[Capabilities of optical coherence tomography in examination of senile scleral plaques]. / Vozmozhnosti opticheskoi kogerentnoi tomografii v otsenke senil'noi skleral'noi blyashki.

Senile scleral plaque (SSP) is a degenerative disease of the sclera manifested by the appearance of gray spots with clearly defined borders anteriorly from the insertion site of horizontal rectus muscles. Even with minimal changes over time changes over time are minor, SSP weakens the structural function of the sclera and creates a risk of a complicated course associated with scleromalacia. Interest in the study of SSP is increasing due to the growing number of transscleral intravitreal injections. PURPOSE: To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT). MATERIAL AND METHODS: The study examined 13 patients (21 eyes) with average age of 77.1±6.3 years. OCT scanning was performed to determine OCT signs of SSP, the length (parallel to the limb), the width and height of the SSP, as well as the depth and thickness of the overlying sclera. RESULTS: A combination of nasal and temporal SSP was observed in 14 eyes, and nasal only SSP was detected in 6 eyes. In all cases, OCT presented a characteristic picture of SSP observed as an intrascleral cavity with hyperreflective content with lower reflectivity than the surrounding tissues, and clear borders represented by unchanged scleral fibers. The length of the SSP parallel to the limb was 3296±820 µm, the width - 2312±436 µm, the height of the SSP cavity - 482±89 µm. The depth of SSP site was 213±36 µm, the thickness of the overlying sclera - 125±29 µm. CONCLUSION: Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.

[Anterior stromal micropuncture for the treatment of persistent corneal epithelial graft defects after penetrating keratoplasty]. / Perednyaya stromal'naya mikropunktsiya v lechenii persistiruyushchei erozii transplantata rogovitsy posle skvoznoi keratoplastiki.

Persistent corneal graft erosion or persistent epithelial corneal defect is a frequent complication of penetrating keratoplasty. Its development can be contributed by the dry eye syndrome, rare blinking, lagophthalmos, symblepharon, viral infection, autoimmune aggression, and the use of epithelial-toxic eye drops. The article presents three clinical observations of patients who developed persistent corneal graft erosion after penetrating keratoplasty. Due to the ineffectiveness of local conservative therapy for more than 3 weeks, anterior stromal corneal micropuncture was performed. After the procedure, there was a gradual epithelial proliferation, complete healing of the corneal surface was observed 10-16 days after the manipulation, the follow-up period was at least 1 year. The mechanism of action of stromal micropuncture is associated with the creation of a porous surface with better adhesion properties, as well as with the activation of the production of extracellular matrix glycoproteins such as fibronectin, type IV collagen and laminin, which are necessary for stable adhesion of the epithelium. The use of stromal micropuncture of the donor flap in the treatment of post-keratoplasty persistent corneal epithelial defect was proposed for the first time.

[Intraocular lens power in Russian population: distribution analysis]. / Raspredelenie opticheskoi sily intraokulyarnykh linz, vostrebovannykh na territorii Rossiiskoi Federatsii.

Approximately 470 thousand cases of cataract surgery with implantation of intraocular lens (IOL) are performed annually in Russia. The distribution of IOL power in the Russian population has not been studied sufficiently, which makes the IOL procurement planning imperfect. PURPOSE: To analyze the distribution of implanted IOL power and optimize the IOL procurement system. MATERIAL AND METHODS: Retrospective analysis of cataract surgeries performed from 2014 to 2015 in the ophthalmic department of Volga District Medical Centre of the FMBA was conducted. Inclusion criteria: age from 20 to 99 years, no refractive surgery in patient's medical history, primary IOL implantation with an A-constant of 118.4, achievement of planned refraction. The studied parameters were IOL power, gender and age of patients. To assess the effectiveness of the procurement system, we analyzed the number of additional «unplanned¼ purchases and exchanges of IOLs over the course of 5 years (2014-2018). RESULTS: According to the inclusion criteria, 1009 medical records were selected, the age of the patients was 68.7±10.9 years. The distribution of IOL power was similar, but different from the normal, characterized by the mismatch of the median and the mean, left-sided asymmetry and peaked shape. Comparison of 2014 and 2015 samples showed no significant differences and low variability of IOL power. Regression analysis revealed a weak correlation between the IOL power and age and no correlation with gender, a trend was observed for IOL power to increase in patients after 50 years. The use of a procurement planning system based on a mathematical model of the IOL power distribution allows reduction of the additional purchases and exchanges of IOLs with the supplier from 5-7% to 1-2% of the total purchases. CONCLUSION: The specific features of the IOL power distribution are related to the distribution of biometry parameters in the population. The use of a scientifically based procurement system reduces staff time and laboring costs, releasing economical and time resources.

