Search

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan® in combined treatment of ON associated with herpesvirus infection (HVI).Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine® preparation 0.5 ml and 12.5 % Dicynone® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon® and Semax®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.Conclusion. The clinical efficacy of the drug Imunofan® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

Purpose. To assess increasing the functional effectiveness of the results of endovitreal surgery in patients with rhegmatogenous retinal detachment (RRD) by using modern pharmacotherapy drug in the postoperative rehabilitation.Material and methods. 108 people (108 eyes) with RRD. All patients underwent standard three-port vitrectomy, after which tamponade of the vitreous cavity with silicone oil with its removal 3 months after operation was performed. Patients were divided into 2 groups: the first – 60 people who received Cytoflavin on the background of standard therapy, and the second – 48 people with postoperative treatment only with standard therapy. Depending on the visual prognosis calculated before the operation, both groups were represented patients with satisfactory (A subgroup) and low (B subgroup) visual prognosis. Laser Doppler fluometry (LDF) was used to study chorioretinal microcirculation: microcirculation index and microcirculation efficiency index were recorded. Using OCT angiography (OCT-A), signs of macular ischemia were investigated: choroidal thickness, area nonperfusion of foveal avascular zone, density in the superficial capillary plexuses and density in the deep capillary plexuses in the macular area.Results. The inclusion of Cytoflavin in the postoperative rehabilitation of patients with RRD increases the possibility of a favorable functional outcome of the operation, affects the positive dynamics in the state of the capillary plexus in the macula. In the aggregate of patients of the 1st group, the increase in visual acuity was 2 times higher than in patients of the 2nd group 6 months after surgery. Also, in patients of the 1st group there was a more significant activation of chorioretinal blood flow according to LDF and OCT-A.Conclusion. The prescription of Cytoflavin in the postoperative treatment of patients underwent endovitreal surgery of RRD, regardless of the visual prognosis, increases the functional outcome of the operation. Improvement in visual functions in patients receiving Cytoflavin therapy is directly related to improved intraocular blood flow and macular perfusion.

Purpose. In prospective research to assess clinical efficacy of different surgical treatments for patients with chronic ocular ischemic syndrome (COIS) associated with hemodynamically significant internal carotid artery stenosis (ICAS).Material and methods. The research included 20 patients with 3rd degree severity COIS. Patients were divided into 3 groups due to type of their treatment. 1st group – 7 patients; only carotid endarterectomy (CE) of ICAS was performed; 2nd group – 6 patients; panretinal photocoagulation (PRP) of retina was performed; 3rd group – 7 patients; combined treatment: PRP of retinal capillary non-perfusion areas was performed by the 1st stage, then after 2 weeks by the 2nd stage CE was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, vessels of eye was performed by ultrasound scan, spiral computed tomography, fundus fluorescein angiography.Results. Monitoring of groups of patients for 1 year depending on type of treatment of COIS, allowed us to determine tactics of patients management and features of the postoperative period. CE at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of best corrected visual acuity in 71% of patients; preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of COIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment.Conclusion. Combined staged treatment of COIS associated with hemodynamically significant stenosis, which including PRP of retina and CE of ICAS, allows to stop the progression of ischemia in retina and to avoid complications, leading to loss of vision, and can be recommended for use in clinical practice for the treatment of COIS. PRP of retina can be use to stabilize process at impossible to perfomed CE. Surgical reconstruction of the ICAS, despite restoration of blood flow in ophthalmic artery, can aggravate processes of ischemic damage to the neurosensory layer of the retina with decreased vision.

