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2019 year, number 3

1.
THE PERSONALIZED IMMUNOGENOTYPIC PREDICTION OF HUMAN PREDISPOSITION TO OPHTHALMO-PATHOLOGY OF DIFFERENT GENESIS

Vladimir Iosifovich KONENKOV1, Alla Vladimirovna SHEVCHENKO1, Viktor Fedorovich PROKOF`EV1, Vadim Valerievich KLIMONTOV1, Dmitriy Valerievich CHERNYKH2, Valeriy Vyacheslavovich CHERNYKH2, Aleksandr Nikolaevich TRUNOV2
1Research Institute of Clinical and Experimental Lymphology - Branch of the Institute of Cytology and Genetics of SB RAS
2S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Novosibirsk Branch
Keywords: возрастная макулярная дегенерация, диабетическая ретинопатия, гены цитокинов, ген фактора роста эндотелия сосудов, гены матриксных металлопротеиназ, age-related macular degeneration, diabetic retinopathy, cytokines genes, vascular endothelial growth factor gene, matrix metalloproteinases genes

Abstract >>
The purpose of the study was to search high-informative genetic criteria of the personalized forecast at presence of the earliest feebly marked of clinical attributes of organum visus pathology development. Material and methods. The results of immunogenotypic survey of 403 persons, among which 102 patients with age-related macular degeneration (AMD) and 90 patients with diabetic retinopathy (DR), 211 patients of similar gender and age as control groups of comparison are submitted. The analysis of regulation locus polymorphism TNFA (rs361525, rs1800629 and rs1800630) , IL1B (rs1143627), IL4 (rs2243250), IL6 (rs1800795), IL10 (rs1800872 , rs1800872) genes , vascular endothelial growth factor gene VEGF (rs3025039 , rs699947), matrix metalloproteinases genes MMP (rs2438650, rs3025058, rs3918242) in this groups has been carried out. Results and discussion. Two groups of parameters have been shown through comparison of combined genetic attributes frequencies in comparable groups with/or absence AMD. One of these groups is distributed with primary frequency among patients with AMD whereas another is distributed only among elderly with absence of clinical and tool attributes of disease. On the contrary the significant prevalence of the attributes positively associated with the pathology development over negatively associated attributes has been revealed among DR. The revealed genetic attributes specify mainly inflammatory character of DR, as against AMD in which prevail degenerate and sclerogenic processes. Conclusion. Thus, the results of received genetic researches show an opportunity to personify predisposition of the significant part of elderly patients to development of ophthalmo-pathology microangiopathy or degenerate genesis with the purpose of realization of purposeful preventive actions.



2.
CHARACTERISTICS OF CULTURES OF CELLS OBTAINED FROM HUMAN LIMB

Mariya Alexandrovna SUROVTSEVA1, Igor Alekseevich ISKAKOV2, Olga Vladimirovna POVESHCHENKO1, Alexandr Petrovich LYKOV1, Irina Innokentievna KIM1, Evgeniya Viktorovna YANKAYTE1, Vladimir Iosifovich KONENKOV1, Valeriy Vyacheslavovich CHERNYKH2
1Research Institute for Clinical and Experimental Lymphology - a Branch of Federal Research Center of the Institute of Cytology and Genetics of SB RAS
2S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Novosibirsk Branch
Keywords: лимб, эксплант, амниотическая мембрана, лимбальные стволовые клетки, мультипотентные мезенхимальные стволовые клетки, limb, explant, amniotic membrane, limbal stem cells, multipotent mesenchymal stem cells

Abstract >>
Limbal epithelial stem cells are localized in the limb, which determine the regeneration of the corneal epithelium, both physiological and reparative. The aim of the study is to characterize the culture of cells isolated by different methods. Materials and methods. Limbal stem cells were isolated from the limbus region of enucleated human eyes. Cell isolation was produced by the enzymatic and explantation methods. Cell cultivation was performed on the amniotic membrane and without it, in DMEM/F12 growth media (Dullbecco’s Modified Eagle Medium/Nutrient F12 Ham) and CECBM (Corneal Epithelial Cell Basal Medium). The morphological assessment and immunophenotyping of cell cultures were performed. Results and its discussion. The obtained culture was distinguished by cell heterogeneity at the enzymatic method of isolating cells from the limbus. The presence of fibroblast-like cells was revealed in the suspension of non-adherent cells, which resembled stromal cells in appearance and growth pattern. Immunophenotyping revealed that most cells carry markers of multipotent mesenchymal stromal cells (CD90+/CD73+/CD105+/CD34-/CD45-) and a small number - markers of epithelial cells (p63α+, ABCG2+, CK19+). Explant culture was more uniform. The cells had a rounded, epithelial-like shape, adhered well to the surface of the amniotic membrane and grew on it. The results of phenotyping indicated that cells are represented mainly by epithelial cells (p63α+, ABCG2+, CK19+). Conclusion. The culture is represented mainly by MMSC at the enzymatic method of isolating cells from the limbal graft and cultivating them without feeder in the growth medium DMEM/F12. Isolation of limb cells by the explantation method and their cultivation in the selective medium CECBM allow us to obtain mainly the culture of epithelial stem cells.



