Maximum Corrected Visual Acuity Research Articles

CLINICAL-OPHTHALMOLOGICAL INDICATORS WHICH DETERMINE THE SEVERITY OF AGE-MACULAR DEGENERATION

Background. The search for biomarkers and simple mathematical systems for predicting the severity of age-related macular degeneration (AMD) is necessary and relevant.
 Aim: to determine prognostic clinical and ophthalmological indicators that determine the severity of AMD.
 Material and methods. The study included observational data of 302 eyes (152 patients), in which the stage of AMD was determined according to the recommendations of the AREDS study. The age of the patients was 71.18 years, 59.9% were women, 40.1% were men. Visual acuity, maximum corrected visual acuity (MCVA), the number of drusen of various calibers, the presence of changes in the retinal pigment epithelium, subretinal neovascular membrane (SNM) and geographic atrophy were determined.
 Results. By age, patients with a mild course of AMD were younger than those with a severe course by 6.9 years (p<0.001). Smokers accounted for 31.5% of patients, the course of AMD in such patients was more often severe – 37.2% versus 21.9% in non-smokers (p=0.006). Visual acuity and MCVA were significantly worse in patients with severe AMD (p<0.001). There was no significant difference in the number of small and medium-sized drusen (p>0.5). Large drusen, pigmentary changes and SNM were found almost only in patients with severe AMD. Moreover, pigmentary changes were present in almost all patients with severe AMD (92.6%), and SNM and geographic atrophy – in 23.9% and 21.8%, respectively. According to the data of the discriminant analysis, almost all indicators had a clear relationship with the course of AMD, but the F coefficient was the largest for pigmentary changes, MCVA, the number of large drusen and age. These indicators were included in the system of discriminant equations for determining the AMD severity.
 Conclusion. With the help of discriminant analysis, the indicators determining the severity of the course of AMD were found.

Results of surgical treatment of children with lens subluxation

AIM: To assess the effectiveness of the surgical treatment of patients with lens subluxation, who were under 18 years old.
 MATERIAL AND METHODS: This study presented an analysis of the results of surgical treatment of eight patients with lens subluxation. The operations were performed in the Department of Ophthalmology of the State Healthcare Institution of Healthcare MCMC “Bonum,” carried out in 2020–2022. The inclusion criteria were as follows: age under 18 years, Marfan-like phenotype, stages 2–4 subluxation, absence of retinal changes and other eye pathologies, and surgical treatment performed in 2020–2022. The mean age at the detection of lens subluxation was 3.9±2.0 years, and the age during primary surgery was 5.4±1.9 years. All patients underwent phacoaspiration of the subluxated lens with anterior vitrectomy, simultaneous implantation, and sclerocorneal fixation of the intraocular lens by the same surgeon using the same equipment and consumables.
 RESULTS: The ophthalmological status was mainly assessed, and a statistical difference (p 0.05) was found between pre- and postoperative indicators. Before surgery, the maximum corrected visual acuity was 0.15±0.12 (min 0.02; max 0.5); spherical equivalent, 6.8±4.7 (min -15; max +16); total astigmatism value, 3.25±1.15 (min, 1; max, 6.5); and corneal astigmatism, 2.4±0.9 (min, 1; max, 3.9). After the surgical treatment, the maximum corrected visual acuity was 0.53±0.31 (min, 0.05; max, 0.9); spherical equivalent, −0.6±1.71 D (min −3.5; max +3); total astigmatism, -1.63±0.75 D (min, -0.25; max, −2.75); corneal astigmatism, 2.4±0.7 D (min 1; max 3.5). All operations were performed without complications. The postoperative period in patients was regarded as unreactive.
 CONCLUSION: The results show that sclerocorneal fixation allows for reliable and safe fixation of intraocular lenses without capsule support. A statistically significant increase in visual acuity was found after surgery; however, for optimal functional results in the postoperative period, refractive errors and pleoptic treatment must be controlled.

