[Bony orbital decompression in thyroid eye disease]. / Kostnaya dekompressiya orbity pri endokrinnoi oftal'mopatii.

This article summarizes the results of research on the morphological and functional features of different types of orbital bone decompression in thyroid eye disease (TED) and presents an analysis of surgical anatomy of the lateral orbital wall in the context of performing deep lateral bone decompression of the orbit was carried out. The study includes an analysis of the results of orbital bone decompression with resection of the greater wing of the sphenoid bone using ultrasound osteodestructor in comparison with osteodestruction using a high-speed drill, description of transethmoidal orbital decompression with endonasal access both as a single method of surgical treatment of TED and in combination with lateral bone decompression of the orbit, including the advantages and disadvantages of the method, and presents a morphological description of the pathological changes in the medial orbital wall bone fragments obtained during endonasal transethmoidal orbital decompression in patients with TED.

[Potential of azoximere bromide for treatment of patients with acute inflammatory and infectious upper respiratory diseases].

AIM: To evaluate the efficacy and safety of Polyoxidonium® in patients with inflammatory and infectious upper respiratory diseases in real clinical practice. MATERIALS AND METHODS: This retrospective multicenter study included data from adults and children over 6 months old with inflammatory and infectious upper respiratory diseases (n=16 365). The exploratory endpoints included: the proportion of patients with complete relief of symptoms, demographic characteristics of patients, the frequency of prescriptions of Polyoxidonium® by disease groups, determination of the groups of concomitant drugs, most commonly prescribed treatment regimen, frequency of prescribing different Polyoxidonium® dosage forms, duration of the most common specific symptoms of acute respiratory infections during therapy, the incidence of treatment-related adverse events. RESULTS: After treatment completion, the proportion of patients with complete relief of symptoms was 40%, with positive dynamics - 99.77%. Polyoxidonium® in combination therapy was also effective in the treatment of COVID-19 and Post-COVID-19 syndrome. The median patient age was 28 years. Polyoxidonium® was most frequently prescribed for the treatment of inflammatory and infectious upper respiratory diseases in combination with antibiotics or symptomatic drugs in dosage form solution. The primary routes of administration were intranasal and sublingual. The resolution of infection symptoms occurred predominantly within the first 5 days after the initiation of therapy. The therapy appeared to be equally effective across all age groups. No Polyoxidonium®-related adverse events occurred. CONCLUSION: Treatment with Polyoxidonium® contributes to achieving favorable outcomes in patients with inflammatory and infectious upper respiratory diseases. The study drug has a high safety profile.

[Complications of transnasal endoscopic orbital decompression in thyroid eye disease]. / Oslozhneniya transnazal'noi endoskopicheskoi dekompressii orbity pri endokrinnoi oftal'mopatii.

PURPOSE: The study evaluates the frequency of complications after transnasal endoscopic orbital decompression (TEOD). MATERIAL AND METHODS: The study included 40 patients (75 orbits) with thyroid eye disease (TED; also termed Graves' ophthalmopathy, GO; thyroid-associated orbitopathy, TAO), who were divided into three groups depending on the method of surgical treatment. The first group consisted of 12 patients (21 orbits) who were treated with TEOD as the only method of surgical treatment. In the second group, there were 9 patients (18 orbits) who underwent TEOD and lateral orbital decompression (LOD) simultaneously. The third group consisted of 19 patients (36 orbits) who underwent TEOD as the second stage after LOD. Pre- and postoperative observation included assessment of visual acuity, visual field, exophthalmos, heterotropia/heterophoria angle. RESULTS: In group I the new-onset strabismus with binocular double vision was detected in 1 patient (8.3%). In 5 patients (41.7%), there was an increase in the angle of deviation and an increase in diplopia. In group II the new-onset strabismus with diplopia occurred in 2 patients (22.2%). In 8 patients (88.9%), an increase in the angle of deviation and an increase in diplopia were revealed. In group III the new-onset strabismus and diplopia occurred in 4 patients (21.0%). An increase in the deviation angle and an increase in diplopia were noted in 8 patients (42.1%). The number of postoperative otorhinolaryngologic complications in group I was 4 (19.0% of the number of orbits). Two intraoperative complications were recorded in group II - 1 case of cerebrospinal rhinorrhea (5.5% of the number of orbits) and 1 case of retrobulbar hematoma without permanent vision loss (5.5% of the number of orbits). The number of postoperative complications was 3 (16.7% of the number of orbits). In group III the number of postoperative complications was 3 (8.3% of the number of orbits). CONCLUSION: The study showed that the most common ophthalmological complication after TEOD is strabismus with binocular double vision. Otorhinolaryngologic complications included synechiae of the nasal cavity, sinusitis and mucocele of the paranasal sinuses.

