No 36 (2015)

Background: Removal of the native lens alters spatial relationships between anterior eyeball structures and results in fluctuations in intraocular pressure. Intraocular pressure control is important for the prevention of early postoperative complications. 

Aim: To study anatomic, topographic and hydrodynamic changes of the eyeball after uncomplicated cataract phacoemulsification with intraocular lens implantation. 

Materials and methods: 75  eyes of 75  patients after uncomplicated cataract phacoemulsification were studied. All patients underwent ultrasound biomicroscopy, electronic tonography and biomechanics study on ocular response analyzer (before the surgery, in 2  weeks, 1 and 3  months after the surgery). 

Results: We found significant increase in anterior chamber depth, distance trabecula-iris at 500  microns from the scleral spur, anterior chamber angle, angle between sclera and iris and angle between sclera and ciliary processes.

Preoperatively, intraocular pressure was 15.67  ± 0.85  mm Hg, in 2  weeks  – 13.22 ± 0.53  mm Hg, after 1  month  – 13.21 ± 0.55  mm Hg, after 3  months  – 12.42  ± 0.46  mm Hg. Cornealcompensated pressure before surgery was 15.91 ± 0.69 mm Hg, it increased from the first day after surgery, reached maximum  19.37 ± 1.52  mm Hg after 2  weeks and returned to preoperative values at 1  month; in 3  months, corneal-compensated pressure decreased to 14.4  ± 0.70 mm Hg. Goldmann intraocular pressure changes were similar with corneal-compensated intraocular pressure. Mean preoperative aqueous outflow easiness coefficient was 0.15 mmі/min/mm Hg, increased after 2  weeks to 0.24  mmі/min/mm Hg and stayed unchanged in 1 and 3 months after surgery (0.22 mmі/min/mm Hg).

Conclusion: Changes of anatomy and topography of anterior part of the eyeball after cataract phacoemulsification lead to decrease of intraocular pressure by 1.5–2  mm Hg in 3  months after the surgery compared to preoperative values. Further studies of the relation between eyeball anatomy and intraocular pressure are needed.

Background: In the modern world, diabetes mellitus is a disease that is growing in epidemic proportions. Numbers of women of childbearing age with this disease are also increasing. 

Aim: To develop a dose-defining algorithm for laser photocoagulation treatment of diabetic retinopathy and diabetic macular edema in pregnant women ensuring optimal efficacy and sustained effects. 

Materials and methods: 12 pregnant women with type I diabetes decompensation before and during pregnancy (НbА1с > 8 %, group 1), 10 women with compensated type I diabetes before and during pregnancy (НbА1с 4.5–6%, group 2), 10 women with type I diabetes decompensation before pregnancy and compensation of diabetesachieved during the 1^st  trimester (НbА1c  6.5%, group 3) were enrolled. In all patients, routine  ophthalmological examination and optical coherent tomography were performed. 

Results: 39 eyes were treated with laser photocoagulation of the retina including 3 panretinal,  16 focal and 20 grid laser procedures. In the group 1, stabilization of the funduscopic picture was observed during the 3 trimester and in the longtermafter the laser treatment. During the 3rd  trimester, additional laser procedure was required in 4 eyes (16%) in the group 1 and in 2 eyes (10%) in the group 2.

Conclusion: Laser photocoagulation results in significant improvement of visual acuity. Visual function changes are dependent from diabetes compensation status, presence of macular edema and volume of the procedure.

Aim: To study the effectiveness of several surgical methods in patients with pseudoexfoliation glaucoma (PEG); to assess frequency of early postoperative complications.

Materials and methods: We analyzed hospital medical records of 554 patients with verified diagnosis of PEG; the patients underwent surgical treatment in the State-Financed Health Institution of the Tyumen Region “Regional Clinical Hospital No. 1”.

