0.1–0.4 (44.0%;) to the level of 0.9 (31%), all in binocular cases. Patients with negative symptoms (strabismus) showed low vision due to functional disorders, especially with congenital amblyopia (caused by obscuration, strabismus, and refractive changes). It required long-term pleoptoorthoptic treatment, but without a guarantee of restoration of binocularity. Finally, children with critical symptoms had extremely low vision (less than 0.09 and up to light perception) and was practically not acceptable for rehabilitation. Children with lens subluxation also required specific surgery. Their monolateral visual acuity with correction ranged from 0.13 to 0.39 (children 3–7 years old) and 0.13–0.8 (12–15 years old), that was sufficiently high, but without binocularity. Key words: congenital cataract, subluxation of the lens, clinical refraction, axial length, strabismus

Clinical case of bilateral rapidly progressive osteoma of the choroid

Choroidal osteoma is a benign neoplasm characterized by the appearance of mature bone tissues at the level of the choroid and unilateral development. This study highlights a clinical case of bilateral rapidly progressing osteoma of the choroid in a child, which was complicated by tumor decalcification and choroidal neovascularization. A 14-year-old male teen has been under observation in the S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg branch since 2019, for bilateral choroidal osteoma. At the initial visit, a yellow-orange lesion with clear boundaries was noted in the left eye, localized at the level of the choroid and parapapillary, and had a trabecular bone structure. Based on the clinical picture and data from instrumental studies (ultrasound and optical coherence tomography), he was diagnosed with choroidal osteoma. During observation, a similar lesion appeared in the right eye, and its relatively rapid growth was observed in both eyes. Owing to the absence of zones of decalcification and neovascularization, further follow-up was initiated. However, in the presence of zones of decalcification of the bone tissue and newly formed vessels of the choroid, a threefold intravitreal injection of an angiogenesis inhibitor was performed. Consequently, regression of choroidal neovascularization was observed. Speculatively, the main reason for the atypical disease course in this teenager is the specificity of bone tissue development in childhood and adolescence.

Энергетическая хирургия катаракты в Санкт-Петербургском филиале МНТК «Микрохирургия глаза»: анализ 27-летнего опыта

Purpose. Based on a comparative analysis of the results of using various laser methods of cataract treatment in the process of developing energy surgery in the St. Petersburg branch The S. Fyodorov Eye Microsurgery Federal State Institution, to determine the advantages and disadvantages of the technologies used. Material and methods. Analysis of the results of laser cataract extraction, ultrasonic phacoemulsification and combined surgery is based on data from a study of 28 802 surgical interventions (Phacoemulsification (Phaco) – 15 520, laser cataract extraction (LCE) – 7945, FemtoPhaco – 5135, FemtoLCE – 202) performed over the period 1995–2022. Results.The operative complication rate was 0.6, 0.55, 0.5 and 0% for Phaco, LCE, FemtoPhaco and FemtoLCE respectively. Visual acuity after LCE and FemtoLCE >0.8 was observed in more than 70% of cases, and in other groups such a functional result was achieved in 57% of cases. Comparing the postoperative spherical equivalent, a significant difference was noted only between the FemtoPhaco and standard Phaco (p=0.03), and between FemtoLCE and LCE groups (p=0.01), it indicates the advantage of femtolaser support for cataract surgery getting in target refraction. Analysis of endothelial cells loss reflects a significant advantage in groups with femtolaser support (p=0.01; p=0.02), as well as in the group of LCE and FemtoLCE over standard Phaco (p=0.01; p=0.02, respectively). Conclusion. Laser cataract extraction is an effective and safe technology that can be compared to ultrasonic phacoemulsification. The use of femtosecond laser assistance provides significantly lower deviation from the planned postoperative refraction. Modern laser technologies are safe and can reduce the risk of endothelial loss more effectively than standard Phaco. Key words: laser cataract extraction, femtosecond laser, femto laser assisted cataract surgery, cataract phacoemulsification, endothelial cell density

