Native Lens Research Articles

Morphofunctional features of the zonular apparatus in complicated cataract

Background. The number of cataract patients in the world reaches 18 million people, and by 2025, it may reach 40 million people. Most authors believe that 50 % of patients have a complicated cataract. Treatment of such patients is an urgent and socially significant problem. Complicated cataract, as a rule, is combined with varying degrees of weakness of ligament apparatus of the lens. It complicates the surgical technique and significantly increases the risk of developing operative and postoperative complications. The diagnosis of hidden disorders of the ligament apparatus is difficult, and some authors (G.E Wenge, A.S. Sarzhevskyi) made attempts to identify them. The proposed methods for calculating the degree of displacement of the lens-iris diaphragm are insufficient to detect disturbed anatomical and topographic relations of the structures of the iridociliary zone. The diagnostic approach to assessing the state of the ligament apparatus of the lens in patients with complicated cataract has not been sufficiently stu­died. So, there is a need to analyze it preoperatively in this cohort, which prompted the initiation of this research. The purpose was to assess the state of the ligament apparatus of the lens in patients with complicated cataract. Materials and methods. A comprehensive ophthalmic examination in the preoperative period was carried out in 83 patients with cataract, 57 (114 eyes) of them had uncomplicated cataract (controls) and 26 (52 eyes) had cataract combined with primary open-angle glaucoma (main group). In addition, the clinical signs of weakness of zonules of Zinn were studied, and also, with the help of A-scan ultrasound, — the biometric parameters of the eye: thickness of the native lens, the anterior chamber depth and the anterior-posterior axis of the eye in the patients’ sitting and lying position, which corresponded to the vertical and horizontal position of the eyeball. To evaluate the position of the lens-iris diaphragm, the anterior chamber depth + half the thickness of the lens were calculated, as well as the Lowe coefficient. Results. Among patients with complicated cataract combined with primary open-angle glaucoma, clinical signs of insufficiency of the ligament apparatus of the lens are detected in 12.5 % of cases, indirect signs — in 42.3 %. A change in the Lowe coefficient for horizontal and vertical positions of the eyeball was not observed in controls, and among patients with complicated cataract, it occurred in 13.1 % of cases. Conclusions. The Lowe coefficient makes it possible to assess the state of the lens-capsular apparatus, the degree of mobility of the lens-iris diaphragm. The difference of the coefficient Lowe in the vertical and horizontal positions of the eyeball above 0.1 characterizes the displacement of the lens-iris diaphragm in complicated cataract and indicates the presence of a hidden subluxation of the lens of the first degree.

TIMELY REFRACTIVE LANCESECTOMY SHOULD BE CONSIDERED AS A PROPHYLACTIC TREATMENT FOR OPENCLOSURE GLAUCOMA IN PATIENTS WITH MULTIPLE CYSTS OF THE IRIDOCILIARY PROCESSES

This article presents a clinical case of bilateral ophthalmic hypertensin a patient at the presbyopic age with cysts of iridocyliary processes. A bilateral lentectomy was carried out with the implant of multifocal IOLs for refractive purposes. To evaluate the сlinico-functional performance of the treatment, an ultrasound biopsy of the anterior segment of the eye was performed and a hydrodynamic assessment was carried out before and after the operation. The remote results of the treatment allow to conclude that timely extraction of native lens can significantly reduce the risk of open-closure glaucoma in patients with cysts of iridocyliary processes.