3.
ULTRASTRUCTURAL ORGANIZATION OF THE LYMPHATIC CAPILLARIES IN CONJUNCTIVA AND THE LYMPHATIC CHANNELS IN HUMAN CHOROID

Sabina Robertovna NOGOVITSINA1, Nataliya Petrovna BGATOVA1, Alena Victorovna EREMINA2, Aleksandr Nikolaevich TRUNOV2, Valeriy Vyacheslavovich CHERNYKH2, Vladimir Iosifovich KONENKOV1
1Research Institute for Clinical and Experimental Lymphology - Branch of Federal Research Center Institute of Cytology and Genetics of SB RAS
2S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Novosibirsk Branch
Keywords: конъюнктива, хориоидея, лимфатический эндотелий, лимфатические каналы, conjunctiva, choroid, lymphatic endothelium, lymphatic channels

Abstract >>
The aim of this work was a comparative study of the ultrastructural organization of lymphatic structures in the choroid and conjunctiva of the human eye. Material and methods. Samples of the choroid and conjunctiva of the human eye, obtained perioperatively, were studied by immunohistochemical analysis using specific antibodies to endothelial cells markers of blood and lymphatic vessels, and electron microscopic studies, morphometric processing and statistical analysis of the results were performed. Results and discussion. Within simultaneous immunohistochemical staining of conjunctiva and choroid samples using antibodies to markers of lymphatic vessels (LYVE-1, Prox1, podoplanin) the positively stained typical lymphatic vessels have been revealed in the conjunctiva structure and positively stained channels with narrow elongated cells, fibroblasts and pigment cells in choriocapillar layer of the choroid and the transition zone between choroid and sclera. Electron microscopic study revealed that cells expressing lymphatic markers and forming lymphatic channels in the choroid have an ultrastructural organization that is differ from typical lymphatic vascular endothelial cells: they do not have stropic filaments, contain a greater volume density of the granular endoplasmic reticulum membranes, and a lower volume density of mitochondria and micropinocytotic vesicles. The data obtained indicate that the lymphatic pathways of the intraocular fluid outflow in the human eye choroid have organ-specific structural features.



4.
RESTORATION OF CORNEA ENDOTHELIUM FUNCTION (review)

Galina Sergeevna BATURINA1,2, Lubov Evgenyevna KATKOVA1, Evgeny Ivanovich SOLENOV1,2,3, Igor Alexeevich ISKAKOV4
1The Federal Research Center Institute of Cytology and Genetics of SB RAS
2Novosibirsk State University
3Novosibirsk State Technical University of Minobrnauki of Russia
4S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Novosibirsk Branch
Keywords: эндотелий роговицы глаза, эпителиально-мезенхимальная трансформация, тканевая инженерия, corneal endothelium, epithelial mesenchymal transition, tissue engineering

Abstract >>
Review highlights modern findings on molecular mechanisms of dysfunction of human corneal endothelial cells causes decline of vision. When water enters the corneal stroma, it disorganizes the regular arrangement of the collagen fibrils, which reduces corneal transparency. Corneal endothelial cells are responsible for keeping the dehydration state of the stroma by pumping out fluid. However, this layer of cells can become deficient, for example following intra-corneal surgery or because of a pathology. Corneal transplantation is currently the only treatment in order to restore vision following endothelial dysfunctions. The authors survey methodological problems and prospects for correction of endothelial cells dysfunction. Human endothelial cells do not proliferate in vivo because these cells arrest in the G1 phase of the cell cycle. Modern research showed that corneal endothelium cells could proliferate in special conditions. An alternative approach is to use human stem cells as an endothelial cells source. New methods and improved technique of storage and preservation of corneal grafts, palliative methods of surgical treatment aimed at reducing the hydration of the surface layers of the cornea are considered. The review includes consideration of works for endothelial tissue engineering using cell culture technologies. Endothelial keratoplasty limited by the technical difficulty of the procedure, a shortage of available grafts, and the potential for graft failure or rejection. These limitations are driving researchers to develop new approaches, such as methods of organ culture



5.
FEMTOLASER-ASSISTANCE OPPORTUNITIES IN THE SURGICAL TREATMENT OF CATARACT ASSOCIATED WITH GLAUCOMA AND PSEUDOEXFOLIATIVE SYNDROME

Benta Gayozovna DZHASHI, Sergey Viktorovich BALALIN
S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Volgograd Branch
Keywords: катаракта, факоэмульсификация, фемтолазер-ассистированная факоэмульсификация, глаукома, псевдоэксфолиативный синдром, cataract, phacoemulsification, femtolaser assistance, glaucoma, pseudoexfoliative syndrome

Abstract >>
Cataract surgery in eyes with glaucoma requires the most gentle manipulation during the operation including capsulorhexis and phacofragmentation. Femtolaser assistance at various stages of cataract phacoemulsification is aimed at minimizing surgical trauma. Aim of the sudy was to analyze the postoperative reactions after phacoemulsification and femtolaser-assisted phacoemulsification (FLACS) of the cataract in eyes with pseudoexfoliating glaucoma. Material and methods. Two groups of patients (30 eyes) were operated and examined (I-phacoemulsification, II-femtolaser-assisted phacoemulsification). In all cases phacodonesis was found. Results. Noted that phacoemulsification without the use of the femtolaser assistance demanded a longer intervention with large expenditure of energy ( p < 0.05). On the first day after surgery in the first group (phacoemulsification), 9 cases (66.7 %) of corneal reaction were detected. In the second group, there were 5 cases (33.3 %) of a corneal postoperative reaction that was stopped during the day. Conclusion. It has been shown that femtolaser assistance in cases of cataract associated with glaucoma and pseudoexfoliative syndrome reduced operation time, amount of ultrasonic energy expended, number of postoperative corneal reactions.



