[Outcomes of hemi-Descemet membrane endothelial keratoplasty and phacoemulsification for the treatment of primary Fuchs' endothelial corneal dystrophy combined with cataract]. / Rezul'taty transplantatsii destsemetovoi membrany s endoteliem i fakoemul'sifikatsii pri pervichnoi endotelial'noi distrofii rogovitsy Fuksa, sochetannoi s kataraktoi.

PURPOSE: This study evaluates the long-term results of surgical treatment of patients with Fuchs' endothelial corneal dystrophy and cataract. MATERIAL AND METHODS: The study included 24 patients (24 eyes) with primary Fuchs' endothelial corneal dystrophy and cataract, who underwent cataract phacoemulsification with IOL implantation and of Descemet's membrane endothelial keratoplasty with a semicircular graft (hemi-DMEK). The effect of treatment was assessed by best corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD). RESULTS: In total, surgical treatment involved 14 donor corneas that were divided in half during the preparation and isolation of the Descemet's membrane (DM). By month 12 after the surgery an increase in visual functions and graft transparency were observed in 23 patients (23 eyes) out of 24. Repeated keratoplasty was required in one case due to fibrosis of the posterior layers of recipient's corneal stroma. At 12 months postoperatively, the study group showed an increase in BCVA from 0.16±0.1 to 0.75±20, a decrease in CCT from 650.9±4.5 µm to 519.6±43.9, and a decreased in ECD from 2850.5±84.7 cells/mm2 up to 1285.5±277.2 cells/mm2. Thus, the loss of endothelial cells at one year after surgery amounted to 54.9%. CONCLUSIONS: The developed method for transplantation of a semicircular DM fragment provides a tissue-saving approach to endothelial keratoplasty, and considering the high percentage of transparent engraftment of grafts and complete visual rehabilitation, it can be recommended in the treatment of patients with cataract and Fuchs' endothelial corneal dystrophy.

[Methods of diagnosis and treatment of corneal neovascularization]. / Metody diagnostiki i lecheniya neovaskulyarizatsii rogovitsy.

Corneal neovascularization is one of the most common causes of decreased visual acuity and disability for vision loss, increase in the risk of corneal graft rejection, and appearance of opacifications on the cornea. This article reviews literature on etiological factors of the development of corneal neovascularization, as well as modern methods of diagnosis, conservative and surgical treatment of this pathology.

[Analysis of the results of modified personalized topographically and tomographically oriented technique of ultraviolet corneal collagen crosslinking]. / Analiz rezul'tatov modifitsirovannoi personalizirovannoi topograficheski i tomograficheski orientirovannoi metodiki ul'trafioletovogo krosslinkinga rogovichnogo kollagena.

PURPOSE: The study aims to develop a modified personalized topographically and tomographically oriented technique of ultraviolet corneal collagen cross-linking (UVCXL) to affect the area of the cornea with weakest biomechanical properties as determined by mathematical modeling. MATERIAL AND METHODS: Modeling of the biomechanics of keratoconic cornea under conditions of external diagnostic action was done using COMSOL Multiphysics® software. Finite-element analysis procured 3D images of stress/deformation distribution pattern throughout the cornea. Matching these 3D images with primary topographic and tomographic Pentacam AXL maps and Corvis ST findings allowed determining localization and dimensions of impaired regions of the cornea. The acquired data helped develop the modified corneal collagen cross-linking technique, which was applied in the treatment of 36 persons (36 eyes) with degrees I and II keratoconus. RESULTS: Uncorrected and best-corrected visual acuity (UCVA and BCVA logMAR) in all patients after modified UVCXL increased after the follow-up period lasting 6-12 months by 0.2±0.19 (23%) and 0.1±0.14 (29%) (p<0.05), respectively, in comparison with preoperative values. Maximum keratometry (Kmax) decreased by 1.35±1.63% (3%; p<0.05) in all cases at 6-12 months follow-up. Improvement of corneal biomechanical strength was determined by statistically significant increase in corneal stiffness index (SP-A1) and corneal stress-strain index (SSI) measured with Pentacam AXL and Corvis ST at 6-12 months follow-up by 15.1±5.04 (18%) and 0.21±0.20 (23%) (p<0.05), respectively. Effectiveness of the developed UVCXL technique is also confirmed by the appearance of a characteristic morphological marker - «demarcation line¼ at the cross-linking site in keratoconus projection at the depth of 240±10.2 µm. CONCLUSION: The developed personalized topographically and tomographically oriented UVCXL technique provides an evident stabilizing effect on the cornea in the form of an increase in its biomechanical strength, improvement of clinical, functional indicators and safety of keratoconus treatment.

