[Results of surgical treatment of glaucoma using sinustrabeculectomy modified for drainage of anterior chamber and suprachoroidal space by autosclera]. / Rezul'taty khirurgicheskogo lecheniya glaukomy metodom sinustrabekulektomii s drenirovaniem perednei kamery i suprakhorioidal'nogo prostranstva autoskleroi.

In order to achieve a persistent hypotensive effect in primary open-angle glaucoma, a modification of the sinustrabeculectomy operation - modified sinustrabeculectomy with basal iridectomy combined with deep sclerectomy involving drainage of the anterior chamber and suprachoroidal space have been developed at the Department of Eye Diseases of the People's Friendship University of Russia. PURPOSE: Development of a new method of surgical treatment of primary open-angle glaucoma based on sinustrabeculectomy with basal iridectomy in combination with deep sclerectomy involving drainage of the anterior chamber and suprachoroidal space by autosclera, and evaluation of the surgical outcomes. MATERIAL AND METHODS: The study analyses the results of surgical treatment of 19 patients (19 eyes) with glaucoma, who underwent sinustrabeculectomy with basal iridectomy in combination with deep sclerectomy and drainage of the anterior chamber and suprachoroidal space. RESULTS: The level of intraocular pressure (IOP) on the first day after surgery decreased from 14 mm Hg to 17.5 mm Hg in the late postoperative period (after 12 months), IOP of 18 patients had normalized and stabilized (IOP averaged 17.0±1.8 mm Hg); in 1 case there was an increase in IOP level, for which hypotensive therapy was prescribed (ß-blockers). CONCLUSION: Modified sinustrabeculectomy with basal iridectomy in combination with deep sclerectomy and drainage of the anterior chamber and suprachoroidal space by autosclera helps achieve a persistent hypotensive effect and does not require the use of donor material.

[Reverse meridional cyclodialysis ab interno with implantation of a metallic implant in patients with glaucoma of different etiology]. / Obratnyi meridional'nyi tsiklodializ ab interno s vvedeniem v supratsiliarnoe prostranstvo metallicheskogo implantata pri glaukome razlichnoi étiologii.

PURPOSE: To evaluate the safety and effectiveness of reverse meridional cyclodialysis (RMC) ab interno with implantation of a metallic implant into the supraciliary space for decreasing intraocular pressure in glaucoma patients. MATERIAL AND METHODS: RMC was performed ab interno in 51 patients, among which 30 patients had a metallic implant inserted into the supraciliary space (implant group). Twenty-one patients who underwent RMC ab interno without implant comprised the control group. The outcomes were evaluated after 12 months. RMC was performed through a clear corneal incision using a special spatula at 4-5 o'clock reaching 5-6 mm deep, width of the cleft was 11-12o of the iridocorneal angle. The evaluation criteria included adverse events, postoperative IOP changes, need for hypotensive medications and repeat surgery. The results were analyzed using variational statistics. RESULTS: Baseline mean IOP was 28.8±4.7 mmHg and 30.2±7.2 mmHg in implant and control groups, respectively, and at 12 months it decreased by 28.7±12.0% and 29.1±17.1%. Baseline mean medication usage was 2.7±0.8 and 2.6±0.9 in respective groups, at 12 months it decreased to 1.1±0.9 and 0.8±0.9. In the implant group, overall success was achieved in 93.3% of cases (complete success - 33.3%, partial success - 60.0%), while in the control group it was 66.7% (complete success - 28.6%, partial success - 38.1%) (p=0.03). In terms of IOP decrease, medication usage and adverse events the difference between the groups was statistically insignificant. Repeat surgery was required 5 times more frequently in the control group (33.3% vs 6.7%, p=3E-05). CONCLUSION: Implantation of a metallic implant into the supraciliary space to keep the cyclodialysis cleft open is safe and effective and substantially decreases the need for repeat surgery.

[Combination treatment for cataract and glaucoma]. / Kombinirovannye metody lecheniia pri sochetanii katarakty i glaukomy.

