Ophthalmology Journal

BACKGROUND: Degenerative optic neuropathies are one of the leading causes of irreversible blindness. The most accessible and effective methods of their early diagnosis are standard and non-standard perimetry.

AIM: The aim of this study is to identify the features of visual field changes in patients with degenerative optic neuropathies.

MATERIALS AND METHODS: The study involved 56 patients (97 eyes) with degenerative optic neuropathies, divided into 3 groups, and the control group consisted of 60 healthy individuals (60 eyes). In addition to the standard ophthalmological examination, all subjects underwent Humphrey visual field testing and Frequency Doubling Technology (FDT) perimetry in the author’s modification.

RESULTS: In patients with degenerative optic neuropathies, the sensitivity level of both FDT perimetry strategies turned out to be significantly higher in the detection of primary open-angle glaucoma than in that of multiple sclerosis, and the specificity level was 2 times higher than that of the Humphrey visual field testing. The data of the variance analysis showed that the results of FDT perimetry reliably separate patients with degenerative optic neuropathies from healthy individuals, but it is not always possible to determine the type of optic neuropathy.

CONCLUSIONS: Both threshold strategies of FDT perimetry are more effective in detecting optic neuropathy in primary open-angle glaucoma than in multiple sclerosis in terms of sensitivity. They have higher specificity than Humphrey perimetry, which indicates the advantage of FDT perimetry in separation between healthy people and patients with degenerative optic neuropathies, and not only of glaucomatous nature. The moderate and reliable correlation between the MD indices of all three strategies of perimetry indicates the expediency of their integrated use for early diagnosis of primary open-angle glaucoma.

BACKGROUND: Penetrating macular holes of the retina remain today one of the main reasons for a significant loss of central vision, especially in working age patients. At the same time, the mainstream problem are the validity and effectiveness of treatment of large and giant macular holes with a diameter of more than 500–1000 µm.

AIM: to optimize the treatment method for patients with large and long-standing macular holes. To analyze the results of treatment of patients with this condition.

MATERIALS AND METHODS: In 2023, 56 patients were operated on for idiopathic large macular hole. During vitrectomy, a new surgical technique was used for the macular hole bed tamponade with flaps of the internal limiting membrane in combination with the introduction of platelet-rich plasma.

RESULTS: After the resorption of the gas-air mixture (1–1.5 months after surgery), ophthalmoscopically and according to optical coherence tomography data, closure of the macular hole was observed in 51 of 56 operated patients, which amounted to 91.1%.

CONCLUSIONS: The surgical treatment technique used allows for closure of large macular holes in 91.1%.

BACKGROUND: A widespread visual impairment among medical students is known, but there are no data on the ophthalmic status of clinical residents.

AIM: To carry out an assessment of the visual analyzer status in Russian medical universities graduates who begin the clinical residency according to the specialty 31.08.59 Ophthalmology.

MATERIALS AND METHODS: An anonymous residents’ online survey was conducted in 15 universities from 14 cities using an original interactive questionnaire. Responses were received from 249 respondents (mostly females: n = 188, 75.5%; mean age 24.80 ± 0.06 years). To compare, we used previously published data on a survey of senior students from 5 Russian medical universities, including 549 respondents (425 females, 77.4%; mean age 22.4 ± 0.06 years).

RESULTS: In comparison to students, residents were significantly more likely to rate their vision as excellent (20.8% and 28.9%, respectively, p = 0.01), to report emmetropia (16.2% versus 26.9%, p < 0.001), to deny continuing vision deterioration (33.0% and 43.5%, p < 0.005), to rate higher the importance of good vision (9.25 ± 0.06 and 9.73 ± 0.05 conditional points, respectively, p < 0.01). Students significantly more often did not know the meaning of the “clinical refraction” term (2.6% and 0.4%, respectively, p = 0.04), more often reported vision problems interfering with their studies (26.2% and 15.7%, p = 0.01), and reported ongoing vision deterioration (57.9% versus 45.0%, p < 0.001). Otherwise, survey results were comparable.

CONCLUSIONS: Visual impairments are widespread among clinical residents-ophthalmologists of Russian medical universities, 58.2% of the responders had ametropia (including 56.1% of myopia), 28.5% had astigmatism, 3.6% had other ocular conditions. The majority of survey participants (59.8%) used or felt a need in optical correction, 19.7% rated their vision as “poor” or “very poor”, about a half (45.0%) believed their vision to worsen during recent years, and about as much (46.6%) reported that they experience limitations in everyday life related to decreased vision. Insufficient awareness of a part of the responders about their vision, and in some responders, a lack in basic ophthalmological knowledge were revealed.

BACKGROUND: Despite the high technological effectiveness of treatment methods for vitreoretinal conditions, secondary glaucoma is a fairly common complication in the postoperative period, especially after tamponade with silicone oil.

AIM: The aim of this study is to evaluate the effectiveness of Ahmed valve drainage device implantation in secondary glaucoma after vitreoretinal surgery with silicone oil tamponade and after the silicone oil removal.

