Home – Home – Jornals – Siberian Scientific Medical Journal 2018 number 5

Purpose: to study the content of proinflammatory cytokines IL-6, IL-8 and IL-17 in lacrimal and intraocular fluid in patients with advanced stage of primary open-angle glaucoma. Material and methods. The study included 56 patients with advanced stage diagnosis of primary open-angle glaucoma (POAG). The diagnosis was determined by ophthalmological examination, including visual acuity, binocular ophthalmoscopy, spheroperimetry, echoophthalmography, optical coherence tomography, intraocular pressure measurement. The number of men was 21 (37.5 %), women - 35 (62.5 %), the average age of patients was 62.8 ± 4.3 years. Exclusion criteria were acute and exacerbation of chronic inflammatory diseases of the organ of vision, diabetic retinopathy, neovascular glaucoma, uveitis, hemophthalmia, autoimmune and tumor processes of any localization, as well as acute and exacerbations of chronic inflammatory diseases of any organs and systems. Patients who took drugs containing prostaglandins analogues for intraocular pressure normalization, that could activate the inflammatory process, were excluded from the study. A comparison group was composed of 30 patients with the uncomplicated cataract diagnosis. All patients underwent the determination of IL-6, IL-8, IL-17 in the lacrimal and intraocular fluid. Results. It has been established that the significant increase in the concentrations of IL-6, IL-8 and IL-17A in the lacrimal and intraocular fluid was revealed in patients with advanced stage of POAG in comparison with those obtained in patients with uncomplicated cataracts. The obtained data testify to the presence of local destructive-inflammatory process in the mechanisms of the development of primary open-angle glaucoma. The revealed unidirectional change in the concentrations of IL-6 (2.8 times the lacrimal fluid and 5.2 times in the intraocular fluid), IL-8 (1.5 times in the lacrimal fluid and 4 times in the aqueous humor), IL-17 (1.75 times in lacrimal fluid and 1.95 times in the intraocular fluid) allows us to conclude that lacrimal fluid can be used to assess changes in cytokine content in the pathogenesis of ophthalmic diseases.

Apart from already established clinical factors, the polymorphic loci of the VEGF gene and its VEGFR2 receptor can have a significant effect on the response to anti-VEGF therapy of diabetic macular edema. The aim was to study the association of single nucleotide polymorphic loci of VEGF and VEGFR2 genes, as well as functional and anatomical parameters with response to ranibizumab therapy in patients with diabetic macular edema. Material and methods. The study includes 145 patients (145 eyes) with diabetic macular edema. All the patients are divided into 2 groups: a positive response (A) and no response to angiogenic therapy (B). The positive response (group A) was the presence of a reduction of at least 10 % of the foveolar thickness (FT) from the baseline according to the OST data. In addition, the response category was assessed: a good response (A1): a reduction in FT by more than 25 %, and an increase in MCHO by more than 5 letters of ETDRS and a poor response (group A2): a reduction in FT of 10-25 % and an increase in MCRI by less than 5 letters ETDRS. Genomic DNA was selected from leukocytes in venous blood, genotyping was performed by real-time PCR using probes of hydrolysing samples. Results. 45 (33.6 %) patients demonstrated a good response (group A1) to therapy and 89 (66.4 %) had a «bad» response (group A2). In group A1, the decrease in FT occurred on average by 25.61 %, the increase in MHC was 0.21 ± 0.07, while in group A2, the visual acuity increased by 0.05, with the thickness of the retina reduction by 74.1 μm (19, 5 %). Rs3025039 of the VEGFA gene is associated with the change in PTC ( p = 0.02). The decrease in the volume of the macula is associated with the allele C rs2010963 of the VEGFA gene ( p = 0.03). For the carriers of the T allele, the locus rs3025039 of the VEGFA gene, on the contrary, shows a lower value of the decrease in the volume of the macula ( p = 0.03). The patients with the T / T genotype of the polymorphic locus rs3025039 of the VEGFA gene statistically respond to anti-VEGF therapy significantly worse.