[Long-term outcomes of treating rhegmatogenous retinal detachment with macular hole using platelet-rich blood plasma]. / Otdalennye rezul'taty khirurgicheskogo lecheniya regmatogennoi otsloiki setchatki, oslozhnennoi makulyarnym razryvom, s ispol'zovaniem bogatoi trombotsitami plazmy krovi.

Currently there is no specific algorithm for treating rhegmatogenous retinal detachment complicated by macular hole. PURPOSE: The study analyzed the long-term outcomes of surgical treatment of rhegmatogenous retinal detachment (RRD) complicated by macular hole (MH) using platelet-rich plasma (PRP) and local staining of the internal limiting membrane (ILM). MATERIAL AND METHODS: This prospective open-label study included 27 patients (15 females and 12 males) aged 57 to 65 (59.2±7.2) years. In all studied cases, RRD complicated by MH was determined. The best corrected visual acuity (BCVA) before surgery was 0.05±0.01 (from 0.02 to 0.08). The average MH diameter measured with OCT was 576.3±150.4 µm (409 µm to 944 µm). After vitrectomy, a perfluororganic compound (PFOC) was injected into the MH area in amount of 2-3 optic nerve head diameters to prevent the ingress of dye under the retina, then the internal limiting membrane (ILM) was stained and removed. After sequential PFOC/air replacement, PRP was injected into the macular hole site. RESULTS AND DISCUSSION: An increase in BCVA from 0.05±0.01 to 0.09±0.03 was observed in the preoperative period one month after surgery, with a further increase to 0.35±0.11 at the maximum follow-up time (two years). The MH was blocked and a glial scar was present in all cases according to OCT data. 1-2 years after the operation, all patients showed a favorable anatomical effect according to OCT data. According to computer microperimetry data, mean macular photosensitivity was 23.8±1.3 dB two years after the surgery. CONCLUSIONS: This study shows a favorable anatomical and functional effect in patients with RRD and MH within a 2-year follow-up. A comparative study involving a larger cohort of patients is required to clarify the indications and contraindications for the use of the studied technique.

[Pharmacological modulation of wound healing in glaucoma surgery]. / Farmakoterapevticheskie podkhody k upravleniyu reparativnymi protsessami v khirurgii glaukomy.

Despite the well-known effectiveness of pharmacological glaucoma therapy, surgical approach remains one of the main treatment options for some forms and stages of the disease. The long-term success of glaucoma surgery depends on the intensity of local wound healing processes at the surgical site. The most common way to influence healing processes in surgical treatment of glaucoma is the use of antimetabolites. However, given the high risk of serious complications associated with their use, the search for new drugs devoid of these disadvantages continues. The aim of this review is to describe the efficacy and safety of both currently used and upcoming pharmacological ways to influence the wound healing process after glaucoma surgery in order to improve the stability of hypotensive effect.

[Outcomes of surgical treatment of rhegmatogenous retinal detachment after phaco surgery and implantation of a trifocal intraocular lens in patients with myopia (clinical observations)]. / Rezul'taty khirurgicheskogo lecheniya regmatogennoi otsloiki setchatki posle fakokhirurgii i implantatsii trifokal'noi intraokulyarnoi linzy pri miopii (klinicheskie nablyudeniya).

