[Ocular myasthenia gravis]. / Glaznaya forma miastenii gravis.

Myasthenia gravis is an autoimmune disease characterized by muscle weakness and pathological fatigue due to autoaggressive phenomena with the formation of antibodies directed against various structures of the neuromuscular synapse. In most patients, the disease begins with the involvement of extraocular muscles, presenting with symptoms such as intermittent ptosis of the upper eyelid and/or binocular diplopia. In 15% of cases, clinical manifestations are limited to impairment of the levator palpebrae superioris and extraocular muscles, characteristic of the ocular form of myasthenia gravis. Specialists often encounter challenges in diagnosing this form, as serological and electrophysiological studies may be uninformative, necessitating diagnosis based on patient history and clinical picture. This literature review outlines the key aspects of the pathogenesis, clinical manifestations, methods of diagnosis and treatment of ocular myasthenia gravis.

[Complications of transnasal endoscopic orbital decompression in thyroid eye disease]. / Oslozhneniya transnazal'noi endoskopicheskoi dekompressii orbity pri endokrinnoi oftal'mopatii.

PURPOSE: The study evaluates the frequency of complications after transnasal endoscopic orbital decompression (TEOD). MATERIAL AND METHODS: The study included 40 patients (75 orbits) with thyroid eye disease (TED; also termed Graves' ophthalmopathy, GO; thyroid-associated orbitopathy, TAO), who were divided into three groups depending on the method of surgical treatment. The first group consisted of 12 patients (21 orbits) who were treated with TEOD as the only method of surgical treatment. In the second group, there were 9 patients (18 orbits) who underwent TEOD and lateral orbital decompression (LOD) simultaneously. The third group consisted of 19 patients (36 orbits) who underwent TEOD as the second stage after LOD. Pre- and postoperative observation included assessment of visual acuity, visual field, exophthalmos, heterotropia/heterophoria angle. RESULTS: In group I the new-onset strabismus with binocular double vision was detected in 1 patient (8.3%). In 5 patients (41.7%), there was an increase in the angle of deviation and an increase in diplopia. In group II the new-onset strabismus with diplopia occurred in 2 patients (22.2%). In 8 patients (88.9%), an increase in the angle of deviation and an increase in diplopia were revealed. In group III the new-onset strabismus and diplopia occurred in 4 patients (21.0%). An increase in the deviation angle and an increase in diplopia were noted in 8 patients (42.1%). The number of postoperative otorhinolaryngologic complications in group I was 4 (19.0% of the number of orbits). Two intraoperative complications were recorded in group II - 1 case of cerebrospinal rhinorrhea (5.5% of the number of orbits) and 1 case of retrobulbar hematoma without permanent vision loss (5.5% of the number of orbits). The number of postoperative complications was 3 (16.7% of the number of orbits). In group III the number of postoperative complications was 3 (8.3% of the number of orbits). CONCLUSION: The study showed that the most common ophthalmological complication after TEOD is strabismus with binocular double vision. Otorhinolaryngologic complications included synechiae of the nasal cavity, sinusitis and mucocele of the paranasal sinuses.

[Ophthalmic complications of endoscopic sinus surgery]. / Oftal'mologicheskie oslozhneniya endoskopicheskikh operatsii na pridatochnykh pazukhakh nosa.

Endoscopic surgery of the accessory nasal sinuses (ANA) is widely used as the main treatment method for ANA diseases. It is a well-proven, safe and effective method. However, occasionally certain complications may occur. Ophthalmic complications are rare but can lead to irreversible changes. Anatomical organization of the orbit and paranasal sinuses contributes to the risk of damaging the eye ball and its appendages. During endoscopic sinus surgeries, lamina papyracea of the ethmoid bone, extraocular muscles, the optic nerve and the lacrimal passages can be damaged. Ophthalmic complications are classified as non-significant, significant and severe. Studying the data obtained with multi-slice computed and/or magnetic resonance tomography and the patient's medical history during the preoperative stage is necessary in order to minimize the risk of such complications, as well as monitoring the clinical data during all stages of treatment.

[Functional multislice computed tomography of the orbits in diagnosis of incomitant strabismus]. / Funktsional'naya mul'tispiral'naya komp'yuternaya tomografiya orbit v algoritme diagnostiki nesodruzhestvennykh form kosoglaziya.