Purpose: to study the effect of differentiated treatment approach in patients with varying degrees of severity chronic ocular ischemic syndrome (OIS) on clinical course of disease and hemodynamics of eyes in prospective research.Patients and methods. The research included 20 patients with chronic OIS. Patients were divided into 4 groups due to severity of chronic OIS and type of treatment. 1st group — 7 patients with moderate severity chronic OIS and hemodynamically significant of internal carotid artery stenosis (ICAS); only carotid endarterectomy (CE) of ICAS was performed. 2nd group — 6 patients with severe degree chronic OIS and hemodynamically significant stenosis of ICAS; 2 weeks before CE, panretinal photocoagulation (PRP) of retinal capillary non-perfusion areas was performed. 3rd group — 4 patients with severe degree chronic OIS, complicated by rubeosis iris and increased IOP on hypotensive regimen, on the background of hemodynamically insignificant ICAS; PRP of retina was performed. 4th group — 3 patients with moderate severity chronic OIS with hemodynamically insignificant ICAS; course of neuroprotective therapy was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, eye vessels was performed by ultrasound scan, spiral computed tomography, OCT-angiography with the AngioVue.Results. Monitoring of patients’ groups for 1 year after chronic OIS treatment allowed us to determine tactics of patient management depending on degree of ICAS and severity of chronic OIS. Reconstructive surgery at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of BCVA in 71 % of patients. Preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of chronic OIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment. Neuroprotective pharmacotherapy in early stages of chronic OIS, in absence of indications for reconstructive surgery and PRP of retina, improved the prognosis for patients’ vision.Conclusion. Differentiated treatment approach in patients with chronic OIS, due to changes of hemodynamics of internal carotid artery, has improved indexes of hemodynamic and visual acuity.

Purpose. Estimate of clinical efficacy of combined use of aflibercept and meldonium at tachyphylaxis of neovascular age-related macular degeneration (nAMD) to ranibizumab. Patients and methods. Comparative analysis of treatment results of nAMD in 25 eyes (25 patients) aged from 52 to 79 years was carried out. Main criterion for the patients inclusion was presence of nAMD resistant to intravitreal injections (IVI) of VEGF inhibitor ranibizumab with visual acuity values of not less than 0.1. Patients with different ophthalmologic pathology, accompanied by development of macular edema, with glaucoma and after any eye operations, performed during study period, were excluded from study. Before using aflibercept, all patients were treated with ranibizumab for 1.5–2 years (from 5 to 7 injections). The lack of persistent positive result was cause for change of course treatment of this patients on aflibercept (3 monthly injections) for enhance anti-vasoproliferative effect. The patients were divided into two groups — main and comparison, comparable by sex, age, visual acuity and type of choroidal neovascularization. In the main group, 3 aflibercept IVI were supplemented parabulbar injections of 0.5 ml of meldonium (with concentration of 500 mg / 5 ml) daily for 10 days. Patients of the comparison group did not receive meldonium. Results. The supplement of meldonium in the main group, relative to the comparison group, led to increase in 1.5 times of best corrected visual acuity, in 1.2 times of b-wave amplitude of the electroretinogram, preservation of the neuro- and pigment epithelium of retina, complete regression of neovascularization. Conclusion. Findings results evidence about clinically advisable to use meldonium in course treatment in patients with nAMD, resistant to ranibizumab, with aflibercept IVI for increase visual functions and stabilize the degenerative changes in neurosensory retina, pigment epithelium and choriocapillary layer.

Background. Annual disability index among patients with rheumatogenic retinal detachment (RRD) is 2–9 %. One of the factors, causing the development of morphofunctional disorders of macula, is the change in intraocular hemodynamics. Aim: substantiation of rational timing of neuroprotection with cytoflavin depending on the prediction of visual functions after endovitreal surgery of RRD.Materials and methods. There were 21 patients (21 eyes) with RRD. A three-port vitrectomy with silicone tamponade and its subsequent removal was performed. Two groups of patients: the 1st group – 10 patients with tolerable prediction of restoration of visual functions (increasing of visual acuity to 0.4–0.2 relative units), the 2nd group – 11 people with low level of visual prognosis (increasing of visual acuity to 0.15 and lower). All patients received cytoflavin at both stages of surgery. We used laser doppler flowmetry (microcirculation index (MI) and microcirculation efficiency index (MEI)). The criteria of “sufficiency” of cytoflavin receiving was periods of recovery of MI and MEI to indexes that were not significantly different from the norm.Results. Dynamics of response of chorioretinal microcirculation at both stages of endovitreal surgery of RRD was unidirectional. At the same time, the indexes of MI and MEI under influence of cytoflavin in patients with tolerable level of visual prognosis reached maximum index at the 15th day of observation as at the stage of silicone oil tamponade and after its removal; and in patients with low level of visual prognosis only at the 25th day of observation.Conclusions. Therapy with cytoflavin neuroprotection in patients after endovitreal surgery of RRD leads to significant increase of indexes of chorioretinal blood flow. The period of cytoflavin treatment justified until achievement of the required positive dynamics of chorioretinal microcirculation depending on the level of visual prognosis: tolerable – 15 days, low – 25 days.

