Ophthalmology Journal

BACKGROUND: Idiopathic macular hole is an acquired condition which decreases central vision. Its size and duration are the factors to be considered in macular holy surgery. As the data on the effectiveness of various surgical techniques of macular hole closure are inconsistent, this issue is relevant and warrants a study.

AIM: The study aimed to analyze the effectiveness of large macular hole surgery by re-approximation of the hole edges after internal limiting membrane peeling using various techniques.

METHODS: The clinical data are based on the results of an examination of 60 patients with stage III–IV idiopathic macular holes (60 eyes). The initial hole diameter ranged from 404 to 907 µm, the mean diameter was 575 ± 63 µm. Best corrected visual acuity ranged from 0.02 to 0.2. The study included three groups of 20 patients each. The groups were divided based on the surgical technique of macular hole closure. Air was used for tamponade in group 1, light silicone oil (5700 cSt) was used in group 2, and group 3 underwent sterile air tamponade with application of up to 0.1 mL of autologous conditioned plasma to the macular hole area.

RESULTS: Macular hole closure was achieved in 16 out of 20 patients of group 1. One year examination results showed increased best corrected visual acuity in all patients, which ranged from 0.04 to 0.7 (mean: 0.34 ± 0.18). In group 2, macular holes were closed in 95% of cases (19 patients). At one year, best corrected visual acuity increased in all patients and ranged from 0.03 to 0.6 (mean: 0.32 ± 0.16). In group 3, primary surgery resulted in macular hole closure in 19 (95%) patients. At one year, they showed an additional improvement of best corrected visual acuity, which ranged from 0.04 to 0.8, with mean best corrected visual acuity of 0.38 ± 0.12.

CONCLUSION: Analysis of the results of large macular hole surgery showed a relatively similar closure rate, which was 95% with autologous conditioned plasma, 95% with silicone oil tamponade, and 80% with sterile air tamponade. Silicone oil tamponade may be used for patients who cannot position facedown after surgery. The disadvantages of silicone oil tamponade include the need for repeated surgery.

BACKGROUND: A phakic intraocular lens (IOL) in the posterior chamber is weighty, changes topography of structures, and can affect ocular fluid dynamics.

AIM: The study aimed to assess the parameters of ocular fluid dynamics after ICL STAAR intraocular lens implantation and their relationship with topography of the phakic intraocular lens position based on ultrasound data.

METHODS: From the general population of 98 patients implanted with ICL STAAR V4 phakic intraocular lens as indicated, 10 patients (18 eyes) with myopia of 5–10 D were randomly selected with their consent to study ocular fluid dynamics. Intraocular pressure was measured using an ocular response analyzer, and corneal-compensated and Goldman intraocular pressure was recorded. Tonography was performed using GlauTest-60. Outflow facility (C) and Becker ratio were calculated. Ultrasound was performed using Aviso Quantel Medical with a 50 MHz high-resolution (linear technology) and Clear Scan scleral probe. Visits were planned before surgery and 3 months post-operatively.

RESULTS: Corneal-compensated intraocular pressure was 14.86 ± 2.63 preoperatively and 13.12 ± 3.64 mmHg 3 moths postoperatively; Goldman intraocular pressure changed from 13.12 ± 3.64 to 13.38 ± 3.90. Pre- and postoperative true intraocular pressure (P0) was 13.3 ± 5.60 and 11.75 ± 1.99 mmHg, respectively. Pre- and postoperative outflow facility was 0.23 ± 0.08 and 0.22 ± 0.07 mm³/min•mmHg, respectively. Pre- and postoperative Becker ratio was 52.64 ± 31.59 and 58.81 ± 21.87, respectively. All parameters did not differ significantly after surgery.

CONCLUSION: Ocular fluid dynamics do not change considerably after implantation of posterior chamber phakic intraocular lenses (ICL STAAR V4c). This can be explained by the optimal design parameters and lens shape, which create a synergistic effect of its elements with multidirectional tension from the fixation point in the iris to the fulcrum in the ciliary body.

Infectious keratitis is one of the leading causes of vision loss worldwide. The issue of its diagnosis and treatment is urgent, as irreversible complications may occur, including inflammatory corneal opacity, perforation and endophthalmitis, which may lead to vision reduction or loss, decrease in the quality of life of patients, and disability. In the Russian Federation, fungal keratitis pathogens are less common than bacterial and viral ones; however, they account for up to half of all identified cases of infectious keratitis in some countries and lead to poor treatment outcomes. One of the reasons for the late treatment start and, as a result, its longer duration is low awareness of ophthalmologists of the fungal etiology of keratitis. The article describes two clinical cases of patients with infectious keratitis caused by extremely rare pathogens—Alternaria alternata and Gibellulopsis nigrescens—and treated at Saint Petersburg City Multifield Hospital No. 2. The article also provides details of medical history, clinical presentation features, and Investigation results, including direct and fluorescent microscopy and inoculation to selective media with antifungal susceptibility testing. Analysis of these clinical cases showed features of medical history, clinical presentation, and results of pathogen-specific laboratory and instrumental diagnostics.