[Transnasal endoscopic orbital decompression in the algorithm of surgical treatment of endocrine ophthalmopathy]. / Transnazal'naya endoskopicheskaya dekompressiya orbity v algoritme khirurgicheskogo lecheniya endokrinnoi oftal'mopatii.

OBJECTIVE: To develop an algorithm for the use of transnasal endoscopic orbital decompression (TEOD) in endocrine ophthalmopathy (EOP). MATERIAL AND METHODS: The results of 225 TEODs are analyzed. 139 patients with EOP were under observation, who were divided into two groups. Group 1 included 64 patients with an inactive form of EOP, group 2 included 75 patients with EOP complicated by optical neuropathy. Group 2 patients are divided into three subgroups. In the first subgroup there were 36 patients who underwent only TEDO, in the second subgroup there were 17 patients who underwent simultaneous TEOD and lateral bone orbital decompression (LBOD), in the third subgroup there were 22 patients who underwent TEOD and with an interval of 7-14 days - LBOD. After surgery, visual acuity, visual fields and color perception, regression of exophthalmos, as well as the presence of strabismus and diplopia were evaluated. RESULTS: In patients of group 1 (64 patients, 104 TEODs), the average regression rate of exophthalmos was 5.49±1.22. Diplopia was observed in 23 (36%) patients, strabismus - in 18 (28%) patients. The transient nature of diplopia and strabismus was noted in 11% of cases. Patients of the first subgroup showed an increase in visual acuity from 0.4±0.28 to 0.7±0.2 (p<0.05). Strabismus and diplopia were observed in 54% of cases. In the subgroup with step-by-step performed TEOD and LBOD, the increase in visual acuity was more pronounced and amounted to 74% (from 0.78±0.71 to 0.2±0.3 according to LogMAR, p<0.05), postoperative strabismus and diplopia remained at a high level - 40% of the number of surgical operations performed. The best results of improving visual functions were obtained in patients of the second subgroup with simultaneous TEOD and LBOD (balanced orbital decompression): the increase in visual acuity was 79% (from 0.57±0.47 to 0.12±0.2 according to LogMAR, p<0.05). In patients of this subgroup, strabismus develops less frequently (22% of the number of operated orbits). CONCLUSION: Transnasal endoscopic decompression of the orbit in the inactive form of the disease is indicated for exophthalmos of more than 4-8 mm. In optical neuropathy, transnasal endoscopic orbital decompression is indicated regardless of the initial visual acuity of the patient and should be supplemented with lateral bone orbital decompression with visual acuity below 0.1. The obtained results allowed us to form an algorithm for surgical treatment of patients with endocrine ophthalmopathy and optical neuropathy using transnasal endoscopic orbital decompression as a surgical intervention.

Stem cell therapy for vocal fold regeneration after scarring: a review of experimental approaches.