MATERIALS AND METHODS: The study included 42 patients with secondary glaucoma after vitreoretinal procedures with silicone oil tamponade for rhegmatogenous retinal detachment. Patients were divided into two groups: group 1 included 27 patients with avitria after silicone oil removal, group 2 — 15 patients with silicone oil tamponade in whom silicone oil removal was not indicated for various reasons. Before surgery, decompensation of intraocular pressure was detected in all patients (32.5 ± 2.9 mmHg, at the maximum hypotensive regimen), visual acuity varied from counting fingers to 0.5 with no correction of refractive error possible.

RESULTS: In all cases, anti-glaucoma surgeries with Ahmed valve implantation were performed without complications. In the early postoperative period, the hypotensive effect was achieved in 100% of cases in both groups, the level of intraocular pressure on the first day after surgery in patients with avitria after removal of silicone oil averaged 9.3 ± 1.5 mmHg, in the group with silicone oil in the vitreal cavity — 10.2 ± 1.8 mmHg. The most common complication in the early postoperative period in patients with silicone oil tamponade was a shallow anterior chamber (in 40% of cases). Intraocular pressure was compensated in all patients within 12 months.

CONCLUSIONS: The use of Ahmed drainage device is an effective method of intraocular pressure normalization in patients with secondary glaucoma after vitreoretinal procedures, both with silicone oil tamponade and avitria.

BACKGROUND: The most popular method of keratorefractive surgery is sublamellar valve technology. It is known that excimer laser systems, which are widely used and are the gold standard in keratorefractive surgery, have a number of disadvantages. Alternative sources of UV radiation generation are solid-state laser systems, in particular the domestic Olimp 2000/213 laser, which previously had no experience in femto-assisted sublamellar surgery.

AIM: To evaluate clinical and functional results of correction of mild, moderate and high myopia using sublamellar keratomileusis technology, performed using the Schwind Amaris 1050 rs excimer laser and the Olimp 2000/213 solid-state ablative laser.

MATERIALS AND METHODS: 190 patients (190 eyes) with stationary myopia were examined and operated on. The follow-up period was 1 year after surgery. The main group consisted of patients who underwent myopia correction using sublamellar keratoablation technology using a solid-state laser Olimp 2000/213 — 92 eyes. The control group consisted of patients after FemtoLASIK, in whom ablation was performed using a Schwind Amaris 1050 rs laser (98 eyes). A comparative analysis was carried out according to modern criteria for refractive surgery.

RESULTS: 190 patients (190 eyes) with stationary myopia were examined and operated on. The follow-up period was 1 year after surgery. The main group patients underwent myopia correction using sublamellar keratoablation technology using a solid-state laser Olimp 2000/213 — 92 eyes. The control group consisted of patients after FemtoLASIK correction, in whom ablation was performed using a Schwind Amaris 1050 rs laser (98 eyes). A comparative analysis was carried out according to modern criteria for refractive surgery.

CONCLUSIONS: The analysis of the clinical and functional results of myopia correction using the technology of sublamellar keratoablation, performed using the Olimp 2000/213 solid-state ablative laser and the Schwind Amaris 1050 rs excimer laser, showed a high comparability of the technologies.

This clinical case demonstrates the toric to monofocal intraocular lens exchange due to the erroneous assessment of corneal topography in a patient with radial corneal scars after keratotomy. Toric intraocular lens power calculation was performed using initial parameters, when its central optical area was transparent, and at the mid-periphery, approximately 4–5 mm from the central optical area in the upper temporal quadrant, there was a subepithelial fibroplasia present. Postoperative refractive result was not optimal; residual astigmatism was noted, and it was decided to eliminate it by scarification of the epithelium in the area of fibroplasia. This lead to a significant change in keratometry and to practically total restoration of corneal spherical form. IOL exchange was performed, which caused an increase in visual function.

Glaucoma is one of the leading causes of blindness worldwide. The etiology of primary glaucoma is usually divided into mechanical and vascular mechanisms. Research of the vascular component of glaucoma was going on since the beginning of the last century with continuous improvement of diagnostic methods from invasive to high-tech non-contact ones. Modern and promising methods are: ultrasound examination in color Doppler mapping and pulsed Doppler modes, optical coherence tomography angiography, and laser speckle flowgraphy. The review describes specific for glaucoma blood flow changes in ocular vessels, correlating with functional and structural changes: decrease of vascular density in macular, parafoveolar, and peripapillary areas, decrease of the integral indicator of microcirculation, decrease of the indicators of volume and linear blood flow velocities in retinal and choroidal vessels, impaired retrobulbar blood circulation. The analysis of literature data is presented concerning the investigation of hemodynamic disturbances in ocular vessels in normotensive glaucoma and glaucoma in myopic eyes, in systemic blood flow disturbances (arterial hypertension and hypotension) in patients with glaucomatous optic neuropathy.

The article is devoted to the presentation of a rational algorithm of post-operative visits of patients who have undergone phacoemulsification. Uncomplicated phacoemulsification of senile cataract performed by an experienced surgeon allows giving up postoperative examinations at the clinic confining them to one visit to a polyclinic in the home area during two weeks after the procedure, but only if the two following preconditions are met. The first is the ability of the patient to promptly report any changes in his health and, if necessary, to arrive immediately for examination at the clinic. The second is effective pharmaceutical support for phacoemulsification, which is intended to solve two main tasks — prevention of infectious complications and control of inflammation.