卷 12, 编号 4 (2019)
- 年: 2019
- 文章: 14
- URL: https://journals.rcsi.science/ov/issue/view/817
- DOI: https://doi.org/10.17816/OV20194
Original researches
超声乳化术中设定的眼压对视网膜中央动脉血流速度的影响
摘要
研究目的：评估在白内障超声乳化术中设定的高眼压(IOP)对视网膜中央动脉和中央静脉血流状态的影响，并判断为应对术中急剧增加的IOP，眼部血流自动调节可能的代偿机制。
材料与方法：在这项前瞻性研究中包括23例不伴随眼部血管病变的白内障患者(15名女性和8名男性)，年龄在62到83岁之间。平均年龄为72.5±5.7岁。所有患者术中均通过超声扫描仪Logiq S8 (GE) 采用彩色多普勒模式和脉冲多普勒模式的彩色双侧扫描成像。测定了球后血管的血流量：即视网膜中央动脉，视网膜中央静脉以及记录的收缩期最大血流速度，舒张末期血流速度和阻力指数(RI)。该研究过程中通过Icare Pro眼压计测量IOP的水平，通过德尔格（Draeger Vista 120）患者监测仪监测患者的血压。在手术室中对眼部血流进行了三次检测：即术前检测；达到设定的IOP水平并封闭手术切口后立即检测；眼压恢复正常并重新封闭角膜隧道切口后的检测。
结果：在术中眼压维持在58.01±8.10 mm Hg水平时，发现视网膜中央动脉血流速度有临床显著降低(p<0.05)。在30.4%的病例中，没有记录到视网膜中央动脉舒张期血流速度。视网膜中央静脉血流速度无明显变化并且与IOP水平无关(p>0.05)。
结论：当人的IOP在 55- 60mm Hg水平时，应对术中急剧升高的IOP，眼部血流自动调节没有代偿机制，直至舒张期视网膜中央动脉血流完全停止，这可能是视网膜缺血的危险因素。
5-12
Innovative approach to barrier amnioplasty in surgical treatment of primary progressive pterygium
摘要
The aim is to evaluate the efficacy of new method of barrier amnioplasty in surgical treatment of primary progressive pterygium.
Materials and methods. 40 patients (40 eyes) with primary progressive pterygium, divided into two groups depending on surgical features of barrier amnionoplasty: in the main group (20 patients), plastic surgery was carried out in the semilunar fold area; in the control group (20 patients) – in the limbal area. All patients underwent special examination: tear pH measurement and cytological evaluation of the cellular composition from the wound surface. The treatment efficacy was evaluated: in the early postoperative period – by the timing of conjunctival inflammation disappearance, corneal epithelialization and vitalization of the amnion; after 1 year – according to the state of the limbus, cornea, visual acuity, degree of corneal astigmatism.
Results and conclusions. The use of amnioplasty method in the area of semilunar fold developed and implemented by us in clinical practice showed high efficacy: time reduction in local cellular inflammatory reactions in the cytological composition of swabs and scrapings and postoperative inflammation of ocular surface, which led to shortening of periods of corneal epithelization by 1.7 times and vitalization of the amnion by 1.5 times. Uncomplicated postoperative course of inflammatory-regenerative reactions allows avoiding the pterygium recurrence and causes reduction of the degree of corneal astigmatism and visual acuity increase.
13-21
Modern extrascleral surgery in the treatment of regmatogenous retinal detachment: efficacy evaluation and functional results
摘要
The basic principles of extrascleral surgery, which are currently used in the treatment of regmatogenous retinal detachment (RD), have not changed much since their heyday in the 70–80s of the 20th century, and they remain relevant both as an independent method to treat this disease in certain clinical cases, and in combination with vitrectomy.
The aim is to evaluate the efficacy of RD extrascleral treatment methods (anatomical result, visual acuity), as well as the frequency and timing of the relapses.
Materials and methods. The study was carried out at the vitreoretinal department of the Ophthalmological Center of the City Hospital No. 2 of St. Petersburg. A sample of 466 patients with RD, operated with extrascleral methods in 2015–2016 has been analyzed. Anatomical results, visual acuity, number and timing of relapses have been assessed.
Results. The efficacy of extrascleral surgery reaches 89%, RD recurrence after surgical treatment occurs in 21% of patients.