Glaucoma in Axenfeld–Rieger Syndrome. A Clinical Case

Background: AxenfeldRieger syndrome is a genetically heterogeneous group of morphogenesis disorders associated with abnormal development of the anterior segment of the eye, teeth, the organ of hearing, and abdominal region. Сongenital glaucoma, which is refractory to standard methods of treatment due to pronounced changes in the structures of the anterior segment of the eyeball and other comorbidities, is frequent manifestation of this syndrome. There are several methods for treating glaucoma in patients with AxenfeldRieger syndrome: sinus trabeculectomy, implantation of drainage devices and transscleral cyclocoagulation. Сlinical case description: A patient with congenital glaucoma associated with AxenfeldRieger syndrome underwent sinus trabeculectomy with posterior scleral trepanation in the right eye and valve drainage implantation in the left eye at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow due to the intraocular pressure decompensation. In the postoperative period, an encapsulated cyst around the body of the drainage was detected, and then a revision of the operation area was performed. After the anti-glaucoma operations, the intraocular pressure compensation was achieved in the follow-up period up to 9 months. Conclusion: Depending on the degree of the changes in the anterior chamber angle structures, sinus trabeculectomy or valve drainage implantation are the methods of choice for the surgical treatment aimed at the intraocular pressure compensation and visual function preservation in patients with Axenfeld-Rieger syndrome.

Study of Frequency and Nosology of Clinical Varieties of Retinal Dystrophies in Children and Adolescents

Background. Particular vigilance in timely detection of retinal dystrophies (RD) in children is necessary as effective measure to prevent formation of rhegmatogenous retinal detachment. Purpose. To study frequency and structure of clinical forms of RD in children of different age groups to find out most typical age of their primary formation, to assess the proportion of their prognostically hazardous forms. Materials and methods. Clinical material — 314 children aged 5 to 17 years, on average 11.0 ± 0.6 years, who applied with various ophthalmological pathologies in the Department of Pediatric Ophthalmology of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from July 2020 to April 2021. All children underwent biomicroscopy, ophthalmoscopy with in-depth examination of the state of the equatorial and periphery parts of the retina in condition of maximum cycloplegia. All 4 quadrants of the fundus were examined using binocular indirect ophthalmoscope with 20D lens. The presence and frequency of RD, their clinical varieties, according to the classification of E.O. Saksonova (1979), were ascertained in each of the studied age groups. Their localization, their length, and eye refraction were also assessed. Results. Presence of RD was revealed in 34 (11 %) children. In structure of identified clinical forms of RD, 11 children had its prognostically non-hazardous forms of RD, 23 children had prognostically hazardous forms (33 % and 67 % respectively). According to our data, the earliest age of detection of RD was 6 years. Further progression of RD was noted in 2 out of 6 children after restrictive photocoagulation of prognostically hazardous forms of RD. Conclusion. Formation of RD occurs not only at puberty, but also at an earlier age, according to our data, from 6 years of age. In view of this, it is necessary to conduct a thorough ophthalmoscopic examination of the periphery parts of the retina, even in young children.

Современные подходы к оказанию высокотехнологичной офтальмологической помощи детям с ретинопатией недоношенных в Калужском филиале МНТК «Микрохирургия глаза»

Purpose. To present modern approaches to providing high-tech ophthalmic care to children with retinopathy of prematurity (ROP) in Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. Methods. For the 2003–2022 period screening for detection of active ROP was carried out in 16 000 premature infants. Various stages of the disease were identified in 4129 premature infants (24.9 %). Premature infants with various stages and forms of active ROP have been subjected to multimodal diagnostics of changes in the vascular system of the eye since 2016. Early laser treatment by pattern laser coagulation of the retina using hexagonal patterns was carried out in 226 children (286 eyes) in 2016–2021. Transpupillary laser coagulation of the retina using navigatied laser system was performed in 16 premature babies (26 eyes) in 2021–2023. Primary vitrectomy for severe stage 3 active ROP with the development of extraretinal retinovitreal neovascularization involving the posterior hyaloid membrane was performed in 9 premature infants (12 eyes) in 2021–2023. Results. Based on a comprehensive analysis of the results of multimodal diagnostics, informative prognostic signs of the type of active ROP were established, according to the data of fluorescein angiography of the fundus, spectral optical coherence tomography in the angio mode, and color duplex scanning. These signs provide an accurate definition of the type of course of the disease – a decisive factor in the choice of tactics for managing patients. The developed technologies of pattern hexagonal and navigatied laser coagulation of the retina provide maximal percentage of disease regression. These technologies create the most favorable conditions for further development of visual functions. Primary vitrectomy in all cases made it possible to achieve stable regression of the pathological process. Conclusion. Modern approaches to the provision of high-tech ophthalmic care for children with ROP, implemented in Kaluga branch of S. Fyodorov Eye Microsurgery Federal State Institution, provide high efficiency in the treatment of active ROP with a minimal risk of late complications in the cicatricial period of the disease. Key words: retinopathy of prematurity; multimodal diagnostics; navigated laser coagulation of the retina; primary vitrectomy.