К вопросу расчета ИОЛ у пациентов с витреоретинальной патологией

Purpose. To estimate the probability of a change in the calculated IOL after microinvasive vitrectomy 25G in patients with operated macular rupture. Methods. A retrospective analysis of patients operated on for a macular rupture with a diameter from 400 microns to 1000 microns was performed. The exclusion criteria were: the axial length of the eye is less than 22.0 mm and more than 26.0 mm, recurrence of previously operated macular ruptures, the presence of concomitant ocular pathology that can affect the final postoperative result (macular degeneration, glaucoma, diabetic and postocclusive retinopathy), the presence of previously performed surgical interventions on the retina. The study involved 64 eyes, of which 34,37 % (22 eyes) with a native lens; 14,06 % (9 eyes) with artifacia before vitrectomy; 6,25 % (4 eyes) vitrectomy with cataract phacoemulsification and IOL implantation and 45,31 % (29 eyes) cataract phacoemulsification with IOL implantation was performed within 4–9 months after primary vitrectomy. These patients were the study group. The comparison parameters are best corrected visual acuity, K1, K2, Ave. K1, Ave. K2, Axis, Ave. K2-K1, axial length of the eye, Ave. axial length of the eye, as well as calculated models of IOL and implantable after vitreoretinal surgery. Results. The change in the optical strength of the IOL occurred in 44,82 %. The change in the IOL model is 37,93 %. The change in the optical strength and model of the IOL is 20,68 %. The change in the optical strength of the previous IOL model is 24,1%. The change in the strong axis of more than 20 ° with the previous IOL parameters is 13,79 %. Only in 27,58 % there were no changes in the calculation of IOL. Conclusion. An individual approach to the calculation and selection of intraocular lenses in patients with vitreoretinal pathology allows implantation of all types of IOLs with maximum patient satisfaction with the functional result. Keywords: biometric indicators, IOL, vitrectomy, cataract, phacoemulsification, keratometry

Возможности использования интраокулярной коррекции со сложной оптикой у пациентов с эпимакулярным фиброзом

Еpimacular fibrosis (EMF) occupies one of the leading positions in the structure of retinal surgical diseases. Vitreoretinal surgeons often face the necessity to perform combined surgical intervention in patients with native lens. Multifocal IOLs and IOLs with complex optics are strongly contraindicated for implantation in patients with macular pathology. However, not so long ago the ophthalmologic world was presented with an innovative method of presbyopia correction using EDOF IOLs (Extended depth-of-focus). Purpose. To study the use of intraocular correction with complex optics in patients with epimacular fibrosis. Material and methods. 14 patients of different genders with clinically significant EMF and initial cataract were included in the study. Patients underwent combined surgery including phacoemulsification (PEK) with implantation of EDOF IOL (Synthesis+ (Cutting Edge), France) and subsequent standard vitrectomy surgery. All patients underwent standard ophthalmologic examination before surgery and one month after surgical treatment. Results and discussion. We found that the distance vision after one month had a significant increase. Determination of IEP at the middle distance also recorded an increase. We recorded a statistically significant increase in the RPE at close distance visometry, which is probably explained by the elimination of central opacity of the own crystalline lens, preventing the ability of clear focusing of vision in the presence of presbyopic refraction. Keywords: epimacular fibrosis, facovitrectomy, EDOF, presbyopia, cataract, IOL

Implantation of a capsular tension ring during cataract surgery attenuates predicted remodeling of the post-surgical lens capsule along the visual axis.

Introduction: Cataract surgery permanently alters the mechanical environment of the lens capsule by placing a hole in the anterior portion and implanting an intraocular lens (IOL) that has a very different geometry from the native lens. We hypothesized that implant configuration and mechanical interactions with the post-surgical lens capsule play a key role in determining long-term fibrotic remodeling. Methods: We developed the first finite element-growth and remodeling (FE-G&R) model of the post-surgical lens capsule to evaluate how implantation of an IOL with and without a capsular tension ring (CTR) impacted evolving lens capsule mechanics and associated fibrosis over time after cataract surgery. Results: Our models predicted that implantation of a CTR with the IOL into the post-surgical lens capsule reduced the mechanical perturbation, thickening, and stiffening along the visual axis in both the remnant anterior and posterior portions compared to implantation of the IOL alone. Discussion: These findings align with patient studies and suggest that implantation of a CTR with the IOL during routine cataract surgery would attenuate the incidence of visually-debilitating capsule fibrosis. Our work demonstrates that use of such modeling techniques has substantial potential to aid in the design of better surgical strategies and implants.