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角膜胶原交联治疗扩张性角膜营养不良的长期结果
摘要
背景：角膜胶原交联(CCC)是预防和治疗进展性角膜扩张最有效的方法之一。在文献中偶尔有关于运用CCC长期结果的数据，但仅限于最常见的角膜扩张形式之一—圆锥角膜。在发表的刊物中，运用CCC对角膜扩张其他比较常见形式的有效性没有长期结果。再就是屈光手术后的继发性扩张。透明边缘性角膜变性的诊断病例也有所增加。在文献中，我们没有找到运用该方法治疗各种形式的角膜扩张的有效性的长期结果进行比较分析。
研究目的：在运用CCC治疗各种形式的角膜扩张并分析长期结果的基础上，评估其有效性。
材料与方法：对不同形式的角膜扩张患者运用CCC术后6年的结果进行了分析。该研究的疾病分类学的结构包括圆锥角膜、透明边缘性角膜变性和继发性扩张。圆锥角膜患者有30例(30只眼睛)，透明边缘性角膜变性患者有30例(30只眼睛)，继发性扩张患者有30例 (30只眼睛)。在观察的第一和第二年由一位专家对患者进行了角膜胶原交联。随后，对角膜状态和视觉功能的变化进行了6年的监测。通过术前及术后的检查结果来评估其有效性。
结果：所有组的最大矫正视力均有所提高，角膜表面不对称指数及其屈光力在扩张中部均有所下降。但在圆锥角膜和继发性扩张患者的组中使用CCC的效果最明显。
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Reviews
Stem cell-based technologies in treatment of age-related macular degeneration patients: current state of the problem
摘要
Age-related macular degeneration (AMD) is the most common disease of the macula – the area responsible for central vision. With regard to the pathogenesis of AMD, the main focus of most researchers is on the pathological processes occurring in the retinal pigment epithelium (RPE), which is considered as the main target of the disease. For the treatment of the “dry” form of the disease, which accounts for about 90% of all AMD cases, up to now no effective treatment methods were elaborated, while in the therapy of the “wet” form, antiangiogenic therapy, photodynamic therapy, and surgical treatment methods have been used with concrete success. Stem cells, possessing enormous therapeutic potential, are gradually being introduced into medical technologies, including ophthalmology. A number of pre-clinical studies have proven the safety of using cultured cells of the RPE, which gave rise to the beginning of clinical trials of the use of stem cells in the treatment of AMD patients. The review analyzes the data of scientific literature on the current understanding of the pathogenesis of AMD, pathogenetically substantiated therapies, including those using cell-based technologies, prospects and problems of using stem cells in the treatment of AMD patients.
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对晚期增殖性糖尿病视网膜病变的患者玻璃体视网膜手术及超声乳化术是分期还是联合？
摘要
本文旨在比较晚期增殖性糖尿病视网膜病变合并初期白内障的联合手术治疗方法(玻璃体视网膜手术加硅油填充联合初期白内障超声乳化术加人工晶状体植入术)和分期手术治疗方法(在玻璃体视网膜手术后，于第二阶段进行初期白内障超声乳化手术，并植入人工晶体，同时去除硅油)。考虑了有关该病的治疗策略的现代观点，考虑到了它的有效性，以及列出了每种手术方法的优点和缺点。
43-48
Ophthalmopharmacology
The use of new cohesive ophthalmic viscoelastic in cataract surgery
摘要
The article presents the results of an original study which was dedicated to the investigation of the new cohesive viscoelastic Cogevisc (sodium hyaluronate 1.6%) in ophthalmic surgery.
Aim. Analysis of the efficacy and safety of a new cohesive viscoelastic (Cogevisc, Solopharm) in phacoemulsification.
Patients and Methods. The clinical study was based on an assessment of the clinical and functional state of 80 patients (80 eyes), which were divided into 2 groups depending on viscoelastic used during the phacoemulsification procedure (Softshell technology): in group I (40 patients, 40 eyes) Viscoat was used to protect tissues, and Amvisc Plus was added to create volume; in group II (40 patients, 40 eyes) Viscoat was used to protect tissues, and Kogevisc was used to create volume. In the postoperative period, all patients received standard anti-inflammatory treatment. There was no significant difference in mean age, gender, preoperative intraocular pressure (IOP) and preoperative central corneal thickness (CCT) between the two groups. Before surgery and in the postoperative period (in one day, 7 days, and 1 month), IOP, CCT, and endothelial cell density (ECD) were measured. The duration of the procedure and the amount of the consumed fluid were estimated.
Results. There was no significant difference in IOP, CCT, ECD 1 day and 1 week postoperatively between the two groups. Mean absolute refractive error was also not significantly different between the two groups. There was no significant difference in procedure duration between groups I and II (1523.81 ± 75.66 seconds, 1500.33 ± 92.56 seconds, respectively, p < 0.001). No complications were observed during the intraocular lens implantation in both groups.
Conclusion. The investigated viscoelastic Cogevisc allows creating and effectively maintaining the necessary depth of the anterior chamber and the maximum diameter of the pupil, which simplifies different stages of phacoemulsification and minimizes the risk of intraoperative complications. Promising for further research is its use in combination with an adhesive viscoelastic of the same production. Reduced cost of Cogevisc is the advantage of this viscoelastic.
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Modern opportunities for the prevention and treatment of inflammatory eye diseases of an infectious nature in children
摘要
The development of inflammatory diseases of the cornea and conjunctiva, as well as the occurrence of infectious complications of intraocular surgery, are largely associated with the presence of saprophytic and pathogenic microflora in the conjunctival cavity. This circumstance is more characteristic of children. At the same time, the possibilities of antibacterial therapy of inflammatory eye diseases of bacterial and chlamydial etiology, as well as perioperative prophylaxis of infectious complications of intraocular surgical procedures in children, have significantly expanded today. The widespread use of fluoroquinolones has significantly improved the treatment of children with acute and chronic bacterial conjunctivitis, keratitis, blepharitis, meibomyitis, chalazion, as well as those with chronic conjunctivitis of chlamydial etiology. At the same time, levofloxacin – fluoroquinolone of the 3rd generation, which is used in our country in the form of a 0.5% solution as eye drops Oftaquix® (Santen, Finland), has demonstrated high efficacy for this purpose. The widespread introduction of the original 0.5% levofloxacin (Oftaquix®), in the treatment regimen for children with inflammatory diseases of the cornea and conjunctiva, as well as for a perioperative prevention of infectious complications of surgical procedures involving them, is a promising way to solve the problem.