This review aims at becoming a guide which will help to plan the experimental design and to choose adequate methods to assess the outcomes when testing cell-based products in the treatment of the damaged vocal folds. The requirements to preclinical trials of cell-based products remain rather hazy and dictated by the country regulations. Most parameters like the way the cells are administered, selection of the cell source, selection of a carrier, and design of in vivo studies are decided upon by each research team and may differ essentially between studies. The review covers the methodological aspects of preclinical studies such as experimental models, characterization of cell products, assessment of the study outcome using molecular, morphological and immunohistochemical analyses, as well as measuring the tissue physical properties. The unified recommendations to perform preclinical trials could significantly facilitate the translation of cell-based products into the clinical practice.

[Dysthyroid optic neuropathy: surgical treatment potential]. / Opticheskaya neiropatiya pri endokrinnoi oftal'mopatii: vozmozhnosti khirurgicheskogo lecheniya.

PURPOSE: To evaluate the effectiveness of bony orbital decompression in patients with dysthyroid optic neuropathy (DON). MATERIAL AND METHODS: The study analyzed 255 patients with thyroid eye disease (TED) and bony orbital decompression. Those among them who had DON as an indication for surgery were investigated further. Patients underwent standard ophthalmological examination, computer perimetry, color vision assessment using Ishihara tables, relative afferent pupillary defect (RAPD), computed tomography (CT) of the orbit, and in some cases optical coherence tomography (OCT) of the optic nerve. RESULTS: Final analysis included 31 patients (52 eyes). On 13 orbits, only lateral wall decompression was performed, and medial wall decompression was the only intervention in 7 orbits. In other cases, these techniques were performed either simultaneously - in 14 orbits, or alternately - in 18 orbits. In the postoperative period, all patients showed significant positive dynamics in terms of visual acuity, visual field, and proptosis. In all cases, decrease of the amount of orbital inflammation was observed. Exophthalmos significantly decreased after surgery and averaged 20.5±3.1 mm, which is 4.7 mm less than the initial one. All changes were statistically significant (p<0.01). CONCLUSION: Bony orbital decompression is an effective and safe treatment option for DON resistant to high doses of glucocorticoids. In the vast majority of cases, this intervention is the only way to improve and stabilize visual function in this severe category of patients.

[Efficacy of transethmoidal orbital decompression in patients with dysthyroid optic neuropathy]. / Effektivnost' transetmoidal'noi dekompressii orbity u patsientov s opticheskoi neiropatiei pri endokrinnoi oftal'mopatii.

OBJECTIVES: To estimate efficacy and safety of endoscopic orbital decompression in patients with dysthyroid optic neuropathy (DON). MATERIAL AND METHODS: 19 patients aged 54.8±7.1 y.o. with DON were enrolled into the study. RESULTS: Visual acuity was from counting fingers till 0.9 (0.4±0.28) before surgery, it increased till 0.7±0.2 (p<0.05) after surgery. The amount of correct Ishihara plates increased from 5.8±7 till 13.3±7.6 (p<0.05). Exophthalmos reduced by 1.7 mm (p<0.05). Significant reduce of orbital inflammation was noted as well. CONCLUSIONS: This study is the first study of this kind in Russian Federation. Obtained results showed high efficacy and safety of endoscopic orbital decompression in patients with DON.

[Extended trans-ethmoidal decompression of the orbit for the treatment of frontal sinus mucopyocele]. / Kombinirovannyi khirurgicheskii dostup pri posttravmaticheskom mukotsele lobnoi pazukhi. Klinicheskoe nabliudenie.

Mucocele of the paranasal sinuses is a rare disease not infrequently associated with massive bone destruction, orbital and intracranial complications. The authors report a patient presenting with the giant post-traumatic frontal mucopyocele associated with the erosion of the posterior and inferior sinus walls that was clinically manifested as hypo- and exophthalmos and has caused the inferolateral eye deviation and orbital decompression. The patient displayed the ophtalmological symptoms 8 years after the frontal sinus fracture. The mucopyocele was treated effectively with the combination of the endoscopic trans-ethmoidal and open trans-frontal approaches. The noticeable intraoperative finding in this patient was the absence of complaints as well as the combination of dura mater defects in the form of its erosion and the leakage of the cerebrospinal fluid together with the presence of purulent discharge in the sinus in the absence of intracranial complications.

