[Changes in accommodation in children with hyperopic anisometropia and unilateral amblyopia after laser refractive surgery and pleoptic treatment]. / Izmenenie akkomodatsii u detei s gipermetropicheskoi anizometropiei i odnostoronnei ambliopiei posle refraktsionno-lazernoi operatsii i pleopticheskogo lecheniya.

PURPOSE: This study comparatively analyzes the state of accommodation in children with hyperopic anisometropia and amblyopia after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) combined with pleoptic treatment, and after conventional pleoptic treatment. MATERIAL AND METHODS: The first group consisted of 30 children with medium and high hyperopia, high and medium amblyopia, and anisometropia greater than 3.0 diopters, who underwent Femto-LASIK in the amblyopic eye. The second group consisted of 28 children with similar local status, who were prescribed traditional correction and received conservative treatment. The follow-up period was 1.5 years. RESULTS: After 1.5 years, higher visual acuity (p<0.05) was achieved in the first group. A significant increase in the coefficient of accommodative response (CAR) was observed in the operated amblyopic eyes in group 1 - by 0.1±0.02 c.u. compared to the control group (p<0.05). In both groups there was an upwards trend for the coefficient of microfluctuations (CMF) in the amblyopic eye, but in the first group CMF increased more significantly (p<0.05). The objective accommodative response (OAR) and positive relative accommodation (PRA) of the amblyopic eye showed a double increase - by 1.0±0.23 and 0.9±0.38 diopters, respectively, at the end of treatment in the first group. The increase in similar indicators in the second group was insignificant (p<0.05). In children of the first group the difference in ciliary muscle thickness (CMT) of the amblyopic eye with disabled and enabled accommodation increased by 0.04±0.01 mm (p<0.05) in the anterior part of the ciliary muscle at the levels of CMTmax and CMT1. CONCLUSION: The data obtained in this study indicate the strong effect of refractive laser surgery in combination with pleoptic treatment on improving the visual acuity and the state of accommodation of the amblyopic and paired dominant eyes in children with hyperopic anisometropia, in contrast to conventional methods of treatment.

[Long-term clinical and functional outcomes of high myopia correction by femtosecond laser-assisted implantation of an intrastromal ring]. / Otdalennye kliniko-funktsional'nye rezul'taty korrektsii miopii vysokoi stepeni metodom intrastromal'noi implantatsii kol'tsa s femtolazernym soprovozhdeniem.

OBJECTIVE: To analyze remote clinical and functional outcomes of correcting high myopia in patients with thin cornea by the method of femtosecond laser-assisted implantation of intracorneal implant MyoRing. MATERIAL AND METHODS: The study included 22 patients (22 eyes; the mean age of study patients was 30.2±5.37 years). Mean spherical equivalent (SE) of refraction was -11.52±1.96 D, cylindrical component (cyl) of refraction was -2.04±1.64 D, minimal pachymetry index in the center was 491.6±20 µm, corneal hysteresis (CH) amounted to 8.6±1.19 mm Hg. The average pupil diameter in mesopic conditions was 5.6±0.23 mm. All patients had a history of mild amblyopia. The follow-up period lasted 2 years. RESULTS: Two years after the surgery uncorrected visual acuity was 0.6±1.22, corrected visual acuity 0.7±0.20. Mean spherical equivalent (SE) of refraction was 0.61±1.43 D, cylindrical component of refraction was -0.13±0.5 D. Predictability of SE within ±0.5 D was recorded in 84% of cases, ±1.0 - also in 84% of cases. Index of safety was 1.16, index of efficacy - 1.0. CH was 9.5±0.03 mm Hg. Mean pachymetry at the center did not change statistically significantly after the surgery in comparison to the initial data (p=1.00). CONCLUSION: MyoRing implantation is an effective and safe method, which ensures correction of the spherical component of refraction, as well as correction of astigmatism, improvement of biomechanical properties of the cornea, and an increase in corneal hysteresis (p=0.01).

[Correction of corneal astigmatism in femtosecond laser-assisted cataract extraction surgery]. / Korrektsiya rogovichnogo astigmatizma pri femtolazer-assistirovannoi ekstraktsii katarakty.