6.
Analysis of selective laser trabeculoplasty effectiveness

Iya Georgievna PASENOVA, Kseniya Viktorovna ALEKSEEVA
Ekaterinburg Center of Eye Microsurgery Federal State Institution of Minzdrav of Russia
Keywords: селективная лазерная трабекулопластика, первичная открытоугольная глаукома, пигментная глаукома, псевдоэксфолиативная глаукома, смешанная глаукома, ВГД цели, статическая автоматизированная периметрия, selective laser trabeculoplasty, primary open-angle glaucoma, pigmentary glaucoma, pseudoexfoliative glaucoma, mixed glaucoma, target IOP, static automated perimetry

Abstract >>
Purpose of the study was to investigate the effectiveness of selective laser trabeculoplasty (SLT) in various forms of glaucoma, in the initial, advanced and far-advanced stages of the disease. Material and methods. An analysis of the effectiveness of the treatment of 132 eyes (132 patients), who were examined and treated in the department of glaucoma diagnostics and treatment of Ekaterinburg Center of Eye Microsurgery Federal State Institution, has been performed from 2016 to 2018. The study included a group of patients with primary open-angle, pseudoexfoliation, pigment, and combined forms of glaucoma previously not operated. Laser iridotomy was previously performed in patients with pigmented and combined glaucoma. The efficacy of SLT was assessed by the level of intraocular pressure (IOP) before SLT, after three days, 1, 6 and 12 months, using the perimetric MD index and according to the need for repeated surgical interventions during the observation period. Results. By the end of the observation period after SLT in patients with initial glaucoma IOP decreased by 5.1 mm Hg (by 20.7 %), with advanced glaucoma - by 6.3 mm Hg (by 25.7 %), with far-advanced glaucoma - by 6.8 mm Hg (by 31 %) compared to baseline values. Analysis of SLT effectiveness depending on the form of the disease showed that 12 months after surgery IOP in patients with primary open-angle glaucoma decreased by 5.5 ± 1.32 mm Hg (23 %) compared with baseline figures, and in patients with combined glaucoma - by 5.5 ± 1, 5 mm Hg (22.8 %). In the follow-up period from 6 to 12 months after SLT, 88 % of patients with pseudoexfoliation glaucoma, 64 % of patients with pigmentary glaucoma and 34 % of patients with combined glaucoma underwent non-penetrating deep sclerectomy, 15 % of patients with primary open-angle glaucoma underwent repeated SLT. Conclusion. SLT is the safe and effective method of glaucoma treating. In all forms and stages of glaucoma, target IOP was obtained, as evidenced by stabilization of retinal sensitivity by automated perimetry, but the hypotensive effect after SLT in patients with pseudoexfoliation glaucoma and pigmentary glaucoma lasted less than 1 year.



7.
Beta zone of peripapillary atrophy by optical coherence tomography as a biomarker of glaucoma associated with myopia

Svetlana Ivanovna ZHUKOVA1, Tat’yana Nikolaevna YUR’YEVA1,2,3, Irina Viktorovna POMKINA1, Anastasiya Sergeevna GRISHCHUK1,2,3
1S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia
2Irkutsk State Medical Academy of Postgraduate Education - Branch of the Russian Medical Academy of Continuing Professional Education of Minzdrav of Russia
3Irkutsk State Medical University of Minzdrav of Russia
Keywords: первичная открытоугольная глаукома, миопия, спектральная оптическая когерентная томография, перипапиллярная атрофия, гамма-зона, бета-зона, primary open-angle glaucoma, myopia, spectral domain optical coherence tomography, peripapillary atrophy, gamma zone, beta zone

Abstract >>
Purpose of the study was to assess changes in the peripapillary retina and in patients with glaucoma associated with myopia and uncomplicated myopia by spectral domain optical coherence tomography. Material and methods. We examined 26 patients (26 eyes) with a clinically advanced of primary open-angle glaucoma on eyes with high myopia and 30 people (30 eyes) with uncomplicated myopia. Spectral domain optical coherence tomography was included in the examination. Results and discussion. A reduction in the rim area in patients with glaucoma combined with myopia, compared with patients with uncomplicated myopia ( M ± SD , respectively, 1.03 ± 0.36 and 1.60 ± 0.42 mm2, p < 0.05) develops against the background of thinning of the choroid, mainly in the lower one (131.36 ± 41.98 and 226,5 ± 98.13 mm, respectively; p = 0.01) and nasal (57.63 ± 9.81 and 216 ± 122.4 mm, respectively; p = 0.0006) segments and is accompanied by an increase in the area of the peripapillary atrophy (1.94 ± 0,5 and 1.05 ± 0.15 mm, respectively; p = 0.005), which indicates the inconsistency of trophic and metabolic processes. In patients with myopia in peripapillary atrophy zone, a gamma zone was identified, in which sclera and RNFL were visualized. The Bruch’s border membrane, retinal pigment epithelium, photoreceptors, and choroid coincided. In myopia combined with glaucoma, along with the gamma zone, the beta zone was visualized, which is characterized by degenerative changes in RPE and photoreceptors against the background of choriocapillary obliteration. Conclusion. Choroidal changes and the presence of beta zone are differential diagnostic criteria for glaucoma associated with myopia and can be used for diagnosis of glaucoma in combination with myopia.



8.
LASER SUTURE lysis AFTER TRABECULECTOMY: INDICATIONS, TECHNIQUE, EFFECTIVENESS

Natal’ya Vasil’yevna VOLKOVA1,2,3, Tat’yana Nikolaevna YUR’YEVA1,2,3, Irina Viktorovna POMKINA1, Elena Viktorovna MUSKATINA1, Anastasiya Sergeevna GRISHCHUK1,2
1S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Irkutsk Branch
2Irkutsk State Medical Academy of Postgraduate Education - Branch of the Russian Medical Academy of Continuing Professional Education of Minzdrav of Russia
3Irkutsk State Medical University of Minzdrav of Russia
Keywords: лазерный сутуролизис, трабекулэктомия, интрасклеральный канал, «плотная» фиксация склерального лоскута, оптическая когерентная томография, ультрабиомикроскопия путей оттока, laser suture lysis, trabeculectomy, intrascleral canal, «tight» fixation of the scleral flap, optical coherence tomography, ultrasound biomicroscopy of outflow pathways