PURPOSE: To study the value of functional multislice computed tomography (MSCT) of the orbits in examination of patients with complex incomitant strabismus. MATERIAL AND METHODS: The study included 34 patients. In 8 (23.5%) out of 34 patients, strabismus occurred as the result of an orbital injury. In some patients, incomitant strabismus was a complication of: retrobulbar injection of drugs (4 cases (11.7%)); endoscopic sinus surgery (6 cases (17.6%)); reconstructive surgery of orbits (7 cases (20.6%)). In 9 cases (26.5%), incomitant strabismus was detected in patients with thyroid eye disease (TED), of them 5 (14.7%) had previously undergone balanced orbital decompression (BOD). All patients underwent functional MSCT of the orbits. RESULTS: Complete absence of the contractile function of the studied muscles was noted in 6 cases with loss of ocular motility in one or several directions of gaze. Contraction of the injured muscle and its fixation in the area of iatrogenic defect in the orbital wall was observed in 6 patients with severe limitation of ocular motility. limitation of the excursion of the inferior and/or medial rectus muscles due to their fixation in the fracture of the orbital wall was observed in 5 patients after orbital trauma. Signs of contracture of the inferior rectus muscle were revealed in 4 cases of strabismus that occurred after retrobulbar anesthesia. Pronounced increase in the lateral dimensions of the extraocular muscles was determined in 4 patients with TED, as well as in patients who had underwent BOD. Displacement of the lateral and medial rectus muscles into the formed bony windows with a change in the vector of their action was observed in patients who had underwent BOD. CONCLUSION: The data obtained with functional MSCT of the orbits in 34 patients allowed more accurate characterization of the oculomotor disorders and evaluation of the functional state of the extraocular muscles.

[Retrobulbar hematoma in endoscopic endonasal dacryocystorhinostomy]. / Retrobul'barnaya gematoma pri endoskopicheskoi endonazal'noi dakriotsistorinostomii.

Recently, an increase in the number of operations on the lacrimal ducts performed by otorhinolaryngologists has been noted throughout the world. During these operations, intra- and postoperative complications may develop, which require the intervention of an ophthalmologist. A rare complication of endoscopic dacryocystorhinostomy is the development of retrobulbar hemorrhage. This article presents a clinical case of the development of retrobulbar hemorrhage in endoscopic dacryocystorhinostomy. The patient with dacryocystitis underwent endoscopic dacryocystorhinostomy. Preoperative computed tomography revealed a lack of bone tissue in the lacrimal sac fossa. Severe bleeding was noted during the operation. Against the background of tamponade of the formed anastomosis, a growing exophthalmos, conjunctival chemosis, subconjunctival hemorrhage were noted. After removing the tampon, a positive trend was noted. Dexamethasone solution was intraoperatively intravenously administered, in the postoperative period - methylprednisolone solution. According to computed tomography data, exophthalmos persisted on the first day after the operation, hematoma was localized. Visual functions are unchanged. Six months after the operation, the patient had no complaints. According to the computed tomography data, a functioning dacryorhinostomy anastomosis was determined. Often, an interdisciplinary approach to such complications is required, since it can provide full orbital decompression, as well as adequate postoperative management of the patient, which contributes to the most complete ophthalmic rehabilitation. The interaction of otorhinolaryngologists and ophthalmologists in such cases is an indispensable condition for the safety of the operation.

[Strabismus and oculomotor disorders induced by injection anesthesia for cataract surgery]. / Kosoglazie i glazodvigatel'nye narusheniya, indutsirovannye in"ektsionnoi anesteziei v khirurgii katarakty.

PURPOSE: To analyze diagnostic and treatment outcomes in patients with strabismus and oculomotor disorders induced by injection anesthesia for cataract surgery. MATERIAL AND METHODS: The study included 11 patients (7 women and 4 men) aged 61 to 85 years (the mean age of 66±7.1 years) who complained of diplopia in the early post-op period after cataract phacoemulsification and elastic IOL implantation under retrobulbar anesthesia. Prior to further surgical treatment, all of the patients underwent functional multispiral computer tomography of the orbits. Prismatic spectacle correction was also used independently or in addition to surgical treatment. RESULTS: Eight out of eleven patients underwent one- or two-step surgical treatment (3 and 5 cases, respectively). In 2 patients, hypotropia did not exceed 10 prism diopters, and thus, diplopia could be compensated with prismatic spectacle correction alone. In 5 cases, binocular vision was achieved throughout the whole field of gaze. In 3 cases, surgical treatment enabled elimination of heterotropia in the primary gaze and compensation of diplopia within a radius of 40º from the center of gaze and within the entire horizontal range of eye-movement in the downward gaze. The limitation of ocular mobility decreased from 2.36 to 0.55 points leading to an associated decrease in the area of binocular diplopia - from 98% to 29%. In one case, spectacle occlusion was used. CONCLUSION: The inferior rectus restriction is the morphological substrate of anatomical and functional changes induced by retrobulbar anesthesia. As treatment options for restrictive vertical strabismus and binocular diplopia, both surgical (extraocular muscle surgery) and optical (prismatic correction, occlusion) methods should be considered.