Possibilities of Applying Viscoelastics in Vitreoretinal Surgery

Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange with a Trifocal Intraocular Lens in Patients with Presbyopia.

Refractive lens exchange (RLE) patients represent a unique population with a different baseline and set of expectations compared to their cataract counterparts. Visual outcomes and patient satisfaction following RLE with bilateral implantation of a trifocal intraocular lens (IOL) were assessed in a cohort of patients with presbyopia and without cataract. Charts of patients with presbyopia who underwent femtosecond laser-assisted RLE with bilateral implantation of the PanOptix trifocal IOL (toric and non-toric) at a single-surgeon, private practice center from September 2019 to August 2020 were retrospectively reviewed. Eyes with prior keratorefractive surgery, amblyopia, or underlying pathology were excluded. Primary endpoints included corrected and uncorrected visual acuity at distance (CDVA and UDVA), intermediate (DCIVA and UIVA), and near (DCNVA and UNVA) at 6months. Secondary endpoints included residual refractive error, patient-reported satisfaction, spectacle independence, and visual disturbance profile as assessed by a validated questionnaire at 6months. Seventy-eight eyes of 39 patients (mean age 56 ± 6years; 79% female) were included. Most eyes were hyperopic (mean SE 2.35 ± 1.81). Postoperatively, 100% and 92% of eyes were within ± 1.00D and ± 0.50D of emmetropia, respectively. One hundred percent, 97%, and 97% of patients achieved UDVA, UNVA, and UIVA of logMAR 0.1 or better. Starbursts were the most frequent (67%) and bothersome (41%) visual disturbance cited, but nearly half (41%) of patients rated them as absent or "not bothersome at all." Overall, 77% of patients reported achieving complete spectacle independence with 87% and 90% of patients stating they were satisfied with their vision and would recommend the same procedure to others, respectively. RLE with bilateral implantation of the PanOptix IOL is a safe and effective procedure with good patient satisfaction. Because of their relatively clear native lenses and visually demanding needs compared to their cataract counterparts, surgeons should take extra precautions to counsel RLE patients on the limitations of trifocal technology.

Клинический случай успешного лечения отслойки сетчатки методом пневморетинопексии у пациента, направленного на витрэктомию

Introduction. Pneumoretinopexy is a minimally invasive intervention that allows to provide both anatomical and functional results in cases of uncomplicated retinal detachment. Perpose. To demonstrate the result of surgical treatment of regmatogenic retinal detachment using pneumoretinopexy instead of vitroctomy. Material and methods. Patient A., 52 years old, was urgently admitted to the vitreoretinal department of Moscow City Ophthalmological Center with the diagnosis: Widespread regmatogenic retinal detachment without macular area capture, proliferative vitreoretinopathy state A. Partial vitreous hemorrhage. Phacosclerosis. A pneumoretinopexy operation was performed by making intravitreal injection of C3F8 gas. Results. On the first day after the operation, complete blocking of the rupture under the gas bubble with full fit of the mesh shell was fixed. The boundaries of the field of view were expanded, the veil disappeared. In the laser center, restrictive laser coagulation was performed around the rupture under the gas bubble. Conclusions. The operation was performed under local anesthesia and did not require hightech equipment. Due to the microinvasiveness of the intervention, the patient managed to maintain high visual functions, avoid removal of the native lens and vitreous. Keywords: pneumoretinopexy, retinal detachment, surgical treatment of retinal detachment, gas tamponade, minimally invasive procedure

Effect of epigallocatechin gallate in green tea on preventing lens opacity and αB-crystallin aggregation in rat model of diabetes.