PURPOSE: To analyze visual functions in moderate and high myopic patients with retinal detachment that developed after implantation of a trifocal intraocular lens (IOL). MATERIAL AND METHODS: The study analyzed the functional outcomes achieved in 3 patients (4 eyes) with retinal detachment developed after implantation of AcrySof IQ PanOptix («Alcon¼, USA) and AT LISA tri 839 MP («Carl Zeiss Meditec¼, Germany) during the follow-up period of 24 months. Patient examination included measurements of visual acuity at far (4 and 5 m), near (40 cm) and intermediate distances (60 cm, 80 cm), spatial contrast sensitivity, spherical equivalent of refraction, and a survey of patients for subjective satisfaction of the obtained vision. RESULTS: In four eyes of three patients with moderate and high myopia, rhegmatogenous retinal detachment was diagnosed during the follow-up period at 4 to 12 months after phacoemulsification of cataract with trifocal IOL implantation. The best visual indicators were found in patient N. as a result of surgical treatment of bilateral rhegmatogenous retinal detachment due to high myopia: visual acuity (VA) at far distance was 1.0 for each eye (with 100 points on the VF-14 questionnaire). In patients P. and M., after the development of unilateral rhegmatogenous retinal detachment, complete retinal reattachment was achieved after surgery with VA at far distance 0.55 (OS) in patient P. and 0.4 (OD) in patient M. (95 and 86 points on VF-14, respectively). CONCLUSION: Good visual functions were achieved in three patients with trifocal IOL after surgical treatment of the rhegmatogenous retinal detachment that developed due to myopia. The implanted trifocal IOL did not affect the effectiveness of vitrectomy. After the treatment patients retained the ability to see at different distances.

[Effects of artificial gravity on perimetry results]. / Vliyanie iskusstvennoi gravitatsii na izmenenie perimetricheskikh pokazatelei organa zreniya.

The active exploration of space requires minimizing negative effects induced by weightlessness (microgravity). Risk reduction can be achieved with the use of artificial gravity created by short-radius centrifuge (SRC). Short-radius centrifuge causes redistribution of body liquids towards the caudal portion of the body imitating a vertical human pose. Presently, studying the safety of this prevention method for the human body in general, and for the visual system in particular, is one of the priority tasks of space medicine. PURPOSE: To study the effects of artificial gravity on the perimetry measurements of the eye. MATERIAL AND METHODS: The study included 9 volunteers (men) aged 31.2±6 years (from 25 to 40 years). Each man was subjected to three rotations on SRC. The operative factor in the tests was overloads in the «head-pelvis¼ direction. Rotations were carried out in three different modes with varying maximum overload value at the feet level of up to 2.0; 2.4; 2.9 G. Pulsar-perimetry was carried out before and 1-2 hours after the rotations estimating the mean threshold of retinal photosensitivity Mean Sensitivity (MS), mean loss of sensitivity Mean Defect (MD), square root of Loss Variance (sLV); the Bebie curve; additionally, cluster analysis was performed. RESULTS: Mean threshold of retinal photosensitivity, mean loss of photosensitivity, square root of Loss Variance by Pulsar-perimetry before (MS=22.75 dB; MD= -0.6 dB; sLV=1.5) and after rotations on SRC (in Mode 1: 23.4; -0.2; 1.5, Mode 2: 23.2; -0.4; 1.4 and Mode 3: 23.5; -0.8; 1.4 respectively) did not change significantly. No adverse phenomena were detected in the eyes. CONCLUSIONS: There were no significant changes in the visual fields of the test subjects after rotations in three different modes according to Pulsar-perimetry data, which gives reason to tentatively conclude that using SCR in these modes is safe for the visual sensory system. According to preliminary data, this method can be successfully used to reduce the risk of long-term space flights and prevent unwanted phenomena caused by weightlessness.

[Comparative study of corneal densitometry values after posterior lamellar keratoplasty]. / Sravnitel'nyi analiz opticheskoi densitometrii rogovitsy u patsientov posle zadnei posloinoi keratoplastiki.