Интраоперационная индукция задней отслойки стекловидного тела без окрашивания задней гиалоидной мембраны как этап хирургического лечения витреоретинальной патологии

Purpose. To develop a technology for intraoperative induction of posterior vitreous detachment without staining the posterior hyaloid membrane and evaluate its clinical effectiveness. Material and methods. The study included 10 premature infants (18 eyes) with stages 3 (8 eyes) and 4a (10 eyes) of active ROP and 70 adult patients (70 eyes) with primary penetrating macular holes, 48 of them with medium (diameter 250–400 µm) and 22 large holes (more than 400 µm in diameter). According to the indications, all patients underwent vitreoretinal surgery using the technique of intraoperative induction of posterior vitreous detachment (PVD) developed in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. A vitreotome is used, while dyes are not used during vitreoretinal surgery. Results. It was possible to initiate the posterior vitreous detachment intraoperatively without the use of dyes and additional instruments for all patients included in the study. There were no complications at this stage of the operation in any case. In children with active ROP, posterior vitreous detachment was induced using the tip of a vitreotome, the posterior hyaloid membrane was separated from the adjacent retina almost along its entire length, and the maximum removal of the vitreum was performed. This was achieved in all 18 eyes. In adult patients with macular rupture after successful induction of posterior vitreous detachment, in all 70 cases it was possible to perform the operation completely, with the formation of the inner limiting membrane flap and the closure of the macular rupture. Conclusion. The developed technique for intraoperative induction of posterior vitreous detachment is effective in separating the posterior hyaloid membrane and posterior cortical layers of the vitreous body from the retina, reduces the duration and trauma of the operation, does not require special instruments or dyes, and can be successfully used as the initial stage of vitreoretinal operations to create access to the subsequent stages of surgery treatment. Key words: induction of posterior vitreous detachment, retinopathy of prematurity, macular rapture

Научная деятельность Хабаровского филиала «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» за 35-летний период

The article assesses the scientific activities of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (Branch) for the period from 1988 to 2023. Over the past 35-year period, the ophthalmologists of the Branch defended 20 dissertations: 16 – for the degree of Candidate of Medical Sciences, 4 – for the degree of Doctor of Medical Sciences. The branch is successfully developing a direction devoted to the study of patterns of changes in the organ of vision during normal and complicated pregnancy, to prevent the development of ocular complications. Within the framework of this scientific problem, two dissertations were defended (doctor of medical sciences O.V. Kolenko). Currently, a study of the patterns of changes in the retina in pregnant women with diabetes mellitus is being carried out (candidate of medical sciences N.V. Pomytkina). For 1988–2023 more than 2,100 scientific publications were made by the doctors of the Branch, including 480 articles in scientific peer-reviewed journals recommended by the Higher Attestation Commission of the Russian Federation with an impact factor of over 0.3 («Ophthalmosurgery», «Bulletin of Ophthalmology», «Siberian Scientific Medical Journal», «National Journal glaucoma», «BC. Clinical ophthalmology», etc.), more than 1600 articles and abstracts have been published in collections of scientific papers of leading ophthalmological scientific and practical conferences held in various subjects of the Russian Federation. 17 monographs have been published, 47 teaching aids for ophthalmologists have been created, including 15 manuals labeled EMA, 182 patents of the Russian Federation for inventions have been received, about 500 rationalization proposals have been registered. More than 1000 reports were presented at scientific conferences of various levels (with international participation, all-Russian, regional). We presented 127 reports at congresses outside the Russian Federation. Ophthalmologists of the Branch actively participate in the work of the annual ophthalmological congresses in Europe and the USA, where they present their innovative developments. Over the past period, significant results have been achieved in scientific activity, the own scientific school of ophthalmological personnel is actively developing in the Far East region of the Russian Federation. Active scientific activity encourages the doctors of the Branch to constant professional growth in order to increase the possibilities of timely detection and effective treatment of vision pathology among residents of the Far East region. Keywords: scientific activity, S. Fyodorov Eye Microsurgery Federal State Institution, dissertations, articles