Предварительные результаты превентивной фланцевой склерокорнеальной монофиксации комплекса внутрикапсульное кольцо – интраокулярная линза в хирургии катаракты при подвывихе хрусталика

Pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery and is associated with possible intra- and postoperative complications. To prevent further dislocation of the intraocular lens (IOL) in the postoperative period, IOL suturing with polypropylene thread is used for one or both supporting elements to the iris, or with sclerocorneal or scleral fixation. Purpose. Development of preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree and evaluation of its effectiveness. Material and methods. Preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree was performed in 15 patients aged 74.4 ± 11.4 years. The lens was fixed by the edge of the capsulorexis with four iris retractors, an intracapsular ring of the SK-2 type (Reper, Russia) was implanted into the capsule bag, an 8/0 polypropylene monofilament was attached to the inner curl of which, the second end of the thread was ab interno transclerally-transcorneally with the formation of a flange, the IOL was implanted into the capsule bag. Results. In all cases, the capsule bag was preserved and intra-capsule implantation of the IOL was performed. Complications during operations and in the postoperative period were not received in any case. The maximum corrected visual acuity (MCVA) during treatment rose from 0.2 ± 0.15 to 0.85 ± 0.14 6 months after surgery (p < 0.01; t-criterion). The loss of endothelial cells 3 months after surgery was 8,9 ± 1,4%. Conclusions. The use of preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree made it possible to preserve the capsular bag in all patients and perform the most physiological intracapsular implantation of IOL. Keywords: cataract, lens subluxation, phacoemulsification, intraocular lens.

Dynamics of cellular immunity indicators in the complex treatment of acute optic neuritis

An increase in the incidence of optic neuritis among the working-age population, as well as an unpromising prognosis for vision due to the development of optic nerve atrophy, determines the high social significance of this problem. The aim of the work is to analyze the effect of Imunofan at the parameters of cellular immunity and clinical symptoms of the disease in the complex treatment of optic neuritis associated with herpes virus infection. The study involved 37 people (37 eyes) with acute optic neuritis associated with herpes infection. The treatment regimen included the appointment of a dexamethasone solution according to a decreasing scheme, a 1% solution of the drug Emoxipin 0.5 mL and a 12.5% solution of the drug Dicynone 0.5 mL through an irrigation system implanted in the retrobulbar space, in combination with the neuroprotection drugs (Pikamilon and Semax) for 10 days. All patients were divided into 2 groups. The main group consisted of 20 patients who received Imunofan to the treatment regimen in addition. The comparison group included 17 patients who were treated only according to the method described above. The course of treatment lasted 10 days. The analysis of the data showed a more significant positive dynamics of cellular immunity parameters in those who received immunotherapy. Our studies showed the effectiveness of this drug in the complex treatment of optic neuritis associated with herpes infection, what is confirmed by the acceleration of inflammation relief, a more significant increase in visual functions of patients treated with Imunofan, and a lower percentage of optic nerve atrophy. In this group of patients, changes in the parameters of the cellular link of immunity occurred earlier and remained stable throughout the entire period of observation. According to our data, an intergroup assessment of the immunoregulatory index showed its faster increase in patients of the comparison group who received Imunofan, and reached normal values already 6 months after treatment. The clinical effectiveness of Imunofan in the complex therapy of optic neuritis associated with herpes infection was characterized by a reduction in the period of relief of signs of inflammation in the optic nerve by 2 times or more, by an increase in the maximum corrected visual acuity by 4.5 times, and by a decrease in the incidence of recurrence of optic neuritis by 2 times over a 12 months observation period.

Клинический случай дезадаптации роговичного рубца у пациента с наличием трансплантированной роговицы после передней послойной кератопластики

Purpose. Demonstration of a clinical case of corneal scar edges disadaptation after removal of sutures in anterior deep layered keratoplasty, assessment of patient's treatment. Material and methods. Patient K., 47 years old, underwent deep anterior lamellar keratoplasty in the right eye for stage 3 keratoconus. The operation went as it planned with no complications. At the time of discharge, maximum corrected visual acuity OD was 0.1 n/c. A year later, the suture was removed from the cornea. 3 instillations of okomistin 0.01 % and dexpanthenol 5 % was prescribed to the patient for 12 days. The next day after the removal of sutures, the patient felt a sharp deterioration in vision, redness of the right eye appeared. In a polyclinic at the place of residence, a divergence of corneal scar edges was detected, lasting from 7 to 12 hours, swelling of the graft and reduction of the anterior chamber. The patient was urgently sent to the eye department of the clinic at the place of residence. There, 7 single sutures were urgently applied to fix the graft. In our clinic, to eliminate the corneal wound edges disadaptation, a circular continuous 10\0 suture was applied. In addition, to stop the detachment of the Descemet's membrane (DM), additional air was injected into the anterior chamber. Results. As a result of the treatment, a complete adaptation of corneal wound edges was achieved, the transparency of the graft was restored due to complete adherence of DM to the corneal stroma. The presence of this complication was probably associated with local disturbances in the reparative processes of the cornea, which led to the formation of zones of inadequate scarring. Conclusion. To prevent disadaptation of the corneal wound after keratoplasty, it is necessary to search for objective criteria for quality of the corneal scar and the optimal timing for removal of the corneal suture. Keywords: disadaptation of the corneal scar; corneal transplant; keratoplasty