To evaluate the effect of epigallocatechin gallate (EGCG) in preventing lens opacity and the aggregation of lens αB-crystallin in model rats of diabetes mellitus (DM). This experimental study included Wistar rats for DM as in vivo models and divided into 5 groups. The treatment groups were administered EGCG by orally for 20d and were then assessed for their degree of lens opacity with binocular microscope and lens αB-crystallin expression from Western blot analyze. Pearson correlation test and regression analysis on EGCG exposure and final random blood sugar (RBS) obtained a significance level of P<0.05. EGCG exposure can significantly lower RBS with an R 2 of 0.5634 (56.34%). The same analysis on EGCG exposure and the degree of lens opacity obtained a significance level of P<0.05 and increased exposure to EGCG can significantly lower the degree of lens opacity with an R 2 of 0.8577 (85.77%). Correlation analysis between EGCG and the expression of lens αB-crystallin can be concluded that the higher the EGCG exposure administered, the higher the native lens αB-crystallin expression and the lower the aggregate lens αB-crystallin expression. There was also significant effect in which every 1 mg/kg body weight dose of EGCG can increase the native lens αB-crystallin expression by 0.0063 and decrease the aggregate lens αB-crystallin expression by 0.0076. The administration of EGCG at a dose of 300, 600, and 1200 mg shows a significant effect on preventing lens opacity and aggregation of αB-crystallin in diabetic rat models and this research could be a biomolecular prevention of cataract.

Spectrofluorimetric changes in the lens after intravitreal injections of brolucizumab

The study evaluates the changes in spectrofluorometric parameters of the lens after intravitreal injections of brolucizumab in eyes with native lens. The study included 13 people with neovascular age-related macular degeneration (AMD) who received IVI of brolucizumab. All patients were over 40 years old; changes in central retinal thickness in the macular area exceeded 300 μm according to optical coherence tomography. Spectrofluorimetric indicators of the lens were studied before and after injections of the drug in both eyes. The spectra were analyzed in the wavelength range 412-698 nm to record the changes in the content of non-tryptophan fluorophore molecules in the lens. Spectrofluorimetry revealed metabolic changes in the native lens after intravitreal injections of the drug brolucizumab. No such changes were observed in the lens of the eyes not injected with the drug (the «Control» group). The proposed investigation technique involves prospective assessment of the safety of various molecules injected intravitreally in terms of cataract development at various times after the injection. Spectrofluorimetry can be used for identifying initial metabolic changes in the lens. It is a promising method for assessing the molecules used in intravitreal injections in terms of their safety for the native lens, as well as for development of detailed instructions for clinically substantiated use of drugs with adverse effects in the form of cataract induction. According to spectrofluorimetry, IVI of the drug brolucizumab affects metabolic changes in the lens.

Adjusting Intraocular Lens Power for Placement in the Ciliary Sulcus

Cataract surgery is the most commonly performed procedure within the National Health Service (1). In most cases, the intended post-operative visual outcome is emmetropia, which is significantly influenced by the intraocular lens (IOL) power calculated and selected by the surgeon (2). The capsular bag is the preferred position for IOL implantation due to its stability and proximity to the position of the native lens (3). The most common intraoperative complication of cataract surgery is posterior capsular (PC) rupture (1). This is one instance in which placement of the IOL in the ciliary sulcus, rather than the capsular bag, may be necessary, in addition to other situations such as cases of zonular laxity (3). The Royal College of Ophthalmologists state in their cataract guidance that back-up lenses should be available in theatre in case non-capsular bag fixation is required (4).

Methodologies to unlock the molecular expression and cellular structure of ocular lens epithelial cells.