35-летняя деятельность Хабаровского филиала «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» в Дальневосточном регионе РФ

The results of medical work of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (Branch) for 35 years. The analysis of the structure and dynamics of the performed operations and courses of treatment for various diseases of the organ of vision and adnexa of the eye is given. The structure of patients treated in the Branch from different regions of the Far Eastern Federal District is presented. An assessment of the implementation of the volumes of high-tech medical care was made. The main directions of development of the Branch to optimize its activities have been determined. Keywords: ophthalmology, S. Fyodorov Eye Microsurgery Federal State Institution, medical work, high-tech medical care

Первые результаты организационной деятельности Хабаровского филиала ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России в Дальневосточном регионе в качестве национального медицинского исследовательского центра

Purpose. Assessment of the first results of the organizational and methodological department (OMD) of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (Branch) activities for 2018–2022. Material and methods. OMD was established in the Branch in February 2019. This was necessary to ensure effective interaction with the Level 3 medical organizations assigned to the Branch as a National Medical Research Center (NMRC) located in the Far Eastern Federal District (FEFD). Results. Some of organizational measures were taken to connect to the Unified State Health Information System, a systematic assessment of the level of ophthalmological care in assigned medical organizations was organized, problems of organizational interaction of the NMRC in the FEFD were identified, ways to solve them were outlined, a system of regular telemedicine consultations was established on management of the most complex patients. For 2018– 2022 in total, 40 visits to regions were made, 41 knowledge transfers were conducted, a scientific and educational module «Age-related macular degeneration, dry form» was created, an assessment was made of the effectiveness of the implementation and application of clinical recommendations, including quality assessment criteria for «Ophthalmology» profile in assigned medical organizations. During this period, 947 telemedicine consultations were performed, as a result of which 23.3 % of patients were hospitalized in the Branch in 2019, 73 % of patients in 2020, 86.3 % of patients in 2021 and 90 % of patients in 2022. Established business contacts with the heads of the highest executive authorities of the supervised subjects of the FEFD. Conclusions. As a result of the OMD activities of the Branch from 2018 to 2022 a clear system of organizational and methodological assistance was formed for Level 3 medical organizations located on the territory of the assigned regions of the FEFD. Keywords: national medical research center, organizational and methodological department, Far Eastern Federal District, telemedicine consultation, knowledge transfer

Эффективность консультативной помощи при лечении и обследовании сложных офтальмологических пациентов с помощью телемедицины

Purpose. Evaluation of the first experience of implementing telemedicine technologies by the national medical research center in medical organizations in the Far Eastern Federal District (FEFD). Material and methods. The analysis of organizational and technical difficulties of creating a stable system of scheduled and unscheduled telecommunication activities between the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution of the Ministry of Health of Russia (Branch) and assigned medical organizations of the 3rd level providing ophthalmological care to patients from 8 administrative territories of the FEFD. Results. The Branch established organizational and methodological department, which clarified and eliminated the factors that prevent the implementation of telemedicine consultations / consultations and the transmission of knowledge for ophthalmologists of medical organizations of the 3rd level; a set of organizational measures was taken to register the data of medical organizations in the Federal Register of Medical Organizations, in the Unified State Information System in the field of healthcare; the equipment necessary for communication was purchased and technically prepared; provided methodological assistance in setting up and adjusting equipment in the regions, including field visits; backup connections of several providers are created; an algorithm for preliminary notification of regional ophthalmologists about knowledge transfers was developed; the organizational algorithm for generating a request for telemedicine consultations was tested. For 2019–2022 the Branch conducted: 41 knowledge broadcasts (in 2019 – 24, in 2020 – 8, in 2021 – 8, in 2022 – 1), 947 telemedicine consultations (in 2019 – 180, in 2020 – 185, in 2021 – 277, in 2022 – 305) to patients living mainly in the territory of the FEFD. Conclusions. The introduction of a system of periodic telecommunication events between the Branch and assigned medical organizations of the 3rd level into the daily clinical practice of ophthalmologists of the FEFD after the elimination of organizational and technical difficulties showed a high demand, allowing consultations on patient management in accordance with modern standards for the provision of ophthalmological care, as well as receiving ophthalmologists of the FEFD new and timely knowledges. Keywords: telemedicine, teleophthalmology, Far Eastern Federal District, translation of knowledge, telemedicine consultation