Ретинальные изменения после коронавирусной инфекции

The SARS-CoV-2 coronavirus infection pandemic has caused 667 million cases. COVID-19 is a severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. The virus primarily affects the respiratory system and runs the gamut from respiratory infection, to acute respiratory distress syndrome. Various ophthalmologic manifestations in both the anterior and posterior segment of the eye are increasingly reported in the literature. Purpose. Present clinical cases of retinal changes after coronavirus infection. Material and methods. We present two clinical observations of patients with ophthalmic manifestations in the posterior segment of the eyes that developed after a coronavirus infection. All patients underwent ophthalmological examination including visometry, anterior segment biomicroscopy, and ophthalmoscopy with non-contact Volk 78D lens, optical coherence tomography (OCT) of macular area and angioregim OCT (DRI OCT Triton plus, Japan). Treatment and recommendations were individualized according to ophthalmological indications. Results. Stabilization of retinal changes after coronavirus infection. There was an increase in maximum corrected visual acuity (MCOZ), reduction of macular edema. Conclusion. It is necessary to pay attention to complaints of the visual organ in patients with coronavirus infection in the early stages of the disease and in the nearest months after recovery. Our clinical observations show the need for further study of pathogenesis, clinic and treatment methods of ophthalmologic complications associated with coronavirus infection. Keywords: coronavirus disease, postthrombotic retinopathy, macular neovascular membrane

Влияние степени адгезии внутренней пограничной мембраны на результаты хирургии тракционного диабетического макулярного отека

Internal limiting membrane (ILM) peeling is a technically complex manipulation that is performed during macular surgery. Experts'opinions vary on its necessity. Visual inspection during surgery does not always make it possible to assess the degree of ILM adhesion to the retina. The aimof the study was to evaluate the morphofunctional parameters of the macular zone after ILM peeling with different degree of adhesion in the long-term postoperative period. Material and methods. A study was conducted that included 119 patients with type 1 (65 (55%) and type 2 (54 (45%) diabetes mellitus with proliferative stage of diabetic retinopathy (PDR) and tractional diabetic macular edema (tDME). All patients underwent a standard three-port 25G vitrectomy with the use of an additional endo-luminaire «chandelier» and bimanual membrane peeling technique. During ILM peeling, all patients underwent intraoperative optical coherence tomography (I-OCT) in order to assess the degree of ILM adhesion to the retina. Before, 1 and 12 months after the operation, the determination of the maximum corrected visual acuity (MCVA), OCT of the macular zone with the measurement of the central retinal thickness (CRT) was performed. Results and discussion. 3 degrees of adhesion of ILM to the retina were identified with I-OCT during ILM peeling. The degree of ILM adhesion in fovea significantly correlated with the development of a retinal defect in its central area. The development of retinal central zone atrophy showed a significant correlation with a decrease in MCVA 12 months after surgery and with the degree of ILM adhesion to the retina in patients with both types of DM. Conclusions. According to the results of this study, a significant correlation was shown between the degree of ILM adhesion to the retina determined by I-OCT and the risk of macular atrophy, which in turn is associated with low visual functions of patients after tDME surgery with ILM peeling. The resulting principle can be used in surgery of other vitreomacular interface pathologies. Keywords: vitreomacular interface, epiretinal membrane, diabetic macular edema, tractional diabetic macular edema, intraoperative optical coherence tomography, vitreoretinal surgery, proliferative diabetic retinopathy

Оценка эффективности интраоперационной периферической капсулотомии при цилиокапсульной фиксации трехчастной интраокулярной линзы с помощью оптической когерентной томографии