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In ophthalmology practitioners
Balloon dacryoplasty in the treatment of recurrent dacryocystitis
摘要
Causes of the recurrence after dacryocystorhinostomy are errors during surgery (small size of the bone window, wrong localization of the dacryostomy (too high or too low); inadequate formation of flaps at the medial wall of the lacrimal sac and at the mucosa of the nasal cavity) or problems occurring in the follow-up period (granulation in ostium area, synechiae between the structures of the nasal cavity near the dacryostomy, canaliculi ostium obliteration). A literature review considers various methods of dacryocystitis recurrence treatment both with external and endonasal approaches. In published studies, promising results were obtained using balloon dacryoplasty in the dacryostomy area after dacryocystitis relapse.
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Vitelliform changes in the central retina occurring in adults
摘要
Introduction. Vitelliform lesions of the central retinal area in adult patients represent a heterogeneous group of diseases. This article describes different variants of vitelliform changes in adults, based on the published literature data.
Materials and methods. We have analyzed and described different variants of vitelliform changes in adults, based on literature data, examples from own clinical practice using multimodal approach are included.
Discussion. Vitelliform lesions of the central retinal area are can debut at various ages, occurring in mono- or multifocal way, have various stages of degradation of vitelliform material, masquerading as other lesions of the macular area and of the posterior pole. Many of these diseases appear due to mutations in determined genes, though, a fairly large proportion of cases is considered to be sporadic. Nowadays, characteristic signs of different diseases with the vitelliform material are described. But differential diagnosis with other similar diseases (some age-related macular degeneration forms and those of central serous chorioretinopathy) is fairly difficult and requires a multimodal ophthalmologic approach, and in some cases genetic studies.
Conclusions. Vitelliform lesions of the central retinal area, occurring in adult patients are a group of diseases that are difficult to diagnose and masquerade themselves as other diseases of the central retina, which requires certain doctor’s knowledge and ability to carry out a multimodal imaging and prescribe the appropriate treatment if needed.
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经结膜入路行Müller肌切除术中白线移动性的评估测试
摘要
背景：众所周知，治疗轻度及中度上睑下垂睑板肌(STM)（又称Müller肌）切除术的主要适应证是去氧肾上腺素试验 (PHE) 呈阳性。但是，最近有研究表明，STM切除术可以在PHE试验呈弱阳性和阴性的情况下进行。然而，根据类似的PHE试验结果，关于外科医生在规划STM切除术时应参考哪些标准的问题仍然没有定论。作者开发了一个测试来评估白线的活动性，并帮助回答这个问题。
材料与方法：研究过程中对75例患者 (103个眼睑) 进行了检查，研究对象是在2017年11月至2019年8月期间由市第二综合医院第五显微眼外科为手术治疗上睑下垂而收治入院的。
结果：PHE试验呈阳性反应的患者术后结果对白线移动性并无明显依赖性，而呈阴性和弱阳性反应的患者则表现出明显的依赖性。
结论：白线移动性的评估测试是判断对PHE试验呈阴性和弱阳性反应患者Müller肌切除量的参考标准。
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Case reports
眼部恶丝虫病：温带地区发病率增加
摘要
近几年来，温带地区人和动物感染恶丝虫病的的数量呈持续增长的趋势。在此之前，2015年至2018年期间我们详细描述过5位眼部恶丝虫病患者的病例。这篇文献还包含了2019年观察的另外四个病例。其中有一例是寄生在眼前房内极其罕见的病例。在全球的临床实践中，只有在巩膜、玻璃体以及视网膜中发现恶丝虫的个别病例。
101-106
Combination treatment of a rare case of a cavernous hemangioma of the orbit
摘要
A case of atypical course of cavernous hemangioma of the orbit. A necessity of a multidisciplinary approach to the diagnosis and surgical treatment of an orbital neoplasm is shown.
107-120
Interdisciplinary aspects
Individual hygiene program of stomatologic conditions prevention in ophthalmologic patients
摘要
Aim. To describe features of formation and carrying-out of an individual hygiene program of stomatologic conditions prevention in ophthalmologic patients.
Methods. The formation of hygiene program of prevention.
Results. Action tendency and procedure of the program stages conduct with consideration for patient’s status are stated. Peculiarities of professional and individual oral hygiene during pre-op and post-op periods are reflected.
Conclusions. It is necessary to take into account physical characteristics of oral hygiene products (vibration, sound, ultrasound, etc.) concerning subsequent ophthalmic procedures and special aspects of post-op period course.
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