[Biomechanics of diabetic vitreopapillary traction syndrome]. / Biomekhanika diabeticheskogo vitreopapillyarnogo traktsionnogo sindroma.

Diabetic vitreopapillary traction syndrome (VPT) is a variant of diabetic retinopathy (DR) that can lead to vision loss in advanced stages. This review reports on the biomechanics of the vitreous in the pathogenesis of proliferative DR, in particular diabetic VPT. The article analyzes and summarizes literature data, presents the views of different authors on this problem, and provides the results of Russian and foreign scientific research on this pathology. It is concluded that further research in this area can lead to a significant improvement in the results of therapy, timely diagnosis, and preservation of vision in patients with DR.

[Episcleral circular buckling in surgical treatment of recurrent rhegmatogenous retinal detachment after vitrectomy]. / Episkleral'noe krugovoe plombirovanie v khirurgii retsidivov regmatogennoi otsloiki setchatki na avitreal'nykh glazakh.

Despite the improvement of the surgical technique of vitreoretinal interventions, the number of recurrences of rhegmatogenous retinal detachment (RRD) remains quite high. PURPOSE: Evaluation of the effectiveness of episcleral circular buckling (ECB) in the treatment of recurrent RRD after vitrectomy due to progression of proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS: The study analyzed the results of surgical treatment of 21 patients (21 eyes) with recurrent RRD after primary vitrectomy. All patients underwent standard preoperative examination including visometry, tonometry, ophthalmobiomicroscopy, and additionally, optical coherence tomography was performed to assess the involvement of the macular area; the presence of anterior proliferative vitreoretinopathy was determined by ultrasound biomicroscopy, axial eye length was measured with an optical biometer. All patients underwent ECB, in some cases combined with repeated vitreoretinal surgery. RESULTS: Preliminary results of the study showed high efficiency of ECB exclusively, as well as ECB combined with revision of the vitreal cavity in case of RRD recurrence after primary vitreoretinal surgery, which amounted to 95% after one additional operation and removal of silicone oil. CONCLUSIONS: Episcleral circular buckling in the treatment of recurrent RRD after vitreoretinal surgery is a multifunctional and safe method that allows achieving favorable functional and anatomical outcomes.

[Modern aspects of the treatment of submacular hemorrhages secondary to macular degeneration]. / Sovremennye aspekty terapii submakulyarnykh krovoizliyanii na fone makulyarnoi degeneratsii.

Age-related macular degeneration complicated by submacular hemorrhage if not treated timely leads to permanent loss of central vision. The basis of effective therapy is its early start, dislocation of blood from central parts of the retina and blockage of neovascularization. This review examines the current methods of treatment of submacular hemorrhages, anatomical and functional outcomes, risks of postoperative complications, as well as trends in the use of combined methods of surgical intervention.

[Vitreopapillary traction syndrome in patients with proliferative diabetic retinopathy]. / Vitreopapillyarnyi traktsionnyi sindrom pri proliferativnoi diabeticheskoi retinopatii.

PURPOSE: To draw attention to characteristic features of the clinical manifestations of vitreopapillary traction syndrome (VPTS) in patients with proliferative diabetic retinopathy (PDR), to determine the role of the biomechanical factor in pathophysiology of this syndrome, and to evaluate the results of surgical treatment. MATERIAL AND METHODS: The features of clinical manifestations of VPTS of 50 patients with PDR who were treated at the ophthalmology center of the National Medical and Surgical Center named after N.I. Pirogov in the period from 2014 to 2018 were analyzed retrospectively. The preoperative study included standard ophthalmological examination methods, as well as ultrasound B-scan, computer perimetry, optical coherence tomography (OCT), fluorescence angiography (FA) in the first two years of observation. The comparison group consisted of 45 patients with PDR without signs of VPTS, who were treated in the center during the same period of time. RESULTS: The obtained results suggest that the pathophysiology of VPTS in diabetes mellitus has distinctive features and is determined by the topography of the peripapillary zone, as well as choroidal vascularization of the optic nerve head; biomechanical factor plays an important role in the formation of a fibrovascular stem (FVS) in VPTS. CONCLUSION: The results indicate that patients with VPTS have a worse prognosis for achieving best corrected visual acuity (BCVA) after surgery than patients without signs of VPTS. Correct and timely diagnosis, early treatment by vitreoretinal surgery give a greater chance of achieving higher BCVA in the postoperative period in this category of patients.

[Effectiveness of multistage surgical treatment of advanced proliferative diabetic retinopathy complicated with primary cataract]. / Effektivnost' mnogoetapnogo khirurgicheskogo lecheniya proliferativnoi diabeticheskoi retinopatii, oslozhnennoi nachal'noi kataraktoi.