Abstract >>
Purpose of the study was to evaluate the impact of «tight fixation» of a scleral flap with the subsequent performance of the laser suture lysis on the morphogenesis of established outflow pathways and hypotensive efficacy of trabeculectomy. Material and methods. This is a retrospective study. Seventy eyes of patients underwent trabeculectomy and LSL 1-1.5 months after it were under observation for 24 months. Comparison groups are determined by the presence of inadequate reparative regeneration syndrome. Technical nuances of trabeculectomy («tight» closure of the scleral flap) were evaluated using optical coherence tomography. The effect of LSL on the remodeling of outflow pathways was evaluated by ultrasound biomicroscopy. In the first group ( n = 22) LSL was as a mechanical adjuvant treatment, in the second ( n = 48) - as an adjuvant option. Ophthalmic tonus was evaluated by Maklakov (Pt) in mm Hg. The indices were estimated using Sstudent’s t-test, p < 0.05 was considered statistically significant. Results and discussion. The «tight» fixation of the scleral flap minimized early postoperative complications and did not detect Pt difference in the groups. LSL led to an increase in the height of the intrascleral channel and scan height in both groups ( p < 0.01). After 24 months, complete hypotensive success was 95.5 % in the 1st and 81.25 % in the 2nd group, qualified - 4.5 and 18.75 %, respectively ( p < 0.01). Despite the difference in IOP achieved: 15.3 ± 1.9 mm Hg. after 12 months, 15.1 ± 1.2 mm Hg. after 24 months in in group 2 ( p < 0.01), more postoperative interventions in group 2 ( p < 0.01), the results of complete and qualified success in the second group were high. Conclusion. The introduction of LSL in clinical practice can improve the effectiveness of glaucomatous fistulizing operations. The use of the technique of «tight» fixation of the scleral flap and the planned implementation of LSL are an example of multimodal approaches to minimize the number of early postoperative complications and increase the hypotensive efficiency of trabeculectomy.



9.
THE USE OF DIGITAL MARKING DEVICE WHEN PERFORMING FEMTOSECOND LASER INTRASTROMAL KERATOPLASTY WITH IMPLANTATION OF INTRASTROMAL SEGMENTS

Aleksandr Vladimirovich TERESHCHENKO, Sergey Konstantinovich DEM’YANCHENKO, Ekaterina Nikolaevna VISHNYAKOVA
S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch
Keywords: лечение кератоконуса, фемтолазерная интрастромальная кератопластика, имплантация интрастромальных сегментов, цифровое разметочное устройство, treatment of keratoconus, femtosecond laser intrastromal keratoplasty, implantation of intrastromal segments, digital marking device

Abstract >>
The aim of the study is to assess the practical significance of the use of the digital marking device «VERION™ Image Guided System» in the technology of intrastromal keratoplasty using a femtosecond laser. Material and methods. According to the developed method, 35 eyes of 27 patients with a diagnosis of keratoconus of the 2nd degree were operated. The median age was 26 years. Formation of intrastromal tunnels was performed using «Femto LDV Z8» femtosecond laser («Ziemer», Switzerland), the laser was centered in strict accordance with the markings obtained by the digital marking device «VERION™ Image Guided System» («Alcon», USA). During the implantation of the segment, this device was also used for its precise positioning in the tunnel. Setting the projection of the required axis, the surgeon intraoperatively to visualize the label that corresponds to the exact position of the end of the segment in the intrastromal tunnel, and carried out precise positioning of the intrastromal segments. Results. When performing operations using the indicated method, it was revealed that the patient’s eye at the aplanation stage of a femtosecond laser has a tendency to rotate and decentralize. Minor decentralizations relative to the pupil center were corrected by the displacement of the intrastromal tunnel pattern in the laser working program along the x-axis by 0.1 ± 0.05 mm, along the y-axis by 0.1 ± 0.04 mm. In patients in the postoperative period there was an increase in uncorrected and corrected visual acuity. By 3 months after the operation, functional parameters and keratometric data stabilized: visual acuity without correction and with maximum correction increased to 0.5 ± 0.16 and 0.7 ± 0.12, respectively, keratometry of flat and steep axis declined to 44.3 ± 1.4 and 50,8 ± 3,2 diopters, respectively. Conclusions. It was found that the applanation of the femtosecond laser aperture on the surface of the conical cornea leads to the rotation of the eye by an average of 9°. The use of femtosecond laser for forming the intrastromal tunnels in the conduct intrastromal keratoplasty requires mandatory marking of the cornea meridian the corresponding to the axis of the cutout for laser centration. Methodology of Verion-assisted femtosecond laser intrastromal keratoplasty allows to position the segments with high precision in accordance with a preoperative calculation that provides high clinical and functional results.



10.
FLUORESCEINT ANGIOGRAPHY IN THE EVALUATION OF THE RESULTS OF LASER COAGULATION OF THE RETINA AT THE ACTIVE STAGES OF RETINOPATHY OF PREMATURITY

Irina Georgievna TRIFANENKOVA, Alexandr Vladimirovich TERESHCHENKO, Yuliya Aleksandrovna SIDOROVA, Vadim Vladimirovich SHAULOV, Sergey Vladimirovich ISAEV
S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch
Keywords: флуоресцентная ангиография, лазерная коагуляция сетчатки, активные стадии ретинопатии недоношенных, fluorescent angiography, retinal laser photocoagulation, the active stage of retinopathy of prematurity