[Fungal keratitis after penetrating keratoplasty]. / Gribkovyi keratit posle skvoznoi keratoplastiki.

The article presents a case of fungal keratitis after penetrating keratoplasty (PKP). A 35-years old patient had previously undergone surgical removal of an intraocular foreign body and developed chronic keratouveitis and epithelial-endothelial corneal dystrophy. PKP and early postoperative period were uneventful. The patient was frequently monitored with anterior segment photos. Two weeks later, fungal keratitis occurred on the edge of the donor flap. Direct microscopic evaluation revealed fungus spores and filaments, but growth of fungi in culture was negative. Instillation of steroids and antibiotics was discontinued, specific therapy included fluconazole and amphotericin B. Despite the ongoing treatment, keratitis has repeatedly recurred, and infiltrates were scraped. Topical and systemic voriconazole was administered instead of fluconazole in combination with regular scarification. After 3 weeks of treatment with voriconazole, stable corneal epithelialization was achieved and the cornea has restored its transparency. During 1.5 years of the follow-up, keratitis did not reccur; sutures were removed, corrected visual acuity increased to 1.0. Patients who had undergone PKP are at risk of developing fungal keratitis. Frequent monitoring of such patients contributes to early diagnosis of infectious complications. In the absence of officinal antifungal eye drops, specialist has to supply the patient with ex tempore antimycotic agents and change the treatment according to its effectiveness in each specific case.

[Papillomacular retinoschisis associated with glaucoma]. / Papillomakuliarnyi retinoshizis, assotsiirovannyi s glaukomoi.

Peripapillary and macular retinoschisis is one of the rare manifestations of advanced glaucoma of different types. The article presents a case report and a mini-review. Peripapillary and macular retinoschisis with visual deterioration was diagnosed in a patient with advanced decompensated open-angle glaucoma and pseudoexfoliation syndrome. Surgical treatment of glaucoma led to intraocular pressure normalization, gradual regress of retinoschisis and improvement of visual functions. The retinal structure fully restored 1.5 years after the operation. The observation period was 3 years, retinoschisis did not recur. The article discusses the pathogenesis and potential algorithm for the treatment of the disease. Risk factors for the development of retinoschisis include high intraocular pressure, significant visual field defects and a wide range of diurnal intraocular pressure fluctuations. The source of the intra-retinal fluid is the vitreous body. Management of the patient consists of medical, laser and surgical normalization of intraocular pressure and regular monitoring. In case of persisting retinoschisis, patient undergoes vitreoretinal surgery or barrier laser coagulation. Retinal structure recovers gradually after the intervention and takes on average 1 year.

[Complications of intracameral cefuroxime in cataract surgery]. / Oslozhneniia vnutrikamernogo vvedeniia tsefuroksima v khirurgii katarakty.

Intracameral injection of cefuroxime during phacoemulsification is considered effective in preventing endophthalmitis. Its widespread usage has led to the accumulation of data on local and systemic adverse reactions. The analysis of complications of cataract surgery with cefuroxime injections described in literature has allowed identifying a few different clusters of toxic and allergic reactions to intracameral cefuroxime for the first time. These clusters included toxic anterior segment syndrome, serous retinal detachment with macular edema, retinal hemorrhagic infarction and anaphylactic reaction. The first two types develop in the cases of both correct and incorrect dosages, and both have favorable prognosis. Retinal hemorrhagic infarction was observed in cases with more than 50 mg intracameral antibiotic injected in the anterior chamber and was accompanied by persistent irreversible visual deterioration. Anaphylactic shock in response to a standard dose of intracameral cefuroxime was described in patients allergic to penicillin. Every clinical variant has specific complication mechanisms, prevention and treatment options. Antibiotic dilution done by medical staff accounts for the risk of incorrect dosage and related complications. Clinical manifestations of the complications of antibiotic prophylaxis should be considered when specifying the causes of decreased vision in the early postoperative period.

[Serous retinal detachment after phacoemulsification with intracameral cefuroxime (a case-control report)]. / Seroznaia otsloika setchatki posle fakoémul'sifikatsii s vnutrikamernym vvedeniem tsefuroksima (klinicheskoe nabliudenie 'sluchai-kontrol'').