[The complications of transethmoidal decompressive orbitotomy associated with endocrine ophthalmopathy]. / Oslozhneniia transétmoidal'noi dekompressionnoi orbitotomii pri éndokrinnoi oftal'mopatii.

The objective of the present study was the analysis of the results of transethmoidal decompressive orbitotomy (TEDO) with the resection of the bone matrix of the medial and inferior orbital walls in the patients presenting with endocrine ophthalmopathy (EOP) with the purpose of reduction of the risk of development of this pathological conditions. A total of 51 patient with EOP at the stage of complete remission or pharmacotherapeutic compensation underwent transethmoidal decompressive medial orbitotomy in the ENT Clinic of 1 I.M. Sechenov First Moscow State Medical University during the period from 2006 to 2016. Twenty two of these patients presented with the unilateral process and 29 ones with bilateral exophthalmos. The surgical intervention was performed on the total of 80 eye orbits. The main complaints of the treated patients during the post-operative period included difficulties in nasal breathing (33%), dryness of the nose and crust formation (43%), discharge from the nose and along the posterior pharyngeal wall (15%), nasal bleeding (2%), pain in the forehead and maxillary region (8%), headache (2%). As far as the state of eyes and sight is concerned, 14 (27%) patients reported double vision at the primary gaze position while 6 others (12%) complained of the appearance of diplopia upon a change in the gaze position during the post-operative period. The post-operative endoscopic study revealed synechiae of different localization in the nasal cavity (47%), discharge from the maxillary sinuses (16%) and from the frontal sinus (2%). Eight (16%) patients were found to suffer from maxillary sinusitis, one had acute frontitis, and one sphenoidal sinus mucocelle. These complications were eliminated by pharmacotherapy and additional surgical interventions (2%). Analysis of the results of the study has demonstrated that the above complications were associated with the inadequate post-operative care for the nasal cavity, the excessively large size of the bone window formed during transethmoidal decompressive orbitotomy, resection of the inferior orbital wall, intrusion of the medial rectus muscle of the eye into the wide bone window. We evaluated the possible influence of the orbital soft tissues on the physiological parameters of the functioning of the paranasal sinuses in the post-operative period including blockade of the paranasal drainage pathways by the prolapsed orbital tissues. A few possible approaches to the reduction of the risk of post-operative complications are proposed. The authors emphasize the importance of the further improvement of the surgical treatment of endocrine ophthalmopathy.

[Transethmoidal decompressive orbitotomy in the patients presenting with endocrine ophthalmopathy at the stage of remission: peculiarities of the surgical intervention and the results of exophthalmos correction]. / Transétmoidal'naia dekompressionnaia orbitotomiia pri éndokrinnoi oftal'mopatii v stadii remissii: osobennosti khirurgicheskogo vmeshatel'stva i rezul'taty korrektsii ékzoftal'ma.

