[Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation)]. / Glubokaya perednyaya posloinaya keratoplastika pri ekstruzii nepolnogo intrastromal'nogo kol'tsa (klinicheskoe nablyudenie).

Intrastromal corneal ring segments (ICRS) of in various shapes are used to correct structural changes in the cornea and improve visual acuity in keratoconus (KC). The most serious complications of the technology infection, vascular ingrowth, and extrusion. In this study a 44-year-old patient underwent deep anterior lamellar keratoplasty (DALK) 5 years after implantation of ICRS in the shape of an incomplete ring to treat its extrusion of up to 30%, vascular ingrowth into the cornea and corneal syndrome. The following DALK technique was used: excision of the free part of the corneal segment, removal of the remaining part of the corneal segment, excision of 80% of thickness of the corneal block with a 8.5-mm trepan, pneumatic dissection of the stroma down to the Descemet membrane (DM), removal of the remaining stroma on the viscoelastic pillow, laying and suture fixation of the donor graft. There were no complications during the postoperative period, the graft remained transparent for up to 10 months. Uncorrected visual acuity (UCVA) increased from 0.01 to 0.4, best corrected visual acuity (BCVA) increased from 0.3 to 0.7. The number of endothelial cells decreased from 2980 to 2670 cells/mm2 (10.4%). This clinical case demonstrates that DALK surgery can be a reliable method of patient rehabilitation in cases of extrusion of ICRS in the shape of an incomplete ring and vascular ingrowth.

[Long-term outcomes of bandage therapeutic-optical keratoplasty in the treatment of keratoconus]. / Otdalennye rezul'taty bandazhnoi lechebno-opticheskoi keratoplastiki pri lechenii progressiruyushchego keratokonusa.

Intrastromal keratoplasty has recently been widely used in the surgical treatment of keratoconus (KC). In 2013, a new type of interlamellar keratoplasty operation was developed - bandage therapeutic-optical keratoplasty (BTOK). PURPOSE: Evaluation of the long-term outcomes of surgical treatment of stages II and III progressive KC with BTOK technique. MATERIAL AND METHODS: The study included 107 patients (126 eyes): group 1 with stage II KC - 78 eyes, 100% of these patients were observed for 1 year, 52 eyes (66%) for 3 years, and 18 eyes (23%) for 5 years; group 2 - 48 eyes with stage III KC, with 100% of them observed for 1 year, 39 eyes (81%) for 3 years, and 12 eyes (25%) - 5 years. All patients received a customized allograft in the form of an intrastromal corneal ring segment (ICRS). RESULTS: During the first year after BTOK surgery, the uncorrected and corrected visual acuity (UCVA and CVA) in the first group increased by 0.5±0.04 (p<0.05) and 0.2±0.02 (p<0.05), respectively, in the second group - by 0.46±0.05 (p<0.05) and 0.47±0.05 (p<0.05) due to a decrease in refractive indices in the central 3.0 mm zone. In the first group, mean refraction in the central 3.0 mm zone (Km) was within 45±3.75 (p<0.05), in the second - 48.63±.2 diopters (p<0.05), while maximum refraction in the central 3.0 mm zone (Kmax) decreased from 50.02±2.20 (p<0.05) to 44.61±1.03 diopters (p<0.05) in the first group, from 58.21±3.43 (p<0.05) to 50.45±3.46 diopters (p<0.05) in the second group. The values of UCVA, CVA and refractive indices of the central corneal zone in the first and second groups did not change statistically significantly after three and five years. Minimum corneal thickness in the first group increased from 476.23±13.35 to 485.08±15.80 µm (p<0.05), in the second - from 412.73±38.63 to 422.00±42.25 µm (p<0.05). CONCLUSION: BTOK surgery can be used in patients with stages II and III KC to improve the visual functions, strengthen the ectatic cornea and stop the progression of the disease.

[On the tactics for surgical treatment of keratoconus in significantly altered corneal thickness]. / K voprosu o taktike khirurgicheskogo lecheniya keratokonusa pri sushchestvennykh izmeneniyakh tolshchiny rogovitsy.