Serous retinal detachment is a rare postoperative complication of phacoemulsification with intracameral antibiotics. Diagnostic and therapeutic strategy in such cases is not well known. PURPOSE: To present a case of serous retinal detachment after phacoemulsification with intracameral cefuroxime. MATERIAL AND METHODS: A retrospective analysis of the medical record of one patient who had underwent cataract phacoemulsification on both eyes; the follow-up period was 5 months. RESULTS: Phacoemulsification of noncomplicated cataract with implantation of intraocular lens in the right eye was completed uneventfully; 1 mg of cefuroxime was administered into the anterior chamber at the end of the surgery. In the first day after the surgery visual acuity decreased to 0.2. Serous detachment of retinal pigment and sensory epithelia in the macula area was revealed by optical coherence tomography (OCT). Fluorescein angiography showed no pathological vascular activity. The patient received standard post-surgery therapy supplemented with subtenon triamcinolone, intravenous dexamethasone injections and systemic acetazolamide ingestion. The retinal detachment status was monitored daily by OCT. By day 6 of the follow-up visual acuity recovered to 1.0. After 5 months, inner retinal profile deformation was revealed. The patient's left eye was considered the 'control' eye; phacoemulsification without cefuroxime was performed on it 5 months after the initial surgery, and no complication occurred during the follow-up. CONCLUSION: Serous detachment of retinal pigment and sensory epithelia during the early postoperative period after cataract surgery may be caused by a toxic reaction to intracameral cefuroxime even when it's administered in standard dosage. This complication has a favorable prognosis, but requires long term monitoring.

[Spontaneous separation of secondary epiretinal membrane]. / Spontannoe otdelenie vtorichnoi épiretinal'noi membrany.

The article presents a rare clinical case of secondary epiretinal membrane (ERM) in a 67-years-old woman. The patient was diagnosed with ERM in the left eye after loss of vision complaints. One year prior to the visit the patient had underwent 2 sessions of laser photocoagulation for proliferative post-thrombotic retinopathy in the left eye. In the context of relatively high visual functions (decimal visual acuity of 0.7 at the time of the visit), observation strategy was carried out. The follow-up period was 2 years. According to optical coherence tomography data, progressive deformation of retinal profile and an increase in diffuse retinal edema up to 391 µm in the fovea were observed in the course of the year, while visual acuity decreased to 0.6. Spontaneous separation of ERM, an increase in visual acuity to 0.9 and a decrease in retinal thickness to 236 µm were found during the subsequent visit. The authors discuss the presumable mechanisms of secondary ERM formation and separation and the impact of such cases in the management of patients with ERM and relatively high visual acuity.

[The frequency and structure of cardiac rhythm disturbances in the women presenting with abdominal obesity during the postmenopausal period].

We have studied the frequency and structure of cardiac rhythm (CR) disturbances in the women presenting with abdominal obesity (AO) in the postmenopausal period. The single-step study involved 210 postmenopausal women (median age 57 years) who were examined by 24-hour ECG monitoring, measurement of arterial pressure, body mass index, and the relationship between waist and hip circumferences. CR disturbances were revealed in all 159 women with abdominal obesity, ischemia in 16.9%, supraventricular extrasystole in 89.3%, ventricular extrasystole (VE) in 58.5%, high-grade extrasystole in 23.9%, paroxysms of supraventricular tachycardia in 1.9%, periods of asystole in 1.3%, synoatrial and atrioventricular blockade in 9.9%, His bundle branch block in 3.3%, sinus tachycardia in 48.8%, and sinus brachycardia in 23.9% of the patients. The risk of development of VE in the women with AO increased by 3.8 times in the presence of concomitant coronary heart disease and by 2.9 times in case of chronic cardiac failure. The frequency of VE was significantly higher in the patients with abdominal obesity than without it (odds ratio 2.2). It is concluded that women presenting with abdominal obesity during the postmenopausal period are characterized by the high frequency of cardiac rhythm disturbances and ischemia, with each fourth patient being at high risk of sudden death. The elevated risk of ventricular extrasystole in the postmenopausal period is associated with AO, coronary heart disease, and chronic heart failure. The frequency of VE is unrelated to ulcer disease, chronic cholecystitis, cholelithiasis, chronic pancreatitis, and impaired function of the thyroid gland.

[Comparison of dysrhythmias in women with hypertension in the period of premenopause and in late fertile period with altered hormonal background in dependence on the variant of left ventricular modeling].