Purpose: to study the frequency and structure of undifferentiated connective tissue dysplasia (UCTD) in school-age children with myopia, their relationship to choroidal thickness and course of myopia.Patients and methods. The object of study was 120 children (240 eyes) aged 11–13 years with school axial myopia (axial length (AL) from 24.5 to 26.0 mm). Special ophthalmological examination included optical coherent tomography of macular zone (“RTVue 100” Optovue, USA) and “Cross Line” scan for measuring choroidal thickness in foveal area and 1000 μm from it in nasal and temporal regions.Results. According to studies, the phenotypic signs of UCTD were diagnosed in 56 children (46.7%) with school myopia, the largest group included phenotypic signs of locomotor syndrome; 14 children (25%) had a weak degree of UCTD, 34 children (60.7%) — moderate degree and 8 children (14.3%) — pronounced degree. Comparative characteristic of changes in choroidal thickness detected a high degree of interrelation between the severity of clinical manifestations of UCTD and the level of decrease in blood-flow in the choroid. In children of the main group with signs of UCTD, the annual growth of AL exceeded the same parameters in children of the control group by more than 2.5 times (p < 0.05); due of accumulation of phenotypic signs of UCTD, a more noticeable tendency to decrease of choroidal thickness and the increase of AL was observed (p < 0.05). The statistical analysis confirmed the presence of significant negative correlation between the decrease in average thickness index in segment of the macular map and the degree of increase of AL (p < 0.05).Conclusions. According to results of diagnostic screening, in 46.7% children with school myopia, we detected phenotypic signs of UCTD. The method of optical coherence tomography showed that with increasing severity of UCTD, indexes of choroidal thickness in the macular zone are significant decreased. In the catamnesis (duration 1 year), it was found that in children with myopia with moderate and pronounced degrees of UCTD, increase of AL is associated with degree of thinning choroidal thickness, which indicates violations of biomechanical status of sclera.

Purpose. To study the clinical effectiveness of the system of complex treatment of optic neuritis (ON) associated with herpesvirus infection(HVI), including methods of immunopharmacotherapy. Patients and methods. The clinical study involved 55 people (55 eyes) with acuteON associated with HVI. The treatment regimen for all patients included 10 days the addition of Dexamethasone solution to optic nerve on decreasing scheme, Emoxypine 1% 0.5 ml, and Dicynone 12.5% 0.5 ml through irrigation system implanted in retrobulbar space, in combination with appoint of neuroprotective drugs (Picamilon and Semax). Depending on features of immunotherapy, all patients were divided into 3 groups. The first group consisted of 20 patients, whose treatment in addition to the above included intravenously infusions 6 mg of Polyoxidonium from the moment they entered the eye hospital. The second group included 17 patients who received in addition to Polyoxidonium, muscle injections of Cycloferon, in mode and doses according to the manufacturer's instructions. The third group of patients (18 peoples) — with using etiotropic immunotherapy that consisted of combination of Polyoxidonium, Cycloferon and endonasal electrophoresis of 0.25% solution of Derinat. The duration of immunotherapy was 10–12 days. Results. The analysis of obtained datas showed that more significant positive dynamics was noted in the clinical course of ON in patients of the 3rd group of observation, who simultaneously received complex of 3 immunotropic drugs in comparison with group 1 and 2, in the treatment of which we used one immunotropic drug Polyoxidonium, or its combination with Cycloferon, without Derinat. Conclusions. The method of etiotropic and pathogenetic immunotherapy developed by us, represented by the combination of Polyoxidonium, Cycloferon and Derinat, at ON, associated with herpesvirus infection, allows to shorten by 2 times or more the period of stopping of signs of inflammation in optic nerve, to exceed the average visual acuity in the period of clinical recovery by 0.5–1.3 times and improve functional results of treatment in the absence of recurrence of the disease within 1 year of observation

