[Micropulse laser treatment of complicated forms of sclerogenic macular degeneration]. / Mikroimpul'snoe lazernoe lechenie oslozhnennykh form sklerogennoi makulyarnoi degeneratsii.

Focal dome-shaped prominence of the macular profile due to thickening of the scleral layers leads to the development of sclerogenic macular degeneration (SMD), which causes a decrease in vision when it evolves into complicated forms. PURPOSE: To evaluate the effectiveness of subthreshold micropulse laser (SML) coagulation in patients with SMD complicated by detachment of neuroepithelium. MATERIAL AND METHODS: The study included 14 patients (13 women and 1 man), aged 28 to 63 years, median age 55.5 (50; 62) years. All patients underwent standard ophthalmologic examination, optical coherence tomography, as well as fluorescence and/or indocyanine-green angiography. Subthreshold micropulse laser treatment was performed using a diode laser with a wavelength of 810 nm, and consisted of 2-3 sessions of 10% micropulse duty cycle in subthreshold mode with an interval of 2-4 months. Patient data were recorded at 5 time points, each subsequent data point was compared with the baseline. Treatment was carried out according to the dense "lattice" technique with an additional effect on the dye leakage zones. The follow-up period lasted 6-12 months. RESULTS: Complete regression of subretinal fluid after all SML sessions was observed in 42.9% of cases. In other cases, persistent positive dynamics in terms of edema decrease was noted. The average values of best corrected visual acuity did not significantly change over the course of the follow-up. According to the OCT data, choroidal thickness in fovea significantly decreased at the 1st, 3rd and 4th time points, while the retinal thickness did not significantly change during the observation period. CONCLUSION: Subthreshold micropulse laser treatment accelerates the resorption of subretinal fluid in SMD, but this effect cannot be considered satisfactory due to the very slow rate of resorption of subretinal fluid and the absence of a significant effect on visual acuity of patients. The effectiveness of this technique must be compared with other treatment techniques and the natural course of the disease.

[Sarcoid granuloma of the iris (clinical cases and state of the problem)]. / Sarkoidoznaya granulema raduzhki (klinicheskie sluchai i sostoyanie problemy).

Granulomatous lesion of the iris has varying etiology, but in the differential diagnostic it should often be considered by sarcoidosis and tuberculosis damage. PURPOSE: To describe a clinical case of sarcoid lesion of the iris and provide an analysis of literature devoted to this problem in the context of its polyetiology. MATERIAL AND METHODS: The article describes one case of sarcoid granuloma of the iris in a young patient with a relapsing course of the disease. RESULTS: The presented clinical case demonstrates the need for differential diagnosis to clarify the causes of the disease and the possibility of recurrence involving appearance of a multifocal lesion. The article also reviews literature on this problem reflecting the polyetiological nature of granulomatous lesions of the iris, and argues the use of interventional diagnostic methods in the absence of extraocular pathology. CONCLUSION: Analysis of the clinical case and literature clearly demonstrates the need for differential diagnosis of granulomatous lesions of the iris.

[Indocyanine green angiography in the diagnostics of choroidal tumors]. / Angiografiya s indotsianinom zelenym v diagnostike novoobrazovanii khorioidei.

PURPOSE: To study the use of ultrasound color Doppler imaging and indocyanine green (ICG) angiography for identification of malignant vasculature of choroidal tumors. MATERIAL AND METHODS: The study included 46 patients (46 eyes) with tumors of the choroid: 19 men and 26 women aged 22 to 89 years, average age 53.2±17.1 years. All patients underwent indocyanine green angiography and Doppler ultrasound imaging. At the time of examination, thickness of the tumors ranged from 1.1 mm to 3.0 mm, and the base diameter from 4.0 mm to 13.0 mm. Choroidal melanoma was diagnosed in 27 patients, choroidal nevus in 10, choroidal hemangioma in 5, and choroidal metastasis in 4 patients. RESULTS: The results of indocyanine green angiography demonstrate that the pathological malignant vasculature was determined: nevi was diagnosed in 7 out of 10 patients, choroidal melanoma in 16 out of 27, metastasis in 2 out of 4, and hemangioma in none of the 5 patients. Pathological malignant vasculature was determined in most patients with choroidal melanoma (77.8%), in all patients with choroidal hemangioma and in 3 patients with choroidal metastases. Ultrasound imaging revealed malignant vasculature in 15 of 27 (56%) patients with choroidal melanoma, it could be identified in all patients with hemangioma in 2 patients and with choroidal metastases, and in none patients with choroidal nevi. CONCLUSIONS: Indocyanine green angiography helps verify malignant vasculature in 77.8% of patients with small and medium sized choroidal melanomas. Angioarchitecture of choroidal tumors visualized with indocyanine green angiography is characterized by variability of patterns, which should be taken into account in the differential diagnosis of various pathological diseases.