Purpose. To evaluate the clinical efficacy of intraoperative peripheral capsulotomy of the anterior leaf of the preserved capsular bag for the prevention of capsular block during cilio-capsular IOL fixation using optical coherence tomography Material and methods. Clinical results of phacoemulsification of complicated cataract with femtosecond laser accompaniment against the background of pseudoexfoliation syndrome, grade I subluxation in a 58-year-old patient in the early postoperative period. In addition to standard examination methods, optical coherence tomography of the anterior segment of the eye was used. During the operation, after filling the haptic elements of the three-part IOL into the ciliary sulcus, and the optics into the anterior capsulorhexis, 0.3 mm to the periphery from the edge of the IOL optics with a spear knife, two peripheral capsulotomies of the anterior capsule were performed opposite to each other. Results. On the 2nd day after the operation, the maximum corrected visual acuity increased and amounted to 0.8, IOP – 11 mm Hg. Art.; before surgery – 0.6 and 22, respectively. According to optical coherence tomography, a sufficient distance between the edge of the iris and the anterior surface of the IOL for free circulation of intraocular fluid was determined, and there were no signs of a capsular block. Conclusion. In the course of the study, it was found that intraoperative peripheral capsulotomy of the anterior leaf of the capsular bag provided natural leaching of viscoelastic from the capsular bag during implantation of a three-part IOL into the ciliary sulcus with infringement of the optic part in the anterior capsulorhexis on the second day after the operation. Key words: capsular block, capsulotomy, capsular-ciliary fixation, three-part intraocular lens, pseudoexfoliative syndrome

Интраоперационная периферическая капсулотомия при цилиокапсулярной фиксации: да или нет?

Purpose. To obtain clinical confirmation of the need for intraoperative peripheral capsulotomy with cilio-capsular fixation. Material and methods. Clinical results of phacoemulsification of complicated cataract with femtosecond laser accompaniment against the background of pseudoexfoliation syndrome, grade I subluxation in a 65-year-old patient in the early postoperative period.In addition to standard examination methods, optical coherence tomography of the anterior segment of the eye was used. During the operation, cilio-capsular fixation of a three-part IOL was used without peripheral capsulotomy of the anterior capsule. In the early postoperative period, due to the developed capsular block, YAG laser dissection of the posterior lens capsule was used. Results. On the 3rd day after the operation, the maximum corrected visual acuity increased and amounted to 0.7, IOP – 12 mm Hg. Art.; before surgery – 0.3 and 22 mm Hg, respectively. According to optical coherence tomography after YAG laser discission, a sufficient decrease in the depth of the retrooptic space was determined, which indicates the absence of signs of a capsular block. Conclusion. During the study, it was found that in the absence of communication between the capsular bag with the anterior chamber, a capsular block is formed during cilio-capsular fixation. This necessitates intraoperative peripheral capsulotomy. Key words: capsular block, capsulotomy, capsular-ciliary fixation, three-part intraocular lens, pseudoexfoliative syndrome

Офтальмологические проявления на заднем отрезке глаза после коронавирусной инфекции

An outbreak of SARS-CoV-2 coronavirus infection has caused 667 million cases. COVID-19 is a severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. The virus primarily affects the respiratory system and causes from mild signs, respiratory infection, to a severe course, acute respiratory distress syndrome. Multiple ophthalmologic manifestations in both the anterior and posterior segment of the eye are increasingly reported in the literature. Purpose. To present clinical cases of postocular ophthalmic manifestations on the ocular fundus. Material and methods. Four clinical cases of ophthalmologic manifestations in the posterior segment of the eyes that developed after a coronavirus infection were presented. All patients underwent ophthalmological examination including visometry, anterior segment biomicroscopy, as well as ophthalmoscopy with non-contact Volk 78D lens, optical coherence tomography (OCT) of macular area and OCT in angioregim (DRI OCT Triton plus, Japan). Treatment and recommendations were individualized according to ophthalmological indications. Results. Stabilization of postocular ophthalmic manifestations in the posterior segment of the eye. There was an increase in maximum corrected visual acuity (MCOZ), reduction of macular edema, adherence of neuroepithelial detachment (ONE). Conclusion. It is necessary to pay attention to the complaints of the visual organ in patients with COVID-19 in the early stages of the disease and in the nearest months after recovery. Our clinical observations show the necessity of further study of pathogenesis, clinic and treatment methods of ocular complications associated with COVID-19. Keywords: coronavirus disease, postthrombotic retinopathy, macular neovascular membrane, central serous chorioretinopathy

Гравитационная дислокация субмакулярных кровоизлияний у пациентов с возрастной макулярной дегенерацией

