卷 12, 编号 3 (2019)

Background. Nowadays, laser surgery methods for glaucoma treatment gained wide use in clinical practice due to their efficacy, safety, and minimal risk of postoperative complications. In the scientific literature, data are presented on the effect of laser radiation on corneal endothelial cells that is why this aspect should be investigated when using new laser technologies in glaucoma treatment. One of the most modern methods of corneal examination is confocal microscopy, which allows visualizing corneal tissue at cellular level.

Purpose: to study the impact of laser radiation on the state of corneal endothelial cells in YAG-laser activation of trabecular meshwork in patients with primary open-angle glaucoma.

Materials and methods. Sixteen eyes of 15 patients were included in the analysis. The mean age of patients was 65.8 ± 5.35 years. In all patients, YAG-laser activation of trabecular meshwork was performed. At different follow-up terms (up to 6 months after laser surgery) the level of IOP was controlled, the state of corneal endothelium was studied using confocal microscopy.

Results. According to dynamic follow-up confocal microscopy results, no statistically significant difference between average density of endothelial cells, polymegathism, and pleomorphism have been identified (p > 0.05).

Conclusion. The study did not reveal any negative impact of YAG-laser activation of trabecular meshwork on the endothelium of the cornea, suggesting the safety of this technology.

背景： 葡萄膜炎是相对罕见且难以诊断的异质性疾病。它占所有眼科疾病的5%-15%。由于该病的病程长，且在大多数情况下是慢性病程，以及并发症的频繁发生并发症，因此具有高度的社会和经济重要性。同时，治疗的效果取决于及时正确的诊断。
目的：改善系统性疾病中葡萄膜炎的诊断

材料和方法：该研究包括两个部分：对205份（2008年-2012年）存档病例的回顾性分析和对210名被诊断为葡萄膜炎并且是在2014-1016期间首次为查明发病原因而就诊的患者的前瞻性研究。对第二组的患者运用激光闪光光度测定、吲哚青绿造影以及完善的实验室仪器检查方法。

结果： 根据研究所得的结果，提出了一种用于“葡萄膜炎”患者进行全面检查的新系统，该系统能确诊83％的葡萄膜炎的病因或伴随疾病，区别于使用常规检查的38.1％。。

结论 ：根据研究，最常见的葡萄膜炎是与HLA-B27相关的前葡萄膜炎和与结节病相关的后葡萄膜炎。 开发的临床仪器诊断系统有助于将病因不明的葡萄膜炎比例降低了3.6倍，以便为患者提供更专业及具体的治疗方案。

The study is aimed to modifying the method of a two-component fibrin glue production, as well as studying the possibility of applying glue fixation of the amniotic membrane to the stroma of the cornea, in comparison with interrupted sutures. An experimental study allowed us to determine the optimal composition of the first (base) and second (activating) components, to modify the method for fibrin glue production, and also to test in vivo in six Chinchilla rabbits the fixation of the amniotic membrane using the proposed protocol. The resulting fibrin glue allows not only to securely fix the amniotic membrane to the stroma of the cornea, to reduce the time of the procedure, but also to create conditions for an earlier onset of epithelization while maintaining the transparency of the cornea compared to suture fixation.

This article presents a historical evolution review of cyclodestructive methods in glaucoma treatment. It also provides the analysis of mechanism of action for each technology, their advantages and disadvantages. Results of clinical studies and most frequent complications of cyclodestructive procedures are also presented. The main attention is paid to the new MicroPulse laser technology, which is used for the treatment of primary open-angle glaucoma at various stages in patients with high visual acuity, as well as refractory forms of glaucoma. Data of clinical and experimental morphological studies of various modifications of transscleral cyclophotocoagulation technology are specified. Theories, research hypothesis upon the mechanism of MicroPulse laser action. In most researchers opinion, despite the relatively short observation period (from 6 months to 5 years), MicroPulse technology is recognized as effective and advanced.

Introduction. Antiseptic drugs currently occupy an important place in the treatment and prevention of ocular infectious and inflammatory diseases. Often microorganisms are characterized not only by resistance to a single antibiotic, but also by the presence of multiple resistances, which limits the choice of an effective drug. This problem requires a detailed study and monitoring of the sensitivity of the main pathogens of ocular infections, not only to antibiotics but also to antiseptics.

The aim was to study the species composition of conjunctival microflora in patients with ocular surface infection and to evaluate the antimicrobial activity of antiseptic eye drops.

Materials and methods. Investigation was carried out in 2012–2018 in 4237 bacterial conjunctivitis patients. The sensitivity to antiseptic preparations of pathogens isolated from patients with conjunctivitis was detected.

Results. 1068 strains of microorganisms isolated from the conjunctival cavity of patients were tested. Gram-positive cocci dominated among clinically significant pathogens – 47.4%. Antimicrobial activity of Vitabact^® eye drops against gram-positive cocci was higher than that of antiseptic Okomistin^®.

Summary. Antimicrobial activity of the studied antiseptics against gram-positive and gram-negative pathogens was different. It is necessary to conduct further research on the antimicrobial activity of antiseptic eye drops.

背景 经结膜入路上睑下垂矫正手术，操作简单，预期效果好，因而广受欢迎。长期以来，去氧肾上腺素试验一直是影响选择上睑下垂矫正术式的主要因素。越来越多的研究表明Müller肌切除术也可适用于去氧肾上腺素试验阴性的患者。本研究提出并详述了一种经过改良的新型Müller肌切除技术，可帮助出现各种去氧肾上腺素试验结果的患者进行上睑下垂矫正。

材料和方法 本研究包括两组轻度至中度上睑下垂患者，上睑提肌肌力不低于8mm。实验组（75例患者，103个眼睑）接受了经过改良的Müller肌切除术，对照组（26例患者，35个眼睑）接受了“开放天空”Müller肌切除术。根据以下流程对实验组制定手术计划。去氧肾上腺素试验呈阳性及反应充分的患者，切除三分之二的Mülle肌。去氧肾上腺素试验呈阳性但反应不够充分的患者，行Mülle肌次全切除术。去氧肾上腺素试验呈阴性或弱阳性的患者，术中增加评估白线活动距离。如果白线的活动距离（单位mm）与下垂程度相当，行Mülle肌次全切除术保留上睑板。如果白线的活动距离低于预期矫正程度，同时行Mülle肌次全切除术与睑板切除术，以达到预期矫正程度，同时睑板剩余高度不得低于5mm。如果上睑板受损或无法达到上睑板预期切除程度，便将白线前移位固定至睑板处。

结果下垂程度、手术结果以及睑裂在中心、角膜外侧缘和角膜内侧缘的宽度、MRD 1和MRD 2无显著组间差异（p > 0.05），实验组矫正不足及矫正过度的频率显著降低（p < 0.05）。

结论 本研究提出的改良Mülle肌切除术是一种新的治疗流程，使去氧肾上腺素试验为弱阳性及阴性的上睑下垂患者可通过经结膜方法接受矫正，减少了矫正不足和矫正过度。

In this article, using a clinical case as example we report clinical features of keratopathy associated with pseudoexfoliation syndrome, as well as pathological changes found by confocal microscopy.