[Optimization of phacoemulsification technique for Morgagnian cataract]. / Optimizatsiya tekhnologii fakoemul'sifikatsii morganievoi katarakty.

PURPOSE: This study was conducted to develop a new optimized phacoemulsification technique for Morgagnian cataract taking into account the anatomical and topographic parameters of the lens nucleus. MATERIAL AND METHODS: A working classification of Morgagnian cataract was developed based on the size of the nucleus: if the edge of the nucleus is visualized at the upper edge of the pupil or between the upper edge and the middle of the pupil, it was classified as an initial stage of Morgagnian cataract with a large nucleus; if the upper edge of the nucleus is visualized in the middle of the pupil and below, it was classified as an advanced stage of Morgagnian cataract with a small nucleus. The first group included six patients who underwent surgery using the scaffold technique with removal of the whole small nucleus into the anterior chamber. The second group included 11 patients who underwent surgery using the scaffold technique with removal of the last fragment of the nucleus into the anterior chamber. RESULTS: The use of the scaffold technique with removal of the nucleus into the anterior chamber helped reduce the number of intraoperative complications to 16.7% in the first group, compared to 27.3% in the second group, and the percentage of endothelial cell loss to 10.1% in the first group, compared to 10.7% in the second group. CONCLUSIONS: The anatomical and topographic features of the lens and the anterior segment of the eye in Morgagnian cataract with a small nucleus allow for preliminary implantation of an intraocular lens into the capsular bag to protect the posterior capsule during phacoemulsification of the nucleus with minimal mechanical, hydrodynamic and acoustic damage to the surrounding structures of the eye.

[Evaluation of the diagnostic capabilities of nailfold capillaroscopy in diabetic retinopathy]. / Diagnosticheskie vozmozhnosti kapillyaroskopii nogtevogo lozha pri diabeticheskoi retinopatii.

PURPOSE: This study evaluates the diagnostic capabilities and the prognostic value of nailfold capillaroscopy data of patients with diabetic retinopathy (DR) to develop an algorithm of monitoring patients with type 2 diabetes mellitus. MATERIAL AND METHODS: The study involved 90 patients (mean age 67 years), among them 31 with nonproliferative diabetic retinopathy, 29 patients with proliferative DR and 30 patients without retinopathy. In addition to conventional ophthalmological examination, optical coherence tomography angiography (OCTA) on the Optovue RTVue-100 device (USA) was performed using en face vessel density protocol to examine the state of the microvasculature of the superficial and deep layers of the vascular plexus of the central retinal zone, as well as nailfold capillaroscopy using computerized capillaroscope KK-01 (ZAO Centr Analiz veshhestv, Russia). RESULTS: The cut-off points for detecting the presence of non-proliferative DR (capillary network density below 38.4%, arterial velocity below 512 mm/s and venous blood flow below 585 mm/s), and the presence of proliferative DR (capillary network density below 30.4%, the arterial velocity below 451 mm/s and the venous blood flow below 441 mm/s) were identified according to ROC-analysis of nailfold capillaroscopy data. In the diagnosis of proliferative DR the capillary network density parameter has a slightly higher diagnostic information value (AUC=0.963) than arterial blood flow velocity (AUC=0.941) or venous blood flow velocity (AUC=0.909). Using the identified critical parameters for predicting the initial and proliferative DR, we created a diagnostic algorithm involving a comprehensive assessment of all characteristics. CONCLUSION: The study revealed that nailfold capillaroscopy indicators (capillary network density, velocity of arterial and venous blood flow) have high diagnostic information value for detecting both non-proliferative and proliferative retinopathy. We constructed mathematical models for predicting DR with an accuracy of predicting the presence of a non-proliferative stage in 92.2% of cases and a proliferative stage in 94.4% of cases. For practical use in clinical environment, we created a computer program calculating the results of DR predictions according to nailfold capillaroscopy data.

[Prognostic value of matrix metalloproteinases in the development of diabetic retinopathy in the elderly].