Purpose. To study the effectiveness and anatomical results of gravitational dislocation of submacular hemorrhages in patients with age-related macular degeneration. Material and methods. We examined 4 patients (4 eyes) with the diagnosis of submacular hemorrhages. The average age of the subjects was 71.45 ± 5.15 years. The duration of the disease was 7determined from the onset of characteristic symptoms to surgical treatment and averaged 7.5 ± 4 days. The maximum corrected acuity averaged 0.02 ± 0.05. According to the data of optical coherence tomography, a high central detachment of the neuro- and pigment epithelium with hemorrhagic contents was determined in patients. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. All patients underwent pars plana vitrectomy combined with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection without any tamponade. The patients were advised to take supine position postoperatively in order t-PA to liquefy the haemorrhage, for 1 h; after which they were positioned upright or lying down on the temporal side of the affected eye, for 3 days. Results. In the early surgical period, there was a tendency to increase the maximum corrected visual acuity (MCI): on the 7th day after the first stage of treatment, it was 0.23 ± 0.06 (p < 0.05 compared with the indicators before treatment). The displacement of the blood clot from the central area of the retina, with the correct positioning of the patient, occurred within 5.87 ± 1.9 days. Lysis of the submacular clot was observed for 14 ± 1.53 days. After 3 loading injections carried out within 1.2 and 3 months after the operation, the MCI increased to 0.4 ± 0.2. Conclusion. Microinvasive subtotal vitrectomy with subretinal injection of Prourokinase, with proper positioning of the patient, help gravitational dislocation of submacular hemorrhages and is an effective treatment method in patients with age-related macular degeneration. Keyword: submacular hemorrhage, age-related macular degeneration, dislocation, optical coherence tomography

Оценка влияния скорости и полноты резорбции интра- и субретинальной жидкости на динамику зрительных функций при неоваскулярной возрастной макулярной дегенерации на фоне терапии бролуцизумабом

Currently, there is insufficient data in the literature on the effect of the rate of regression of sub- and intraretinal fluid on the dynamics of maximum corrected visual acuity in the treatment of neovascular age-related macular degeneration (nAMD) against the background of the use of brolucizumab. In the course of the study, it was found that rapid resorption of intraretinal and subretinal fluid does not affect the functional results of treatment, and the severity of retinal edema at the start of therapy affects the timing of reducing the thickness of the central retinal zone. Keywords: neovascular age-related macular degeneration, brolucizumab, the rate and completeness of fluid regression

Efficacy and Safety of Nutraceutical Support in Age-Related Macular Degeneration Patients

Purpose: to assess the possibilities of nutraceutical support in AREDS-3 category age-related macular degeneration (AMD) patients.Patients and methods. The study included 30 AREDS-3 category AMD patients (30 eyes) aged 69.2 ± 5.7 years (12 men, 18 women). As the ophthalmic nutraceutical, the biological active supplement was used, including vitamins E, B1, B2, B3, B9, B12, C, lutein, zeaxantin, lycopene, resveratrol, beta-carotene, coenzyme Q10, copper, zinc, selenium (Oftolik®; 1 capsule, 2 times a day). Follow-up period: 12–16 months (6–8 courses of therapy). All those observed underwent: standard ophthalmological examination; fundus photo registration (Nidek); OCT (Opto-Vue); OCT-angiography (Zeiss); possible systemic side effects registration. The main criterion for nutraceutical support effectiveness was stabilization of AMD manifestation. The significance of a possible increase in number and (or) size of drusen (with the AREDS-3 category), as well as the appearance of patients with AMD of the AREDS-4 category, was assessed using the Pearson γ2 test. An additional criterion was the maximum corrected visual acuity (MCVA) stabilization. The mean and its standard deviation (M ± s) were calculated, the significance of differences was assessed using the Wilcoxon’s T-test.Results. None of the eyes included in the study showed progression from the AMD AREDS-3 category to AREDS-4. In one eye (3.33 %), an increase in the number of drusen was recorded; in 29 eyes (96.67 %), the number and size of drusen remained stable. These changes were not statistically significant (γ2 = 1.017; p = 0.314; p > 0.05). MCVA during the follow-up period remained stable with a slight but statistically insignificant trend towards its increase (from 0.69 ± 0.096 to 0.71 ± 0.07; Temp = 165, p > 0.05). In all observed patients, the tolerability of ophthalmonutraceutical was good, no significant side effects were recorded.Conclusion. Nutraceutical support prevented the progression of AMD from AREDS-3 to AREDS-4 during follow-up of 12–16 months. In the vast majority of patients (96.67 %), manifestation of AMD within the AREDS-3 category remained stable. After 6-8 courses of therapy, no significant side effects of nutraceutical support were recorded.