AIM: To develop a new combination treatment for cataract and glaucoma that would involve drainage of the suprachoroidal space with an autoscleral flap and to assess the outcomes of patients who underwent combined phacoemulsification and non-penetrating deep sclerectomy with suprachoroidal drainage with an autoscleral flap. MATERIAL AND METHODS: We have studied the results of combination surgical treatment of cataract and glaucoma performed in 34 patients (34 eyes), notably phacoemulsification and non-penetrating deep sclerectomy with suprachoroidal drainage. RESULTS: In the early postoperative period, visual acuity ranged from 0.5 to 0.7 and was consistent with retinal changes. Particularly, in 7 cases (21%) visual acuity was 0.5, in 16 cases (47%) - 0.6, and in 11 cases (32%) - 0.7. The intraocular pressure (IOP) decreased to an average of 17.2±2.4 mmHg. At 6 months, the IOP remained within statistically normal limits (16.0±1.8 mmHg) in all cases. Visual acuity ranged from 0.5 to 0.7. In the late postoperative period (after 1 year), 32 patients were normotonic (their IOP averaged 16.0±2.3 mmHg) and 2 patients developed elevated IOP and, thus, were prescribed antihypertensive therapy (ß-blockers). CONCLUSION: Non-penetrating deep sclerectomy with suprachoroidal drainage ensures the IOP reduction's stability and does not require the use of donor material.

[Significance of anti-myelin basic protein antibodies for ocular hydrodynamic disturbances in primary open-angle glaucoma]. / Rol' antitel k osnovnomu belku mielina v narushenii gidrodinamiki pri pervichnoi otkrytougol'noi glaukome.

The aim of the study was to investigate the significance of anti-myelin basic protein (MBP) antibodies (AB) for ocular hydrodynamic disturbances in primary open-angle glaucoma (POAG). The study was conducted using the enzyme-linked immunosorbent assay (ELISA). The patients included had either high-tension (82 cases), or normal-tension (62 patients) glaucoma (HTG and NTG). In 46.3% of HTG patients and 38.7% of NTG patients, anti-MBP antibodies were lower than in the controls. There were also some cases (12.9%) of increased AB production at NTG onset. According to the canons of immunology, a decrease in anti-MBP antibodies can be explained by their binding to the protein and an increase - by stimulation of AB production through antigen release. In other words, antigen release must precede an increase in antibodies, which, in turn, must be followed by a subsequent decrease. In this aspect, an increase in anti-MBP antibody production at the stage of early hydrodynamic disturbances (NTG) and its decrease at the stage of pronounced changes (HTG) are perfectly natural. The level of anti-MBP antibodies correlated with the following indicators of ocular hydrodynamics: aqueous humor secretion (r=0.20841, p<0.05), intraocular pressure (r=-0.24046, р<0.05), ease of outflow (r=-0, 21552; р<0.05), and Becker's coefficient that reflects dissociation of control mechanisms in the regulation of hydrodynamics (r=-0.21683, p<0.05). The authors came to the conclusion that catalytic antibodies to MBP (also able to cause destruction of the myelin sheath of axons) play an important role in the pathogenesis of open-angle glaucoma. A decrease as well as an increase in anti-MBP antibodies has an unfavorable effect on ocular hydrodynamics. A theory has been put forward that these disorders may be induced by demyelination of peripheral nervous system axons involved in the regulation of intraocular fluid secretion and outflow.

[Markers of Fas-mediated apoptosis in primary open-angle glaucoma and opportunities of their pharmacological correction].

In order to assess the role of apoptosis in pathogenesis of primary open-angle glaucoma (POAG) apoptosis markers were studied in blood serum and tear fluid of patients with or suspected to have different stages glaucoma. To date the study of POAC pathogenesis goes along with search of possible ways of pharmacotherapy, neuroprotection is considered to be a promising option. Dynamics of sFas/Apo-1 and sFasL as the markers of Fas-mediated apoptosis was studied during treatment. We used nootropic citicoline as a neuroprotector. The markers were studied using enzyme immunoassay. The results show association of POAG onset and progression with interruption of Fas-mediated apoptosis, indicated by the level and proportion of sFas/Apo-1 and sFasL in tear fluid and in a less degree in blood serum. Characteristic features are detected in Fas/FasL system associated with glaucoma stage and correlating with some clinical and functional parameters (perimetry) that is important for understanding of POAG pathogenesis and for prognosis of disease course.

