Maximum Corrected Visual Acuity Research Articles

Эффективность сочетанной терапии неоваскулярной возрастной макулярной дегенерации с применением анти-VEGF-препарата афлиберцепт и нутрицевтика «Ресвега форте»

Purpose. To evaluate the clinical efficacy of using the angiogenesis inhibitor aflibercept in combination with the nutraceutical «Resvega Forte» in the treatment of neovascular age-related macular degeneration (nAMD) Material and methods. The clinical study involved 25 patients (25 eyes) with nAMD, who received 3 «loading» intravitreal injections of aflibercept (IIA) 2.0 mg (0.05 ml) at intervals of 1 time per month. Further, during the year, all patients received therapy according to the «heal and extend the interval» protocol. The patients of the main group (14 people) were supplemented with triple IIA with the administration of the «Resvega Forte» complex, 1 capsule 2 times a day for three months and then, after 6 months, continued with a second course. Patients of the comparison group (11 persons) did not receive the «Resvega Forte» complex. The central retinal thickness (CRT), the presence of detachment of the retinal pigment epithelium and neuroepithelium, subretinal, intraretinal or fluid under the pigment epithelium were assessed. Results. By the 12th month of observation, none of the patients of the main group against the background of two complexes «Resvega Forte» was found to have a resumption of disease activity. The maximum corrected visual acuity increased 3 times and amounted to 0.75±0.03 compared to the initial 0.25±0.06. The circulatory system in these patients on average corresponded to the norm – 254.6±11.3 µm. In the comparison group, the resumption of disease activity was noted twice, which was accompanied by a decrease in the functional and morphological parameters of the retina. Conclusion. The inclusion of the nutraceutical «Resvega Forte» in the treatment regimen allows not only to reduce the risk of progression of nAMD, but also to increase the functional and morphological parameters of the retina. An integrated approach makes it possible to increase the interval between injections and reduce the required number of them without additional monitoring, which reduces the burden on both the patient and the doctor. Key words: neovascular age-related macular degeneration, aflibercept, nutraceutical «Resvega forte».

Long-term follow-up of school-age children on the effectiveness of myopia correction with contact lenses

Introduction and purpose. Early use of contact correction for congenital myopia and astigmatism in children and adolescents contributes to their social rehabilitation. The myopia correction with contact lenses provides sustainability of correction and absence of periods of blurred retinal images, which are experienced with the use of glasses. The purpose of the study was to determine, through long-term follow-up, the extent to which contact lens correction improves uncorrected and maximally corrected visual acuity in school-age children with myopia and myopic astigmatism. Material and methods. We followed up for three years 84 children (168 eyes) aged 6–16 years with myopic manifest refraction and astigmatism, who used soft silicone hydrogel aspherical contact lenses to correct ametropia. In the early and late follow-up, these patients were examined for visual acuity, objective and subjective clinical refraction, axial eye length, corneal thickness and diameter, keratometry, and phorometric data (accommodation, vergence, disparate areas, and oculomotor apparatus and their interaction). Results.In course of long-term monitoring of myopia and myopic astigmatism correction with contact lenses in school-age children, the statistically significant results were recorded after three years of observation, namely: an increase in uncorrected visual acuity by 47% (t=5.2; p<0.01), corrected acuity vision by 8% (t=9.3; p<0.01), the spheroequivalent by 17% (t=3.7; p<0.01), anteroposterior segment of the eye by 4% (t=7,1; p<0.01), amplitude of accommodation by 27% (t=14.6; p<0.01), negative part of relative accommodation by 17% (t=7.3; p<0.01), positive part of relative accommodation by 32% (t=7.1; p<0.01), flexibility of accommodation by 35% (t=14.2; p<0.01), the ratio of accommodation convergence to accommodation by 19% (t=3.4, p<0.01), stereovision acuity by 56% (t=4.1; p<0.01), as well as a decrease in keratometry index in the strong meridian by 2% (t=5.2; p<0.01), delays in accommodative responses by 33% (t=14.2; p <0.01), distance phoria by 16% (t=10.1; p<0.01), near phoria by 16% (t=11.3, p<0.01). Conclusions. The study has shown that the use of contact lenses by school-aged children with myopia and myopic astigmatism can increase uncorrected and maximum corrected visual acuity. The increase of the spheroequivalent and anteroposterior axis (APA) of the eye indicates progression of myopia, but the use of soft contact lenses (SCL) leads to changes of the anterior corneal surface: an increase of the thickness in the central zone, and its flattening. Improvement of accommodation, vergence, disparate parts of the oculomotor apparatus, and their interaction was also observed. The results obtained indicate deceleration of myopia progression.