Purpose. To study hemodynamic of optic nerve (ON) in process of complex pathogenetic direct treatment in patients with anteriorischemic optic neuropathy (AION). Patients and methods. 43 patients with acute phase AION were exanimated and treated. Besides the functional results (visual acuity, visual field), the diagnosis AION was based on indicators of ophthalmologic and angiographic researches of ON. Patients were divided into two groups. 23 patients were in the main group. They received neurometabolic medicinal preparations (MP) through a silicone retrobulbar catheter. The control group consisted of 20 patients who had the traditional method of medicines injection. Indexes of hemodynamic were estimated according to Doppler ultrasound of local blood flow at the short posterior ciliary arteries (SPCA). At the same time following indexes were estimated: Peak Systolic Velocity (PSV, cm/sec), End Diastolic Velocity (EDV, cm/sec), Average Blood Velocity (ABV, cm/sec), Index of peripheral vascular resistance (R1, M ± m). Results. After the end of hospitalization of patients with AION, more favorable shifts in indexes of hemodynamic in SPCA were reached in patients of main group of research that authentically exceeded the similar data obtained at patients in the control group. Improvement of blood flow of ON was followed by positive changes of thickness of the retinal nerve fiber layer and condition of disk ON. To the final stage of researches (12 months from beginning of treatment) according to degrees of functional disorders severity in the main group of patients prevailed I (14 patients, 60%), less often II degrees (9 patients, 40%) of optic nerve atrophy and absented patients with III degrees of defeat of ON. Among patients of control group II–III degree optic nerve atrophy (12 patients, 60%) met more often, less often I degrees (8 patients, 40%). Conclusion. The conducted research showed that at patients with AION receiving sub-Tenon's infusions of MP more significant favorable functional results were reached thanks to increase of indicators of blood flow in SPCA: PSV — on 24.5%, EDV — on 16.2%, ABV — on 32.2% that significantly exceeds similar data at patients in control group with traditional methods of MP injections.

Purpose. The analysis of clinical effectiveness of a triplex transplant in recovery of extensive through eyelid defects. Patients and methods. 18 patients were under observation (18 eyes) aged from 27 to 68 years with extensive through eyelid defects. The area ofdefects varied from 69 to 105 mm2 (average 87.5 ± 9.0 mm2). The reasons of through eyelid defects were: a mechanical trauma —5 patients, an explosive trauma — 2 patients, result of surgery of tumors a century — 11 patients. All patients were divided into2 groups. The main group consisted of 9 people (9 eyes) who had triplex transplant containing a temporal muscle for replacement ofthrough eyelid defects. The control group consisted of 9 people (9 eyes) who had a double-layer tissular transplant for replacement ofthrough eyelid defects. Besides basic ophthalmologic examination, the research of speed and intensity of recovery of local hemodynamic of transplant was conducted to all patients. The examination was made in 3, 10 days, 1 month after operation, then once in 6 months. Results. In 1 month after operation in main group reparative process came to the end with formation of a gentle thin hem on border of skin transplant. Color of skin transplant was identical to nearby tissues. Secondary cicatricial deformations of skin transplant were absent. Only in 5 patients of control group in 1 month after operation process came to the end with formation of thin hem on border of transplant. 3–6 months later rough deformations of transplant was not observed in any patients of the main group. Cicatricial shortening of the operated eyelid with formation of partial coloboma and eversion of eyelid were in 3 patients of control group that demanded carrying out the second stage of surgical treatment. Conclusion. The offered method of blepharoplasty with use of a temporal muscle makes a practical contribution in development of the perspective direction of a reconstructive plastic surgery of extensive through eyelid defects.