The objective of the present study was to analyze the original results of the transethmoidal decompressive surgical interventions on the eye orbits of the patients presenting with endocrine ophthalmopathy (EOP) including the evaluation of regress of exophthalmos during the post-operative period. The study included 51 patients with endocrine ophthalmopathy at the stage of remission or pharmacotherapeutic compensation of the underlying process. A total of 80 eye-socket were treated in 29 patients with unilateral exophthalmos and 22 ones having bilateral exophthalmos. All the patients underwent transethmoidal decompression of the orbit (TEDO) with the use of the endonasal approach. The examination before and after surgery included the standard ophthalmological evaluation (such as the external inspection, visiometry, tonometry, computed perimetry, biomicroscopy, and ophthalmoscopy) as well as additional studies including exophthalmometry and orbitometry. The activity of endocrine ophthalmopathy was estimated with use of the clinical activity score scale. The main indication for surgery was cosmetically unacceptable exophthalmos. The results of the analysis of the surgical techniques employed in the present study, anatomical features revealed intra-operatively, methods of post-operative care for the patients, and final outcomes of the treatment taken together have demonstrated the high effectiveness of transethmoidal decompressive surgery. Not a single case of visual acuity deterioration was documented during the follow-up period. Persistent convergent strabismus and post-operative diplopia developed in 18% of the patients. Regress of exophthalmos following transethmoidal decompressive orbitotomy varied from 3.5 to 6.5 mm and averaged 5.1 mm in comparison with the mean initial value of 23.9 mm. In means that transethmoidal decompressive orbitotomy ensured the overall regress of exophthalmos by 18.8 mm (p<0.05). The multispiral CT study revealed the significant reduction of the volume of the eye muscles and the intraorbital adipose tissue. It is worthwhile to emphasize the necessity of the detailed preoperative examination of the patients. Our study included the patients presenting with endocrine ophthalmopathy at the stage of remission or pharmacotherapeutic compensation which gave hope of the favourable outcome of the treatment in terms of the degree of regress of exophthalmos and the improvement of the quality of life. The decision to perform transethmoidal decompressive orbitotomy should be taken based on the results of the multidisciplinary conference including an otorhinolaryngologist, ophthalmologist, and endocrinologist. It is concluded that the results of the present study give evidence of the social significance of transethmoidal decompressive orbitotomy taking into consideration that the patients given such treatment experience dramatic improvement of the quality of life.

[Surgical rehabilitation of patients with thyroid eye disease: systematic approach]. / , Khirurgicheskaya reabilitatsiya patsientov s endokrinnoi oftal'mopatiei: sistematizirovannyi podkhod.

AIM: to analyze the results of surgical treatment of patients with thyroid eye disease (TED), including the type of surgery, indications, and outcomes. MATERIAL AND METHODS: Hundred thirty-nine patients with TED (112 females, 27 males) aged 45.8±13.6 years. RESULTS: Bony orbital decompression was performed in 91 patients (128 orbits). After the surgery, visual acuity increased from 0.84±0.47 up to 0.94±0.32 (р<0.05), exophthalmos got reduced by the average of 3.4 mm. Strabismus surgery was performed in 15 patients. The absence of diplopia in the primary position of gaze was achieved in 12 cases and the degree of residual heterophoria averaged 3.33 PD (2-6 PD). Ocular motility improved from 10.7° up to 34.58°. Eyelid surgery was performed in 81 patients. CONCLUSIONS: 1. Surgical treatment for thyroid eye disease is indicated in patients with visual impairment and/or significant decrease in the quality of life, if pathogenetic treatment fails. 2. The choice of surgical strategy depends on several factors, such as TED activity and severity, thyroid function, pathologic changes in the orbital tissues, and surgeon's experience and preference. 3. Current surgical techniques for thyroid eye disease enable correction of disease consequences, such as exophthalmos, optic neuropathy, impairment of ocular movement, and exposure keratopathy. 4. Adherence to the systematic approach that includes bony orbital decompression, strabismus surgery, and correction of lagophthalmos and eyelid retraction, ensures high-level functional and cosmetic rehabilitation in patients with TED.

[Potentials of intraoperative navigation during balanced orbital bony decompression in thyroid eye disease (preliminary results)]. / Vozmozhnosti intraoperatsionnoi navigatsii v sbalansirovannoi kostnoi dekompressii orbity pri endokrinnoi oftal'mopatii (predvaritel'noe soobshchenie).