Хирургическое лечение массивных субмакулярных кровоизлияний при влажной форме возрастной макулодистрофии с автоматизированной субретинальной инъекцией

Purpose. The purpose of the study was to assess the results of the proposed method of surgical treatment of massive subretinal macular hemorrhage in the wet form of age-related macular degeneration. Material and methods. A comparative study of the results of treatment of massive subretinal hemorrhage associated with the exudative AMD-related. 17 patients (17 eyes) were being observed in the clinic with submacular hemorrhages of varying severity, which occurred against the background of exudative AMD-related. The average age of the subjects was 71.47±6.15 years. The maximum corrected visual acuity at the time of admission averaged 0,04±0.03. All patients were previously treated with anti-VEGF therapy, and number intravitreal injections was in the range from 3 to 14. The experience of the disease was 2,35±0,77 years, the prescription of hemorrhage – 5,47±3,55 days. The mean size of the subretinal hemorrhage was 21.41±3.37 DD. According to optical coherence tomography, the average value of retinal thickness in the macular region was 1081,29±389,67 microns. The day before surgery all patients underwent surgical treatment according to the author's method (patent No. 2696056) – intravitreal injection Gemase® 3000 ME, 0,2 ml. The next day was performed vitrectomy 25G, local removal of the ILM and subretinal injection Gemase® 3000 ME – 0.3 ml and 0.2 ml of sterile air, fluid-air exchange 70% of the volume vitreal cavity, intravitreal injection Eylea® 0.05 ml, tamponade of vitreous cavity with 20% SF6. After the operation, the patient was placed «horizontally on the back» for 2 hours, then he had to be in an upright position to move the blood clot to the lower parts of the ocular floor. Results. Intraoperative complications were not observed in any of the cases. A complete dislocation of subretinal hemorrhage from under fovea zone was achieved in every patient's postoperative period. Conclusion. The proposed surgical method provides rapid recovery of subject vision and can be used in the treatment of massive submacular hemorrhages of any etiology. Key words: AMD, submacular hemorrhages, vitrectomy, prourokinase.

Еvaluate the Effectiveness of Accelerated Collagen Crosslinking in the Treatment of Corneal Endothelial Decompensation

The article discusses the effectiveness of accelerated collagen crosslinking in the treatment of patients with corneal diseases, a common basic pathogenetic link of which is endothelial corneal decompensation. This method was used to treat patients with bullous keratopathy and endothelial dystrophy of Fuchs’ cornea with a long postoperative follow-up. In connection with the controversial results of researchers, reflecting the positive dynamics of the postoperative period, the question of the expediency of accelerated collagen cross-linking in patients with this pathology as a monotherapy is discussed.The study included 25 patients (26 eyes) with mean age 69.10 ± 10.61 years (40 to 82 years). There was Fuchs corneal endothelial dystrophy in 16 patients (17 eyes), in 9 patients (10 eyes) — stage II, in 7 patients (7 eyes) — stage III. Bullous keratopathy was present in 9 patients (9 eyes). All patients underwent treatment according to the method of accelerated collagen corneal crosslinking. In patients with bullous keratopathy (9 eyes), the data on the central thickness of the cornea and the maximum corrected visual acuity did not differ from the initial data at any of the postoperative visits, and did not differ from each other (p > 0.83). On the contrary, in some patients the dystrophic process progressed in the form of the appearance of fibrotic changes in the stroma of the cornea. Corneal transplantation was recommended to all patients under observation after treatment at different periods of observation. In patients with Fuchs endothelial dystrophy, a significant difference in the maximum corrected visual acuity from the initial data was observed only 6 months after surgery.The expediency of accelerated collagen cross-linking in the treatment of patients with corneal diseases accompanied by endothelial decompensation as monotherapy is very doubtful. The study of combined surgical methods for treating this complex corneal pathology using cross-linking as an auxiliary method seems promising.