PURPOSE: To perform a comparative analysis of clinical and functional results and efficiency of corneal astigmatism correction after femtosecond laser-assisted cataract surgery (FLACS) with implantation of toric intraocular lens (TIOL) and in combination with arcuate keratotomy (FL-AC). MATERIAL AND METHODS: The examination included 60 patients (60 eyes). The first group consisted of 30 patients (30 eyes) who underwent FLACS with implantation of TIOL (Acrysof IQ Toric, Alcon, U.S.A.); the second group consisted of 30 patients (30 eyes) who underwent FLACS in combination with FL-AC. The examination was carried out before the operation, on the 3rd day and 3 months after surgery. Corneal astigmatism correction efficiency was analyzed using the Alpins method and graphical vector analysis. RESULTS: Uncorrected visual acuity (UCVA) indices increased to 0.70±0.24 and 0.66±0.31 in the FLACS with TIOL and FLACS with FL-AC groups, respectively, without statistically significant differences between the groups (p=0.03). The value of the residual cylinder was significantly lower in the FLACS with TIOL group (-0.77±0.58 and -0.80±0.39) compared with FLACS with FL-AC (-1.08±0.81 and -1.18±0.63) both on day 3 (p=0.02), and 3 months after surgery (p=0.02). In the FLACS with TIOL group, a higher correction index (0.99±0.18) and a smaller difference vector (0.77±0.64) were achieved compared to the FLACS with FL-AC group (0.78±0.35 and 1.05±0.76, respectively). Corneal higher-order aberrations (HOA) significantly differed on the 3rd day after surgery in the 3.0 mm (p=0.04) and 5.0 mm (p=0.04) zones between the groups. Endothelial cells density was 2460.50±328.40 and 2526.125±196.74 cl/mm2 after 3 months of observation in the FLACS with TIOL and FLACS with FL-AC groups, respectively (p=0.61). CONCLUSION: Both methods had comparable visual acuity results (p=0.03). FLACS with TIOL provided more effective correction of the cylindrical component of refraction to 3.0 D.

[Pachymetric and topographic changes of cornea after femtosecond laser-assisted keratomileusis in hypermetropic children]. / Pakhimetricheskie i topograficheskie izmeneniia rogovitsy posle keratomileza s femtolazernym soprovozhdeniem pri gipermetropii u detei.

PURPOSE: To analyze the state of cornea using 'Pentacam' device data before and five years after femtolaser-assisted in situ keratomileusis (FS-LASIK) in hyperopic children. MATERIAL AND METHODS: The study included 40 children aged 6-15 years examined before and five years after FS-LASIK. RESULTS: Central corneal thickness (CCT) amounted to 548.88±37.24 µm, at 6.5 mm zone - 631.58±48.23 µm, at 8 mm zone - 723.61±57.7 µm. Five years after the surgery corneal thickness at main influence zone (6.5-8.0 mm from the center of the cornea) decreased in average by 6%. Pachymetry at the center showed 545.06±48.11 µm, at 6.5 mm zone - 592.54±36.55 µm, at 8 mm zone - 683.54±50.89 µm. Mean posterior corneal elevation was +21±3.75 µm. Keratotopographic indices ISV and IVA increased 3.6 and 2.7 times compared to initial data and amounted to 83.86±30 mm and 0.58±0.4 mm respectively. Other indices were IHA - 22.8±9.82 µm, Rmin - 6.95±0.38 mm, KI - 1.1±0.09 and CKI - 1.05±0.03. CONCLUSION: Monitoring of the cornea state with 'Pentacam' before and 5 years after hyperopic FS-LASIK in children on the background of stable refraction revealed changes of keratotopographic indices associated to corneal thickness change in the laser ablation zone and the absence of pathologic posterior corneal surface elevation. These changes reflect the corneal profile after laser correction of hyperopia and should be perceived as topographic 'pseudo keratectasia'.

[Morphological changes of cornea in children with hyperopia in the immediate and remote postoperative period after laser keratomieleusis according to confocal microscopy data]. / . Morfologicheskie izmeneniia rogovitsy u detei s gipermetropiei v rannie i otdalennye sroki posle lazernogo keratomileza po dannym konfokal'noi mikroskopii.

Studying morphological changes of cornea in the remote postoperative period is becoming increasingly relevant with refractive surgeries being adapted for children. PURPOSE: comparative analysis of keratocyte density and hystomorphologic changes of cornea after laser in situ keratomieleusis (LASIK) and femtosecond laser-assisted LASIK (FS-LASIK) in children with hyperopia. MATERIAL AND METHODS: 109 patients aged 6-17 years in 2 groups were examined with 'Confoscan-4' confocal microscope. RESULTS: In comparison with initial data, keratocyte density decreased in the immediate postoperative period after FS-LASIK and LASIK in average by 17.09%, 64.31% and 12.2% in the corneal flap, directly in the laser influence zone (interface) and in the retroablation zone respectively. After 5 years, keratocyte density decreased in the corneal flap, interface zone and retroablation zone by 12.01%, 48.71% and 8.06% respectively in comparison with initial data. A circular scar at the flap edge was left after FS-LASIK; keratocyte density in the corneal flap and in the interface zone was in average 8.9% and 15.28% higher respectively, and twice more subepithelial nerves were noted compared to LASIK. CONCLUSIONS: In the remote postoperative period keratocyte density in the corneal decreased in average by 43% after FS-LASIK and by 46% after LASIK in comparison with initial data. No changes were seen in the morphologic state of the cornea outside the influence zone. Both the technologies are safe, however keratocyte density and the number of subepithelial nerves are higher in the cornea flap and in the interface zone after FS-LASIK; corneal stability is assured by a circular scar formed at the flap edge.