The development of diabetic retinopathy is associated with matrix metalloproteinases, but they are rarely used to predict this pathology. The aim of the study was to predict the development of non-proliferative diabetic retinopathy in old age by the level of matrix metalloproteinases in blood plasma. The main study group consisted of 63 patients aged 60-74 years with type 2 diabetes mellitus and non-proliferative diabetic retinopathy, the control was 56 patients of the same age with type 2 diabetes mellitus and the absence of diabetic retinopathy and other ophthalmopathology at present and in the anamnesis. Examination of patients of both groups included: tonometry, visiometry, standard fundus photoregistration, optical coherence tomography, optical coherence tomography-A, fluorescent angiography. Determination of matrix metalloproteinases was carried out by the method of solid-phase enzyme immunoassay. There was a statistically significant increase in matrix metalloproteinase-9 in the main group of patients to 55,7±2,6 ng/ml versus 40,2±1,9 ng/ml in the age control, matrix metalloproteinase-2 to 269,8±4,2 ng/ml versus 221,9±3,6 ng/ml, respectively. Based on the level of matrix metalloproteinases-2 (X1) and -9 (X2) in the blood, a regression model was created by the regression method to predict the development of diabetic retinopathy, having the form Y=28,315+3,892·X1+2,453·X2, which will allow detecting the disease at an early stage.

[Femtolaser-assisted phacoemulsification of intumescent cataract]. / Fakoemul'sifikatsiya nabukhayushchei katarakty s femtolazernym soprovozhdeniem.

PURPOSE: To optimize the technique of intumescent cataract phacoemulsification by involving the use of femtosecond lasers. MATERIAL AND METHODS: Group 1 included 29 patients (30 eyes) with mature intumescent cataract, who underwent femtolaser-assisted phacoemulsification using a new, optimized technique. Group 2 included 20 patients (20 eyes), in whom the femtolaser stage was performed using the standard technique. Patients of groups 1 and 2 were almost identical in all preoperative parameters. The optimized femto-capsulorhexis technique included: preoperative assessment of intralenticular pressure, staining of the anterior capsule of the swelling lens with trypan blue, introduction of a viscoelastic with high molecular weight into the anterior chamber to balance intraocular and intralenticular pressures, increasing the laser energy when performing anterior capsulorhexis up to 10 mJ. RESULTS: In group 1, there was a non-penetration of the anterior capsule in 2 eyes, in one of them in the 30° sector, in the second - in the 45° sector. Leakage of lens material into the anterior chamber and the floating anterior capsule were not observed in patients of group 1. In group 2, non-penetration of the anterior capsule was observed in 6 eyes, in the 45-60° sector - in 2 eyes, in the 90° sector - in 3 eyes, in the 180° sector - in 1 eye. Floating anterior capsule was observed in 5 cases. Leakage of lens material into the anterior chamber was observed in 9 eyes. CONCLUSION: The optimized technique of femtolaser-assisted intumescent cataract phacoemulsification eliminates leakage of lens material into the anterior chamber and allows performing anterior capsulorhexis of given size and shape.

[Prevalence and detection rate of senile cataract in individuals with cardiovascular diseases]. / Rasprostranennost' i vyyavlyaemost' vozrastnoi katarakty pri zabolevaniyakh serdechno-sosudistoi sistemy.