We carried out 24 hour Holter ECG monitoring in 106 women with hypertension in the period of premenopause and in late fertile period with altered hormonal background. Comparative analysis of character and structure of dysrhythmias showed that supraventricular premature beats including rapid and allorhythmic extrasystoles were more often registered among premenopausal women than among patients in fertile period. Same tendencies took place concerning frequency of ventricular rhythm disturbances (in most cases I grade II-IV ventricular extrasystoles). Comparative analysis of dysrhythmias in premenopausal and fertile hypertensive women with normal left ventricular geometry and with hypertrophic type of remodeling showed that both supraventricular and ventricular rhythm disturbances were significantly more often registered in hypertrophic variants of left ventricular remodeling, especially in premenopausal women.

[A cross-sectional study of lipid metabolism in postmenopausal women].

AIM: To assess frequency of atherogenic dyslipidemia in postmenopausal residents of Ekateringurg. METHODS: Cross-sectional study included 1100 female patients of outpatient menopausal clinic. All were residents of Ekaterinburg aged from 28 to 64 years. The participants of the study were divided into 3 groups; the 1st group consisted of women younger than 45 years, the 2nd group included persons aged between 45 and 54 years, in the 3rd group comprized patients aged from 55 to 64 years. RESULTS: Normal lipid metabolism parameters were found in 18% of women. Most frequent dyslipidemias were 2A (44%) and 2B (26%) types. Frequencies of stable angina on exertion, transitory cerebral ischemic attacks, and myocardial infarction increased after the age of 45 years. CONCLUSION: More than 80% of symptomatic postmenopausal women had atherogenic dyslipidemias. The percentage of postmenopausal women who had indication for lipid lowering therapy was high.

[Magnesium deficit in climacteric women].

The aim of the study was to assess the prevalence of magnesium deficit (MD) in climacteric women and its effect on the severity of climacteric syndrome (CS). This cross-sectional study included 165 women with typical CS manifestations. Patients with arterial hypertension were excluded. Blood levels of magnesium and calcium as well as lipid exchange variables in blood serum were studied. The degree of CS was determined using modified menopausal index (MMI). MD was revealed in 62.4% of the patients. The frequency of obesity and excessive body mass was significantly higher in MD women vs. women whose magnesium levels were normal (chi2 = 4.477; p = 0.034). MD was associated with a higher risk of peripheral bone fractures (OR = 2.28; 95% CI 1.06-4.93). Normal magnesium levels were found in less than 50% of women with clinical manifestations of DM. MD was associated with a higher frequency of abdominal obesity and bone fractures of extremities.

[Osteoarthrosis of the knee joints in climacteric women with excessive body weight or obesity].

The purpose of the study was to evaluate body weight (BW) effect on the frequency and clinical manifestations of knee joint osteoarthrosis (KJOA) in climacteric women with excessive BW or obesity. The subjects of this case control study were divided into three groups: group 1 consisted of 283 climacteric women with normal BW; group 2 consisted of 283 women with excessive BW; 283 obese women constituted group 3. All the three groups were comparable by age and menopause duration. The diagnosis of KJOA was established according to American Rheumatology Association criteria. Joint pain intensity was assessed using 100-mm visual analog scale. Lequesne algofunctional index was used to determine functional limitations. Lipid and carbohydrate exchange parameters were studied as well. The frequency of KJOA was significantly higher in group 2 (47.3%) and group 3 (56.1%) vs. group 1 (39.9%). Abdominal obesity was significantly more frequent in patients with KJOA (32.2%). Obesity was associated with an increased risk of KJOA (relative risk = 1.91; 95% confidence interval = 1.37-2.67), but not other variants of osteoarthrosis. Thus, in Russian population of climacteric women the frequency of KJOA was significantly higher in those with excessive body weight or obesity vs. women with normal body weight. Abdominal obesity was found to be an independent risk factor of KJOA, but not other localizations of osteoarthrosis.

[The evaluation of cardiovascular risk in postmenopausal women with osteopenia].