[Analysis of corneal biomechanical changes after femtosecond laser-assisted laser in situ keratomileusis in children with hyperopic anisometropia]. / Analiz biomekhanicheskikh izmenenii rogovitsy posle lazernogo intrastromal'nogo keratomileza s femtolazernym soprovozhdeniem u detei s gipermetropicheskoi anizometropiei.

AIM: to analyze corneal hysteresis (CH) and corneal resistance factor (RF) readings obtained with the Reichert Ocular Response Analyzer (ORA) before and after hyperopic femtolaser-assisted laser in situ keratomileusis (FS-LASIK) in children with anisometropia as well as to establish factors that may cause changes in these parameters. MATERIAL AND METHODS: CH and RF were evaluated before and 1.5 years after FS-LASIK performed on amblyopic eyes of 28 patients aged 6-14 years. Preoperatively, there was a correlation between CH and RF (r=0.41, p=0.03). No correlation was found between CH and age (r=-0.02, p=0.82) or between CH (r=0.00, p=0.98), RF (r=0.04, p=0.83), and cornea thickness. RESULTS: The mean preoperative CH was 12.56±1.21 mmHg, RF 12.31±1.57 mmHg. Postoperatively, a statistically significant change occurred to both CH (by 0.97±1.51 mmHg, p=0.002) and RF (by 1.42±1.55 mmHg, p=0.000). No correlation was found between CH before and after surgery (r=0.11, p=0.57) as well as between the ablation depth and changes in CH (r=0,04, p=0.83) and RF (r=0.21, p=0.28). Regression analysis showed that the extent of CH (r2=0.52, p=0.00) and RF (r2=0,48, p=0.00) changes was closely related to their preoperative values. CONCLUSION: The statistically significant relative change in CH and RF after hyperopic FS-LASIK was 8% and 12%, respectively. CH and RF changes correlated with their preoperative values, but not with the ablation depth or cornea thickness.

[Spatial contrast sensitivity and corneal higher-order aberrations after refractive surgery in children with hypermetropic anisometropia].

Spatial contrast sensitivity (SCS) was analyzed using mesopic (light off 10 candel/m2) and intensive illumination (light on 20,000 candel/m2) and corneal higher-order aberrations (CHOA) in 29 children with high-grade unilateral hypermetropia complicated by severe and moderate amblyopia after LASIK, Epi-LASIK, and intra-LASIK surgery. The values were comparable in the groups following 6 months under the intensive illumination and mesopic conditions at low and moderate frequencies. Under mesopic conditions, at high spatial frequencies, the values of SCS, as compared with the baseline values of 0.32 log units, the values of SCS were 0.34 log units after LASIKC (p > 0.05), 0.86 log units after intra-LASIK (p < 0.001), and 1.09 log units (p < 0.001). CHOA increased by 2.7 times after LASIK, by 1.45 times after intra-LASIK and epi-LASIK The operations showed an average of 1.5-fold improvement in children as compared with the baseline values.

[Laser thermokeratoplasty in the treatment of hyperopia in children].

The effectiveness, safety, and stability of multimodality treatment for hyperopia, hyperopic and mixed astigmatism complicated by amblyopia and anisometropia were studied in 117 patients (117 eyes) aged 9 to 16 years, by using the new laser units "Lik-100" and "Glasser" at 1.54 microm. The patients were divided into 3 groups: 1) 43 patients (43 eyes) with hyperopia, spheric anisometropia and amblyopia; 2) 38 patients (38 eyes) with hyperopia, simple and complicated hyperopic astigmatism, astigmatic anisometropia, and amblyopia; 3) 36 patients (36 eyes) with hyperopia, simple and complicated hyperopic astigmatism, mixed anisometropia, and amblyopia. All the groups underwent multimodality treatment involving laser thermokeratoplasty and drug therapy for amblyopia. In children and adolescents, the refraction effect was 2.99 and 3.61 (mean 3.37 +/- 0.60) diopters, respectively. Astigmatism diminished by 2.01 diopters (63%) in children and by 2.62 diopters (79%) in adolescents (mean 2/35 diopters). The predictability of a refraction effect in the range of +/- 0.5 diopters averaged 77% in all the groups. Anisometropia diminished by an average of 2.88 +/- 0.8 diopters, which was 85% of the baseline data (the upper range of residual refraction was not more than 1.5 diopters. In all the groups, uncorrectable visual acuity increased by an average of 0.36 diopters (0.43 and 0.4 diopters in children and adolescents, respectively); correctable visual acuity increased by an average of 0.22 diopters (0.36 and 0.31 diopters in children and adolescents, respectively). Loss of correctable visual acuity lines did not greater than 2.7% (5 eyes). That of endothelial cells was not more than 6-8%. The angle of squint strabismus could be decreased or corrected in 79% after treatment. Binocular vision restored in 57%.