Синдром сухого глаза на фоне дисфункции мейбомиевых желез у пациента рефракционного профиля (клинический случай)

Purpose. To describe a clinical case of a patient planning keratorefractive surgery, diagnosed with dry eye syndrome (DES) on the background of meibomian gland dysfunction (MGD). Material and methods. Patient S. applied to the Department of laser refractive surgery of S.N. Fyodorov Eye Microsurgery Federal State Institution. She was 27 years old with a diagnosis of moderate myopia in both eyes for possible keratorefractive surgery. She underwent a standard refractive diagnosis and consultation with an ophthalmic surgeon. Results.During biomicroscopy and standard ophthalmological examinations of the ocular surface, patient S. was found to have DES and MGD. It was decided to conduct a course of conservative treatment to restore the ocular surface. Conclusion. Thus, the proposed utility model for the treatment of MGD and the associated DES makes it possible to normalize the secretory work of these glands and, as a result, stabilize the condition of the tear film, which contributes to the safe planning of keratorefractive surgery. Keywords: dry eye syndrome, dysfunction of the meibomian glands, tear film, keratorefractive surgery

Эффективность применения тимолола при лечении инфантильной гемангиомы век у детей грудного возраста

The S. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk Branch, Khabarovsk, Russian Federation

Клинический случай пациентки с развитием макулярного отека после перенесенной новой коронавирусной инфекции (COVID-19)

Purpose. Description of a clinical case of a patient with the development of macular edema after suffering COVID-19. Material and methods. A description of the clinical observation of a patient with the development of macular edema after a new coronavirus infection (COVID-19) was carried out. Patient Ch., 68 years old, used a standard ophthalmological examination, ultrasound, optical coherence tomography. Results. The patient developed uveitis complicated by macular edema after a novel coronavirus infection (COVID-19). Antiinflammatory treatment was carried out using autologous platelet lysate in the conditions of the Novosibirsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. The prescribed treatment made it possible to maintain visual functions and improve life quality of the patient. Conclusion. COVID-19 is a serious pathology that can be accompanied by the development of panuveitis with cystic macular edema, which causes visual impairment. The management of such patients requires a multidisciplinary approach, regular monitoring and timely adequate treatment Keywords: uveitis; macular edema; new coronavirus infection

Наш опыт организационных мероприятий по обеспечению функционирования крупной офтальмологической клиники в период пандемии COVID-19

Purpose. To analyze changes in work of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (the Khabarovsk branch) caused by combination of elective and emergency ophthalmic care in the context of a pandemic of the novel coronavirus disease (COVID-19). Material and methods. The article presents the organizational restructuring of activities medical units of the Khabarovsk branch, due to need for additional performance of functions emergency ophthalmological service in connection with closure of the regional ophthalmological center of City Clinical Hospital named after Professor A.M. Voyno-Yasenetsky, which previously performed this function. Complex of organizational anti-epidemic measures taken to prevent the spread of COVID-19 in pandemic is presented, their feasibility is analyzed, the results of the clinic's activities in new conditions of the COVID-19 pandemic are reflected. Results. The COVID-19 epidemic required a significant organizational restructuring of the Khabarovsk branch. In addition to large volumes of elective surgery, emergency ophthalmosurgical care was added, performed in a round-theclock hospital. All this was superimposed on the organizational restructuring of patient flows, created to minimize their interpersonal contacts. Conclusions. The Khabarovsk branch fully coped with the tasks set, stable work was organized in the new pandemic conditions, effectively combining planned and emergency algorithms of ophthalmic surgical care. The measures taken made it possible to provide emergency ophthalmic care in full throughout the entire period of the epidemic, to resume the provision of planned ophthalmic care in full, without compromising the safety of patients' stay in the clinic. Keywords: COVID-19; SARS-CoV-2, pandemic, emergency care, eye emergency department, Eye casualty, coronavirus disease, organization of medical care