Abstract >>
The aim of the study is to evaluate the effectiveness of retinal laser photocoagulation (RLC) in retinopathy of prematurity (RP) using fluorescent angiography (FAG), to identify angiographic signs of regression and progression of the disease, the features of the formation of vessels in the previously avascular retina, depending on the RP stage and the method of treatment used. Material and methods. The study included 58 preterm infants (116 eyes) with different stages of active ROP, requiring RLC. Gestational age of children ranged from 24 to 31 weeks (average 28.1 weeks), birth weight - from 680 to 1800 g (average 1100 g). All infants underwent digital retinoscopy with FAG on a retinal pediatric digital video system «RetCam-3» («Clarity Medical Systems Inc.», USA) with a built-in angiographic unit. In 94 cases, LC was performed in the pattern mode on the laser ophthalmic system «PASCAL Photocoagulator» («OptiMedica», USA) using the developed technology of early dosed coagulation optimized for energy parameters. In 12 cases, LC was performed in a single pulse mode on a laser ophthalmic device «Visulas 532s», laser type Nd:YLF («Carl Zeiss Meditec AG», Germany). In 10 cases, the RLC was conducted in the perinatal centre of the extremely premature children non-transportable diode laser «Iridex IQ 810» («IRIDEX», USA) using head ophthalmoscope. Results. The technique of dosed pattern RLC was the most optimal from the point of view of efficiency and safety for a premature baby, which was confirmed by the angiographic data obtained, indicating an active vascular germination in the coagulation zone. Angiographic picture of the regression of RP after the RLC in single pulse was not significantly different from the pattern LC. However, taking into consideration the pattern technology advantages, the single pulse technology should be used only in case of high-tech equipment absence. Postoperative angiographic monitoring after LC using a forehead ophthalmoscope showed the imperfection of this technology, which is manifested by characteristic angiographic signs, such as chaotic growth of blood vessels in the LC area. Conclusion. FAG opens wide possibilities both in the early assessment of the efficacy of LC and in the detailed assessment of the long-term results of treatment depending on the RP stage and the used LC method. The use of the results of FAG studies will contribute to the improvement of laser technologies and improve the quality of RP treatment.



11.
COMPARATIVE ANALYSIS OF USING EX-PRESS DRAINAGE DEVICE AND POLYMER MICRO SHUNT В«REPER-NN» MANUFACTURED IN RUSSIA IN PRIMARY OPEN-ANGLE GLAUCOMA SURGERY

Oleg Lvovich FABRIKANTOV1,2, Oksava Anatol’yevna KOLPAKOVA3
1S.N. Fedorov NMRC В«MNTK В«Eye Microsurgery», Tambov Branch
2Tambov State University n.a. G.R. Derzhavin
3S.N. Fedorov NMRC В«MNTK В«Eye Microsurgery», Tambov Branch, S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Tambov Branch
Keywords: глаукома, внутриглазное давление, полимерный микрошунт «Репер-НН», шунт «Ex-PRESS», glaucoma, intraocular pressure, polymer micro shunt «Reper-NN», «Ex-Press» shunt

Abstract >>
Purpose of the study was to analyze and compare the outcomes of implantation of polymer micro shunt «Reper-NN» manufactured in Russia and «Ex-PRESS» shunt in surgical treatment of open-angle glaucoma. Material and methods. The results of treating 74 patients with open-angle glaucoma were analyzed. All patients were divided into 2 groups: group I consisted of 48 patients underwent micro shunt «Ex-PRESS» implantation, group II with 26 patients underwent Russian polymer micro shunt implantation. The control criteria in the early and remote postoperative period were: Maklakov tonometry, visual acuity, computer perimetry. Results and discussion. The significant reduction in intraocular pressure compared with the preoperative level has been achieved in the early and remote period as a result of implanting both shunts. The implantation simplicity and design features of polymer micro shunt «Reper-NN» provided with the relatively similar to «Ex-PRESS» shunt risks of complications such as postoperative hypotonia and ciliochoroidal detachment. Thus, the first experience of using Russian manufactured polymer shunt showed the sufficient efficacy and safety in primary open-angle glaucoma surgery and allowed recommending its further application in clinical practice.



12.
CLINICAL SIGNIFICANCE OF MICROALBUMINURIA IN FORMATION OF VASCULAR DISEASES OF POSTERIOR EYE SEGMENT IN WOMEN After PREECLAMPSIA, POSSIBILITIES OF PROGNOSIS

Oleg Vladimirovich KOLENKO1,2, Natalya Viktorovna POMYTKINA1, Evgeniy Leonidovich SOROKIN1, Galina Vsevolodovna CHIZHOVA2, Yaroslav Evgen’evich PASHENTSEV1, Yuriy Nikolaevich BERDAKOV3
1S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Khabarovsk Branch
2Postgraduate Institute for Public Health Workers of Minzdrav of Khabarovsk Region
3Perinatal center of Minzdrav of Khabarovsk region
Keywords: преэклампсия, микроальбуминурия, сосудистая патология заднего отрезка глаза, preeclampsia, microalbuminuria, vascular pathology of posterior eye segment

Abstract >>
The purpose of study is to assess the clinical significance of microalbuminuria (MAU) in pregnant women with preeclampsia in formation of vascular eye pathology in long-term postpartum period. Material and methods. In retrospect, according to medical records, analysis of somatic condition of 114 women who had preeclampsia during pregnancy was carried out, and presence / absence of MAU during pregnancy were determined. MAU was detected in the 3rd trimester of pregnancy using test strips «Woerhringer Ingelheim» (Austria), considering the test to be positive with a value of 30 mg/day and more. The age of women at time of research was from 24 to 52 years, the period after suffering preeclampsia was 12.5 ± 6.5 years. Two groups were formed: the main - 35 women with initial MAU during pregnancy; the comparison - 79 women who had no MAU during pregnancy. The controls were 36 women with physiological pregnancy and delivery. Results and discussion. In period after delivery, vascular diseases of posterior eye segment occurred in 14 people in the main group (40 %) and 15 people in the comparison group (19 %). In the control group in this period, vascular pathology of posterior eye segment was formed in 2 women. Conclusion. Statistically significant increase of frequency of formation of vascular pathology of posterior eye segment in postpartum period was revealed in women, who had pregnancy complicated by preeclampsia and MAU in the 3rd trimester, which increased through 10 and more years after delivery. The initial presence of MAU during pregnancy can be the marker of increased risk of formation of vascular pathology of posterior eye segment at different periods of the postpartum period.



