[Vitrectomy technique in aggressive posterior retinopathy of prematurity]. / Tekhnika vitrék-tomii pri zadnei agressivnoi retinopatii nedonoshennykh.

AIM: to develop the methodology of early primary vitrectomy for aggressive posterior retinopathy of prematurity. MATERIAL AND METHODS: The study included 10 preterm infants (20 eyes; gestational term - 26-30 weeks, post-conceptual age - 34-39 weeks) with severe forms of aggressive posterior retinopathy of prematurity (AP-ROP). All patients underwent a complex ophthalmic examination. Their results were compared with retrospective data of earlier treated AP-ROP patients (10 preterm infants, 20 eyes), in whom laser photocoagulation (LC) was done first (gestational period at the time of LC ranged from 26 to 30 weeks, post-conceptual age - from 34 to 39 weeks). In all cases, the disease progressed despite LC, thus, second-stage vitrectomy was required. Taking into account the similarity between clinical and morphometric data of the study group and retrospective patients, laser treatment was voted inexpedient as predictably inefficient and, therefore, a decision was made to perform vitreoretinal surgery. For that, an original technique of vitrectomy without preliminary LC was designed. Follow-up periods were up to 6 months. RESULTS: In all cases, AP-ROP regression to inactive stage was diagnosed 1 month after vitrectomy. According to digital retinoscopy findings, initial sings of blood vessel growth into the previously avascular retina appeared on day 20-26 after surgery. This was confirmed by the results of fluorescein angiography. In general, complete retinal reattachment was obtained in 16 eyes (80%), partial - in 3 eyes (15%). In 1 case, the retina failed to reattach (5%). CONCLUSION: The proposed method of primary vitrectomy enables optimization of the treatment approach to severe AP-ROP and can be regarded as promising.

[Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes]. / Metodika poetapnogo formirovaniya fragmenta vnutrennei pogranichnoi membrany v khirurgicheskom lechenii bol'shikh idiopaticheskikh makulyarnykh otverstii.

AIM: to develop a surgical procedure for large idiopathic macular holes (MH) that would involve creation of an original internal limiting membrane (ILM) flap to close the hole with. MATERIAL AND METHODS: Nineteen patients aged from 59 to 71 years with stage 3 idiopathic MH (by J. Gass) were enrolled. Besides standard ophthalmic examination, spectral optical coherence tomography and microperimetry were performed in all cases. The patients were followed up 2 weeks and then 1 and 3 months after surgery. Surgical procedure was notable for an original ILM flap created in a way that resembles removing petals from a flower. The new method implies that the ILM is peeled off all the way round the MH except for the foveolar area and one particular ILM fragment, which is only partially separated from the retina, from the periphery towards the MH, stopping at some 0.1-0.2 mm from its margin. This last fragment is then inverted to cover the MH. RESULTS: All surgeries were completed without complications. Visual acuity has gradually increased over the follow-up period in all patients: from 0.1-0.4 to 0.3-0.7 (0.39±0.15 on the average; Sivtsev-Golovin chart). Foveal anatomy has also improved: complete closure of the MH was achieved in 8 patients, partial - in 11. Moreover, all patients demonstrated a shift of the retinal fixation point towards the center of the fovea for 153-369 mm, at that, their fixation has stabilized and absolute central scotomas disappeared. CONCLUSION: The method developed is a promising treatment for large idiopathic macular holes. Further studies are required.

[Triggering factors and pathogenesis of radiation cataract].

Cataract is one of the most common eye diseases in the world. Many factors, including genetic, metabolic, nutritional, and environmental, are involved in its formation. It is necessary to know main causal agents and cellular mechanism of cataractogenesis. The tissue of the lens is considered radiosensitive, thus, lens opacities are possible late effects of exposure to ionizing radiation. The use of medical radiation for both diagnostic and therapeutic purposes grows worldwide. At the same time, there continues to be much confusion regarding the actual threshold dose of radiation exposure for cataract formation. Eye safety and the risk of cataract development are not entirely clear. However, with an ever-widening range of interventional procedures, one should take attempts to reduce the risk for radiation cataract.