PURPOSE: To evaluate the clinical and functional outcomes of bandage therapeutic-optical keratoplasty (BTOK) surgery in patients with keratoconus (KC) and significant changes in corneal thickness. MATERIAL AND METHODS: Surgical treatment was performed in 15 patients (15 eyes) with stage IV KC aged from 22 to 51 years (mean age - 32.61±7.94 years). The follow-up period lasted 3 years. All patients underwent BTOK surgery using an interlamellar graft with a thickness of 320 to 350 µm. RESULTS: Uncorrected and best corrected visual acuity increased in all patients after BTOK surgery and did not change statistically significantly during the entire follow-up period (3 years), amounting to 0.47±0.12 and 0.53±0.13, respectively. Keratometric parameters also remained stable by that observation time point and amounted to: Kmax - 53.01±2.30 D; Kmin - 41.63±2.24 D; Km - 47.32±1.91 D. CONCLUSION: The BTOK surgery helps achieve long-term (3 years) visual, optical and strengthening outcomes in stage IV KC patients when the use of other known techniques (corneal collagen crosslinking, corneal segments) is technically impossible because of the risk of complications due to significantly thinned cornea (less than 400 µm).

[Comparative assessment of the quality of life of keratoconus patients before and after intrastromal keratoplasty]. / Sravnitel'naya otsenka kachestva zhizni do i posle intrastromal'noi keratoplastiki pri keratokonuse.

Surgical treatment of keratectasia, in addition to its cessation, is aimed at increasing the acuity and quality of vision. This can also significantly affect patient's quality of life. The criteria for assessing the quality of life does not always consider the balance between quantitative indicators and subjective perception, which can depend on the psychological aspect of self-esteem.Purpose - to perform comparative assessment of the quality of life of patients with keratoconus (KK) before and after intrastromal keratoplasty by a newly developed method using an original questionnaire. MATERIAL AND METHODS: The study included 20 patients (14 men and 6 women, with mean age of 33 years, from 21 to 45 years old; 20 eyes) diagnosed with degree II-IV KK, with non-corrected visual acuity of 0.3 or lower. The original questionnaire with three blocks of questions about subjective assessment of the severity of discomfort associated with the disease, expectations of treatment results and its effectiveness was used to study the quality of life of KK patients who underwent surgery. The evaluation method used a five-point grading scale. RESULTS: Despite the inability to objectively assess the result of treatment, patients can generally note the trend for improvement. Especially significant are the increase of visual acuity, improvement of general health, feeling of comfort and more optimistic view of one's future. Comparison of the expectations and treatment results has shown that some therapeutic effects are overestimated by the patients, while some others are underestimated. A priori, they overvalue the effects of treatment (actions associated with visual tasks - reading, writing), but at the same time undervalue the characteristics of overall personal and emotional state (except for spatial safety and comfort), i.e. the characteristics that determine the quality of life. CONCLUSION: The aims of writing a valid and reliable questionnaire have been achieved partially, and its further development requires comparison of the obtained results with psychodiagnostic data, which would reveal the nature of psychological factors that form the quality of life perception in patients with various vision disorders.

[Results of confocal microscopy of the cornea after bandage therapeutic-optical keratoplasty in keratoconus]. / Rezul'taty konfokal'noi mikroskopii rogovitsy posle bandazhnoi lechebno-opticheskoi keratoplastiki pri keratokonuse.

Bandage therapeutic-optical keratoplasty (BTOK) is one of the modern methods of surgical treatment of keratoconus (KC) that allows to improve visual functions by changing keratotopographic and pachymetric parameters of the cornea in the zone of ectasia. Long-term results show that changes also affect the central part of the cornea, which tends to flatten. PURPOSE: To compare the light confocal microscopy appearance of the cornea before and after BTOK surgery. MATERIAL AND METHODS: We examined 15 patients (15 eyes) with progressive keratoconus (7 eyes with Amsler stage I KC and 8 eyes with Amsler stage III KC), who subsequently underwent BTOCK surgery. Using the Confoscan-4 confocal light microscope (Nidek, Japan), we studied the structure of central and paracentral cornea. The exact zone of interest was determined individually depending on the location of the graft. RESULTS: In all cases, morphological changes in the cornea characteristic of the stage II and III KC were detected. Twelve months after the operation, there was an increase in the transparency of intercellular substance of the stroma with a clearer visualization of keratocyte nuclei in the optical zone as well as at the site of the graft. In the area of interface, tissue compaction in the form of diffuse fibrosis with local scar formation could be seen. Neither significant changes in the cell structure, nor a decrease in cell density were found in the central part of ectasia and the areas of clear visualization of the endothelium under the graft. Additional postoperative assessment of the level of corneal light scattering indicated a tendency towards restoration of stromal transparency and optical uniformity. CONCLUSION: As a result of interlayer graft implantation in the zone of corneal ectasia, a tendency to structural improvement in its central and paracentral parts was revealed. Local fibrosis in the interface area can indirectly indicate biomechanical «strengthening¼ of this zone.