13.
PHACOEMULSIFICATION OF BROWN CATARACTS ON AVITREAL EYES

Sergey Viktorovich SHUKHAEV, Anastasiya Yurievna ULITINA, Ernest Vitalyevich BOYKO
S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg Branch
Keywords: плотный хрусталик, авитрия, факоэмульсификация катаракты, hard nucleus, vitrectomised eye, cataract phacoemulsification

Abstract >>
Analysis of the features of surgical treatment of brown cataracts in the eyes with previously performed posterior vitrectomy. The study included 25 patients (25 eyes) with nuclear cataracts 6+ density according to LOCS III classification. All patients underwent microinvasive posterior vitrectomy more than 6 months ago. Microcoaxial (2.2 mm) phacoemulsification of cataract with implantation of flexible intraocular lens was planned for all patients. In 15 patients (60 %), a system of capsule hooks was used in order to support the capsule bag 4 in 16 % of cases and 6 in 44 % of cases. Results and discussion. Sutureless surgery were performed in 24 patients (96 %). In one case with nigra cataract despite the use of capsule hooks, due to the high risk of dislocation of the lens into the vitreous cavity, the surgery was converted into a large incision. Microcoaxial phacoemulsification is the surgery of choice in the case of a combination of dense lens and lack of vitreous support. The use of capsular hooks greatly simplifies surgery and increases the chances of sutureless surgery.



14.
A NEW METHOD OF SILICONE INTUBATION OF THE LACRIMAL PATHWAYS

Galina Sergeevna SHKOLNIK, Sergey Filippovich SHKOLNIK
S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Cheboksary Branch
Keywords: дренирование слезных путей, интубация слезных путей, реканализация, трансканаликулярная эндоскопия, непроходимость слезных путей, дакриоцисториностомия, drainage of the lacrimal ducts, intubation of the lacrimal ducts, recanalization, transcanalicular endoscopy, obstruction of the lacrimal ducts, dacryocystorhinostomy

Abstract >>
The method of bicanalicular silicone intubation of tear ducts is widely used as a stage of external and endonasal dacryocystorhinostomy, as well as during recanalization of the tear duct. The introduction of a silicone stent is the most common way to prevent rhinostoma closure. Its purpose is to maintain the permeability of the tubules or anastomoses during the healing period and can improve the results of surgical treatment if used correctly. Typically, pre-packaged kits consisting of silicone tubes attached to metal probes are used for the drainage implantation procedure. The disadvantages of using such kits are their high cost, insufficient length of metal probes when using them after dacryocystorhinostomy, and invasiveness of the procedure in the absence of visual inspection. The aim of our work was to develop a new method of silicone intubation of tear ducts, devoid of the described shortcomings. Material and methods. Silicone tubes 200 mm long were used as the lacrimal intubation kit. A line was antegradely conducted along the probe, which was then removed from the nasal cavity with a hook by endoscopic control. The procedure was repeated with the paired tear duct. Then the silicone tube was tied by both ends of the fishing line and passed to the free ends of it from the nose into the nasal cavity, where they were riveted and clipped. Results and discussion. In all cases, the drainage was performed as described. As in the case of other modifications of the drainage, holding the tube into the tear-nasal canal required more effort and more skill as compared to draining of the formed anastomosis. In all cases, the effectiveness of the method of holding the tube in the lacrimal duct depended on the severity of the obstruction. Conclusions. The method developed by us for carrying out a silicone tube into the lacrimal duct is effective, simple and does not require the use of complex technologies for the manufacture of an intubation kit.



15.
PRISMATIC CORRECTION IN STRABISMOLOGY: THEORY AND PRACTICE

Galina Vladimirovna GLADYSHEVA, Igor Leonidovich PLISOV, Varvara Borisovna PUSHCHINA, Natalya Gennadievna ANTSIFEROVA, Darya Rimovna MAMULAT, Mikhail Aleksandrovich SHAROKHIN, Kseniya Aleksandrovna BELOUSOVA
S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Novosibirsk Branch
Keywords: содружественное косоглазие, несодружественное косоглазие, диплопия, призматическая коррекция, эластичные призмы Френеля, comitant strabismus, incomitant strabismus, diplopia, prismatic correction, elastic Fresnel prisms

Abstract >>
The purpose of our study was to analyze the effectiveness of the use of Fresnel prisms for various disorders of the eye movement. Material and methods. The studied group included 40 patients with prismatic correction and was divided into 2 groups of patients depending on the type of strabismus: 25 patients with incomitant strabismus, 15 patients with comitant strabismus. Elastic Fresnel prisms (EFP) were chosen and prescribed for prismatic correction. The patients were under dynamic monitoring under conditions of continuous use of EFP and positional trainings were performed if necessary (when doubling wasn’t completely compensated by EFP). The study had a prospective character. Results and its discussion. The prismatic correction made it possible to eliminate diplopia in direct gaze position and peripheral gaze directions in all 25 patients with paretic strabismus. In 18 out of 20 cases, the prismatic correction allowed to achieve functional recovery without subsequent chemorecession or surgical treatment. In 8 patients with comitant strabismus after the first stage of surgical treatment with stable deviation, binocular vision was formed under natural conditions. In 1 year, dynamic prismatic correction contributed to the recovery of 7 patients without surgical treatment with orthophoria in vivo. Conclusion. Prismatic correction of diplopia as an independent or additional functional method of treatment contributes to the achievement of the comitance of the eye muscles.