Purpose: to modify the calculated parameters of the refractive operation - extraction of the lenticle through small access (Smile), evaluate its safety and clinical effectiveness in correcting high-grade myopia. Material and methods. 34 patients (68 eyes) were operated by the modified Smile technology under local anesthesia. In all cases, patients had a high degree of myopia, in 37 % - in combination with astigmatism. Uncorrected visual acuity before surgery was on average 0.05 ± 0.11, Best corrected visual acuity was 0.94 ± 0.1, preoperative spherical refractive component -7.23 ± 0.75, cylindrical component -0.48 ± 0.59. During the surgery, in order to obtain the maximum possible refractive result according to the proposed method (patent No. 2018113414 of April 13, 2013), the standard parameters of the operation were changed: the thickness of the corneal flap was reduced to 100 μm, the neutral optical layer was 5 μm, the diameter of the optical zone depended on the residual thickness of the cornea, which should exceed 290 microns. The increase in corneal access was 15-20 degrees. Results. During the surgical intervention and in the postoperative period there were no complications. The next day after surgery, monocular uncorrected visual acuity in the distance in 73 % of patients was 0.8 and above, and in 41 % of cases it was equal to or exceeded 1.0. The spherical equivalent in the first day after the operation had a small hypermetropic shift, which was completely leveled by the year of observation. Conclusion. Using the proposed algorithm for calculating the refractive effect of the SMILE operation in high degree myopia allows obtaining a high refractive effect and avoiding possible complications.

Purpose: to study the etiological structure and incidence rate of various genesis optical neuropathies (ON) according to the own observation data. Material and methods. The study is based on the data analysis from a survey of 658 patients (982 eyes) with ON. The results of routine physical examination of all patients were analyzed to determine the genesis of ON. Results. The most common cases of ON were ischemic ON (31.2 % of all cases), as well as optic neuritis (18.3 % of cases). The anterior optic pathway tumor or infiltrative lesions were detected in 9.9 %, dysthyroid ON was found in 7.2 %. Acute and chronic ON with the optic nerve drusen accounted for 12.4 % of all cases of ON, was found in 60.5 % of all patients with the optic nerve drusen. Hereditary ON was found in 10 % of all cases of ON, toxic - in 4,3 % as a result of acute and chronic alcohol intoxication, chronic narcotic poisoning, drug poisoning. Traumatic ON was found in 6.7 % of all cases of ON. Conclusions. The causes of ON are diverse, vary from innate changes to diseases of the optic nerve as a result of serious therapeutic and neurosurgical pathology, which threaten not only the ophthalmologic, but also the life prediction. The patient thorough clinical study is required to determine the disease genesis at the time of ON symptoms identifying.

The study aim was to investigate structural peculiarities of sclera in different types of glaucoma, with an accent on changes of the eye drainage system. Materials and methods. Comparative descriptive case-control study of 103 patients (206 eyes) with different glaucoma types has been carried out: primary congenital glaucoma - 8 people, juvenile open-angle glaucoma - 10, primary open-angle glaucoma - 24, pseudoexfoliative - 35, pigmentary - 4, angle-closure -22. A pathomorphological study of 103 surgical scleral specimens has been conducted. Results. Distinctive changes of eye drainage system connective tissue were revealed according to the glaucoma type. Congenital glaucoma is characterized by an abundance of collector channels, a quantity of matrix-producing cells and explicit hydrophilic fiber compartment of sclera. Angle-closure glaucoma is defined by aseptic inflammation with polymorphic perivascular cell infiltrate and edema of eye drainage system endothelium as well. Structural equivalents of a long-lasting dystrophic process with a gradual destruction and reduction of cell elements are distinguishing features of primary open-angle glaucoma. Different glaucoma types vary in the explicitly and location of pigment imbibition of the drainage system components. Conclusion. Stereotypical and specific changes of eye drainage system were revealed in pathomorphogenesis of different types of glaucoma. These features determine the universal character and polymorphism of clinical aspects of glaucoma.