Studying clinical and functional outcomes of femtosecond laser-assisted posterior lamellar keratoplasty is an actual problem in endothelial keratoplasty. PURPOSE: To compare the values of corneal densitometry (CD) as measured by the Scheimpflug camera (Pentacam) following femtosecond laser-assisted Descemet stripping endothelial keratoplasty (DSEK) vs microkeratome-assisted Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). MATERIAL AND METHODS: The prospective single center randomized study included 37 eyes of 37 patients with Fuchs endothelial dystrophy and cataract. 20 patients underwent cataract phacoemulsification combined with Femto-DSEK; 17 patients of the control group underwent cataract phacoemulsification combined with DSAEK. Outcome measurements included optical coherence tomography of the anterior segment of the eye, endothelial microscopy and densitometry. Optical density of the cornea and its various layers: anterior layer (AL), central layer (CL), posterior layer (PL) and interface zone was assessed in the 0-2 and 2-6 mm zones. The follow-up period lasted 1 year. RESULTS: Comparative analysis did not reveal statistically significant differences in AL, CL, and CCT values between the groups (p>0.05). In the Femto-DSEK group, densitometry indices of the posterior layers of the cornea and the interface zone were significantly higher than in the DSAEK group (p<0.05). Postoperative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) differed significantly throughout all follow-up period with DSAEK group having better results (p<0.05). Endothelial cell density (ECD) at 12 months was higher in the Femto-DSEK group compared with the DSAEK group (65.7±7.7% and 58.5±8.1%, p=0.02, respectively). CONCLUSION: After one year, corneal density values (AL, CL, PL) and CCT were comparable between the groups. UCVA, BSCVA and ECD were significantly better after DSAEK.

[Morphological changes in rabbit cornea after implantation of a new keratoprosthesis supporting plate]. / Morfologicheskie izmeneniya rogovitsy krolika pri implantatsii novoi modeli opornoi plastinki keratoproteza.

PURPOSE: To evaluate biocompatibility of the new keratoprosthesis supporting plates (KSP) in rabbits in vivo. MATERIAL AND METHODS: The study included 15 chinchilla rabbits. In the first group (5 rabbit eyes) KSP made of hydrophobic acryl with square penetrating holes of 220×220 micron (model 1) were inserted into rabbits' corneas. In the second group (5 eyes), KSP made of hydrophobic acryl were used that had trapezoidal fenestrations with size (from 170×130 micron to 180×70 microns) gradually changing from periphery to the center of KSP (model 2). The control group rabbits (5 eyes) had 1/2 of Fyodorov-Zuev KSP made of titanium implanted. All animals were observed for up to 3 months with biomicroscopy and optical coherence tomography of the anterior segment. The animals were then euthanized and had their corneo-scleral discs excised and then examined with optical microscopy and scanning electron microscopy (SEM). RESULTS: After 3 months, there was only one case of KSP protrusion in the first group. In the second group, thinning of the corneal layers above the central part of KSP occurred in one case. The presence of polymer KSP (of both models) in the corneal stroma was found not to cause formation of rough fibrotic tissue. At the same time, adhered cellular and fibrous elements were discovered on the surface and inside the holes of the polymer KSP, while on the surface of the titanium plate cellular elements were absent. CONCLUSION: Supporting plates made of hydrophobic acrylic material can potentially serve as a foundation for the new keratoprosthesis design.

[Clinical results of posterior lamellar femto-keratoplasty in patients with corneal endothelial dystrophies]. / Klinicheskie rezul'taty zadnei posloinoi femtokeratoplastiki pri endotelial'noi distrofii rogovitsy.