16.
OPTICAL COHERENCE TOMOGRAPHY OF THE VITREOLENTICULAR INTERFACE AFTER PHACOEMULSIFICATION WITH PRIMARY POSTERIOR CAPSULORHEXIS

Elena Vladilenovna EGOROVA
S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Novosibirsk Branch
Keywords: первичный задний капсулорексис, витреолентикулярный интерфейс, передняя гиалоидная мембрана, факоэмульсификация, primary posterior capsulorhexis, vitreolenticular interface, anterior hyaloid membrane, phacoemulsification

Abstract >>
The discussion about the safety and efficiency of the posterior capsulorhexis is still ongoing. Optical coherence tomography (OCT) can help us to study the process of capsule barrier recovering and condition of the anterior hyaloid membrane after primary posterior capsulorhexis. Aim of the study was to investigate the features of the vitreolenticular interface (VLI) after lens surgery with the primary posterior capsulorhexis. Material and methods. VLI OCT (RTVue, «Optovue», USA) was performed in 101 patients (123 eyes) after phacoemulsification with primary posterior capsulorexis. The postoperative period ranged from 1 day to 9 years. Results. We revealed a large variability of the VLI. This was due to the degree of the involutional changes in the involved structures. In the early postoperative period we observed the different variants of the relationships between the posterior capsule and the intraocular lens (IOL): from almost contact to subtotal inadhesion with a movable margin of the capsulorhexis. However, in all cases we noted the contact between posterior capsule and IOL along the optical edge of the latter. In the following days the adhesion between the lens optics and the posterior capsule progressed from the periphery to the center. The term needed for complete adhesion was 1-8 days. Three main types of VLI have been identified in the late postoperative period. Conclusion. The involutional changes of structures determine the features of the VLI in the early and late postoperative period. The contact between posterior capsule and IOL along the lens optics edge was detected from the first day, full adhesion was noted 1-8 days after surgery.



17.
MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT OF RETINAL VEIN OCCLUSION

Pavel Lvovich VOLODIN, Elena Vladimirovna IVANOVA, Yuliya Igorevna KUKHARSKAYA
The S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia
Keywords: окклюзия ретинальных вен, макулярный отек, оптическая когерентная томография в ангиорежиме, лазерное лечение, retinal vein occlusion, macular edema, optical coherence tomography angiography, laser treatment

Abstract >>
Retinal vein occlusion is the one of the most common diseases, which amounts to 60 % of all acute vascular ocular pathology, and takes second place in the severity of retinal lesions and prognosis after diabetic retinopathy. It causes the visual disability in 15 % of cases. The main reason for the decrease vision in patients with occlusion of the central retinal vein and its branches is the development of macular edema, the degree of intensity of which depends mainly on the level and severity of the retinal vascular bed lesion. The article provides a review on the current aspects of retinal vein occlusion etiology and pathogenesis, and novel methods of diagnostics. The implementation into practice of highly precise non-invasive diagnostic method - optical coherence tomography angiography was a significant progress in clinical and diagnostic studies of macular edema as a result of retinal vein occlusions. The necessity of multimodal approach to management of patients with retinal vein occlusion for improvement of the treatment clinical and functional results is emphasized. The modern techniques for the treatment of retinal vein occlusion, their advantages and disadvantages are described; data on the anatomical and functional results of the use of these techniques are given. Actual approaches to treatment are divided into laser and pharmacological methods. The prospects of further improvement and development of combined treatment for retinal vein occlusion are considered.



18.
INTERFERONS AND EYE DISEASES

Nikolay Andreevich KIKHTENKO1, Pavel Gennad’evich MADONOV2
1В«Vision center “Doctor Linz”», Ltd
2Novosibirsk State Medical University of Minzdrav of Russia
Keywords: интерфероны, клиническое применение, иммунобиологическая терапия, противовирусная терапия, офтальмология, interferons, clinical use, immunobiological therapy, antiviral therapy, ophthalmology

Abstract >>
The review contains an analysis of the medical use of interferons - a group of signaling protein molecules that have antiviral, antitumor, and immunomodulatory activity - in ophthalmic practice. Interferons have a wide spectrum of action, including antiviral, immunomodulatory, antitumor and other types of activity. This provides a great potential for interferon use in ophthalmology, both in combination and as a first-line therapy for conjunctival papillomatosis, squamous cell neoplasia, conjunctival melanoma, keratitis caused by the herpes simplex virus, uveitis, geographical choriopathy, cystic and diabetic macular edemas, etc. There are considered mechanism of action, dosing regimens, side effects of using interferons and such their solutions as use of newly discovered interferon lambda and interferon pegylation. In contrast to the ubiquitous expression of the IFN-α receptor, IFN-λ receptor is determined mainly in the epithelial cells of the mucous membranes and skin keratinocytes, which provides a more targeted effect of the drugs. Modifying the properties of biologically active substances by combining them with low molecular weight carriers, for example, polyethylene glycol molecules (PEG), leads to a decrease in the therapeutic dose of the drug and an increase in the selectivity of its action due to changes in pharmacokinetic and pharmacodynamic parameters.



19.
THE EXPERIENCE OF ORGANIZING COLLABORATIVE WORK OF ORENBURG BRANCH OF S. FYODOROV EYE MICROSURGERY FEDERAL STATE INSTITUTION AND ORENBURG REGIONAL PERINATAL CENTRE FOR THE CONTROL OF RETINOPATHY OF PREMATURity

Alexandr Dmitrievich CHUPROV, Elena Konstantinovna MALGINA
S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Orenburg Branch
Keywords: ретинопатия недоношенных, ретинальная камера, лазеркоагуляция, «RetCam3», экстраретинальная пролиферация, retinopathy of prematurity, retinal camera, laser coagulation, «RetCam3», extraretinal proliferation