The purpose of the study was to evaluate the features of hemodynamics in patients with intraocular pressure (IOP) fluctuations, to reveal differential diagnostic criteria for adequate monitoring of glaucoma course according to optical coherence tomography (OCT) with the function of angiography. Material and methods. 25 patients (25 eyes) with hypertensive POAG were examined. The study included OCT of the retina and optic disk with the function of angiography. Patients of the clinical group underwent a non-penetrating fistulizing operation followed by laser goniopuncture. The examination was performed before the operation, in the early postoperative period, 1 and 3 months after the surgical intervention. The control group was 12 people (24 eyes) without ophthalmic pathology of the corresponding age and sex. Results and discussion. The obtained results testify to the role of regional hemodynamics in the formation of glaucoma neuroopticopathy. The revealed hemodynamic disturbances in the form of the decrease in the thickness of the choroid, decrease in the density of the radial peripapillary, superficial vascular plexus, and the corresponding glaucomatous changes in the optic disk, the layer of nerve fibers and the ganglionic retina complex, allow speaking about hypoperfusion caused by the decrease in the metabolic needs of atrophied tissue. Surgical interventions used in the treatment of patients with glaucoma lead to an improvement in blood flow parameters. Retinal and choroidal vessels respond differently to intraocular pressure fluctuations, which indicate different mechanism of adaptation of the eye’s vascular system in response to the change in the ophthalmotonus. In this connection, the question arises of the need to determine the individual intraocular pressure.

Traditional surgery of cataract in pseudoexfoliation syndrome (PEX) can be excessively aggressive and increase zonular instability. The main technological target of this surgery is reducing of a zonular stress at all stages and especially when removing the lens nucleus. Purpose was to develop an effective and safe technique for nucleus removal without rotating crystalline lens during phacoemulsification in PEX. Material and methods. 765 eyes with PEX were treated by phacoemulsification without nuclear rotation using original technique. The left paracentral oblique groove was made after capsulotomy and hydrodissection. Nucleus was divided by phaco tip and chopper. In right heminucleus a lateral deep groove was performed such way to create a big asymmetric wedge including central part of nucleus. This wedge was removed without rude manipulation and rotation. The remaining two peripheral segments were easily gripped and pull into pupil area for safe phacoemulsification. Results. In all cases this technique allowed for safe removing of the nucleus. Cataract surgery was finished without serious intraoperative complications. Conclusion. This method allows reducing intraoperative zonular stress and removing all nucleus fragments in the conditions of limited mydriasis at the maximum distance from the corneal endothelium. The rotationless technology of nucleous removal is effective and safe at cataract in PEX.

Research objective was to study the changes of intraocular pressure (IOP) in the postoperative period after a fistulizing antiglaucomatous operation by measurement with the method of a bidirectional cornea pneumoapplanation. Material and methods. Clinical trial was performed on the sampling from 50 patients (50 eyes) underwent antiglaucomatous operation - a trabeculectomy with basal iridectomy. The research by means of the biomechanical Ocular Response Analyzer was carried out before operation, in 1-2 months and in 6-12 months. The control group was made of 100 patients (100 eyes) with glaucoma against the background of hypotensive therapy. Results and discussion. The surgical glaucoma treatment led to IOP depression and normalization in all cases of research group. Level of the corneal compensated IOP before operation was in the range from 19.3 to 34.3 mmHg. The glaucoma surgical treatment led to the corneal compensated IOP expressed depression on average on 8.5 mmHg (34 % of initial). The augmentation of this indicator on average on 1,4 mmHg was revealed in the remote period. The corneal compensated IOP in this situation is more important indicator from the prognostic point of view. The revealed difference of IOP is similar to a tonometry according to Goldman emphasizes high probability of mistakes in this group of patients. Important feature of cornea bidirectional application is the possibility of the corneogram analysis and estimating the quality of IOP measurement.