PURPOSE: To evaluate clinical results of posterior lamellar keratoplasty performed with Russian femtosecond laser «Vizum¼ for treating patients with primary and secondary corneal endothelial dystrophies. MATERIAL AND METHODS: The study included 30 operated eyes: 10 with Fuch's primary endothelial dystrophy of the cornea and 20 with secondary endothelial dystrophy. Patients were examined on the 7th day, as well as at 3, 6, 12 and 24 months after the surgery. All 28 patients (30 eyes) were followed-up for 12 months, 12 patients (14 eyes) were followed-up for 24 months. RESULTS: In 3 months after the surgery, transparent engraftment was observed in most cases. In 1 case, its primary failure was diagnosed and repeated keratoplasty was performed. Postoperative haze in host-donor interface was observed in 1 case. Central corneal thickness (CCT) was 554±43 µm. Transplant thickness in the central zone was 80±13 µm. The amount of eyes with Best Spectacle-Corrected Visual Acuity (BSCVA) of 0.3 was 43%. Endothelial cells density (ECD) was 1538±500 cells/mm2. Endothelial cells loss amounted to 30.4%. By the 12th month, recipient's cornea and the transplant remained transparent in all cases. Haze in the host-donor interface was still observed in 1 case. CCT was 581±47 µm, transplant thickness was 80±16 µm. The amount of eyes with BSCVA of 0.3 was 53%. Keratometry astigmatism was 2.08±1.47 D, refractive astigmatism - 1.72±0.83 D. ECD was 1324±383 cells/mm2. Endothelial cells loss amounted to 40.1%. At 24th months after the surgery (12 patients, 14 eyes) the recipient's cornea and the transplant remained clear in all cases. CCT was 591±48 µm, transplant thickness was 81±15 µm. Amount of eyes with BSCVA of 0.3 was 71.4%. ECD was 1426±422 cells/mm2. Endothelial cells loss - 35.1%. CONCLUSIONS: The predictability of applanation and high quality of cutting of the «Vizum¼ femtosecond laser assure the predictability of the process of preparing an ultrathin cornel graft from the endothelial side. Clinical results have demonstrated its effectiveness for rehabilitation of visual functions (up to BSCVA 1.0).

[Comparative analysis of the functional results after implantation of various diffractive trifocal intraocular lenses]. / Sravnitel'nyi analiz funktsional'nykh rezul'tatov implantatsii razlichnykh modelei trifokal'nykh difraktsionnykh intraokuliarnykh linz.

PURPOSE: To compare visual outcomes after implantation of two models of diffractive trifocal IOLs using various vision assessment systems. MATERIAL AND METHODS: The study included 25 patients (25 eyes) who were implanted with AcrySof IQ PanOptix (TFN) and 25 patients (25 eyes) implanted with AT LISA tri 839 MP (TRI). Postoperative examination at 1 year included assessment of monocular visual acuity for far, intermediate and near distance using decimal scale, as well as LogMAR and an interactive computer program (ICP). Contrast sensitivity was assessed with the Optec 6500 device. A questionnaire was used to evaluate subjective quality of vision and the intensity of optical phenomena. RESULTS: Uncorrected visual acuity (UCVA) at distance, intermediate and near was better in the TFN group in comparison with the TRI group as measured with decimal scale, ICP and LogMAR. Under photopic and mesopic conditions with and without glare, at all spatial frequencies the contrast sensitivity function (CSF) was higher after implantation of TFN in comparison with TRI. The average VF-14 score was 97.2 after implantation of TFN and 96.7 after implantation of TRI. The amount of patients who required spectacle correction after the surgery was 5.5% less in the TFN group compared to the TRI group. CONCLUSION: High visual outcomes at all distances were observed in patients after implantation of both trifocal IOLs with TFN showing a slight advantage. Evaluation of the visual outcomes using various systems showed the benefits of the ICP assessment. The CSF had typical configuration with maximum value in the mid-range region and a decrease in the high-frequency range after implantation of both IOLs, however the indicators were better in the TFN group. The postoperative period was characterized by high levels of patient satisfaction and spectacle independence in both groups.

[Search for genetic markers for precise diagnostics of keratoconus]. / Poisk geneticheskikh markerov dlia utochniaiushchei diagnostiki keratokonusa.