Purpose. Assessment of efficiency in the use of a multi-component tissue complex for an optimization of reconstructive plastic surgery for extensive cicatrical deformations of blepharons.Material and methods. The analysis of plastic reconstruction of extensive cicatrical defects of blepharons was carried out in 30 patients (30 eyes) aged from 27 to 68 years (average: 52.9±14 years). The reasons of cicatrical deformations of blepharons were: mechanical traumas – 9 patients, gunshot injuries and explosive traumas – 4, tumor surgeries – 12, stings of animals – 5. The area of the eyelid defect was from 69 to 105 mm2(average: 87.5±9.0 mm2).All patients were divided into 2 groups. The main group included 15 patients (15 eyes) who underwent the operation with the technique of layerby-layer reconstruction of the eyelid using a three-layer multicomponent tissue complex consisting of a mucoperiosteal flap, a muscle-fascial flap of the temporal muscle, free skin graft. The comparative group was composed of 15 patients (15 eyes) where a two-layer graft was used which consisted of a mucoperiosteal flap and a skin flap on the nourishing base to recover the penetrating extensive eyelid defect.Results and discussion. On the 5th day after the operation, signs of infection and hematoma of the eyelids were absent, and there was a moderate edema of tissues in all patients of the main and comparative groups.On the 10th day after the operation, the skin graft acquired a pink tint on its entire surface in patients of the main group. In the comparative group, the pink shade of the skin graft was noted only from the side of the nourishing pedicle, the rest part kept a pale shade and areas of epidermal necrosis.After 1 month, the reparative process culminated in the formation of a tender fine scar, and the mobility of the eyelids appeared in the patients of the main group. The size of palpebral fissure varied from 9 to 11mm (on average 10.1±0.5mm), the deviation of the palpebral fissure size was about «-»16%. In the comparative group, the reparative process was completed by the formation of a tender fine scar only in 5 patients. In 10 patients a reduction of the graft and a formation of scar tissue retraction were observed, with a deviation in the size of the palpebral fissure by 8-12mm (on average 10.9±1.0) compared with the healthy one. Visible scar deformations of the eyelids were not observed 3 months after the operation in patients of the main group. The deviation of the palpebral fissure size was «-»7-8%. In the comparative group a cicatricial shortening of the operated eyelid with the formation of coloboma and ectropion occurred in 3 patients.During 2 years of follow-up, the correct position and anatomy of the eyelids remained in the patients of the main group, the size of the palpebral fissure averaged to 11.7±0.5mm and did not differ significantly from the healthy eye (11.9±0.4mm), p>0.05.Within the same period in the comparison group 5 patients had an incorrect position of the operated eyelid (retraction, ectropion, entropion), which required repeated plastic reconstructions.Indices of hemodynamics: in the main group, the complete correspondence of parameters of blood flow to the tissues of the healthy eyelid occurred 1 month after the operation (p>0.05). In the comparative group positive changes were detected only 3 months after blepharoplasty. In the comparative group positive changes were detected only 3 months after blepharoplasty.Conclusions. The proposed combined method of blepharoplasty for extensive complicated cicatrical defects allows to reduce its multistage approach, to increase donor resources in order to receive the desired plastic material, to empower ophthalmoplasty without serious postoperative complications, to improve esthetic results of rehabilitation. Key words: blepharoplasty, extensive cicatrical defects of blepharons,

Purpose. To study medical social rehabilitation possibilities of the congenital cataract surgery with primary IOL implantation in children of thoracal age.Material and methods. At preschool age (6 years) there were analyzed the results of surgical treatment of congenital cataract with primary intracapsular implantation of Acrysof Natural IOL (Alcon, USA) in 19 children (29 eyes) operated at thoracal age (5.4Ѓ}2.6 months) – the main group, and in 20 children (31 eyes) operated in the period of the early childhood (2.3Ѓ}0.7 years) – the comparative group. Both analyzed groups were representative in the congenital cataract clinical forms, condition of anterior and posterior segments of eyes, severity and nature of neurologic burdens and frequency of postoperative YAG discissions of secondary cataract (p>0.05).Results. According to the obtained data in children with congenital cataract operated at thoracal age relatively to the comparative group, an average value of visual acuity of pseudophakic eyes by the preschool period increased 1.6 times, a specific gravity of children with a stable binocular vision was enlarged 1.4 times, a quantity of children with the bilateral pseudophakia who were capable to be trained at the comprehensive school was raised 1.9 times.Conclusion. The congenital cataract aspiration with a primary IOL implantation in children of thoracal age allows to achieve a high rehabilitation effect (visual acuity increase up to 0.5 and more in combination with binocular nature of vision) by the preschool period 2.5 times more often in comparison with the period of the early childhood.