OBJECTIVE: To determine the prevalence of senile cataracts and its detection rate among the population at the age of 40 and older with diseases of the cardiovascular system. MATERIAL AND METHODS: This observational cross-sectional study was based on the information extracted from electronic health records (EHR) of patients aged 40-99 years assigned for medical services to a city polyclinic. RESULTS: Among the population with essential hypertension (EH) senile cataract occurs with the frequency of 10.4±0.3% (95% CI 9.8-10.9%) of cases, in patients with cerebrovascular diseases (CVD) - 17.1±0.2% (95% CI 16.6-17.5%) of cases, with varicose veins of the lower extremities - 19.9±0.2% (95% CI 19.4-20.3%) of cases, with ischemic heart disease (IHD) - 15.8±0.2% (95% CI 15.4-16.2%) of cases. At the same time, senile cataract is associated with an increase in the likelihood of its detection in patients with hypertension by 6.8 times (OR 6.57; 95% CI 5.89-7.74), with CVD by 5 times (OR 5.02; 95% CI 4.64-5.44), with varicose veins by 3.7 times (OR 3.70; 95% CI 3.34-4.10), with IHD by 3.5 times (OR 3.53; 95% CI 3.20-3.90). Female gender is associated with an increased likelihood of developing senile cataracts in the presence of EH by 1.4 times (OR 1.420; 95% CI 1.299-1.553), in the presence of CVD by 1.2 times (OR 1.199; 95% CI 1.066-1.348), in the presence of varicose veins by 1.4 times (OR 1.355; 95% CI 1.064-1.725), in the presence of IHD by 1.5 times (OR 1.476; 95% CI 1.298-1.679). The detection rate of senile cataract is highest at the ages of 70-79 years, amounting to 18.1% of cases with hypertension, 24.0% of cases with CVD, 29.2% of cases with varicose veins, and 33.7% of cases with ischemic heart disease. CONCLUSION: Target population groups have been identified for more effective screening studies in order to detect senile cataracts among them.

[Optimization of phacoemulsification in complicated cataract with lens subluxation]. / Optimizatsiya tekhnologii fakoemul'sifikatsii pri oslozhnennoi katarakte s podvyvikhom khrustalika.

Purpose - to optimize the process of phacoemulsification in patients with cataract complicated by degree I-II lens subluxation by using the scaffold technique, and to determine the indications for its application. MATERIAL AND METHODS: The patients were divided into two groups: group 1 - the main group - included 29 patients (29 eyes; 47.54%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using the scaffold technique. Group 2 - the comparison group - included 32 patients (32 eyes; 54.46%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using standard technique. RESULTS: Patients' visual acuity improved up to 0.53 (0.35; 0.80) in group 1, and up to 0.50 (0.45; 0.80) in group 2 by the time of hospital discharge. At 6 months and 1 year follow-ups, visual functions were equal, in group 1 - 0.70 (0.65; 0.80), in group 2 - 0.70 (0.60; 0.90). The number of intraoperative complications decreased from 8.20% in standard phacoemulsification to 1.64% in scaffold technique. The latter reduces endothelial cell loss by 1.95% in comparison with traditional phacoemulsification over 1 year follow-up. With the scaffold technique, the number of intraoperative complications decreased from 15.63% in group 2 to 3.45% in group 1, the number of postoperative complications - from 43.75% to 31.04%, respectively. CONCLUSION: The scaffold technique is indicated in pseudoexfoliation syndrome with weakness of zonular apparatus, degree I-II lens subluxation, in hard nucleus with absence of posterior cortical layer, in intumescent cataract, Morgagnian cataract to stabilize the posterior capsule and protect it from rupture.

[Applications of optical coherence tomography in glaucoma]. / Vozmozhnosti opticheskoi kogerentnoi tomografii pri glaukome.

The article reviews literature on optical coherence tomography (OCT) - one of the modern methods of early diagnostics of primary open-angle glaucoma, which has won great popularity among Russian and foreign ophthalmologists. In addition to a summary of the history of the emergence and development of this method, the main purpose was to compare the investigation results and the analysis of the optic disc as the main target subjected to pathological alterations in glaucoma development. Most of the studies comparing the diagnostic capabilities of OCT and Heidelberg retinal tomography (HRT) in the early detection of glaucoma show equivalence of these methods. On the other hand, OCT allows performing subtler structural analysis of the retina, whereas HRT provides more accurate analysis of internal parameters of the optic disc.

[Experience of combined laser treatment for pigmentary glaucoma]. / Opyt kombinirovannogo lazernogo lecheniia pigmentnoi glaukomy.