Vitreoretinal surgery (VRS) is the «gold standard¼ for surgical treatment of patients with proliferative diabetic retinopathy (PDR). However, the timing for the removal of primary cataract in this category of patients remains uncertain. PURPOSE: To evaluate the effectiveness of multistage surgical treatment of patients with advanced PDR complicated with primary cataract. MATERIAL AND METHODS: The study involved 94 cases of surgical treatment of patients with PDR and complicated primary cataract. These patients were divided into two groups depending on the treatment tactics. In the first group, patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade performed as the first step in their treatment followed by phacoemulsification, silicone oil removal, and IOL implantation, respectively, as the second step. In subgroup 1a - VRS was performed with standard pharmacological support. In subgroup 1b - intravitreal injection of angiogenesis inhibitors preceded VRS. In the second group, the first step was phacoemulsification performed simultaneously with vitreoretinal surgery with silicone oil tamponade; the second step consisted of removing silicone oil from the vitreous cavity. Subgroup 2a - surgical treatment was performed with standard pharmacological support (similar to subgroup 1a). Subgroup 2b - intravitreal injection of anti-VEGF drugs preceded VRS. RESULTS: Visual functions improved in 88.8% and 83.4% of cases in subgroups 1a and 1b, and in 51.3% and 66.7% in subgroups 2a and 2b, respectively. CONCLUSIONS: The study confirms the effectiveness of staged (multi-step) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated primary cataract. Conducting phacoemulsification sometime later along with silicone oil removal in PDR patients with preoperative intravitreal injection of angiogenesis inhibitors is a gentler approach for the anatomic structures of the eye during the first stage (VRS) and contributes to the reduction in the number of intraoperative and postoperative complications.

[Protocol of intravitreal drug delivery. Consensus of the Expert Counsil of Retina and Optic Nerve Diseases of the All-Russian Public Organasation «Association of Ophthalmologists¼]. / Protokol vypolneniya intravitreal'nogo vvedeniya lekarstvennykh preparatov. Konsensus Ekspertnogo soveta po zabolevaniyam setchatki i zritel'nogo nerva Obshcherossiiskoi obshchestvennoi organizatsii «Assotsiatsiya vrachei-oftal'mologov¼.

Intravitreal drug administration is a procedure that has become widespread in modern ophthalmology. However, there is no global consensus on certain aspects of this manipulation, and practitioners feel the need for guidelines. In the Russian Federation, until now, such a document was not available. The expert council on diseases of the retina and optic nerve of All-Russian public organization «Association of Ophthalmologists¼, with participation of invited specialists, has studied and analyzed the existing foreign guidelines for performing intravitreal injections, as well as the regulatory framework in Russia. As a result, this Protocol was developed and approved for use in the healthcare system of the Russian Federation. The document regulates the requirements for specialists and organizations, the conditions for performing the procedure and the necessary material resources and presents an algorithm for performing intravitreal drug administration, a patient examination check-list for various conditions of the procedure, as well as parameters for evaluating and monitoring the quality of the procedure.

[Changes in perfusional and morphological parameters of the macular area after silicone oil tamponade of the vitreous cavity]. / Dinamika perfuzionnykh i morfologicheskikh parametrov makulyarnoi zony pri silikonovoi tamponade vitreal'noi polosti.

PURPOSE: To compare the changes of the macular morphological and functional parameters in the postoperative period in patients with silicone oil tamponade after successful surgery of the macula-on rhegmatogenous retinal detachment (RRD). MATERIAL AND METHODS: The study included 20 eyes operated on for macula-on RRD, which made up the first group, and the control group (20 eyes) for comparison. All patients of the study group underwent vitrectomy using silicone oil tamponade. Standard ophthalmological examination was performed on the 3rd day (early postoperative period) and the 14th day (late postoperative period), including OCT and OCT-A that were used to assess morphological and functional changes. RESULTS: A significant decrease in visual acuity was seen on the 3rd day after surgery involving the use of silicone oil tamponade, in comparison with the 14th day (p=0.0237) and the control group (p=0.0001). A decrease in the FD parameter (p=0.045), a decrease in vascular density in the fovea (p=0.020) and parafovea (p=0.024) in SCP were found on the 3rd day in comparison with control. On the 14th day of postoperative observation, a tendency was detected for choroidal perfusion to restore, as well as significant increase in FD (p=0.016), and an increase in vascular density in parafovea (p=0.01) compared with the early postoperative period. No statistically significant changes were seen in the FAZ area and vessel density DCP (p>0.05).

[Influence of treatment adherence on the progression of primary open-angle glaucoma in clinical setting]. / Vliianie priverzhennosti k lecheniiu na progressirovanie pervichnoi otkrytougol'noi glaukomy u patsientov v usloviiakh klinicheskoi praktiki.

