卷 14, 编号 2 (2021)

这项研究的目的是测量正常眼压的青光眼患者和健康受试者巩膜筛板的厚度和深度以及视神经蛛网膜下腔（ONSS）的宽度，并将这些数据与我们自己的试验研究结果进行比较。

材料和方法: 第一组纳入13名正常眼压的青光眼患者（22只眼睛），年龄在39至88岁（平均年龄为59.8±10.9岁）；第二组（对照组）纳入10名健康受试者（20只眼睛），年龄在40至59岁（平均年龄为47.9±5.5岁）。所有受试者都使用RTVue-100光学相干断层扫描仪（Optovue，美国）、Humphrey视野分析仪（HFA II 745i，德国-美国）和一种专门改进的空间频率倍增视野分析仪对视神经盘进行结构和功能评估。通过使用RS-3000 Advance光学相干断层仪（Nidek，日本）测量了巩膜筛板的厚度和 深度。用GE Optima MR450w磁共振成像设备（美国）进行的视神经横断面图像被用来测量ONSS。

结果: 第1组和第2组的平均巩膜筛板厚度（分别为234.14±27.73和336.25±21.0μm；p=0.0000）、 深度（分别为461.8±101.7和361.65±58.2μm；p=0.0004）和ONSS的宽度（分别为1.371±0.035和1.52±0.133 mm；p=0.011）之间的差异具有统计学意义。

结论: 与健康受试者相比，正常眼压性青光眼患者的巩膜筛板深度明显较高，巩膜筛板厚度和ONSS的宽度明显较低，与我们的初步研究结果相媲美，证实了这些形态测量对诊断正常眼压性青光眼的重要性。

AIM: to evaluate the effectiveness of the platelet-rich plasma lysate (PRP lysate) use in the treatment of persistent epithelial defects (PED) after keratoplasty.

MATERIALS AND METHODS: In the study, 60 patients with PED after keratoplasty were included. The 1st group (24 cases) included patients after keratoplasty with “low risk” of rejection, and the 2nd group – 36 cases after keratoplasty with “high risk” of rejection. Each group was divided into two subgroups – control subgroups 1a (cases 10) and 2a (cases 16), where patients received only standard postoperative therapy, and the main subgroups 1b (cases 14) and 2b (cases 20), in which PRP lysate was prescribed against the background of standard therapy, starting from the Day 15 post-op. As the criterion for effective treatment, complete persistent epithelialization after keratoplasty was considered.

RESULTS: The effectiveness of the use of PRP lysate in the subgroup 1b was 85.7%, while complete epithelialization in the control subgroup 1a was recorded in 70%; in the subgroup 2b, complete epithelialization was observed in 55%, in the control subgroup 2a – in 43.75%.

CONCLUSION: The use of PRP lysate in the treatment of PED after corneal transplantation as an adjuvant therapy is effective and safe in both high and low risk keratoplasty. In the examined category of patients, treatment with blood derivatives increases the frequency and rate of complete epithelialization.

BACKGROUND: Particular difficulties in treatment of children with monolateral strabismus are associated with the presence of severe amblyopia in the squinting eye in combination with a visual fixation defect (acentral or intermittent).

AIM: To assess the anatomical and functional status of children with visual fixation defects, to find out the causes of failures in treatment of this group of patients, to determine the tactics of their management.

MATERIALS AND METHODS: The study included 92 children of preschool age (from 3 to 7 years) with monolateral concomitant strabismus. The follow-up period for the children ranged from 12 to 72 months. The average age of the examined children was 4.6 ± 1.1 years. Three variants of visual fixation were identified in the squinting eye: central visual fixation (CVF) – 68 eyes; intermittent visual fixation (IVF ) – 7 eyes; and acentral visual fixation (AVF) – 17 eyes. All patients underwent a comprehensive examination: visometry; strabometry; autorefractometry; determination of the critical frequency of light flashes; assessment of visual fixation; optical coherence tomography of the retina. All children underwent “passive” and active pleoptics.

RESULTS: The visual acuity of children with CVF significantly increased due to pleoptics. At the same time in cases of IVF and even more in those of AVF, visual acuity remained significantly lower than that of the “fixating” eye, pleoptics were ineffective in this group of patients. In patients with CVF, the critical frequency of light flashes of the squinting eye increased in statistically significant figures, while in IVF and AVF, the difference between squinting and fixing eye remained. According to OCT data, changes in the macular area were detected in 18 (75%) eyes in patients with IVF and AVF, which allows us to distinguish organic pathology from amblyopia.

CONCLUSIONS: In children with monolateral strabismus, it is necessary to determine visual fixation of the squinting eye. At IVF and AVF, it is mandatory to conduct optical coherence tomography of the macular area to exclude organic pathology. In patients with monolateral concomitant strabismus with IVF and AVF, surgery on oculomotor muscles is indicated.

AIM: to carry out a clinical and statistical analysis of patients’ references at the third stage of ophthalmic care in Azerbaijan Republic conditions.

MATERIALS AND METHODS: Materials of the National Ophthalmology Center named after the Academician Zarifa Aliyeva are used. All the cases of primary references during 2019 are analyzed.

RESULTS: The lowest proportion of unjustified references was among residents of republican subordination cities (1.3 ± 0.1%), where the frequency of primary visits is low as well (1.28 ± 0.04‰). The rate of unjustified references of regional centre city residents – (4.8 ± 0.1%), and of those of rural settlements (10.7 ± 0.1%) were significantly different. There were significant differences concerning the rate of primary visits (2.32 ± 0.026 and 2.56 ± 0.024‰). The rate of primary visits between male and female populations also was significantly different (2.58 ± 0.024 and 3.02 ± 0.021‰, р < 0.01).