PURPOSE: To analyze the results of combined laser treatment for pigmentary glaucoma using laser iridectomy (LIE) and selective laser trabeculoplasty (SLT). MATERIAL AND METHODS: The two-stage laser treatment was performed in 12 patients (22 eyes) with pigmentary glaucoma (primary stage - 19 eyes, advanced - 3 eyes). The first stage consisted of LIE; after 5.5±2.2 months, second stage in the form of SLT took place. The follow-up was 16.8±3.2 months. RESULTS: In the early post-op period after LIE, P0 decreased to 14.76±0.72 mm Hg, however the intraocular pressure (IOP) gradually increased during the further follow-up. After SLT, a steady P0 decrease to 12.39±0.66 mm Hg was reached - significantly lower in comparison with the initial data (19.94±0.94 mm Hg). Moreover, significant decrease in the number of hypotensive medications used was noted by the end of the follow-up - from 1.73±0.18 to 0.86±0.15. CONCLUSION: The combined laser treatment involving LIE and SLT was effective in treating primary and advanced pigmentary glaucoma.

[Ultrasound biomicroscopy for examination of the anterior segment of the eye in patients with intumescent cataract]. / Ul'trazvukovaia biomikroskopiia struktur perednego otdela glaza pri nabukhaiushchei katarakte.

According to a prospective review study by H. Gimbel, A. Willerscheidt (1993), among 2967 cataract cases analyzed in 1991, mature intumescent cataract was observed in 34 (1.15%) patients. PURPOSE: To determine the parameters of the ocular anterior segment in patients with intumescent cataract and in their fellow eyes using ultrasound biomicroscopy (UBM) for identification of differential characteristics of intumescent cataract. MATERIAL AND METHODS: The results of preoperative diagnostic examination of the anterior segment of the eye with UBM of 21 patients (21 eyes) with intumescent cataract and their 21 fellow eyes (42 eyes in total) were analyzed. RESULTS: The mean anterior chamber depth according to UBM was 1.96±0.108 mm (from corneal endothelium), in the fellow eyes - 2.74±0.11 mm. The anterior chamber angle was 11.54±2.19°, in the fellow eyes - 20.63±4.08°. The lens thickness in the eyes with intumescent cataract was 5.26±0.13 mm, in the fellow eyes - 4.34±0.09 mm. The length of Zinn ligaments in the external, interior and superior ocular segments of the main group eyes were equal, in the inferior segments they were longer by 0.1 mm. The difference in Zinn ligament length in the eyes with intumescent cataract and fellow eyes was approximately 0.1-0.15 mm in all segments. The equatorial angle in the eyes with intumescent cataract was 32.52±0.92°, in the fellow eyes - 14.85±1.09°. CONCLUSION: A differential symptom of intumescent cataract was identified - complete spherophakia, as confirmed by a specific UBM sign: increase of the equatorial angle by 17° in comparison with the fellow eye, while the length of Zinn ligament remains equal in all segments.

[Intumescent cataract surgery]. / Khirurgiia nabukhaiushchei katarakty.

Intumescent cataract surgery is one of the topical problems of ophthalmology. The article reviews methods of intumescent cataract diagnostics and structural features of swelling lens. Manual or femtolaser-assisted anterior continuous circular capsulorhexis and intumescent cataract phacoemulsification techniques require further research.

[Determination of intralenticular pressure in patients with intumescent cataract]. / Metodika opredeleniia vnutrikhrustalikovogo davleniia pri nabukhaiushchei katarakte.

When the lens swells, a liquefied lenticular substance that increases intralenticular pressure accumulates in the lens bag making it difficult to perform standard capsulorhexis. Thus, determination of the intralenticular pressure value is of great importance for safe intumescent cataract phacoemulsification. PURPOSE: To develop a technology for intralenticular pressure measurement in patients with intumescent cataract and to construct a mathematical model for its prognosis according to preoperative examination data. MATERIAL AND METHODS: Intralenticular pressure was measured in 11 eyes with intumescent cataract. Before that, the following parameters of the anterior compartment of the eye were examined: anterior chamber depth, lens thickness according to ultrasound biomicroscopy (UBM), hypoechogenic layer (the anterior layer of liquefied lenticular masses), equatorial angle. RESULTS: The intraoperative technology of the intralenticular pressure measurement was developed. The direct dependency between thickness of the swelling lens, hypoechogenic layer value (the anterior layer of liquefied lenticular masses), anterior chamber depth and intralenticular pressure magnitude was defined. CONCLUSION: For the first time, the intraoperative intralenticular pressure was measured in patients with intumescent cataract. A dependency was defined between the thickness of the lens and the anterior layer of liquefied lenticular masses, anterior chamber depth, and intralenticular pressure magnitude; based on this, a mathematical model for intralenticular pressure measurement was constructed.