[Role of ocular ischaemic syndrome in establishing indications for revasculization of the carotid basin in stenotic lesions of extracranial portions of carotid arteries].

The article is dedicated to the problem concerning indications for revascularization of the carotid basin. The aim was to determine significance of ocular ischaemic syndrome in establishing indications for revascularization of the carotid basin in stenotic lesions of extracranial portions of carotid arteries.

[Morphological features of corneal exposure to experimental near infrared emission laser].

Effect of laser radiation with wave length 1,4 microm on exposed cornea of isolated bull eye (in vitro) is studied. Experimental laser coagulator with wave length 1,4 microm based on the semiconductor laser with a fiber radiation output was used in the study. Cornea was exposed at the standardized distance to radiation with different energy settings. Coagulates were morphologically studied, photoregistration and morphometric analysis of obtained images were performed. The depth of radiation absorbtion, type and degree of corneal damage were estimated in the focus and marginal area. The analysis of results shows potential of this laser coagulator to be used for selective effects at different corneal layers. This laser may be applied both for coagulation and therapueutic purposes.

[The effect of parenteral citicoline on visual functions and life quality of patients with primary open-angle glaucoma].

The effect of nootropic drug citicoline on visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality of patients with primary open-angle glaucoma (POAG) stage I-III and normalized intraocular pressure (IOP) was studied. 40 patients aged 46-78 years old with POAG stage I-III and normalized IOP were treated with citicoline. Among them there were 24 female and 16 male. The patients were divided into 2 equal groups--experimental and control. Patients of both groups were treated with intravenous citicoline for 10 days. The dose of citicoline in experimental group was 1000 mg/day, in control--500 mg/day. After treatment in both groups visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality showed improvement. Citicoline has significant neuroprotective effect preventing apoptosis.

[Surgical treatment of certain forms of secondary glaucoma]. / Khirurgicheskoe lechenie nekotorykh form vtorichnoi glaukomy.

The technique of penetrating deep sclerectomy with suprachoroidal explanto-drainage as well as the results of postoperative follow-up, exceeding 2 years, and of the early-described sinustrabeculectomy with regulated filtration are presented in the article. Operations were made on 59 eyes (58 patients aged 13 to 70) with the below forms of secondary glaucomas: new-vascular, postuveal, dystrophic (at retinal detachment), posttraumatic (contusion-type), phakotopic, postoperative (aphakic), and hemolytic. The below goals were set while elaborating the methods: the possibility to regulate postoperatively the intraocular pressure, elimination of the pain syndrome, the organ-preserving effect, stabilization of the clinical cause and shaping-up of reliable drainage paths. The authors registered a positive effect in 87.5% of cases.

[Remote results of high myopia surgical correction by tunnel keratoplasty ]. / Otdalennye rezul'taty khirurgicheskoi korrektsii blizorukosti vysokoi stepeni metodom tonnel'noi keratoplastiki.

Remote results evidence high refraction efficiency of tunnel keratoplasty, stable results being observed for up to 15 years. A total of 104 operations (58 patients) were analyzed for a period of observation of more than 10 years. The patients' ages varied from 17 to 52 years, there were 34 women and 24 men. The main advantage of interlamellar refraction meridional keratoplasty is easiness of operation. At present it is the operation of choice for dosed reduction of eye refraction aimed at correction of high myopia and astigmatism. The possibility of correcting residual myopia after keratotomy and repair of refraction abnormalities resultant from perforating keratoplasty is particularly interesting. The possibility of regulating the corrective effect in remote periods by replacing the implants also deserves attention. Hence, low traumatism, high efficiency, and stability of the refraction effect once more confirm our recommendation to use tunnel keratoplasty in clinical practice.

[Sinusotrabeculectomy with regulated filtration in the treatment of secondary glaucoma]. / Sinusotrabekuléktomiia s reguliruemoi fil'tratsiei pri lechenii vtorichnykh glaukom.

