卷 13, 编号 1 (2020)

目的 探讨在进行超声乳化术前评估伴发青光眼（包括已接受抗青光眼手术治疗的）对人工晶体(IOL)度数计算准确性的影响。材料和方法 该研究共纳入了 413 例患者，并将其分为4组: 第一组—无伴发青光眼的白内障患者(251 例); 第二组—白内障合并原发性开角型青光眼且使用药物降压治疗的患者(103 例); 第三组 — 接受过小梁切除术的白内障患者(42 例); 第四组 — 白内障合并原发性闭角型青光眼且使用药物降压治疗的患者(17例)。使用 IOL-Master 500 仪器通过光学生物测量法对所有患者均进行了IOL计算。一个月后，将根据 Barrett Universal II 公式计算得出的屈光度和根据 Topcon-8800 自动验光仪得出的屈光度进行对比。

结果 在前三组的研究中IOL计算的准确性没有显著差异 (每组对应的计算误差分别为 –0.09 ± 0.39 D,

–0.08 ± 0.45 D, –0.03 ± 0.49 D)。然而在第四组中显示较明显的近视屈光偏移(–0.47 ± 0.48 D, p = 0.095)。

结论 针对白内障合并青光眼且使用药物降压治疗以及接受过小梁切除术的患者在IOL计算算法上并未进行任何修改。但是，为了避免超声乳化术后近视屈光度过高，针对原发性闭角型青光眼的患者建议选择小 0.5 D 的人工晶体。

Aim. A comparative study of Bowman layer transplantation (BLT) after its ultraviolet (UV) crosslinking and BLT without preliminary UV crosslinking in patients with advanced keratoconus (KC) stages III to IV.

Materials and methods. There were 30 patients aged 14 to 37 years with KC III–IV stages. The first group included 15 patients who underwent BLT without prior UV crosslinking. The second group included 15 patients who underwent BLT after UV crosslinking. The criteria for inclusion of patients in the study were: progressive KC, with corneal thinnest point (CTP) without epithelium of 400 μm or less, a maximum keratometric index (K_max) of 58 D and more, with patient satisfied by his visual acuity in a scleral contact lens (SCL) and refusing keratoplasty.

Results. In comparison with preoperative data in both groups, K_max decreased by an average 0.6 ± 0.5 D, and CTP increased in the first group by an average of 41.5 ± 16.3 µm, and in the second group by an average of 31,9 ± 9.2 μm. Best corrected visual acuity (BCVA) did not change.

Conclusion. During the follow-up of 26.6 ± 6.2 (from 6 to 36) months, CTP and K_max indices remained stable in operated patients, which indicates the arrest of KC progression after BLT with crosslinking and without it. The preservation of endothelial cell density and BCVA values indicates the safety of both methods.

手术治疗白内障的主要方法是超声乳化术 (PHACO)。假性剥脱综合征 (PEX) 的存在会使手术操作困难,还是引起很多术中和术后并发症的原因。目的 评估 PEX 对 PHACO 过程的影响。材料和方法 总共 1010 例患者因需行白内障手术治疗收治入院(580 例有 PEX 和 430 例无 PEX)并接受了 PHACO 及不同类型人工晶体的植入。

对 PHACO 的主要参数进行了分析: 累积释放能量, 平衡盐溶液 (BSS) 的抽吸量及手术时长。另外还对一些术中可能出现的并发症发生率进行了评估: 角膜后弹力层脱离（descemet membrane detachment，DMD), 后囊膜破裂,

晶状体基质位于晶状体后间隙和晶状体脱位。结果 在 PEX 患者中局部的 DMD 较为常见,其次是晶状体基质位于晶状体后间隙也较常见。因此,在这种情况下,白内障超声乳化术中累积释放能量也更高。结论 在计划 PHACO 手术时 PEX 患者需要更仔细的术前检查, 术中更高的警觉性以及术后更长的观察期。

Telemedicine (TM) is one of the fastest growing segments of healthcare and medical business in the world. In a broad sense, TM means the use of the most modern data technologies in distant medical care practice. Teleophthalmology (TO) is an important area of TM, it includes several priorities, main of which being remote diagnosis, treatment and management of patients with ophthalmic diseases, in particular, diabetic retinopathy, glaucoma and age-related macular degeneration. The development of TO is conditioned by the need for high-tech specialized medical care for people in remote regions. On the path of introducing TO worldwide and in Russia, a huge number of obstacles exists: obtaining high-quality fundus images, training specialists to work in the TM area , creation of standards for image analysis and transmission, TM implementation into the legal field, ensuring of stable financing, creating positive patients and doctors attitude towards TO. In this part, we provide an overview of TO development trends, as well as ways to solve the problems standing in its way.