[Neurotization of the cornea as pathogenically targeted method of treating neurotrophic keratitis in patients with facial paralysis]. / Nevrotizatsiya rogovitsy kak patogeneticheski napravlennyi metod lecheniya neirotroficheskogo keratita u patsientov s litsevym paralichom.

Combined lesions of the facial and trigeminal cranial nerves are typical after neurosurgical treatment. Violation of the innervation of orbicularis muscle leads to inability to completely close the eyelids, while denervation of the cornea is often manifested as a long-term ongoing and recurring neurotrophic keratitis. The restoration of corneal innervation is a pathogenetically targeted treatment for this pathology. For this purpose, neurotrophic keratitis could be reversed via the method of corneal neurotization using contralateral n. ophthalmicus. The presented clinical case demonstrates the results of the first operation of neurotization of the cornea in a patient with combined lesions of the facial and trigeminal nerves.

[Strabismus surgery and anterior segment ischemia syndrome]. / Khirurgiia kosoglaziia i sindrom ishemii perednego segmenta glaza.

The review summarizes the results of studies related to ischemia of the anterior segment of the eye after surgeries on straight extraocular muscles for strabismus and presents classification, clinical manifestations and risk factors for the development of the syndrome. The principal prevention measures for the clinically significant syndrome are focused on limiting the extent of surgical intervention: in the presence of risk factors and the need for intervention on more than two muscles - staged surgical treatment (i.e. ensuring a time interval between surgeries) that allows collateral circulation to form properly.

[Posttraumatic orbital defect correction with bone autografts]. / Ustranenie posttravmaticheskikh defektov glaznitsy s primeneniem kostnykh autotransplantatov.

The aim of the study was the assessment of safety of posttraumatic orbital defect correction with bone autografts. The study comprised 69 patients divided in 2 groups: 21 patients with isolated orbital floor and medial wall deformities and 48 patients with complex midface injuries. Membranous bone autografts were used for deformities correction along with soft tissues hypercorrection with a mix of bone chips and platelet rich plasms. The paper presents diagnostic algorithm for orbital trauma patients. Correction of complex midfacial injuries in group 2 resulted in restricted ocular mobility and increase in diplopy square. Subciliary approach caused lower lid retraction deteriorating esthetic results of the surgery. Ocular vessels hemodynamics showed improvement 1 year after surgery.

[Hyaluronic acid gel implants for correction of pathological conditions of the orbit and eyelids]. / Primenenie in''ektsionnykh implantatov na osnove gelia gialuronovoi kisloty pri patologii vek i orbity.

PURPOSE: To evaluate the effectiveness of injectable implants made of hyaluronic acid gel (HAG) in ophthalmoplastics. MATERIAL AND METHODS: The study included 57 patients (37 patients with lagophthalmos related to acute or chronic facial nerve palsy, endocrine ophthalmopathy; 20 patients with enophthalmos, anophthalmic syndrome). Depending on filler particle size, the patients received either intrapalpebral or intraorbital HAG injection. The biometric measures of palpebral fissure, the position of the eye/implant, and the condition of the cornea were evaluated during the follow-up period (12 months for eyelid and 18 for orbital injection). RESULTS: In the course of the follow-up, all patients showed reliable reduction of lagophthalmos; additionally, improvement of the condition of the cornea was observed in patients after intrapalpebral injection; patients after intraorbital injection exhibited reduction in enophthalmos, upper orbital palpebral fold retraction and upper eyelid excursion. No serious complications have occurred after the injection. CONCLUSION: As minimally invasive method of treating various pathologies of the orbit and eyelids, HAG fillers showed good clinical effectiveness and safety.