A new method for surgical treatment of secondary glaucoma (neovascular, postuveal, traumatic, and aphakic) is described. The aims of the new method are as follows: regulation of ophthalmic tone in the postoperative period, pain relief, organ preservation, stabilization of the process, and creation of reliable routes of intraocular fluid discharge with formation of a stable diffuse functional pad. Seven patients (8 eyes) aged 13-70 years were operated on and followed up for up to 6 months. Preliminary results are presented. Positive shifts were observed in all cases.

[The optimization of a surgical intervention to stabilize progressive myopia]. / Optimizatsiia khirurgicheskogo vmeshatel'stva s tsel'iu stabilizatsii progressiruiushchei blizorukosti.

Results of 236 sclera-fortifying surgeries are followed up for more than 25 years. Progressive myopia stabilized in 95.8% cases after bandaging scleroplasty and in 87.03% cases after chondroplasty. Clinical refraction and posteroanterior axis of the eye did not increase after surgery; visual functions stabilized, and brightness sensitivity threshold was lowered. The technique of operation and clinical course of the postoperative period are described. Based on analysis of the clinical material, the authors propose the optimal approach to scleroplastic operations aimed at stabilization of progressive myopia.

[Modern aspects of surgical treatment of myopia]. / Sovremennye aspekty khirurgicheskogo lecheniia miopii.

Problems in complex surgical treatment of myopia are discussed. Extensive clinical data and long follow-up of the patients permitted the authors to develop a well-based system of care which helps not only arrest the progress of myopia, but correct it within a rather wide range. The pathogenesis of tissue process in progressive myopia is discussed basing on the regularities revealed experimentally. The main modern operations on the cornea and sclera are described. Data on the inter-layer transplantation of the cornea, developed at the Chair of Ophthalmic Diseases of the Russian University of Peoples' Friendship are presented.

[A case of relapsing iridocyclitis in tropical malaria]. / Sluchai retsidiviruiushchego iridotsiklita pri tropicheskoi maliarii.

An African student developed bilateral relapsing iridocyclitis with increased intraocular pressure. General examinations and parasitological studies revealed tropical malaria. Etiotropic and local therapy normalized intraocular pressure and improved vision acuity of both eyes. This case should be borne in mind by general practitioners as a possibility of transportation of various tropical diseases.

[Interlamellar sectoral keratoplasty in the surgical correction of astigmatism]. / Mezhsloinaia sektoral'naia keratoplastika v khirurgicheskoi korrektsii astigmatizma.

A new original method of interlamellar sectorial keratoplasty is proposed for surgical correction of astigmatism. Eleven operations were carried out in 8 patients (11 eyes) with astigmatism of 4 to 7.0 diopters. Vision acuity without correction was 0.6 to 1.0 in 5 patients (7 eyes, 63.6%). In 2 patients (2 eyes, 18.2%) vision acuity without correction was 0.3 to 0.5 diopters, and in 2 more patients (2 eyes, 18.2%) it was from 0.1 to 0.3 diopters, that is, equal to the maximal vision acuity with the optimal correction. The refraction effect stabilized in 3-4 months. The highest refraction effect attained was 7.0 diopters. The patients were followed up for 3 months to 4 years. Clinical analysis of the operations confirmed the efficacy and reliability of the method and stability of refraction. Interlamellar sectorial keratoplasty is recommended for surgical correction of astigmatism.

[A case of toxocariasis of the eye]. / Sluchai toksokaroza glaza.

A case with toxocariasis of the eye is described. The diagnosis was confirmed serologically. Vision acuity improved to 100% as a result of treatment. The authors emphasize that toxocariasis should ruled out in all ocular involvements of obscure etiology.

[Interlamellar circular keratoplasty for correction of high myopia]. / Mezhsloinaia kol'tsevaia keratoplastika v korrektsii miopii vysokoi stepeni.

A new method is proposed for the correction of high myopia: Interlamellar circular keratoplasty. This method has been used in 15 patients (17 eyes) aged 18 to 54 with 9 to 17 diopters myopia. Vision acuity attained was at least 0.5 in 10 (60.3%) patients; in 7 (35.2%) patients vision acuity was 0.3 without correction, that is, was equal to the maximal vision acuity with the optimal correction. The highest refraction effect was 15.0 diopters. The patients were followed up for 3 months to 16 years. The proposed method for the correction of high myopia is highly effective, simple, and is recommended for clinical practice.