Our Experience of Nutraceutical Effects in Age-Related Macular Degeneration

Purpose: to assess the possibilities of ophthalmonutraceuticals using in age-related macular degeneration (AND) patients.Patients Methods. The study included 35 patients (68.3 ± 6.3 years old; 15 men, 20 women) with AMD (AREDS-2 and AREDS-3 categories). As an ophthalmic nutraceutical, a biological active supplement was used, included vitamins C and E, zinc, lutein, zeaxantine, cooper, selenium (Retinorm; 3 capsules per day with meals). The observation period was 12 months (6 courses of therapy). There were the main control points: examination at study entry and examination at study completion. All those observed patients were underwent standard ophthalmological examination; fundus state photo registration (Nidek); OCT (Opto-Vue). The significance of a possible increase in the proportion of AREDS-3–4 AMD category patients 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. The study was completed in 33 patients. In 2 eyes a transition of AMD from the AREDS-2 to AREDS-3 category was recorded (an increase in the number and size of druses, with the appearance of large druses). The increase in the proportion of patients with the AREDS-3 AMD category was statistically insignificant (γ2 = 0.267; p = 0.606). In no case was there a transition to the AREDS-4 category. In the vast majority of those who completed the study (31 eyes; 93.9 %), the manifestations of AMD were stable, which, taking in account the chosen criterion, allows us to consider nutraceutical support to be affective. MCVA during the observation period also remained stable with a slight, but statistically insignificant tendency to its increase (from 0.72 ± 0.07 to 0.75 ± 0.09; t = 37.5, p > 0.05). One patient was excluded from the study after 6 months of observation due to development of an allergic skin reaction (presumably to the components of a nutraceutical). In the vast majority of patients (97.1%), no significant side effects of therapy were observed, the nutraceutical regimen was comfortable. One more patient was excluded from the study (after 3 months) due to his failure to appear for next follow-up examination.Conclusion. The use of Retinorm ophthalmonutraceutical can stabilize the manifestations of AMD (AREDS-2–3) in 93.9 % of patients with follow-up periods of up to 12 months. Repeated courses of therapy in 97.1 % of patients are not accompanied by significant side effects, and the regimen for taking ophthalmonutraceuticals is characterized by patients as comfortable.

Crosslinking and Fulguration in the Treatment of Acanthamoebic Keratitis

Purpose: to study the combined Photo-Activated Chromophore for Keratitis — Corneal Cross-Linking (PACK-CXL) in combination with fulguration of the infiltration zone in the treatment of medically refractive acanthamoebic keratitis.Patients and methods. The study included 9 patients (10 eyes) with medically refractive acanthamoebic keratitis. The diagnosis was confirmed by confocal microscopy data from a microbiological study of scraping of corneal tissue from the lesion site with Romanovsky-Giemsa stain. All patients underwent combined surgical treatment of PACK-CXL with pre-fulguration. Optical coherence tomography (OCT) of the anterior segment of the eye was also performed using an RTVue-100 apparatus (Optovue USA), determination of visual acuity, photographing before and after surgery.Results. In 6 cases (60 %), a positive effect was noted, relief of the symptoms of the disease and the formation of turbidity within a month after the procedure, as well as an increase in the maximum corrected visual acuity. According in vivo confocal microscopy, 6 months after the intervention, no signs of infection were detected. In 4 cases, the therapeutic effect was absent. Subsequently, 3 patients (3 eyes) underwent therapeutic keratoplasty. In one eye, the infectious process was stopped medically for 6 months.Conclusion. The combined PACK-CXL method together with fulguration can be effective and safe in the treatment of medically refractive acanthamoebic keratitis, allowing keratoplasty to be performed with an optical goal if necessary, after stopping the infection process in a distant period.

Effectiveness of the Cataract Prevention in Patients with Epiretinal Membrane after Vitrectomy

Purpose: tо evaluate effectiveness of cataractogenesis prophylaxis in patients with epiretinal membrane (ERM) after vitrectomy based on the pirenoxin use.Patients and мethods. The study included 72 patients (64.5 ± 6.4 years old; 31 men, 41 women) with ERM before and after 25G microinvasive vitrectomy with removal of ERM. The 1-st group patients (36 eyes) received pirenoxin instillation (Catalin®; 3 times a day, 6 months) in addition to the standard pharmacological support. The 2-nd group patients received only standard therapy. All patients underwent: standard ophthalmologic examination; lens state photoregistration with an assessment of lens opacities intensity (LOCS-III classification) with the calculation of the cataract development index (CDI). These were control points: examination before vitrectomy and 5 months after surgery. At control points, the incidence of lens opacities in the observation groups was also evaluated. Statistical analysis included: calculation of the mean and its standard deviation (M ± s); assessment of the significance of differences in control points with each group (Wilcoxon's T-test) and between groups (Mann—Whitney U-test); Pearson xi-square test.Results: In the 1-st group (pirenoxin instillation), 6 months after vitrectomy and ERM removal, the following indicators were noted: the initial cataract incidence was 5.6 %; CDI — 0.36 ± 0.03 points, increasing the maximum corrected visual acuity (MCVA) from 0.31 ± 0.03 to 0.6 ± 0.05. In the 2-nd group similar indicators significantly differed from the 1-st group data: the initial cataract incidence was 36.1 % (Pearson xi-square test > 3; p < 0.05); CDI — 3.1 ± 0.3 points (p < 0.01); the MCVA increase from 0.3 ± 0.05 to 0.43 ± 0.1 (p < 0.05).Conclusion. Pirenoxin (Catalin®) has demonstrated quite high efficacy in the cataract prevention in patients after vitrectomy with ERM removal.