[Bandage lamellar-optical keratoplasty for post-excimer laser keratectasia]. / Bandazhnaia lechebno-opticheskaia keratoplastika v lechenii iatrogennoi keratéktazii.

INTRODUCTION: According to various sources, occurrence rate of keratectasia (KE) after Laser in situ Keratomileusis (LASIK) ranges from 0.04 to 0.2%. No known technique for keratorefractive surgery eliminates the probability. Neither corneal cross-linking, nor implantation of polymeric segments can completely prevent its development. PURPOSE: To treat KE after LASIK with bandage lamellar-optical keratoplasty (BLOK) surgery and to evaluate the results. MATERIAL AND METHODS: The study included 22 patients with KE after LASIK divided into two groups. The first group consisted of 6 patients; they underwent BLOK surgery using a segment transplant 1.5 mm in width and 180-220 µm in thickness. The second group included 16 patients who underwent BLOK surgery using 2.75 mm wide, 290-350 µm thick allogeneic transplant of individual length. The follow-up lasted 4 years. RESULTS: In the first group, uncorrected visual acuity (UCVA) improved by 0.4±007, in the second group - by 0.46±0.15. After two years, two patients had their transplant exchanged for a wider one due to ectasia progression. Corneal refraction was stable at 45.36±1.47 Diopters in all other patients of the first group. In the second group, it was consistently between 40.6 and 45.7 Diopters. The main complication of the BLOK surgery was displacement of the edge of the corneal flap formed during LASIK - occurred in 4 patients. CONCLUSION: Bandage lamellar-optical keratoplasty proved effective in treating patients with KE after LASIK, leading to improvement of visual acuity, strengthening of the cornea and normalization of its surface; it slows further progression of ectasia.

[Modern methods of surgical treatment of keratectasias]. / Sovremennye khirurgicheskie metody lecheniia keratéktazii.

Keratectasia (KE) ranks as one of the main causes of impaired vision. The pathology is characterized by progressive thinning of the cornea, which causes its deformation, the appearance of irregular astigmatism, and the reduction of vision acuity. The article reviews modern surgical methods that can be used to prevent the progression and treat various types of KE.

[Bandage keratoplasty therapeutic-optical in treatment of progressing pellucid marginal corneal degeneration (a preliminary report)]. / Bandazhnaia lechebno-opticheskaia keratoplastika pri progressiruiushchei pelliutsidnoi marginal'noi degeneratsii rogovitsy (predvaritel'noe soobshchenie).

PURPOSE: To provide preliminary estimation of the effectiveness of bandage therapeutic-optical keratoplasty (BTOK; previously called inralamellar bandage keratoplasty) in patients with pellucid marginal corneal degeneration (PMD). MATERIAL AND METHODS: The study included 7 patients (8 eyes) with PMD aged 35 to 55 years operated with intralamellar bandage keratoplasty, the follow-up period comprised 3, 6, and 12 months after the surgery. RESULTS: All patients with PMD operated with intralamellar bandage keratoplasty showed increase in visual acuity to an average of 0.55±0.35 a year after the surgery; by that time, the maximum refractive power of the cornea decreased to an average of -44.5±3.0 D. The area of stromal thinning was thickened by donor corneal flap. No signs of rejection were detected over the entire observation period. CONCLUSION: Intralamellar bandage keratoplasty may be the method of choice to stop further progression of PMD with improvement of optical properties of the cornea.

[Objective assessment of donor material for penetrating corneal transplantation]. / Ob''ektivizatsiia otsenki donorskogo materiala dlia skvoznoi peresadki rogovitsy.

Reliable suitability evaluation of donor material is the crucial issue of penetrating corneal transplantation. The main parameter to be considered is endothelial cell density (ECD). However, when it comes to practice, one has to admit significant variation in ECD readings of cadaver corneas obtained by different methods. AIM: to investigate discrepancies in ECD measurements and to define objective criteria for the evaluation of a donor cornea before full-thickness grafting. MATERIAL AND METHODS: In a hundred cadaver eyes, discrepancies in ECD measurements by different methods (specular microscopy, confocal microscopy, and keratoanalyzer) were studied and objective evaluation criteria developed along with an optimal algorithm of pretransplantation assessment. Digital fluorescence microscopy was chosen as the reference method. RESULTS: It has been established that a triple measurement average obtained with any of the tested methods is informative enough as to the state of the donor cornea. CONCLUSION: The highest ECD values were obtained with specular microscopy, the lowest - with confocal microscopy. For reliable evaluation of donor corneas, we recommend that the average of a triple ECD measurement be taken using one of the mentioned methods.