Aim: to demonstrate the benefit of individual normal range of intraocular pressure (inIOP) in early glaucoma diagnostics. Material and methods. The study included 40 patients (40 eyes) without established glaucoma diagnosis, no hypotensive regimen and average IOP level corresponding with the typical norm of ≤ 21 mm Hg, but at the same time exceeding inIOP level of ≤ 13.4 ± 4.1 mm Hg. All patients underwent visometry, biomicroscopy, tonometry, inIOP calculation, standard automated perimetry, retinal tomography. Follow-up period was 12 months. Results and discussion. At the baseline examination we revealed glaucomatous changes of morphofunctional parameters. After IOP level reduction to correspond with the individual normal range, all parameters were stabilized and showed no progression during the follow-up period. Conclusion. The method of individual normal range of intraocular pressure calculation may prove to be beneficial for early glaucoma diagnostics, as well as treatment tactics assessment.

The effectiveness of topical application of various drugs in ophthalmology is no more than 3 % due to the presence of anatomical and physiological barriers. The therapeutic effect accomplishment is possible with increasing concentration or multiplicity of drug use. The article presents the results of the development of a new type of therapeutic contact lens for the deposition of medications in order to shorten the periods of treatment and to obtain a result without repeated manipulation. The quantitative evaluation of the drug content in the lens is given. The dynamics of the release of the drug substance from the lens was determined by the method of spectrometry. Practically complete elimination of the drug from the soft contact lens (SCL) depot (both on the outer and inner surfaces of the lens) is observed on the 13-14 day. With the help of the chromatography method, the absence of drug diffusion from saturated SCL during storage in buffer solutions was proved. The design features of the lens: a depot with a drug on the external and / or internal surface of the therapeutic SCL allow for a dosed and directed effect on various structural components of the oculer surface. The presence of a transparent optical center allows maintaining high visual functions. If it is necessary to prolong therapy, it is possible to re-saturate the same SCL with a drug substance.

Purpose of the study was to assess the spectrum of molecular genetic disorders and the variety of clinical forms in patients with Stargardt disease. Material and methods. 56 patients aged 15-44 years who had been diagnosed with Stargardt disease in a history or at the time of the examination were included in the study. All patients underwent standard complete ophthalmic examination, as well as high-performance parallel sequencing of the coding sequences and adjacent areas of the introns of the ABCA4, ELOVL4, PROM1 and CNGB3 genes, as well as of the minor exons of the ABCA4 gene. Results. Mutations in one of 4 genes ( ABCA4, ELOVL4, PROM1 and CNGB3 ) were detected in 46 of 56 patients (82.1 %). An inverse correlation was found between the duration of the disease and the loss of visual acuity per year for the three groups ( k = -0.86, k = -0.93, k = -0.63, p < 0.05, respectively, with the debut of the Stargardt disease at 10 year, 11-30 year and > 31 year). A frequent mutation of the ABCA4 gene, p.G1961E was detected in 18 patients and in 83 % of cases (15 patients) is associated with a mild course of Stargardt disease. Complex mutation [p.L541P, p.A1038V] was detected in 17 patients, in 53 % (9 people) of cases was associated with more severe phenotype. However, in the compound heterozygous state with the missense mutation p.G1961E, a relatively mild course of the disease was observed. Conclusions. The loss of visual functions in Stargardt disease depends on the severity of the genetic defect in each case and on the disease’s duration in general.

Purpose of the study was to evaluate the influence of the spheropalatine blockade on the state of redox potential in the surgical treatment of congenital cataract in children. Materials and methods. A prospective, nonrandomized study included 52 patients who underwent planned surgery. The first group ( n = 26) included patients underwent anesthesia based on sevorane in combination with spheropalatine blockade as a regional component; a distinctive feature of 2nd group ( n = 28) was the implementation of a retrobulbar blockade as a regional component. The integral index in the form of the redox coefficient (FORD / FORT) before and after operation was estimated. The characteristic of heart rate variability in the frequency domain with the analysis of low frequency / high frequency parameters and the stress index of autonomic system was studied. Results and discussion. The obtained results convincingly show that the use of the spheropalatine blockade is accompanied by adequate antinociceptive protection of the body at the stage of the operative intervention and in the early postoperative period. The positive effect of prolonged regional analgesia is due to blockade not only of nociceptive pathways, but also of sympathetic innervation due to the effect on the periarterial sympathetic plexus of the internal carotid artery. The antioxidative and antinociceptive efficacy of the spheropalatine blockade is consistent with the positive dynamics of clinical indices. Thus, spheropalatine blockade in the surgery of congenital cataract in children is not only a method of postoperative analgesia, but also a therapeutic factor that has a significant positive effect on the outcome of surgical treatment in general.