Frequency of retinal changes in patients with COVID-19: an observational study

In order to enter cells, SARS-CoV-2 virus uses the angiotensin-converting enzyme 2 receptor that is also expressed in retina.Aim.Determination of the frequency and nature of retinal changes, evaluation of visual functions in patients who have got over COVID-19.Materials and methods.This observational research includes 31 patients aged from 28 to 79 that got over COVID-19 (with severity according to computed tomography (CT): 1–3) in the period from 15 to 40 days before the research. Standard ophthalmological examination and optical coherence tomography (OCT) were performed; visual acuity measurement and threshold static perimetry were used to assess visual functions.Results.Pathology of the ocular surface wasn’t detected. Ophthalmoscopy revealed retinal changes in only one patient. At OCT, 27 (87%) patients proved to have de novo changes in the retinal neuroepithelium at the level of the internal plexiform layer and the retinal ganglion cell layer in the form of hyper-reflective polymorphic foci with clear borders; 18 (67%) patients had monocular lesions. The maximum corrected visual acuity didn’t differ from the previously defined one; no violations of retinal light sensitivity were detected. No association was found between the severity of CT lung changes and retinal changes. The detected retinal changes weren’t associated with symptoms of anosmia (hyposmia) and ageusia. OCT repeated after 12–15 days showed no dynamics of hyperreflective foci: they remained unchanged in their shape, echogenicity and size.Conclusion.De novo changes in retinal neuroepithelium at the level of the inner plexiform layer and the retinal ganglion cell layer were detected according to OCT data in 87% of patients who had undergone COVID-19. Anatomical changes in the retina weren’t manifested by functional visual disturbances. There is no association of retinal changes with lesions of I and IX cranial nerve pairs.

Intravitreal Dexamethasone implant injection: Analysis of clinical efficacy and subjective satisfaction of patients with post-thrombotic macular edema

Objective: Analysis of clinical efficacy and subjective satisfaction of patients with post-thrombotic macular edema after intravitreal administration of Ozurdex (dexamethasone).Methods: Thestudy included 33 patients (33 eyes) aged from 51 to 75 years with post-thrombotic macular retinal edema. The results were assessed before the intravitreal implantation, after one day, after a month, and three months later after the surgery.Results: The central retinal thickness significantly decreased on the first day after the surgery remaining almost the same after one and three months. The average retinal thickness had the similar dynamics. The macular volume reduced by 1.5 times in a day after the surgery. The maximum corrected visual acuity gradually increased over the time, remaining on average at the level of 0.5 diopters after one and three months. The subjective evalua‑ tion of quality of life (according to the VF-14 questionnaire) during the observation period progressively increased reaching 47.1 points by the end of the study.Conclusions: The study findings convincingly indicate the clinical efficacy of the intravitreal administration of dexamethasone and the subjective satisfaction of patients with the quality of treatment both in the early and late postoperative periods.

Primary Angle-Closure Glaucoma Due to Cyst of the Ciliary Body. Clinical Case

There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.

Результаты применения интравитреального имплантата дексаметазона Озурдекс для лечения диабетического макулярного отека