The transparent ocular lens in the anterior chamber of the eye is responsible for fine focusing of light onto the retina. The lens is entirely cellular with bulk of the tissue composed of fiber cells, and the anterior hemisphere of the lens is covered by a monolayer of epithelial cells. Lens epithelial cells are important for maintaining fiber cell homeostasis and for continual growth of the lens tissue throughout life. Cataracts, defined as any opacity in the lens, remain the leading cause of blindness in the world. Following cataract surgery, lens epithelial cells can undergo a process of epithelial-to-mesenchymal transition (EMT), leading to secondary cataracts due to posterior capsular opacification (PCO). Since the epithelial cells make up only a small fraction of the lens, specialized techniques are required to study lens epithelial cell biology and pathology. Studies using native lens epithelial cells often require pooling of samples to obtain enough cells to make sufficient samples for traditional molecular biology techniques. Here, we provide detailed protocols that enable the study of native mouse lens epithelial cells, including immunostaining of the native lens epithelium in flat mounts, extraction of RNA and proteins from pairs of lens epithelial monolayers, and isolation of lens epithelial cells for primary culture. These protocols will enable researchers to gain better insight on representative molecular expression and cellular structure of lens epithelial cells. We also provide comparative data between native, primary culture, and immortalized lens epithelial cells and discuss the advantages and disadvantages of each technique presented.

Оценка функциональных результатов лечения пациентов с различными хирургическими подходами удаления хрусталика при регматогенной отслойке сетчатки

Currently, the most popular treatment for retinal detachment is microinvasive vitrectomy with vitreous cavity tamponade. Often, surgical intervention in the posterior segment is preceded by the removal of the lens with intraocular lens implantation. However, when there is the absence of opacities in the lens in a young patient, another surgical tactic – the preservation of the native lens and the implementation of delayed phacoemulsification can be used. In the present study, we compared two groups of patients who were treated for rhegmatogenous retinal detachment with simultaneous removal of the lens and two-stage treatment with preservation of the native lens at the first stage of treatment. The comparison was carried out on quantitative and qualitative features. Quantitative features included: age of the patient; value of the anterior-posterior axis of the eye (APO); BCVA value before surgery and in the early postoperative period (from 1 to 3 months after surgery). Qualitative features included: detachment age (up to a month; 1–3 months; more than 3 months); macula capture (presence, absence); tactics of lens surgery (combined operation (single-stage) or combined (two-stage treatment). According to the results of the retrospective analysis, it was found that patients of the compared groups differed significantly only in the value of BCVA before surgery. However, despite the absence of significant differences between the compared groups in terms of qualitative features, it should be assumed that the decrease in the value of BCVA in patients of the second group is more related to the age of retinal detachment. Concerning the lack of a statistically significant relationship between the dynamics of BCVA and the tactics of cataract surgery, it should be assumed that both approaches to patient management take place in practical ophthalmology. Keywords: retinal detachment, cataract, combined operations.