The problem of development and course of retinal venous occlusions (RVO) is relevant for today. The etiology of development of the RVO is multifaceted, and has not been fully studied. One of the main reasons for the decline in vision is the development of macular edema. The main problem in the treatment of macular edema is the difficulty in predicting increased visual acuity when disease is combined with retinal ischemia. One of the risk factors for the development of ischemia is endothelial dysfunction, whose important markers are endothelin-1 and hypoxia-inducible factors (HIF1α, HIF2α). Aim of the study was to evaluate the effect of the systemic level of endothelin-1 and hypoxia factors on the course of retinal venous occlusions. Material and methods. Content of the main markers of endothelial dysfunction (endothelin-1, HIF1α, HIF2α) was measured in 137 patients with RVO, among them 59 patients with central retinal vein occlusion and 78 - with central retinal vein branch occlusion. The average age of the patients was 73.35 ± 7.6 years. The level of markers of endothelial dysfunction was determined in serum by ELISA. Results and discussion. A statistically significant increase in endothelin-1 content in patients with optic nerve edema ( p = 0.018) was found. There were no statistically significant data on the effect on the course of the RVO of hypoxia factors HIF1 α and HIF2 α. Conclusion. Assessment of main markers indices of endothelial dysfunction can be used for understanding the etiology of RVO development and the correct tactics of the patients’ treatment forming.

Nowadays age-related macular degeneration (AMD) and glaucoma are the main causes of the irreversible loss of sight in the developed countries. The analysis of 5000 of out-patient records of senior patients (over 50 years) has revealed glaucoma in 30.3 %, AMD in 37.94 %, and their combination in 20.3 % cases. In AMD, the structure signs of the dry form of the disease are diagnosed in 74 % of the cases, the geographical atrophy in 12 % and the wet atrophy - in 14 %. Primary open-angle glaucoma reduces risk of the wet AMD development while the tendency of early formation of the geographical atrophy of the retina increases and the share of the patients with the wet form goes down to 7 %. The article is intended to scrutinize the main pathogenetic mechanisms of the development of the diseases. Distinctions in the quantitative and qualitative components of biomarkers of the oxidative stress, endothelial dysfunction and inflammation are analysed as predictors of the start and development of comorbid pathology. This allows to identify the risk groups and therapy prospects. The vascular theory of pathogenesis related to the reduction of the perfusion of the head of the optic nerve, retina and chorioidea defines the diagnostic importance of the layer thickness parameters of the peripapillar nervous fibers and ganglion cell in differential diagnostics of this pathology. Application of anti-VEGF to patients with AMD and glaucoma is harmless and does not significantly influence the level of intraocular pressure and intraocular blood circulation. However, it requires careful monitoring of dynamics of the visual-functional and structural changes of the retina and optic nerve, as well as timely therapy correction. A combined course of the diseases with neurodegenerative nature of lesion leads to decrease of not only visual, but also cognitive functions, significantly influences of the senior age group patients’ quality of life and their adaptation in society.