Purpose . To evaluate the effectiveness of intravitreal injection of biodegradable intravitreal implant containing dexamethasone (Ozurdex) in patients with resistant diabetic macular edema (DME). Material and methods . The study was conducted of 24 patients with diabetic macular edema resistant to therapy with angiogenesis inhibitors (3-5 intravitreal injections without a positive structural and functional result) on the background of compensated type 2 diabetes mellitus. A biodegradable intravitreal implant containing dexamethasone (Ozurdex) was injected once according to standard method at a dose of 0.7 mg. The follow-up period was 6 months. Results . According to optical coherence tomography of the macular area, within 6 months after intravitreal injection of Ozurdex implant, the retinal thickness in the fovea decreased on average from 558.4 ± 25.1 μm to 188.3 ± 18.4 μm, with partial restoration of the foveolar cavity. The maximum corrected visual acuity increased on average from 0,04±0,01 to 0,3±0,09, intraocular pressure did not exceed 18.0 mm Hg. Conclusion . If the anti-angiogenic therapy of DME is ineffective, the use of the biodegradable intravitreal implant containing dexamethasone (Ozurdex) is considered as an effective treatment method that provides a significant and stable (prolonged) improvement of the structural and functional parameters of the eye in 86,6% cases.

Pharmacoeconomic research of using aflibercept in patients with the wet age-related macular degeneration

Purpose . To evaluate the economic and clinical results of the aflibercept and ranibizumab angiogenesis inhibitors in the treat-and-extend regimen in patients with the “wet” form of age-related macular degeneration (wAMD). Materials and methods . We analyzed cost minimization, impact on the budget and “missed opportunities” for the treatment of patients with wAMD using intravitreal injections (IVI) of aflibercept compared to ranibizumab in the “treat-and-extend” regimen (T & E). Costs were calculated with regard to the budget of the system of compulsory health insurance. To calculate the number of IVI, network meta-analysis data (P. Lanzetta, et al., 2019), including a matching-adjusted indirect comparison of aflibercept and ranibizumab in wAMD patients in the T & E regimen, were taken into account. The budget impact analysis involved a cohort of 1,000 wAMD patients. To assess the stability of the results, a one-factor multicomponent sensitivity analysis was used. Results . Network meta-analysis data showed that aflibercept and ranibizumab used in the T & E regimen revealed comparable changes in the maximum corrected visual acuity; however, the use of aflibercept required a significantly lower (by 6 procedures in two years) number of IVI compared to ranibizumab. Analysis of cost minimization showed that the use of aflibercept can reduce costs by 36 % in two years compared to ranibizumab in the T & E regimen. The use of aflibercept in the T & E regimen with wAMD will reduce the cost of compulsory medical insurance by 281 million rubles in two years of therapy per 1,000 patients. The analysis of “missed opportunities” showed that budget savings of the compulsory medical insurance as a result of transferring 1,000 patients from ranibizumab to aflibercept will allow an additional 563 patients to be treated in two years. A sensitivity analysis confirmed the robustness of the study results. Conclusion . Treating wAMD with aflibercept in the T & E regimen saves a significant part of health protection resources compared to using ranibizumab in the same regimen.

Results of corneal lenticule extraction for correction

The prospective study included 24 patients aged 26.8±4.6 years (24 eyes) who underwent surgeries for moderate and high myopia on the Ziemer LDV Z8 device at the S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery» in January 2020. After correction of moderate and high myopia using the Ziemer LDV Z8 device, patients showed stable improvement in visual acuity one week after surgery, which remained throughout the postoperative period. Dynamic 1-month follow-up of patients operated on the Ziemer LDV Z8 platform for moderate and high myopia showed that the median value of uncorrected visual acuity one week after surgery was 0.9 [0.7; 1.0], and after one month - 1.0 [1.0; 1.0]. Patients operated on the Ziemer LDV Z8 platform had no intra- or postoperative complications, 79.2% of patients also had no loss of maximum corrected visual acuity. The mean corneal thickness before surgery was 555.9±28.2 μm, it significantly decreased to an average value of 464.8±26.9 μm one week after surgery (p<0.05). The cost of tissue was 17 microns per 1 diopter. The obtained results indicate the high effectiveness of the correction of moderate and high myopia using the Ziemer LDV Z8 device.

Modern optimizing techniques of surgical treatment of proliferative diabetic retinopathy