Reduced Size of Telangiectatic Capillaries After Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents in Diabetic Macular Edema

Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents reduces microaneurysms in patients with diabetic macular edema (DME). However, residual anti-VEGF-resistant telangiectatic capillaries (TelCaps) have been reported. In this study, we investigated changes in the size of TelCaps after intravitreal injection of anti-VEGF agents in DME. Indocyanine green angiography (IA) and optical coherence tomography were performed before and 3 months after the intravitreal injection of anti-VEGF agents (pro re nata regimen after three monthly loading doses) in 12 eyes of 12 patients (7 males and 5 females, mean age 65.2 ± 8.8 years) with DME. The number and size of TelCaps within a 6-mm diameter macular region of the edema were measured using optical coherence tomography B-scan images overlaid on IA images. There were significant reductions in the number and size of TelCaps between the baseline and 3 months after anti-VEGF agent administration (P < 0.05 and P < 0.0001, respectively). The maximum corrected visual acuity (logMAR visual acuity) and the central macular thickness after anti-VEGF therapy were significantly improved (P < 0.01 and P < 0.02, respectively). The TelCaps remaining after loading three consecutive anti-VEGF agents had a significantly larger mean size at baseline than the TelCaps that resolved after the treatment (P < 0.03). Our study demonstrated that intravitreal injection of anti-VEGF agents could reduce TelCap size in patients with DME. We propose that larger-sized TelCaps detected by IA might be useful predictors of refractory DME, which could thus be principal targets of laser photocoagulation.

Influence of complex application of heliox therapy and acupuncture on maximally corrected visual acuity in patients with acute form of central serous chorioretinopathy

BACKGROUND: Central serous chorioretinopathy is a socially significant problem, as it is one of the most common diseases of the retina. It is more common in males of working age.&#x0D; AIM: to evaluate the effect of the combined use of heliox therapy and acupuncture on the most corrected visual acuity in patients with acute central serous chorioretinopathy.&#x0D; MATERIAL AND METHODS: The study included 34 men (34 eyes) with central serous chorioretinopathy, whose mean age was 362.3 years. The patients were divided into 2 groups comparable according to clinical and laboratory data: the main one ― 22 people, average age 323.1 years, who in the first two weeks received a complex of physiotherapeutic treatment, including: heliox 21, for a course of 10 daily procedures and acupuncture, also for a course of 10 daily procedures, and a control ― 12 people, average age 341.5 years, who, after consulting a neurologist, were prescribed medication (light sedatives, the Nutrof vitamin complex, diuretics 1 time in 3 days with restoration of electrolyte balance, alcohol restriction), which served as a background in the main group.&#x0D; Visometry (visual acuity) was used to assess the effectiveness of treatment. Before treatment, after 2 weeks, after 1 month, 3 months, 6 months, 12 months.&#x0D; RESULTS: Before treatment in patients with acute central serous chorioretinopathy, the maximum corrected visual acuity was reduced by 44.2% compared to the norm ― 0.950.05 (p 0.001) and comparable in the main group 0.540.05 and in the control group 0.530.05 (p=0.901). The maximum increase in visual acuity in patients of the main group was already two weeks later, with a subsequent increase in the indicator during the year, approaching the normal values at the last observation point (1 year). In addition, all patients after treatment noted a decrease in the intensity or exclusion of metamorphopsia. In the maximally corrected visual acuity control group, significantly less significant results were obtained at all control points.&#x0D; CONCLUSION: Under the influence of the combined use of heliox therapy and acupuncture in patients with acute form of central serous chorioretinopathy, a more pronounced and persistent increase in maximally corrected visual acuity occurred compared to drug treatment.

Возможности повышения эффективности комплексного лечения оптического неврита герпесвирусной этиологии

Purpose. Evaluation of morphofunctional and laboratory-immunological results of the use of immunotherapy in the complex treatment of optic neuritis (ON) associated with herpesvirus infection (HVI). Material and methods. 39 people (39 eyes) with acute ON associated with HVI. The treatment regimen included the appointment of a dexamethasone solution according to a decreasing scheme, a 1 % solution of the drug «Emoxipin» 0.5 ml and a 12.5 % solution of the drug «Dicynone» 0.5 ml through an irrigation system implanted in the retrobulbar space, in combination with the prescription of drugs neuroprotection («Pikamilon» and «Semax») for 10 days. All patients were divided into 2 groups. The main group – 22 patients, in the treatment regimen of which the drug «Imunofan» was added. The control group included 17 patients who received standard treatment. Immunotherapy was carried out for 10–12 days. Results. Data analysis showed that the most significant positive dynamics was noted in patients of the main group. Conclusion. The clinical efficacy of the drug «Imunofan» in the complex therapy of ON associated with HVI was characterized by a reduction in the time for relief of signs of inflammation in the optic nerve by 2 times or more, an increase in the maximum corrected visual acuity by 4.5 times, a decrease in the incidence of relapses of ON by 2 times with follow-up period of 12 months. Keywords: optic neuritis, herpesvirus infection, corticosteroid therapy, immunotherapy

