Vol 15, No 2 (2022)

BACKGROUND: Bullous keratopathy is a chronic edema of the cornea, accompanied by a significant visual acuity loss and pain. The cause of bullous keratopathy is a pathological irreversible decrease in the number of endothelial cells, in which the endothelial layer cannot perform its main barrier and pumping functions.

AIM: To evaluate the reproducibility and functional results of femto-assisted posterior lamellar keratoplasty using intraoperative OCT at the stage IV–V of bullous keratopathy.

MATERIALS AND METHODS: The study was conducted on 23 eyes of 23 patients diagnosed with stage IV–V of bullous keratopathy. The mean age of patients was 69 ± 12 years, there were 14 male patients and 9 female patients. Before surgery, light perception with correct light projection was recorded in 15 cases, in 5 cases — the count of fingers at the face (0.005), in 3 cases visual acuity was 0.01. The central corneal thickness varied from 981 μm to 1960 μm and averaged 1008 ± 96 μm. Femto LDV Z8 femtosecond laser (Ziemer, Switzerland) was used to form an endothelial graft. All surgeries were performed using the Hi-R Neo 900 operating microscope with an integrated third-generation OCT module (Haag-Streit Surgical, Germany).

RESULTS: No intraoperative complications were noted. The presence of objective control in the form of intraoperative OCT made it possible in all cases to clearly differentiate stromal and endothelial surfaces of the posterior layered graft located in the anterior chamber of the eye. The postoperative course was standard for posterior lamellar keratoplasty, accompanied by resorption of corneal edema with restoration of its transparency. The normalization of corneal thickness was noted by 1 month after surgery, and the restoration of corneal optical properties was noted by 3–6 months and was accompanied by gradual increase in visual acuity. Corrected visual acuity by 1 month was 0.05 ± 0.03, by 3, 6, 12 months — 0.1 ± 0.05, 0.15 ± 0.05 and 0.15 ± 0.04, respectively. By 12 months after surgery, the central corneal thickness was 596 ± 42 μm, the thickness of the ultrathin graft tended to decrease somewhat to 67 ± 8 μm, the loss of endothelial cells was 59.3%. Endothelial graft survival was achieved in 82.6% of cases.

CONCLUSIONS: The use of intraoperative OCT allows expanding the indications for posterior lamellar keratoplasty in bullous keratopathy, including the stage IV–V of the disease.

BACKGROUND: Penetrating keratoplasty leads, on the one hand, in 100% of cases, to the formation of induced astigmatism of variable degree, on the other hand, to a decrease in the density of endothelial cells of the corneal graft, which can reach from 19.1 to 38.3%. Thus, today the task of safe cataract extraction with minimal loss of density of endothelial cells and maximal correction of corneal astigmatism by the aid of an implantation of a toric intraocular lens is paramount.

AIM: The aim of the study is to conduct a clinical and functional analysis of cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty.

MATERIALS AND METHODS: We performed phacoemulsification with implantation of a toric intraocular lens in 25 eyes (25 patients) having a history of penetrating keratoplasty. The 1^st degree of the lens nucleus density (according to Buratto classification) was noted in 4 eyes, the 2^nd degree — in 17 eyes, the 3^rd degree — in 4 eyes. According to keratotopography, all patients had a symmetrical type of postkeratoplastic astigmatism. The average follow-up period was 1 year.

RESULTS: Intra- and postoperative complications were noted. One month after surgery, uncorrected visual acuity increased from an average of 1.3 ± 1.6 to 0.3 ± 0.9 LogMAR, best corrected visual acuity increased from 1.0 ± 1.18 to 0.1 ± 0.9 LogMAR, refractive astigmatism decreased from –7.5 ± 2.43 to –1.43 ± 0.38 D, and did not change during 1 year of follow-up. The density of endothelial cells decreased by 9% 1 year after surgery.

CONCLUSIONS: Cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty allows achieving high refractive results. Preoperative analysis of endothelial cell density, careful approach to the intraocular lens calculation, and standard protocol of phacoemulsification make this operation predictable and safe.

BACKGROUND: Most of the thyroid eye disease (TED) patients have dry eye syndrome. Upper eyelid retraction (UER) is the most common TED symptom and one of dry eye causes. There are two groups of UER surgical treatment methods: transconjunctival and transcutaneous, which can influence on upper eyelid contour, tear film and ocular surface.

AIM: To evaluate the influence of different methods of UER surgery on upper eyelid contour and ocular surface.

MATERIALS AND METHODS: 12 patients (19 eyes) were included in the study. Visual acuity test, measurements of UER and palpebral fissure height, Shirmer 1 test, LIPCOF-test and tear break-up time test, Meibomian gland dysfunction staging, corneal and conjunctival fluorescein staining and determination of the ocular surface disease index (OSDI) were performed before surgery and 1 week, 1 and 3 months after. Patients were divided into two groups. Patients of group 1 had UER less than 4 mm and they underwent an upper tarsal muscle extirpation. Patients of group 2 had UER 4 mm and more and they underwent a recession of the levator palpebrae superioris muscle apouneurosis.

RESULTS: In all patients UER and the height of the palpebral fissure decreased 7 days after surgery and increased again after 3 months, and the dynamics of this change was more pronounced in group 2. There was one patient (both sides) with poor upper eyelid contour after surgery in both groups. BCVA and OSDI improved, while other parameters had a large scatter of data.

CONCLUSIONS: We have found that surgical treatment of UER caused by TED improves the contour of the eyelid, increases visual acuity and leads to a subjective improvement in the condition of the ocular surface.

The article presents the pathogenetic mechanisms of eye damage by gas self-defense weapons in detail. We discuss the mechanisms of eye damage and structural changes of the tissues after gas-trauma. The causes of these changes and the main clinical manifestations accompanying them are analyzed. We analyzed the factors, influencing the development of dystrophic changes of the ocular surface in detail. The information on various techniques for self-assistance, mutual aid and earlier specific treatment of this injury was summarized. An aqueous solution of pediphene substance promising for use is considered, which has a number of pharmacological properties that fundamentally affect the pathogenetic mechanisms of gas-weapon trauma. Its effectiveness was shown in the experiment in comparison with the control group without treatment and the group using the combined drug-dexamethasone in combination with an antibiotic.

BACKGROUND: The cutting action of a femtosecond laser (FS-laser) on the corneal tissue is performed using a photodestructive effect. FS-laser technology is used in many different areas of corneal surgery, and studying this effect is an actual issue.

AIM: To evaluate the surface of the corneal incision created by a FS-laser (experimental study).

MATERIALS AND METHODS: 20 porcine eyes were divided into two groups (FS-laser and keratome). The corneal tissue surface in the area of contact between two lips of the incision was visualized by electron microscopy.

RESULTS: In all cases, we received a full-thickness incisions through the cornea. Images obtained by electron microscopy showed regular surface, no signs of thermal or mechanical damage to the corneal structure.

CONCLUSIONS: The FS-laser is used as a microscopic scalpel in surgery. The precision cutting process is performed by mechanical forces generated by photodestruction by expanding cavitation bubbles.

Peripapillary retinoschisis is a rare condition and is detected more often in patients with glaucoma or glaucoma suspects, while data on the pathophysiological mechanisms of development and the effect on the course of glaucoma are limited. The article presents two clinical cases of unilateral peripapillary retinoschisis detected accidentally during a routine examination of patients with glaucoma.