Keratoconus is a chronic disorder of the cornea, characterized by its progressive thinning, stretching, and conical protrusion. Diagnostics of subclinical keratoconus, as well as its early stages (forme fruste), is a complex problem. The presence of these forms of keratoconus in a patient is one of the reasons for the development of keratectasia after laser refractive surgery. Currently, the role of genetic factors in keratoconus development has been proven. This indicates the possibility of diagnostics of subclinical and forme fruste keratoconus using genetic markers. Knowledge about the patient's genetic susceptibility to keratoconus would allow correcting the tactics of treatment of refractive anomalies and avoiding serious side effects. The studies of causal mutations indicate the genetic heterogeneity of keratoconus, which complicates the development of a diagnostic panel. Selection of candidate variants from the currently known ones based on clear criteria may be one of the approaches for diagnostic markers search. In this review, we have analyzed articles on keratoconus markers in order to form a list of candidate variants for genotyping in the Russian population. The selection criteria took into account the complexes of symptoms in which a marker was found, populations in which a particular marker was investigated, the presence and results of replication studies. The analysis included markers in VSX1, SOD1, ZEB1, LOX, CAST, DOCK9, TGFBI, HGF, MAP3K19, KCND3, COL4A3, COL4A4, COL5A1, FNDC3B, FOXO1, BANP-ZNF469, MPDZ-NF1B, WNT10A genes. Based on the results of the analysis, the following candidate variants were selected for genotyping in the Russian population of patients with keratoconus: rs1536482 and rs7044529 in the COL5A1 gene, rs5745752 and rs2286194 in the HGF gene, rs4954218 in the MAP3K19 gene, rs4839200 near the KCND3 gene, rs2721051 near the FOXO1 gene, rs1324183 between the MPDZ and the NF1B genes, and rs121908120 in the WNT10A gene.

[Transplantation of endothelium and Descemet's membrane]. / Transplantatsiia éndoteliia i destsemetovoi membrany.

Nowadays, endothelial keratoplasty has become an alternative to penetrating keratoplasty (PKP) in the management of corneal endothelial dysfunction. Descemet membrane endothelial keratoplasty (DMEK) is a relatively new corneal transplantation surgery technique suited for patients with endothelial insufficiency, an increasing number of surgeons are learning the graft preparation technique and the surgery itself after seeing its excellent postoperative visual outcomes and faster rehabilitation of patients. DMEK has significant advantages in comparison with automated and manual Descemet Stripping Endothelial Keratoplasty (DSAEK/DSEK) and PKP including lower risk of immunologic graft rejection (1-2%), lower cost of the procedure, and it does not require expensive equipment such as a microkeratome or a femtosecond laser device. Another advantage is that the corneal graft tissue can be used for several recipients - e.g. when the Descemet's membrane and endothelium are used for a patient with endothelial dysfunction of the cornea, the retained stroma and epithelium can be then used for another patient with pathology of these corneal layers. Key problematic issues regarding this surgery are the technical difficulties during graft preparation and during surgery itself, however the majority of surgeons report very good results after gaining some experience. The article reviews latest clinical trials on DMEK and describes its strengths and weaknesses.

[Mechanical dilation of the pupil and its possible applications in femtosecond laser-assisted cataract surgery]. / Mekhanicheskaia dilatatsiia zrachka i vozmozhnosti ee primeneniia v khirurgii katarakty s femtosekundnym lazernym soprovozhdeniem.

In certain cases intraoperative pupil dilation during cataract surgery may be necessary to improve the visualization of intraocular structures and assure the atraumatic nature of surgical manipulations. The article reviews a wide range of pupil expanders, their historical aspects and possibilities of their application in modern cataract surgery.

[Regional ophthalmological cluster as a resource basis for the process and the procedure of specialist accreditation]. / Regional'nyi oftal'mologicheskii klaster kak osnova resursnogo obespecheniia protsessa i protsedury akkreditatsii vrachei.

Since 2016, phased introduction of specialist accreditation has been launched. Many issues like how training at regional accreditation centers (RACs) should be organized - for applicants applying for primary specialized accreditation as residents in ophthalmology (2018) or periodic accreditation as practicing ophthalmologists (2021) - are yet debatable. AIM: to provide organizational and educational resources for arranging accreditation of ophthalmologists at the background of improving the quality of medical care in a federal subject of the Russian Federation. MATERIAL AND METHODS: The study object was the process and the procedure of accreditation, the study subject - the system of specialist accreditation. METHODS: bibliographical, analytical, and expert. Methodological basis for tasks solving: mobilization of an independent organizational structure, that is, the regional ophthalmological scientific-educational cluster (ROSEC). RESULTS: Three complex problems have been defined that require solution. 1. Discrepancies between accreditation procedures depending on the type of accreditation. The absence of practical skills assessment within the periodical accreditation procedure and low availability of innovative simulation systems impede the achievement of the declared goals of accreditation. 2. The absence of a clear order and criteria for portfolio assessment as well as a legal format of its formation during non-interrupted medical education (NIME) demands active management. 3. There is still a lack of appropriate organizational, educational, material technical, and personnel support of the accreditation system. The proposed organizational and methodological approaches are aimed at solving issues of accreditation support, proper functioning of RACs, and improving the quality and regional availability of NIME. CONCLUSION: Systematic approach effectively solves the problem of resource support of accreditation. ROSEC should be regarded as the provision basis for complex of all stages of ophthalmologist accreditation and proper functioning of RACs. ROSEC involvement is highly advisable.