Research purpose was to study the presence and local levels of inflammation markers (cytokines) in the anterior chamber and blood in patients with penetrating corneal wound. Material and methods. Thirty patients aged 24-55 years (mean age 31.2 ± 0.34 years) with penetrating corneal wound for 1-2 days from the moment of trauma were examined. The control group consisted of 30 patients aged 38-55 years (mean age 43.9 ± 0.21 years) hospitalized for surgical treatment - phacoemulsification of cataract without concomitant pathology. Anterior chamber aqueous humor sampling was made in all patients: in the experimental group during the primary surgical debridement of cornea penetrating wound, in the control group - during the phacoemulsification of cataract. Peripheral blood sampling also was made just before the operation. IL-1β, IL-1Ra, IL-4, IL-6, IFN-α, TNF-α levels, measured by EIA, and the expression of the herpes viruses (cytomegalovirus and herpes simplex virus I and II), measured by PCR, were studied. Results and discussion. The study showed that all the investigated cytokines were in the blood and in the AC aqueous humor of examined patients. High concentration of IL-1Ra, IL-1β, TNF-a и IL-4 was in the experimental group, as compared to control group. Systemic innate immunity was activated in the experimental group and was significantly higher in the C-reactive protein index in patients of the experimental group as compared to control group. Conclusion. An acute period of eye injury is accompanied by a local and systemic increase in proinflammatory and anti-inflammatory cytokines, which indicates an imbalance in the regulation of immune inflammation, as the basis for the implementation of immuno-inflammatory complications.

The purpose of the work is to evaluate the characteristics of primary posttraumatic eyeball removal in the adult population of the Krasnoyarsk Territory. Material and methods. The analysis of 87 patients’ medical documents from the Krasnoyarsk Regional Ophthalmologic Clinical Hospital has been carried out since 2003 till 2016; the primary posttraumatic eyeball removal was performed. Gender, age, place of residence, social and labor status of patients, the type and nature of the injuries that caused the eyeball removal as a primary surgical intervention have been taken into account. Results and discussion. Between 2003-2016 the proportion of primary posttraumatic removal of the eyeball was ranged from 9 % to 42.9 % of all eye removal procedures due to trauma., Their were 73 (83.9 %) men and 14 (16.1 %) women among 87 patients aged 18-88 years. Distribution by social status came up to unemployed citizens (48.3 %), officially employed - 28.8 % and pensioners - 22.9 %. Home accident trauma was more common (68.9 % of cases), criminal (24.1 %) and industrial (6.9 %) injuries were less often. The period from the eye injury moment till its removal was 0-90 days. The main causes of primary posttraumatic eye removal were eyeball destruction in 65.5 % of cases, panophthalmia was in 19.6 %, eye painful subatrophy - in 14.9 % of cases. Conclusion. Primary posttraumatic eyeball removal can be considered as a model of the entire population of post-traumatic enucleations. Specific gravity (23.9 %), increase in the frequency of primary post-traumatic eyeball removal can influence on the waiting time for traumatic enucleation in general. In the overwhelming number of injured patients, the primary removal of the eyeball is the consequence of the injury severity, in 34.5 % of cases it is due to the imperfection of medical care at various stages of its delivery.

In recent years, the approaches to assessing results have been changed in both clinical and real life trials with the introduction of Aflibercept to clinical practice. In most countries, ranibizumab and aflibercept are licensed for the treatment of neovascular age-related macular degeneration (AMD). The assessment of the treatment effectiveness and economic cost was carried out within the frame of different clinical trials with existing strict limitations. The article reviews the results of studies conducted in various clinical trials. Data on long-term follow-up after anti-VEGF therapy for neovascular AMD form, especially in real-life studies, are limited. In the framework of the HORIZON study, representing an extended four-year follow-up of ANCHOR and MARINA patients, the gradual reduction in visual acuity has been revealed in the first 2 years of follow-up period. The re-examination of 10 % of patients from the initial ANCHOR and MARINA studies has been described in the SEVEN-UP study; herewith the decrement in visual activity has been detected after 7 years on the beginning of the clinical studies examination (loss of 8.6 letters against initial letter). The data obtained can not be directly transmitted into routine clinical practice, due to the patients’ inclusion and exclusion Criterion presence, protocols for the introduction of drugs, etc. A study of the therapy’s effectiveness and economic cost in real time allows optimizing the treatment of patients with neovascular AMD.