According to various studies, treatment adherence of patients with primary open-angle glaucoma ranges from 5% to 80% and significantly influences the effectiveness of the therapy. Some authors report higher levels of adherence in patients receiving preservative-free medications. PURPOSE: To study the influence of treatment adherence in patients receiving preservative-free and preserved medications on the progression of primary open-angle glaucoma (POAG). MATERIAL AND METHODS: This prospective multicenter non-interventional study was conducted in clinical setting and included 504 patients with primary open-angle glaucoma receiving drug therapy; 51 ophthalmologist was involved in the management of patients' diaries. RESULTS: The percentage of patients who did not reach target IOP was three times lower in the group with high adherence, in comparison to patients with medium and low adherence (7% against 22%, respectively). Development of side effects was one of the factors influencing treatment adherence, their rates and expressiveness were much lower in the preservative-free group compared with the group receiving preserved medication (13.9% against 35.4%). The rate of patients who did not reach target IOP was two times lower in the group of preservative-free medication (10% against 21%). CONCLUSION: The study confirms that preservative-free glaucoma medication promotes higher adherence to treatment in clinical setting predominantly due to the reduction of quantity and severity of side effects leading to treatment gaps, which results in increased effectiveness and better stabilization of glaucoma.

[Morphological changes in the ocular structures in the simulation of proliferative vitreoretinopathy and in the presence of an extraocular focus of chronic infection].

The pathomorphological features of proliferative vitreoretinopathy (PVR) were studied in the presence or absence of an extraocular focus of chronic infection. The study was performed on 60 Chinchilla rabbits. In experimental animal group 1, the left eyes were used to simulate a thrombocytic model of PVR; physiological sodium chloride solution was injected into the right eyes that served as control. In Group 2 animals, a chronic infection focus had been previously reproduced by subcutaneously injecting 0.2 ml of BGC vaccine into the nasal bridge and PVR was simulated 2 weeks later. A comparative study of hematoxylin- and eosin-stained histological specimens from the eyes of Groups 1 and 2 animals, a study of the cellular composition on semithin sections, and electron microscopy showed a poor course of the proliferative process in the presence of an extraocular focus of chronic infection. In the presence of a chronic infection focus, PVR is constantly maintained; it takes a severer course for a longer period while in its absence the proliferative process tends to regress.

[Effect of fluorinated silicone oil on the rabbit retinal antioxidant status].

The high-grade fluorinated silicone oil made in Russia was tested for its effect on the rabbit retinal antioxidant status. Experiments were made on 36 rabbits (72 eyes) undergoing replacement of the excised vitreous body with sterile 0.9 NaCl solution or with one of the study implants (fluorinated silicon oil, silicon oil, or perfluorodecahydronaphthalene) after subtotal vitrectomy. The impact of the study implants on the rabbit retinal antioxidant status was postoperattively investigated. The experimental findings suggest that the high-grade fluorinated silicon oil made in Russia may be used as an implant for short-term vitreous chamber tamponade.

[Limbal transplantation in the treatment of and optic rehabilitation of the patients with severe chemical burns of the eyes]. / Limbal'naia transplantatsiia v lechenii i zritel'noi reabilitatsii patsientov s tiazhelymi khimicheskimi ozhogami glaz.

Described in the paper are the results of observations of the autogenous and allogenic limb transplantation (LT) made in 4 patients at exacerbation of severe and extra severe burns of the eyes and made in 8 patients in the remote period after severe chemical burns (4 months and more after trauma). A total vascularized corneal leukoma shaped up in 3 patients with LT made at exacerbation; an intense corneal opacification was observed in 1 more such patient. As for the patients, who were operated on in the remote period, better corneal properties and significantly improved visual acuity were registered in them. Relapsing corneal conjunctivalization were observed only in 3 cases of allogenic LT. Thus, LT was proven to be an effective tool in the remote visual rehabilitation of patients with severe eye burns, whereas, the procedure made at exacerbation and in cases of acute and extra acute burns with extensive lesions in the conjunctiva is low effective or a failure.

[Eye protection for servicemen under battle conditions by the use of special glasses]. / Zashchita glaz voennosluzhashchikh v boevykh usloviiakh s pomoshch'iu spetsial'nykh ochkov.

The paper substantiates a possibility of eye protection for military men in combat with special glasses and corrective spectacles. It shows that explosive shrapnel wounds dominate over the gunshot ones of visual organs. In the overwhelming majority of cases they are produced by small splinters with kinetic energy less than 18 J. It is found that the high-impact resistant polymeric optical material can be used for effective eye protection, which should result in a considerable reduction of eye wounds.

[Comparative evaluation of the results of various methods of scleroplasty in progressive myopia]. / Sravnitel'naia otsenka rezul'tatov razlichnykh sposobov skleroplastiki pri progressiruiushchei blizorukosti.

Six methods of scleroplasty are compared. A total of 476 operations on 423 eyes of 224 patients were carried out. The advantages of the technique suggested by the authors--fortification of the eyeball posterior pole with an auto-cartilage plate of the concha of the auricle 15 X 10 X 1 (1.5) mm in size--were revealed: both the immediate and late results of surgery were good, the surgery was low traumatic, no allergic reactions were recorded, the unpleasant sensations of the patients were the minimal; possible complications of scleroplasty, such as optic nerve and vorticose vein compression or perforation of thinned sclera, became less threatening.