UNLABELLED: Precise instrument localization is of great importance in orbital decompression surgery. Different navigation systems were designed to fulfill this task and gained wide acceptance. AIM: to describe principal features and determine advantages of intraoperatively navigated orbital bony decompression. MATERIAL AND METHODS: Data on orbital decompression surgery performed with or without intraoperative image guidance is presented. Each time two surgeons were involved - an ophthalmologist (lateral wall decompression) and otolaryngologist (medial wall decompression). RESULTS: In lateral wall decompression, electromagnetic navigation was mostly used to enlarge the created bone window upward and backward, which is particularly challenging in case of bone thinning in the posterior part of its inner rim. In transethmoidal decompression, the image guidance allowed a more extensive removing of the greater sphenoid wing as well as the posterior medial wall where it joins the lateral wall of the sphenoid sinus. As shown by MSCT, lateral rectus muscle dislocation into the created bone window was more significant in navigated procedures. CONCLUSION: This preliminary data convincingly shows advantages and potentials of the use of electromagnetic navigation in orbital decompression surgery, especially, for optic neuropathy in thyroid eye disease patients.

[The overview of the surgical methods for the treatment of endocrine ophthalmopathy].

To analyse the efficacy of various surgical methods for the treatment of endocrine ophthalmopathy and to estimate the potential of endonasal endoscopic surgery for the management of this pathology. The available literature publications concerning surgical treatment of endocrine ophthalmopathy were reviewed; their data were compared with the results of endoscopic endonasal surgery performed by the authors. Various surgical techniques including those with the use of external and endonasal transethmoidal approachers are discussed with special emphasis on the resection of the medial and inferior orbital walls. The analysis of surgical techniques, peculiarities of postoperative treatment, and its outcomes is presented. This study has demonstrated the advantages of endonasal endoscopic transethmoidal decompression of the orbit over the external surgical approach used to manage endocrine ophthalmopathy.

[The influence of the surgical and medicamental treatment on the olfactory function in the patients presenting with polypous rhinosinusitis].

The objective of the present investigation was to study dynamics of the olfactory function in the patients presenting with polypous rhinosinusitis receiving medicamental therapy and in different periods after the surgical intervention. A total of 40 patients were available for the examination in the "Sniffin Sticks" test. The patients of group 1 (n=20) were treated with intramuscular injections of dexamethasone (8 mg twice daily) with gradual tapering the dose during 10 days. The patients comprising group 2 underwent bilateral endoscopic polysinusotomy. Both treatment modalities were followed by momethasone fuorate therapy 6 months in duration. Examination of the patients on the first control visit (i.e. within 1 month after the onset of the treatment) revealed the significant improvement of all measured olfactory parameters that were not significantly different between the two groups. On the second control visit (within 4 months after the onset of the treatment), the patients of group 1 showed a significantly impaired ability to identify smells although other olfactory parameters remained virtually unaltered as compared with those on the first visit. At the same time, no significant impairment of the olfactory function was apparent in the patients of group 2. It is concluded that the patients having non-obstructive polyps in the nasal cavity should be advised in the first place to undergo a course of glucocorticosteroid therapy rather than surgical treatment because the results of conservative therapy and endoscopic polysinusotomy do not differ significantly, at least within the first 4 months after the beginning of the treatment.

[The olfactory function in the patients with the curved nasal septum before and after surgical treatment].

The authors compared the frequency of subjective complains of hyposmia and results of objective study (olfactometry) in the patients with the curved nasal septum. In addition, the influence of septoplastic surgery on the olfactory function in such patients was estimated. The study included 40 patients aged from 18 to 59 years who examined by olfactometry with the use of the Sniffing sticks test. Subjective evaluation of the olfactory function was performed based on the 10-point visual analog scale. All the patients underwent septoplasty; olfactometry was repeated within 1 and 4 months after surgery. Sixty percent of the patients interviewed prior to the surgical treatment complained of compromised sense of smell. Olfactometry revealed this condition in 75% of the patients of whom 52.5% presented with hyposmia of the mixed type. Significant improvement of all parameters of the olfactory function was documented within 1 month after the surgical treatment. The results of estimation of certain parameters (differentiation, identification, overall olfactory index) suggest further recovery of the olfactory function during the next 4 months. It is concluded that normalization of the nasal breathing improves the function of the olfactory analyzer even though the complete recovery of the olfactory function is hardly possible in the patients presenting with the curved nasal septum prior to surgical treatment.