Aim. To evaluate the clinical efficacy of microinvasive vitrectomy and three-dimensional digital imaging in patients with proliferative diabetic retinopathy.&#x0D; Methods. The clinical treatment results were studied in 62 patients (62 eyes) with proliferative diabetic retinopathy complicated by tractional retinal detachment who underwent vitreoretinal surgery with the use of microinvasive techniques and three-dimensional digital imaging. There were 38 (61%) women, 24 (39%) men, mean age 57±5.2 years. The duration of diabetes mellitus was 6 to 13 years (an average of 11.7 years). Of the 62 patients, 11 had insulin-dependent diabetes mellitus, and 51 had non-insulin-dependent diabetes.&#x0D; Results. Final anatomical result (the elimination of the zones of proliferation and adhesion of the retina) was reached in 59/62 (95.1%) of the eyes: in 54/62 (87%) eyes after the first intervention, in 8/62 eyes after additional surgical intervention. The maximum corrected visual acuity increased in 55/62 (88.7%) eyes from 0.01±0.12 to 0.22±0.11 (p &lt;0.05); in 3/62 (4.8%) eyes remained the same; 4/62 (6.5%) eyes had visual impairment. Complications were diagnosed in 14 (22.6%) of the eyes: retinal tears (10), hemophthalmus (2), subchoroid hemorrhage (1), detachment of the choroid (1). Postoperative control of intraocular pressure demonstrated the following: 36 (58.1%) eyes had normal intraocular pressure (11–22 mm Hg), 20 (32.3%) — increased intraocular pressure (≥22 mm Hg), 6 (9.7%) — reduced intraocular pressure (≤10 mm Hg). In the postoperative period (up to 1 month after surgery) additional surgical interventions were performed on 8/62 (12.9%) eyes.&#x0D; Conclusion. In patients with proliferative diabetic retinopathy, the use of microinvasive vitreoretinal technologies and digital imaging system provide high anatomical (95.1% of patients) and functional results (88.7% of patients).

The features of cataract surgery in a patient with Graves’ disease and endocrine ophthalmopathy

After the phacoemulsification technique was implemented in ophthalmic practice surgeries to replace the clouded lens have become routine for ophthalmologists. Today, over half a million phacoemulsification surgeries are annually conducted in Russia. Cataract combined with endocrine ophthalmopathy poses a significant challenge for an operating surgeon because of the unusual anatomical presentation of the orbit and the eyeball, as well as the elevated intraocular pressure caused by edema of the orbital tissues (i.e., retrobulbar tissue and extraocular muscles) rather than by primary glaucoma.&#x0D; We analyze the features of surgical treatment of the cataract involving intraocular lens implantation in a patient with Graves’ disease and endocrine ophthalmopathy complicated by secondary ocular hypertension, optical neuropathy, and lagophthalmos.&#x0D; After restoring the euthyroid state and reducing the severity of endocrine ophthalmopathy, phacoemulsification was performed in both eyes, with an interval of 2 months. Neither intra- nor postoperative complications of the patients’ organ of vision were observed. The maximum corrected visual acuity achieved on both eyes was 0.4–0.5 in the Snellen eye chart.

Early vitrectomy in the case of stage IVA retinopathy of prematurity: pro and contra

Objective. To evaluate the effectiveness and safety of early lens-sparing vitrectomy for the treatment of the children presenting with stage IVa retinopathy of prematurity during the early and late periods after the surgical intervention. Material and methods. We analyzed the results of the early surgical intervention for vitrectomy with synechiae removal in 83children (116 eyes) at the mean age of 40.0 ± 1.8 weeks with stage IVa retinopathy of prematurity with the use of modern methods including electrophysiological techniques. Results. Stabilization of stage retinopathy of prematurity with the complete reattachment of the retina and the elimination of the vascular activity in the fundus have been achieved in 97.4% of the cases (113 eyes). Thirteen patients (15 eyes or 13.3%) turned out to have glaucoma within the first 3 months after the onset of observations. The maximum corrected visual acuity after vitrectomy in the children at the age of 4.0 ± 0.6 averaged 0.34 ± 0.07, the spherical equivalent of myopic refraction was estimated at 9.8 ± 1,5 D. The electrophysiological study has demonstrated the well apparent reduction of electrogenesis in the central portion of the retina especially in the cone cells and the bipolar nuclear cell layer despite the absence of the noticeable ophthalmological changes in the posterior pole of the fundus in the children treated by lens-sparing vitrectomy as well as in the patients presenting with stage IVa retinopathy of prematurity managed given no vitreoretinal surgery. Conclusion. Urgent vitrectomy with synechiae removal durng the acute period of stage IVa of retinopathy of prematurity is an efficacious and pathogenetically substantiated method for the stabilization of this pathology provided the surgical intervention is performed upon the appearance of the very first signs of retinal detachment. However, the increased risk of glaucoma formation after minimally invasive lens-sparing vitrectomy should be taken into consideration. Moreover, the visual acuity remains impaired due to the inhibition of maturation of the retina at stage IVa of retinopathy of prematurity both after vitrectomy with synechiae removal and in the absence of such intervention.