Toxic damage to the optic nerve is one of the causes of the development of degenerative processes in the fibers of the optic nerve, leading to its atrophy. Exposure to methanol and ethanol is associated with the damaging effects of metabolites, which lead to ATP deficiency. Knowledge and understanding of pathogenetic processes can help the doctor to make a timely diagnosis, which will allow the start of etiopathogenetic therapy as early as possible. The prognosis for acute poisoning with methanol and ethanol depends not only on the degree of intoxication, but also on the timeliness and accuracy of diagnostic and therapeutic tactics.

Aim. To determine the optimal shape of the locomotor stump and the configuration of the corresponding ocular prosthesis, ensuring their maximum motility in patients with anophthalmia with different methods of eye removal.

Materials and methods. The study group consisted of 132 patients aged 18–80 years after enucleation or evisceration. Examination methods included medical history; examination of eyelids, measurement of length and width of the palpebral fissure, as well as of the depth of conjunctival fornices on both sides; assessment of the volume, shape, surface topography, position and excursions of the locomotor stump, of the protrusion of the ocular prosthesis compared to the contralateral eye; photo registration of the studied parameters.

Results. During the study, there were 3 types of locomotor stump identified: moderate with retraction in the upper third; voluminous flattened; voluminous hemispherical. The locomotor stump after enucleation was voluminous flattened or moderate with retraction in the upper third. The best motility of the locomotor stump was noted nasally and downward. The motility of the ocular prosthesis was 47.4% compared to the contralateral eye. The locomotor stump after evisceration with keratectomy was voluminous hemispherical or voluminous flattened. Its motility in all four directions was about the same. The motility of the ocular prosthesis in comparison to the contralateral eye was 55.9%. The locomotor stump after evisceration without keratectomy was voluminous hemispherical, uniform, smooth. The motility of the locomotor stump was maximal in comparison to other groups and relatively equal in all four directions. The motility of the ocular prosthesis in comparison to the contralateral eye was 68.2%.

Conclusion. The optimal shape of the locomotor stump, providing the greatest motility of the ocular prosthesis is voluminous hemispherical. The same protrusion of the eyeball and that of the cosmetic prosthesis relatively to the frontal plane after enucleation is achieved by increasing the thickness of the prosthesis itself, which reduces its motility. Evisceration with implantation of the orbital prosthesis involves the use of a thin-walled ocular prosthesis, the back surface of which ideally repeats the locomotor stump surface and does not prevent its maximum motility. When removing a squinting eyeball with preserved corneal diameter, a smaller implant should be used to prevent excessive opening of the palpebral fissure, or to prefer evisceration with keratectomy.

I invite our dear readers to participate in the discussion on the proposed topic.

The article presents a rare case of combination of von Hippel–Lindau disease and Hodgkin’s disease. The disease began with neurological symptoms with gradual progression over the next 3 years. The diagnosis of von Hippel–Lindau disease was made after MRI of brain and spinal cord, abdominal MICTs, and detection of brain stem and spinal cord tumors, multiple pancreatic cysts. We performed resection trepanation of the posterior cranial fossa and microsurgical total removal of hemangioblastoma of the medulla oblongata. After 1.5 years the patient is diagnosed with Hodgkin’s disease and several courses of chemotherapy are carried out, reaching full remission, confirmed by PET with CT. 14 months later, the patient consulted an ophthalmologist due to visual impairment and floating opacities in her left eye. The ophthalmologic examination for the first time revealed multiple bilateral retinal hemangiomas and vitreal hemorrhages from tractional retinal tears caused by posterior hyaloid detachment and unrelated to hemangiomas in the left eye. The barrier laser coagulation of the left eye retinal tears was performed, and the observation tactics was adopted.

This article contains a case of central retinal artery occlusion in a young man associated with cocaine abuse. Survey data, dynamic monitoring of the patient are presented in the article. Possible mechanisms of vascular pathology associated with stimulant drugs are described.