Features of Visual Dysfunctions in Patients with Primary Hypothyroidism and Thyrotoxicosis

Purpose: to study the prevalence and nature of visual dysfunctions in patients with primary hypothyroidism and thyrotoxicosis.Material and methods. The material for this study was the results of a survey of 54 patients (108 eyes) with thyroid dysfunctions: 32 people (64 eyes) with primary untreated hypothyroidism and 22 people (44 eyes) with primary untreated thyrotoxicosis. Static automated perimetry and dedicated shortwave infrared (blue-yellow) perimetry were performed. The average total value of the photosensitivity of each (n = 74) tested point of the field of view was analyzed, the topography of the location of focal defects was studied, and the severity of impairments to photosensitivity was assessed by aggregate signs.Results. Reliably high sensitivity (92.6 %) and specificity (50.0 %) of short-wave infrared perimetry in relation to static automated perimetry were revealed. In thyroid dysfunctions, the prevalence of optic neuropathy reaches 93 % according to the data of short-wave infrared perimetry versus 7 % of static automated perimetry. It is manifested by a diffuse decrease in light sensitivity to blue stimulus with an increase in the depth of depression from the center to the periphery in both types of thyroid dysfunction. Against this background, with primary hypothyroidism, focal defects appeared in the form of first-order scotomas, and with primary thyrotoxicosis, second-order scotomas. Scotomas were located at the periphery of the central visual field, 20–30° from the fixation point. In the analyzed groups, high average group indices of the maximum corrected visual acuity were established, which allows us to speak about the safety of the photopic (cone) component of the visual analyzer.Conclusion. The pattern of photosensitivity disorders, the topography of the location of the loci of local defects revealed by the short-wave infrared perimetry, indicate that the earliest signs of optical neuropathy are manifested at the level of photoreceptors — selectively in the S-cones. Decreased sensitivity to blue stimulus (440 nm) refers to an acquired color anomaly called tritanopia; which can be present with high visual function, is most often associated with a decrease in the number of S-cones and a deficiency of retinol (the source of cyanolab synthesis).

Послеоперационный мультимодальный анализ результатов хирургического лечения субмакулярных кровоизлияний

Objective. To evaluate the morphological and functional effectiveness of minimally invasive administration of recombinant prourokinase followed by endovitreal gas tamponade without vitrectomy in comparison with antivasoproliferative therapy in patients with submacular hemorrhages. Material and methods. Patients of the 1st group at the 1st stage underwent two-port 27 G surgery with subretinal injection of a solution of recombinant prourokinase 500 IU through a 38 G cannula with the introduction of up to 20% of the volume of the vitreal cavity of C2F6 gas. At stage 2, therapy with anti-vasoproliferative drugs was prescribed according to the treat and extend regimen. Patients of the 2nd group were prescribed intravitreal injections of antivasoproliferative drugs according to the standard scheme with the transition to the treat and extend mode after 3 loading injections. Results. In group 1, there was a pronounced positive trend in maximum corrected visual acuity (BCVA) over the entire observation period: on the 14th day after stage 1 of treatment, it was 0.18 ± 0.05 (p &lt; 0.05 compared to before treatment), after 3 loading injections – 0.3 ± 0.1 and after 6 months – an increase in photosensitivity values up to 4.7 ± 2.2 dB was demonstrated (p &lt; 0.05 in comparison with the values before treatment ) and up to 12.6 ± 4.6 in the 1st group (p &lt; 0.05 in comparison with the indicators before treatment, the indicators of the 2nd group), respectively. An inverse correlation of functional parameters was noted against the background of depression of the central retinal thickness up to 222.0 ± 60.7 µm and the height of the neovascular membrane up to 72.0 ± 23.0 at the end of the observation. Conclusion. Combined treatment of patients with SMC on the background of AMD, including subretinal administration of tissue plasminogen activator against the background of antivasoproliferative therapy, improves morphofunctional results with a high frequency of complete dislocation of hemorrhages. The use of a combined technique provides 4-fold depression of the CTS and 2.8-fold elevation of CNV against the background of a 10-fold increase in BCVA. According to the results of microperimetry, there is a decrease in the zone of absolute scotoma by 4.7 times, with an increase in the total photosensitivity of the macular zone by 12.6 times. Postoperative appointment of antivasoproliferative therapy for 14 days ensures the preservation of the morphofunctional results achieved after. Keywords: submacular hemorrhage, tissue plasminogen activator, pneumodislocation

