[Comparison of ultrasound and hydrodynamic parameters in phacoemulsification]. / Metod sravnitel'noi otsenki ul'trazvukovykh i gidrodinamicheskikh pokazatelei v protsesse fakoémul'sifikatsii.

Modern phacoemulsifiers have the widest selection of ultrasound parameters. Existing approaches to comparing the settings of the phaco machines have shortcomings and thus cannot be considered objective. PURPOSE: To find a technique that would allow objective in vivo evaluation of various ultrasound and hydrodynamic parameters after performing phacoemulsification. To compare the two types of phaco settings using the proposed technique. MATERIAL AND METHODS: The principle of the 'Femtocomparison' method is to have each patient undergo femtolaser pretreatment before phacoemulsification, in which the lens is divided by laser into equal parts and a corneal incision and capsulotomy are performed with the same settings. Then, during the manual part, basic ultrasound and hydrodynamic data is recorded after the removal of each quadrant of the lens. The study included 58 patients with cataracts of varying densities who underwent femtosecond laser-assisted cataract surgery. In each case, one half of the nucleus was removed using torsional ultrasound with IP technology, while the other half - using a combination of torsional and longitudinal ultrasound. RESULTS: The 'Femtocomparison' technique allowed objective in vivo comparison of two types of ultrasound settings. When assessing these parameters, no significant differences were found in any of the patients regardless of the density of the lens nucleus (p>0.05). In soft nuclei group (NC 1-3) CDE were significantly lower when using torsional ultrasound and IP (p<0.05). In the group with dense nuclei (NC 6+), CDE and aspiration time were significantly lower when using combination ultrasound (p<0.05). CONCLUSION: The 'Femtocomparison' technique has shown that torsional ultrasound with IP technology is preferable for aspiration of soft cataracts, while combined use of torsional and longitudinal ultrasound is better when removing dense lenses.

[Long-term results of combined surgery for open-angle glaucoma]. / Otdalennye rezul'taty kombinirovannogo lazerno-khirurgicheskogo lecheniya otkrytougol'noi glaukomy.

AIM: to comparatively evaluate the hypotensive effect of minimally invasive (type 1) and basic (type 2) subscleral removing of the external wall of Schlemm's canal with subsequent laser trabeculopuncture in patients with open-angle glaucoma (POAG). MATERIAL AND METHODS: The main group included 60 patients (64 eyes) treated with the minimally invasive technique. The control group included 105 patients (105 eyes), who underwent the type 2 surgery. RESULTS: After sinusotomy, intraocular pressure (IOP) decreased by 25% of its preoperative values in most patients (in 90.6% of patients from the main group and 81.9% of the controls, p<0.05). After laser trabeculopuncture, IOP further decreased down to 15.6±0.4 mmHg in the main group and 17.4±0.3 mmHg in the control group (p<0.05). Twelve months after the combined treatment, the hypotensive effect was still present in 81.2% of patients from the main group and 90.5% of the controls. None of the patients required additional hypotensive therapy. CONCLUSION: In POAG patients, the effect of minimally invasive subscleral removal of the external wall of Schlemm's canal (microfistulazing procedure) followed by laser trabeculopuncture is no weaker than that of basic technique.

[Morpho-physiological features of the human eye sclera as the key unit in the level of intraocular pressure under normal conditions and in glaucoma].

The results of sclera investigations from the positions of morphology, physiology, biomechanics and control-system theory, are summarized. The morphological evidence was obtained supporting the physiological hypothesis stating that the specific anatomical organization and spatial displacement of elastic fiber-containing scleral layers against one another, are the key elements in formation of the individual level of intraocular pressure (IOP) in man both under normal and pathological conditions. It was shown that the elastic fibers outlined the collagen lamallae in of scleral internal layers. External scleral layer lacked elastic fibers. Scleral elastic fibers are necessary for the functioning of the mechanism of sclera microfluctuations associated with the intraocular fluid accumulation and removal, they are also important for dampening the sudden changes of IOP. Under normal conditions, age-related increase in scleral rigidity is primarily associated with the process of accelerated aging of its superficial non-elastic layers, resulting in the physiological response of the current IOP level elevation. As IOP becomes elevated under normal conditions, the internal elastic fiber-containing scleral layers are increasingly pressed against more rigid external layer. This limits the displacement capacity of internal layers against each other, resulting in the decline of the efficiency of elastic fiber work in dampening the sudden changes of IOP. In the healthy eyes, the process of scleral aging brings to a natural development of ophthalmohypertension, when IOP elevation is physiologically required for the maintenance of the volume microfluctuation mechanism ("scleral respiration"). In glaucoma, the pathological rearrangement of the scleral fibrous structures is observed, resulting in an additional abrupt increase of its rigidity, with the reciprocal significant elevation of the current level of IOP and the amplitude of its jumps. Pathophysiological mechanism of these significant changes in glaucoma remains currently unknown, however, morphological evidence indicates that it is associated with the changes in the metabolic processes in sclera.

[Photodynamic therapy with visudyne: criteria for treatment success].

The paper specifies indications and success criteria for photodynamic therapy with visudine for classical macular choroidal neovascularization. Three major clinical types of a response to treatment are presented. These include: 1) complete regression of the subretinal neovascular membrane (SNM) with retinal edema resolution; 2) partial regression of SNM with its shift to inactive status that is attended by a significant reduction in pathological transudation from the newly formed vessels; 3) partial regression with the preserved high transudating activity of SNM. There was stabilization of lesion extents and visual functions in types 1 and 2 responses to therapy and a continued SNM growth and progressive visual worsening in type 3 response.

[The use of argon laser coagulation in the combination treatment of patients with tuberculous chorioretinitis]. / Primenenie argonovoi lazernoi koaguliatsii v kompleksnom lechenii bol'nykh tuberkuleznymi khorioretinitami.

The outcomes of argon laser coagulation (ALC) of active tuberculous chorioretinal foci (mainly of exudative and hemorrhagic nature, macular and paramacular localization) in 26 patients are illustrated. The coagulation was performed concurrently with a combined general and local antituberculosis therapy (with 48 patients as controls). The developed direct ALC technique was used together with antibacterial therapy of the total surface of the inflammation focus itself. The examination findings prove that the effectiveness of the above technique is high, since the disappearance of the clinical signs of the inflammatory activity is achieved in a relatively short time (45 days); acute conditions and relapses are prevented; complications are excluded; and an evident economic effect is produced (the shorter period of hospitalization, less duration of the main therapeutic regimen and lower frequency of relapses).