Through a Native Lens: American Indian Photography by Nicole Dawn Strathman

Reviewed by: Through a Native Lens: American Indian Photography by Nicole Dawn Strathman Audrey Goodman (bio) Through a Native Lens: American Indian Photography by Nicole Dawn Strathman University of Oklahoma Press, 2020 THROUGH A NATIVE LENS DEMONSTRATES the many ways that Native people in North America practiced photography, participated in image production and exchange, and integrated photographs into their communities. By design, it is not a comprehensive study. Instead, it offers a selective, well-paced overview of situations, practices, and interpretations of images made of Native subjects and/or by Native photographers between 1840 and 1940. It presents a clear critical framework or "rubric" for approaching both familiar and archival images, and the extensive illustrations in the book complicate and enrich existing published records and recent museum exhibitions. Rather than delve into the politics of repatriation, develop a sustained theoretical argument, or explore in detail the ongoing social lives of the images, the book realizes the value of the author's extensive archival research by concentrating on the conditions and contexts of image production. Strathman examines in detail how Indian subjects crafted their public personas and identities on many scales. With its wide range of visual materials, appealing design, high-quality reproductions, and clear structure, this informative and well-researched book is a pleasure to view and read. Strathman worked extensively in state, territorial, and tribal archives, including the Autry National Center's Braun Research Library, the National Anthropological Archives, the Oklahoma Historical Society, the American Heritage Center, the University of Wyoming, the Yukon Archives, and the Cherokee National Archives. The book shares her discoveries through narrative sketches of each photographer's experience. Divided into two parts, "Native Participants" and "Native Practitioners," the book distinguishes between the agency exercised by subjects and that exercised by creators. Within those parts, each chapter assembles topics, figures, and visual materials according to the degree of the subject's public notoriety or the photographer's professional expertise. It reports on the origin and status of each archival collection and invites readers to view, interpret, and delight in the array of photographs on display. The book contends that Native subjects and photographers "used photography to assert their right of self-representation," whether through small [End Page 154] gestures of resistance visible in the photographs themselves, negotiations for payment, or running a successful studio (179). Part I advances this claim through discussions of leaders such as Red Cloud (Oglala), the Hawaiian royal family, and Sarah Winnemucca (Paiute), each of whom used portrait photography to craft political strategies and public personas. Other examples reveal how Native people negotiated with non-Native photographers to control the production and circulation of images: at times they restricted the events that outsiders could photograph, or adapted rituals to make only secular elements visible, or chose whether to admit a photographer to witness and record family life. While many of the images reproduced in this section will be familiar to readers, they continue to command attention and have a cumulative power. The most original and rewarding chapters of the book are found in Part II, where Strathman explores a broad cross-section of practices by semi-professional and amateur Native photographers: visual ethnographers and collectors such as Louis Shotridge (Yeilgooxu); Bureau of Indian Affairs employee Richard Throssel (Crow/Scottish/adopted Cree); Benjamin Haldane (Tsimshian), owner of a photography studio in Metlakatla, Alaska; Jennie Ross Cobb (Cherokee), whose archive flaunts the confidence, independence, and personal style of young Cherokee women during the Progressive era; and George Hunt (Tlingit/British), whose snapshots convey the Tlingit community's pride in hunting and other rituals. For each, Strathman deftly assesses the archive, probes the limits of the historical record, teases out stylistic and rhetorical contrasts between the Native photographers and their mentors, and summarizes the political, commercial, and cultural pressures of each location and moment. Through a Native Lens is a fascinating and beautifully produced record of Native photography as a diverse enterprise. As Strathman writes in the conclusion, "There is no single Native American way of practicing photography but, instead, multiple photographies" (177). The study is a substantial contribution to recent and ongoing appraisals and revisions of Native photographic histories by a diverse group of...

Nicole Dawn Strathman. Through a Native Lens: American Indian Photography; Mick Gidley. The Grass Shall Grow: Helen Post Photographs the Native American West.

N<scp>icole</scp> D<scp>awn</scp> S<scp>trathman</scp>. <i>Through a Native Lens: American Indian Photography</i>; <scp>Mick Gidley</scp>. <i>The Grass Shall Grow: Helen Post Photographs the Native American West</i>.

Film and Video Review

Film and Video Review

A Clinical Case of Two-Stage Visual-Functional Rehabilitation of a Patient with Postinfectious Central Corneal Opacity in Combination with Mixed Astigmatism Using Laser Keratorefractive Surgery