Abstract >>
The purpose of the study is to increase the efficiency of delivering high-tech eye care to the infants of Orenburg and the Orenburg region. Material and methods. An algorithm has been developed to deliver specialized care for retinopathy of prematurity. Recently purchased «RetCam3» pediatric retinal camera made it possible to conduct dynamic screening and monitoring of preterm infants who were prematurely born at risk of retinopathy. The examination was prescribed to children at risk (gestation age up to 35 weeks, birth weight up to 2500 g). The time frame for fundoscopy varied from 3 to 7 weeks after birth depending on the infant physical condition. The number of examinations at 3th-4th weeks of life was 63 %, at 5th-6th weeks - 29 %, at 6th-7th weeks - 8 %. Screening examinations were carried out in the perinatal centre with intervals, depending on the stage of retinopathy of prematurity: preretinopathy, stage I and II from 1 to 2 weeks, III and more severe stages from several days to a week. 60 initial examinations were performed in 6 months, laser treatment was provided for 13 patients (21.7 %). Results and discussion. For 6 months, 60 initial examinations were performed; laser treatment was performed in 13 patients (21.7 %). We observed positive changes for all the infants after laser treatment, which proves high efficiency of the developed algorithm of treatment premature infants with retinopathy, which is the prevention of blindness and low vision from infancy. Repeated monitoring after laser coagulation was carried out after 2, 4 and 8 weeks. Conclusions. Thus, screening contributes to the identification of this pathology at an early stage, dynamic monitoring of the fundus changes is carried out using retinal camera, which contributes to timely laser treatment. The developed algorithm improves the quality of specialty care for premature infants at risk of developing retinopathy of prematurity, and, accordingly, improves the quality of their life.



20.
MEDICAL AND ORGANIZATIONAL BASES OF THE RESOURCE SUPPORT OF THE REGIONAL OPHTHALMOLOGICAL SERVICE IN THE RUSSIAN FEDERATION: REGULATORY ASPECTS (REVIEW)

Alexandr Grigorievich ZABOLOTNIY1,2
1S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia, Krasnodar Branch
2Kuban State Medical University of Minzdrav of Russia
Keywords: региональная офтальмологическая служба, нормативно-правовая база, ресурсное обеспечение здравоохранения, офтальмологическая помощь, regional ophthalmological service, regulatory and legal framework, resource provision of health care, eye care

Abstract >>
The aim of the study was to conduct a directed analytical review of the legislative, regulatory and legal framework (RLF), of the special literature on the normative and legal regulation (NLR) and the provision of medical and organizational activities (MOA) of the sectoral and regional ophthalmological service (OphS), the medical establishment (ME) of the health system of Russia (HS). Material and methods. The federal legislative, RLF has been studied on the official websites of the government, the Ministry of Health (MH) of the Russian Federation ((RF), and the health administration authorities (HAA) of the federal subjects of RF, including subordinate regulatory and legal acts. An analytical review of the relevant periodical literature on NLR and the provision of MOA of the sectoral and regional OphS, ME industry has been carried out. Bibliographic, informational and analytical methods, expert assessment method, content analysis were used. Results and discussion. A modern RLF for the provision of MOA of the sectoral and regional OphS, MO of HS is represented by more 100 current documents - orders, decrees and directions, guidelines of MH RF and HAA of the subjects of RF, several hundreds of applications. It was established that the primary regulatory and legal basis for the activities of OphS is considered «Procedures for providing medical care (MC) to the population in case of diseases of the eye, its adnexa, and orbit for adults and children»; Requirements and guidelines for the organization and maintenance of MOA of MO branch (orders of MH of RF N 132н/27.02.2016, N 358/08.06.2016, N 182/20.04.2018). Standards for the provision of MC and clinical recommendations - auxiliary. Conclusion. Analysis of RLF support of OphS MOA in the current three-level HS, since 2012-2014 till present, has shown that the legislative and RLF on NLR and the provision of MOA of OphS the industry as a whole has been created. The main established shortcomings are the lack of a unified conceptual approach and compulsory RLF and medical-organizational mechanism for ensuring and final implementation, as declared by the regulations, in particular, resource support of the activities of regional OphS.



21.
EFFICACY OF THE INDICATORS IN THE SYSTEM OF INTERNAL CONTROL AND MANAGEMENT OF THE QUALITY AND SAFETY OF MEDICAL ACTIVITY IN S. FYODOROV EYE MICROSURGERY FEDERAL STATE INSTITUTION

Alexandr Mikhaylovich CHUKHRAYOV, Nazrulla Sagdullaevich KHODZHAEV, Tatyana Vitalyevna BELIKOVA
S. Fyodorov Eye Microsurgery Federal State Institution of Minzdrav of Russia
Keywords: индикаторы качества, качество медицинской помощи, quality indicators, the quality of care

Abstract >>
The purpose of the study was to evaluate the efficacy of quality indicators in the system of internal control and management of ophthalmic activities at S. Fyodorov Eye Microsurgery Federal State Institution (Institution). Material and methods. The values of quality indicators were determined and compared in dynamics over the last 5 years of the Institution (indicators of structure, indicators of technological processes, and indicators of results). The actual values of the indicators are calculated using statistical data of accounting principles on the structure, medical processes and results achieved. Target values were established on clinical recommendations results of best practices, based on the introduction of modern technologies in medicine. Results. Analysis of changes in the indicators of structure reflects a positive dynamics of realization of the potential of the Institution medical-industrial activity (over a 5 years period reduced staff turnover, increased the number of doctors and medical sisters having certification category). Indicators of medical technological processes demonstrate the stable increase of the technological level of the Institution (the proportion of implantation of toric multifocal intraocular lenses, microinvasive endovitreal interventions 25-27 G, femtosecond stages of corneal and cataract surgery were introduced). After the comparative analysis of target and actual indicators of the result, the dynamics of indicators over 5 years was evaluated and showed their growth. Conclusion. The effectiveness of quality control and safety of medical assistance in the Institution with the use of dynamic assessment system and analysis of indicators has been proven by the increase in the quantitative-qualitative indicators of health activity for the last 5 years.