The purpose of the study was to evaluate the prevalence of the most important cardiovascular risk factors in postmenopausal women in correlation with bone mineral density (BMD). A hundred and fifty postmenopausal women were included in a case control study. The subjects were distributed into three equal groups: normal bone mass; osteopenia; non-complicated osteoporosis. BMD was measured with lumbar double-energy X-ray absorptiometry. Cardiovascular risk factors were assessed. The level of triglycerides was significantly higher in patients with osteoporosis vs. subjects with normal BMD. Arterial hypertension and a 10-year fatal risk of more than 0% were significantly more prevalent in the group with normal BMD. Osteoporosis presents an independent cardiovascular risk factor. Postmenopausal women with decreased BMD should be considered to have a higher risk of cardiovascular events, because standard risk scales do not take BMD into account.

[Hyperinsulinemia and insulin-resistance in climacteric women with metabolic syndrome].

The purpose of the study was to evaluate the peculiarities of carbohydrate and lipid dysmetabolism in climacteric women with metabolic syndrome (MS). The subjects of this case-control study were 124 women. The main group consisted of 62 women with MS according to A TP III classification; the control group included 62 women without MS. Anthropometric parameters, blood levels of glucose and immunoreactive insulin, and lipid exchange indices were measured. Thirty-three patients in the main group were obese, and 12 had an excessive body weight; in the control group these conditions were found in 6 and 23 patients, respectively. Patients in the main group developed insulin resistance (IR) significantly more often than the controls did (33 and 15 cases, respectively); the frequency of arterial hypertension, differed significantly between the groups, too. High incidence of IR and carbohydrate dysmetabolism in climacteric women suffering from MS is associated with lipid exchange disturbances, the latter being an independent risk factor of coronary heart disease.

[Arterial hypertension, disorders of carbohydrate and lipid metabolism in obese perimenopausal females].

AIM: To examine prevalence of arterial hypertension (AH), disorders of carbohydrate and lipid metabolism in females with obesity in perimenopause. MATERIAL AND METHODS: One-stage trial enrolled 358 obese females in menopause seeking advice in the city center for health and family planning in Ekaterinburg (mean age 50.5 +/- 5.4 years). RESULTS: 111 (31%) females suffered from obesity, 154 (43%) had overweight, 93--normal body mass. A relative risk to develop AH in overweight was 2.61, in obesity--3.52. Diabetes mellitus was in 15 females with obesity, disturbed glucose tolerance was in 38 females with overweight. CONCLUSION: Body weight loss is an important component of perimenopausal women rehabilitation.

[Crystallogenic properties of serum lipid fraction in healthy persons and in patients with ischemic heart disease]. / Kristallogennye svoistva lipidnoi fraktsii syvorotki krovi zdorovykh i bol'nykh ishemicheskoi bolezn'iu serdtsa.

A crystallization method was proposed to assess disturbances in the lipid system; it was based on the interaction of a serum lipid fraction with a lecithin matrix. A total of 255 invidividuals were examined. A model experiment was performed by using chemically pure cholesterol (96 samples) and 10 different cholesterol esters (240 samples). There were a great differences in the frequency of various pattern structural types (homogeneous texture, fan crystals) in the healthy persons and patients. The test results were found to be related to the ratio of esterified to non-esterified cholesterol in the serum lipid fraction. The application of rheopolyglucin, , hemosorption, quantum hemotherapy in the patients contributed to normalization of crystallization test indices.

[Methods of hormone replacement therapy in hypertensive women]. / Taktika zamestitel'noi gormonal'noi terapii u zhenshchin s arterial'noi gipertenziei.

A comparative retrospective study was made to examine influence of replacement therapy by estradiol valeriate and climonorm on perimenopausal hypertension. The test group (25 hypertensive women) received climonorm for 6 months. Control women received hypotensive therapy. Lipid metabolism and risk of vascular events were assessed. The replacement therapy had a positive effect on lipid metabolism. Criteria of Mann-Whitney, Friedmann, Wilkinson and of chi 2 were made use of. The target arterial pressure was achieved only with hypotensive therapy which also diminished intensity of menopausal disorders. To determine individual policy, it is necessary to stratify risk of cardiovascular events. The best effect is achieved at combination of hypotensive therapy with replacement hormone treatment.

[The significance of variation pulsometry in the diagnosis of ischemic heart disease during mass screening of the population]. / Znachenie variatsionnoi pul'sometrii v diagnostike ishemicheskoi bolezni serdtsa pri massovykh osmotrakh naseleniia.

The use of computerized heart rhythm assessment in diagnosis of patients at high risk of ischemic heart disease during epidemiological surveys is discussed. The method has been shown to be of value in detection of ischemic heart lesions developing in menopausal women. The method can be used to monitor patients in the course of long-term follow-up.