Хирургическое лечение дегенеративного ламеллярного макулярного разрыва с применением богатой тромбоцитами плазмы крови

Introduction. Surgical treatment of patients with degenerative lamellar macular hole (LMH) does not always improve visual acuity. One of the risk factors for such results is pronounced thinning of the retina in the area of the hole. In such cases, it was suggested to supplement the standard surgical technique with the application of autologous platelet-rich blood plasma (PRP) to the area of the hole. Purpose. To present a clinical case of surgical treatment of degenerative LMH with pronounced retinal thinning using PRP. Material and methods. Patient C., 68 years old, complained of distortion of objects contours and decreased vision in the right eye. His corrected visual acuity was 0.4. Optical coherence tomography revealed a degenerative LMH (Govetto A. et al. classification, 2016) of the right eye with significant retinal tissue defect, with ellipsoidal photoreceptor zone defect and minimal retinal thickness of 59 μm. A three-port subtotal 27G vitrectomy was performed with removal of the epiretinal membranes and internal limiting membrane, tamponade of the vitreal cavity with air, and application of autologous PRP to the hole area. Results. The dynamics of retinal recovery in terms of up to 9 months after surgery is described, the minimum retinal thickness increased from 59 to 238 μm; the maximum corrected visual acuity increased from 0.4 to 1.0. The formation of a hyperreflective zone similar in optical density to plexiform layers was noted in the area where the hole had previously occurred. The size of the hyperreflective zone decreased during observation. By 9 months after surgery, the ellipsoidal zone defect was virtually undetectable. Conclusion. The use of PRP resulted in not only closure of the hole but also normal retinal thickness in the foveal area which contributed to the restoration of the ellipsoidal zone of the photoreceptors and a significant increase of visual acuity. Presumably, PRP contributes to the speedy closure of the hole due to the formation of a glial scar of minimal size. Key words: degenerative lamellar macular hole, platelet-rich blood plasma, vitrectomy, hyperreflective zone, glial scar

Comparative Analysis of Treatment of Patients with Refractory Glaucoma of Various Stages by Microimpulse Transscleral Cyclophotocoagulation

Objective: to analyze the results of treatment in patients with refractory glaucoma of various stages of the disease by microimpulse cyclophotocoagulation.Patients and methods. We examined 43 patients aged 68.5 ± 13.2 years with primary open-angle repeatedly operated subcompensated glaucoma (POAG) of advanced (13) and advanced (30) stages before and after performing MCPC (SUPRA 810 device, QuantelMedical, France) using standard laser parameters: energy W = 2000 MJ, 31.3 % — duty cycle, exposure time — 80 seconds per hemisphere.Results. The operation and postoperative period were uneventful. The hypotensive effect was achieved in all cases up to 6 months of follow-up. In the advanced stage of the disease, IOP decreased from 26.8 ± 7.8 mm Hg to an average of 17.1 ± 8.1 mm Hg (p &lt; 0.05), and the amount of antihypertensive agents decreased from 2.89 ± 0.74 to 2.4 ± 0.6. in patients with advanced stage, IOP decreased from 29.9 ± 7.8 mm Hg to 21.0 ± 8.3 mm Hg (p &lt; 0.05), and the amount of antihypertensive agents decreased from 3.1 ± 0.4 to 2.8 ± 0.5. The maximum corrected visual acuity (MCI) in all patients remained at the preoperative level during the entire follow-up period.Conclusion. Analysis of the results has shown that the use of microcyclophotocoagulation in patients with refractory glaucoma has not led to the development of postoperative complications, reduced intraocular pressure by 36.2 % from baseline, when developed and 29.8 % in advanced stages of the disease, reduced the number of antihypertensive drugs was 17 % in the second and 10 % at third stage and have not led to a decrease in visual function at 6 months follow-up. Thus, it is proved that the use of a diode laser in micro-pulse mode during microcyclophotocoagulation is a safe and effective method of treating refractory forms of glaucoma at various stages of the disease.