Ophthalmic plastic surgery of ptosis requires effective techniques which provide long-term functional and aesthetic results. Current surgical techniques have both advantages and disadvantages, including transcutaneous approach, the risk of severe postoperative scarring, a long recovery period, and standardized amount of resected tissue. Transconjunctival access is used primarily for superior tarsal muscle resection and is associated with the risk of corneal injury with sutures in the early postoperative period. Thus, there is an urgent issue of development of minimally traumatic techniques which consider the individual anatomical and physiological characteristics of a patient with ptosis to provide stable results without asymmetry of the upper lid contour and under- or overcorrection in the postoperative period. This clinical case clearly demonstrates the potential of the optimized transconjunctival technique for ptosis treatment. The developed technique allows for resecting a pre-determined amount of tissues calculated using a diagnostic algorithm. The surgical technique uses a single biodegradable suture, which significantly reduces the risk of postoperative corneal injury. Personalized ptosis surgery ensures predictable and stable functional and aesthetic results.

Capsular bag contraction syndrome, also known as anterior capsule contraction syndrome or capsular phimosis, is a phacoemulsification complication. This condition is characterized by capsular wrinkling, intraocular lens decentration or tilt, and considerably decreased vision. Some publications describe its pathogenesis based on the cellular theory of proliferation, migration, and differentiation of residual lens epithelial cells. This article provides the most common manifestations of capsular bag contraction syndrome, its causes, current classifications, and prevention and treatment options. Its risk factors are discussed based on the surgical technique, the material and shape of intraocular lenses, comorbidities, and patient’s age. The article also discusses prevention methods affecting both the reduction of the centripetal forces of the capsulorhexis edges and the increase in the centrifugal forces of the zonular fiber. Advantages and disadvantages of each method are described using clinical examples and published data. It has been demonstrated that combined methods to prevent capsular bag contraction syndrome, aimed simultaneously at various pathogenesis events, are the most effective. The author’s technique is proposed. It includes implantation of two capsular tension rings into the capsular bag and fixed to the iris and longitudinal capsulotomy. One capsular tension ring may be implanted into the capsular bag and fixed to the iris. This technique allows for not only completely eliminating centripetal effects using incisions of the capsulorhexis edge, but also creating a uniform circular tension of the capsule bag equator. Moreover, prevention of capsular bag contraction by reducing its diameter is expected to be ensured by the proximal edges of the capsular tension ring placed into the ciliary sulcus. This mechanism also reduces the pathological mobility of the capsular bag caused by inertial globe movements.

Currently, the long-term effects of phacoemulsification with intraocular lens implantation, including uncomplicated, are more frequently identified. Uveitis–glaucoma–hyphema syndrome, also known as Ellingson syndrome, is one of these complications, but the names cannot reflect its various manifestations. This condition shows no true signs of uveitis, and glaucomatous optic neuropathy is less common than ocular hypertension. The term “chronic uveal traumatization syndrome” demonstrates the pathogenesis of this condition, namely prolonged intraocular lens trauma to the iris and/or ciliary body. It develops when the intraocular lens is located in the ciliary sulcus or naturally in the fibrous capsular bag and in case of combined fixation. Chronic uveal traumatization syndrome is most common after implantation of an intraocular lens with a sharp optical and haptic edge. The condition is characterized by periodic blurring or a sharp decrease in vision and floaters, depending on the severity and location of intraocular hemorrhage. Pain, photophobia, and eye redness are signs of secondary ocular hypertension. An early and pathognomonic sign is defects in the iris pigmented layer at the site of its contact with the intraocular lens, detected using transillumination. Intraocular hemorrhages appear as microhyphema, hyphema, and vitreous hemorrhage. Anterior chamber flare is caused by abnormalities in the blood–aqueous barrier, dispersion of pigment and blood cells. Relapses usually include corneal edema associated with ocular hypertension, toxic effects of degradating blood, and endothelial decompensation. Corneal edema is not typical for primary open-angle glaucoma, even in case of high intraocular pressure, but it does not rule out their combination. Chronic uveal traumatization syndrome is associated with pseudo-phacodonesis, capsular contraction syndrome, and intraocular lens dislocation. Rare manifestations include cystoid macular edema and glaucomatous optic neuropathy caused by secondary glaucoma. Unlike uveitis, chronic uveal traumatization syndrome is not characterized by no precipitates, hypopyon, or blurred iris pattern. Ultrasound biomicroscopy assesses the intraocular lens position (in the sulcus ciliaris, combined, or intracapsular), decentration, tilt, or deformation, capsular bag fibrosis, Soemmering ring, iris prolapse, optic or haptic contact with the iris and ciliary body. Timely diagnosis and pathogenesis-directed therapy prevent optic nerve atrophy associated with secondary glaucoma.