CONCLUSION: The rate of primary references at the third stage was 4.62 ± 0.04‰ in Baku, 2.56 ± 0.024‰ – in rural settlements, 2.32 ± 0.031‰ – in regional centre cities, and 1.28 ± 0.04‰ – in republican subordination cities; it had significant gender specificities. Within primary visit causes, accommodation and refraction disorders (32.3 ± 0.5%), ocular trauma and that of eye adnexa (19.7 ± 0.4%) prevail.

Currently, intravitreal injections are firmly in the lead as a drug delivery method for treatment of a wide range of eye diseases. With the accumulation of clinical material, knowledge about the complications and side effects of this technique is expanding. One of the undesirable phenomena that has been actively studied recently is the ingress of silicone oil droplets from single-use syringes and needles used to perform the procedure into the vitreous cavity of patients’ eyes. The analysis of the results of original studies on this issue is carried out, and the currently available practical recommendations aimed at reducing the risk of this complication are presented. The article is illustrated with original clinical examples. It can be concluded that the penetration of silicone oil into the eye cavity during intravitreal injections is an urgent problem of modern ophthalmology that requires further investigation and solution.

AIM: To assess the effect of Stelfrin supra (phenylephrine 2.5%) on the condition of accommodation, refraction and evaluate subjective comfort in instillation and adolescents with various refractive disorders.

MATERIALS AND METHODS: Examined 45 people with mild emmetropia and hyperopia with symptoms of habitual excess tension of accommodation (15 people), with mild myopia (15 people), with moderate myopia (15 people) at the age of 7 to 16 years. Visometry, autorefractometry, assessment of the volume of absolute accommodation (positive and negative parts), subjective assessment of asthenopic complaints according to the OSDI scale were carried out before and 1 month after daily instillations of Stelfrin supra (phenylephrine 2.5%).

RESULTS: After 1 month of instillation of the Stelfrin supra, the manifestations of accommodative asthenopia in the vast majority of patients in the study groups decreased, the habitual tonus of accommodation decreased, the volume of absolute accommodation increased, most significantly – its negative part. The uncorrected visual acuity increased by 31% in patients of group 1 with emmetropia and mild hyperopia with habitually – excessive tension of accommodation. The uncorrected visual acuity increased by 23% in patients of group 2 with mild myopia. An increase in the margin of relative accommodation was noted in patients of groups 1 and 2. Instillation of the drug was not accompanied by severe discomfort in the vast majority of patients.

CONCLUSIONS: Stelfrin supra has shown its effectiveness in accommodating and refractive disorders in childhood and can be recommended in the treatment of children with accommodation disorders, asthenopia and mild to moderate myopia.

THE AIM was to evaluate clinical efficacy of aflibercept treatment in patients with ranibizumab-resistant neovascular age-related macular degeneration.

MATERIALS AND METHODS. 13 patients (13 eyes) after intravitreal ranibizumab therapy for 1 year (from 6 to 8 injections with an interval of 1.5 to 2 months). However, in all patients, there was a recurrence of the exudative activity of the process. Aflibercept treatment method consisted of 3 monthly “loading” intravitreal injections with follow-up period of 4 months.

RESULTS. One month after 1st aflibercept injection among all patients, the average index of best-corrected visual acuity (BCVA) increased to 0.41 ± 0.02 and the central retinal thickness (CRT) index decreased to 307 ± 14.5 μm versus the initial CRT value 431 ± 64 μm. After the 3rd aflibercept injection, the CRT index was the lowest and amounted to 189.5 ± 13.0 μm, which was accompanied BCVA increase to 0.42 ± 0.03 versus 0.29 ± 0.05 as the initial value. According to the optical coherence tomography data, after “loading” phase, good anatomical effect was observed with significant edema reduction, complete resorption of fluid in the subretinal space, and decrease of the pigment epithelial detachment’s height.

CONCLUSION. Evaluating the results of our study, we found that the use of angiogenesis inhibitor aflibercept made it possible to suppress the signs of activity of choroidal neovascularization and to obtain additional improvement of visual functions in patients with neovascular age-related macular degeneration, when the therapeutic effect from the early ranibizumab therapy was insufficient or completely absent.

新冠状病毒感染（COVID-19）是一种病毒性呼吸道疾病，伴有系统性"内皮炎"。COVID-19患者常常表现出与高凝状态、纤维蛋白溶解度低、血管内血小板聚集增加有关的变化，以及血管壁的抗血栓能力下降和血管舒缩功能受损，这显著增加了血栓栓塞并发症的风险。目前正在积极研究COVID-19与视神经和视网膜的血管性和炎症性病变相关的致病因素。诱发眼部血管血流受损的原因之一可能是在感染过程的急性期观察到的灌注压下降。这既是由于其临床过程的特殊性，也是由于所采取的抢救措施的特殊性。作为感染后血管壁损伤的机制，其继发性自身免疫性炎症被认为是一个重要的因素。本出版物是第一个冠状病毒相关的缺血性神经炎的例子，它研究了这些疾病之间可能的致病关系。

This article describes a clinical case of a bilateral exudative retinal detachment development in a young woman with severe preeclampsia. The data of the ophthalmological examination, as well as those of the dynamic observation of the patient, are presented. The possible mechanisms of the formation of exudative retinal detachment on the background of preeclampsia are considered in detail. The described clinical case is of great interest, since this condition is a rare complication in preeclampsia. Exudative retinal detachment against the background of preeclampsia requires adherence to bed rest, normalization of blood pressure, control of proteinuria and, as a rule, does not require surgical intervention.