Introduction: to evaluate the clinical and functional results of two-stage treatment in a patient with post-infectious Central corneal opacity combined with mixed astigmatism.Patient and methods. Patient N., 19 years old with postinfectious (postherpetic) Central corneal opacity, mixed astigmatism was examined and operated using two-stage corneal laser treatment. To determine the possibility of surgical treatment of the patient, a complex of General ophthalmology was performed (checking visual acuity near and far in natural conditions and in conditions of drug-induced mydriasis, IOP measurement, autorefractometry, examination of visual fields, A- and Bscanning, ophthalmoscopy with examination of the Central and peripheral areas of the fundus), as well as special (keratopography and Scheimpflug camera examination, optical coherence tomography (OCT) of the anterior segment of the eye with analysis of the epithelial map, quantitative assessment (Schirmer test-1) and qualitative (tear film rupture time) lachrymal products, assessment of the epithelium state when stained with vital dyes and infrared meibography) research methods. To determine the activity of herpetic infection, PCR diagnostics were performed. The follow-up period was 2 years.Results and discussion. To achieve high visual-functional rehabilitation while preserving the native lens, a two-stage treatment algorithm was developed using technologies of laser corneal refractive surgery. At the first stage, in order to regularize the ocular surface and eliminate Central corneal opacity, an inverted topographically oriented PRK was performed; at the second stage, residual refractive errors were corrected using topographically oriented FemtoLASIK technology.Conclusion. According to the results of a literature search and analysis of Internet resources, there were no previously recorded and published works using a similar two-stage method. Therefore, the described clinical case justifies the relevance and novelty of the goal and has an evidence-based Foundation for the use of a two-stage laser keratorefractive treatment system in the ophthalmological practice of visual and functional rehabilitation of patients with Central corneal opacity in combination with mixed astigmatism or hypermetropic refraction. The two-year postoperative follow-up period showed stable and high visual-functional results with no recurrence of the inflammatory process.

Composite drainage in glaucoma surgery

PURPOSE. To assess the hypotensive effectiveness, frequency and nature of intra- and postoperative complications in patients with various clinical manifestations of refractory glaucoma.MATERIALS AND METHODS. The study included 196 patients (196 eyes) with various forms, stages and clinical manifestations of glaucoma. There were 142 patients with primary glaucoma, among them 120 with open-angle glaucoma and 22 with angle-closure glaucoma. Among the patients with primary glaucoma, 85 had pseudophakia (77 with openangle and 8 with angle-closure forms); 57 had a native lens (43 with open-angle and 14 with angle-closure forms of the disease). Secondary glaucoma was presented mainly by patients with neovascular (21) and postuveal (16) glaucoma. The intraocular pressure (IOP) level in the group as a whole ranged from 16 to 50 mm Hg (on average 30.1±2.6 mm Hg). In all presented cases of surgical intervention, the Glautex drainage was used, which is a bioresorbable composite biomaterial based on polylactic acid (polylactide) and polyethylene glycol (manufactured by “HiBiTech”, Russia). Standard methods of patient examination were used. RESULTS.In patients with POAG, the IOP averaged 13.7± 4.7 mm Hg one week after surgery and 16.1±3 mm Hg 12 months after surgery. The absolute success of the operation was noted in 71 patients with POAG (59.2%); the relative hypotensive effect — in 85.8%. In primary angle-closure glaucoma, the same indicators were 47.6 and 61.1%, respectively. In the group of patients with neovascular and postuveal glaucoma, the hypotensive effect was as expected lower and amounted to 42.8 and 50.0%, respectively. The restart of therapy at different periods of observation was done in 78.3%. Complications, their frequency and nature, noted by us in the operated patients, could be attributed to those typical for fistulizing operations in refractory glaucoma. The most common complication was ciliochoroidal detachment, which was seen in all groups, but percentage-wise was more common in patients with PACG, neovascular and postuveal glaucoma.CONCLUSION. Composite drainage based on polylactic acid (polylactide) and polyethylene glycol (glautex) is an effective and safe solution to the issue of surgical treatment of glaucoma. The antihypertensive effectiveness of the Glautex drainage implant depends on the severity of the glaucomatous process and the timeliness of the surgical intervention. The frequency and nature of complications depends on the degree of refractoriness of glaucoma, initial clinical characteristics of the process, and patients' multimorbidity.

Through a Native Lens: American Indian Photography. By Nicole Dawn Strathman

<i>Through a Native Lens: American Indian Photography</i>. By Nicole Dawn Strathman

There and Back Again: A Commentary on Social Welfare Policy in the Wake of 2020

There and Back Again: A Commentary on Social Welfare Policy in the Wake of 2020