[Clinical and functional results of one-step phaco surgery and central descemetorhexis for cataract and Fuchs primary endothelial corneal dystrophy]. / Kliniko-funktsional'nye rezul'taty khirurgicheskogo lecheniia katarakty i pervichnoi éndotelial'noi distrofii rogovitsy Fuksa metodom odnomomentnoi fakoémul'sifikatsii i tsentral'nogo destsemetoreksisa.

Poor visual function associated with Fuchs endothelial corneal dystrophy (FECD) is one of the main indications for keratoplasty. Reports of successful visual rehabilitation of patients with spontaneous or scheduled removal of the Descemet's membrane and the endothelium or donor material adhesion failure, suggest this research direction perspective. AIM: to evaluate the potential as well as clinical and functional outcomes of phacoemulsification with central circular descemetorhexis in patients with Fuchs endothelial corneal dystrophy. MATERIAL AND METHODS: A total of 19 patients aged 51-84 years were included. The preoperative best corrected visual acuity averaged 0.32±0.19, endothelial cells density - 629.6±336.9 cells/mm2, and central corneal pachymetry - 587.8±44.8 µm. After phacoemulsification with IOL implantation, a 4 mm tap was created from the epithelial side of the cornea. Central circular descemetorhexis was done using a microhook. The membrane was removed with microforceps. RESULTS: On day 1, there was central corneal edema matching the circular defect in the Descemet's membrane. As many as 26.3% of patients demonstrated rapid responses to the treatment, which implies that corneal transparency and visual improvement were achieved by the end of the first month after surgery. In other 26.3% of patients, full corneal transparency was not achieved and, therefore, endothelium transplantation had to be performed. The main group included 12 patients. At 12 months, the best corrected visual acuity was 0.66±0.29, central pachymetry - 569.27±63.74 µm, endothelial cells density - 634.00±170.41 cells/mm2. CONCLUSION: In 63.8% of patients, visual rehabilitation was achieved without endothelial transplantation, which provides new prospects for tissue-saving technologies in patients with endothelial corneal dystrophy.

Molecular mechanisms of vasoconstrictor action of imidazo[1,2-alpha]benzimidazole derivative RU-1117 possessing local anesthetic properties.

We studied the mechanisms of action of imidazobenzimidazole derivative RU-1117 on calcium homeostasis in myocytes isolated from rat thoracic aorta. In therapeutic concentrations, RU-1117 increased the content of free calcium ions due to their mobilization from intracellular depot via the IP3-dependent mechanisms. Antagonists of angiotensin II AT1-receptors irbesartan and, to greater extent, eprosartan abolished the calcium-mobilizing action of RU-1117. Selective antagonist of endothelin ETA-receptors sitaxsentan and alpha1-adrenoceptor agonist prazosin produced no effect on calcium mobilization caused by novel local anesthetic RU-1117.

Conformation and kinetic characteristics of interactions between local anesthetics and aqueous solutions of hydroxypropylmethylcellulose.

Conformation and kinetic characteristics of the interactions of local anesthetics lidocaine (xycaine), tetracaine (dicaine), bupivacaine, and new RU-1117 compound with proven anesthetic activity with Visiton (1% hydroxypropylmethylcellulose in phosphate buffer) were studied. It was found that complex formation between the local anesthetics and hydroxypropylmethylcellulose is a time-dependent reversible process. The equilibrium is attained within 2.5-8.0 h and depends on the chemical nature of local anesthetic.