[Heidelberg retinal tomography of the optic disc in the early diagnosis of glaucoma]. / Geidel'bergskaia retinotomografiia diska zritel'nogo nerva v rannei diagnostike glaukomy.

AIM: To analyze anatomical and topographic optic disc parameters with account to the disc area in glaucoma suspects. MATERIAL AND METHODS: The study included 302 patients (408 eyes) aged 25 to 76 years (the mean age of 50.5±12.5 years); men and women roughly equal in number. The eyes were divided into 8 groups depending on the disc area, which ranged from 0.89 to 3.5 mm2. With HRT, 11 global and sector optic disc parameters were examined, 4 of which (disc area, rim area, cup/disc ratio, mean RNFL thickness) are presented in this paper. RESULTS: The study revealed a great variability of disc area values as well as individual morphometric features of the examined optic discs. We have also established high statistical significance of the difference between the above-listed optic disc parameters, both global and sectoral, in groups with different disc areas with the exception of the mean RNFL thickness. CONCLUSION: For early glaucoma detection with HRT, it is advisable to consider the individual area-dependent anatomical and topographic features of the optic disc.

[Complex treatment results in a congenital glaucoma patient (case report)]. / Rezul'taty kompleksnogo lecheniia patsienta s vrozhdennoĭ glaukomoĭ (klinicheskiĭ sluchaĭ).

Early diagnosis of congenital glaucoma allows surgery to be performed at the stage of reversible glaucomatous alterations of the optic disc and retina. In primary congenital glaucoma, the main reason for visual acuity reduction following surgical stabilization of the intraocular pressure are corneal changes. These include an increased corneal diameter, Haab's striae, areas of thickening and a greater posterior elevation. The resultant irregular astigmatism leads to amblyopia and a marked decrease in visual acuity. Active pleoptic treatment started from a very early age in children operated on for compensated congenital glaucoma provides them an opportunity to achieve high visual acuity and full rehabilitation.

[Surgical treatment of mature intumescent cataract].

AIM: To improve phacoemulsification technique of mature intumescent cataract and to study mechanisms of possible uncontrolled tearing of the anterior lens capsule during creation of the anterior capsulorhexis. MATERIAL AND METHODS: Two groups were formed. Group 1 consisted of 52 patients with mature intumescent cataract, in whom a two-stage capsulorhexis was performed with lenticular masses removed from the anterior and posterior capsular bag compartments in between the two stages. Group 2 consisted of 55 patients with mature intumescent cataract, whose capsulorhexis was standard. RESULTS: We have specified appropriate methods for diagnosing intumescent cataract and thoroughly investigated the mechanism of uncontrolled tearing of the anterior capsule that can occur during creation of the anterior capsulorhexis. Five structural variants of the swollen lens have been described. As to surgical complications, there were 2 cases (3.8%) of small anterior capsulorhexis tearing in group 1 that were managed by converting the capsulorhexis into the a bigger one and, thus, did not affect surgical outcomes. In group 2, there were 7 cases of uncontrolled tearing of the anterior capsule during creation of the anterior capsulorhexis, in 4 of them (7,3%) the posterior capsule got also involved. CONCLUSION: 1. It has been found that on ultrasound biomicroscopy, mature intumescent cataract is notable for a 10--15° wider equatorial angle as compared to the fellow eye, which can be regarded as spherophakia. 2. Five different structural variants of the swollen opaque lens have been described. 3. The mechanism of uncontrolled tearing of the anterior capsule during creation of the anterior capsulorhexis has been studied and the expediency of two-stage capsulorhexis with lenticular mass removal from capsular bag compartments proved.