[Dome-shaped macula: features of differential diagnostics with clinical examples]. / Fenomen kupoloobraznoi makuly: osobennosti differentsial'noi diagnostiki (klinicheskie nabliudeniia).

The phenomenon of dome-shaped macula (DSM) constitutes protrusion of membranes of the posterior pole of the eye toward the vitreous body due to local thickening of sclera layers. The phenomenon was detected using enhanced depth imaging optical coherence tomography (EDI-OCT). In uncomplicated forms of DSM, all layers of the retina are contiguous, but the setting of DSM can involve a number of pathological conditions causing decrease in vision. One of the most often described concurrent conditions in DSM is serous retinal detachment (SRD). Such complicated forms of DSM are often masked as a non-pigmented neoplasm of the choroid, in particular hemangioma (HC). PURPOSE: To demonstrate the possibilities of differential diagnostics of DSM with HC using modern instrumental diagnostic methods. MATERIAL AND METHODS: The study involved two clinical cases of patients with DSM and HC, who underwent comprehensive ophthalmological examination including EDI-OCT and OCT angiography, fluorescent angiography (FA), indocyanine-green angiography (ICG) and magnetic resonance imaging of brain and orbits (MRI). RESULTS: The most simple and highly informative method for differential diagnostic of DSM with HC is currently EDI-OCT. In difficult differential diagnostic cases, it is recommended to use FA and MRI. Additionally, for identification of the cause of SRD in DSM, OCT-angiography and ICG-angiography can be used. Thus, diagnostics of DSM is difficult today primarily because of the low awareness of ophthalmologists about the presence of such macula pathology. Detection of this anatomical feature by means of ophthalmoscopy alone can be difficult and requires special skills and experience. The use of EDI-OCT, as well as FA and MRI in difficult differential diagnostic cases, and correct interpretation of the obtained data can help avoid diagnostic errors.

[Virtual surgeries based on spiral computed tomography]. / Virtual'nye khirurgicheskie operatsii na osnove ispol'zovaniia spiral'noi komp'iuternoi tomografii.

Experience of spiral computed tomography with bolus contrast enhancement and subsequent 3D-reconstruction of picture for virtual modeling of surgeries is presented. The method was used in 204 patients with tumors and diseases of the liver, pancreas, spleen, kidneys, adrenal glands, parapapillary diverticula of the duodenum, coarctations and aneurysms of aorta, extraorganic tumors of the retroperitoneal cavity and neck. Coincidence of virtual and real types of surgeries reached 75-92.8% depending on the disease and clinical situation. Perspectives of 3D-reconstruction for evaluation of normal and pathologic anatomic features in an individual patient, choice of an optimal surgical variant, prognosis of possible complications and their prophylaxis are demonstrated. Integration of surgeon's and radiologist's thinking is very important for correct diagnosis and surgical policy.

[Role of abnormalities of the lung surfactant system in the development of respiratory failure in critical states caused by acute neurotoxic poisoning]. / Rol' patologii surfaktantnoi sistemy legkikh v razvitii dykhatel'noi nedostatochnosti pri kriticheskikh sostoianiiakh, obuslovlennykh ostrymi otravleniiami iadami neirotoksicheskogo deistviia.

Clinical data on the surfactant system of the lungs during poisoning with neurotoxic toxins are presented and approaches to drug correction of lung system disorders in severe intoxication with neurotoxic agents are offered.

[Effect of the transcranial electrical stimulation of the endorphinergic brain structures on the functional activity of hepatocytes after toxic exposure]. / Vliianie transkranial'noi élektrostimuliatsii éndorfinnykh struktur mozga krys na funktsional'nuiu aktivnost' gepatotsitov pri ikh toksicheskom povrezhdenii.

Biochemical events of the rat hepatocytes cytolysis and deterioration of their synthetic activity and detoxification ability, as well as morphological events of lipid degeneration after acute poisoning with dichloretane and CCl4, were significantly reduced by effects of transcranial stimulation (TES). Blockade of the TES effects with naloxone revealed its endorphinergic nature. Combined effects of the TES and Essenciale preparation were lower than separate those of these agents. The TES effects were clinically corroborated in treatment of toxic hepatitis.