Results: The majority of patients were > 70 years old (mean age was 67.5 ± 21.5 years old). Types of surgical treatment were as follows: sinus trabeculectomy (STE) with posterior scleral trepanation in 73.1% of the cases (n = 405), non-penetrating deep sclerectomy (NPDS) – in 23.8% (n = 132); STE + posterior scleral trepanation and use of silicone drainage Repegel-1 (STE + drainage) – in 3.1% (n = 17). After primary STE, postoperative complications were found in 20% (n = 31) of the patients; after repeated STE – in 76.8% (n = 119); after STE + drainage – in 3.2% (n = 5). Early postoperative complications of STE were diagnosed in 28% (n = 155) of the patients including hyphema in 45% (n = 70) of cases, postoperative hypertension in 31% (n = 48), absence of filtering bleb in 20% (n = 31) and others in 4% (n = 6) of cases. After repeated STE, early postoperative hypertension

was found only in patients with hyphema (in 99.2% (n = 118) of cases, p < 0,05).

Сonclusion: Analysis of the results of several surgical methods of treatment for pseudoexfoliation glaucoma demonstrated inefficiency of NPDS; on the contrary, STE and STE + drainage are regarded as methods of choice. Concomitant cardiovascular diseases contribute to the progression of PEG and increase the risk of early postoperative complications.

Background: The results of implantation of refractive intraocular lenses (IOL), especially with an inferior segmental near add are of great interest due to advantages of the new lenses over more frequently used diffractive multifocal IOL. 

Aim: To assess the ocular optical performance of eyes implanted with a new IOL Lentis Mplus. 

Materials and methods: 78 patients (100 eyes) aged > 50 years were implanted with 100 IOLs Lentis Mplus. Preoperative examination included measuring uncorrected and corrected distance visual acuity, uncorrected and corrected near visual acuity. Postoperatively, uncorrected and corrected distance visual acuity, uncorrected and corrected near visual acuity (distance 33 cm) were estimated along with intermediate vision measurement using near-vision charts (60 cm). 

Results: On the day 3 after the procedure, distance visual acuity was good, and patients were able to near-reading of medium-size fonts. In 1 year, uncorrected visual acuity was 0.8–1.0 in two thirds of patients. 25% of patients needed distance visual correction from (-)0.5 to (-)0.75 D. Corrected visual acuity improved to 0.9–1.0. In 1 year, near visual acuity was 0.5 or more and intermediate visual acuity was 0.4 or more in all patients. In 78% of patients, 60 cm visual acuity was 0.5. 

Conclusion: Implantation of multifocal IOL Lentis Mplus produced good distance visual acuity and satisfactory (working) near and intermediate visual performance.

Background: Glaucoma-induced visual impairment negatively influences quality of life of oncologic patients. Yet, tumor in itself and methods of its treatment may promote glaucoma progression. 

Aim: To study characteristics and course of primary open-angle glaucoma in oncologic patients. 

Materials and methods: We analyzed case reports of 19 oncologic patients after primary open-angle glaucoma-related sinus trabeculectomy (34 eyes) and laser cyclopexy (1 eye). Diagnosed malignancies included colorectal cancer in 5 patients, uterine body and cervical cancer in 4 patients, chronic lymphocytic leukemia in 1 patient, renal cell carcinoma in 1 patient, adrenal cancer in 1 patient, prostatic cancer in 1 patient, breast cancer in 1 patient, vulvar cancer in 1 patient, tongue root cancer in 1 patient. Antiglaucomatous surgery was accomplished during the first 5 years from the diagnosis of tumor in 14 patients. In 9 patients, chemotherapy or hormone therapy was continued by the time of surgery. Follow-up of the patients was undertaken in 4–12 months after the antiglaucomatous operation; it included routine ophthalmological examination and dry eye syndrome functional tests. 

Results: Duration of postoperative period was 4 months or more. All patients had uveitis postoperatively. During late postoperative period, choroidal detachment was diagnosed in 4 patients. Bleb scarring was found in 2 patients. All patients received hypotensive treatment postoperatively including selective and non-selective beta-adrenergic blockers. Conjunctival and corneal xerosis was observed in all patients. 

Conclusion: In oncologic patients undergoing antiglaucomatous surgery, long-term (4 months or more) postoperative anti-inflammatory therapy is needed along with monthly ophthalmological follow-up during the first year after the operation. In patients with ongoing cytostatic drug treatment, artificial tear should be administrated.

Background: Multiple sclerosis is regarded as the most frequent cause of neurological disability. Visual disturbances are common and may be due to pathology of retina, optic nerve and cerebral conduction tracts (optic tract). Routine methods of assessment of visual function are insufficient in diagnosing some visual problems including color vision disturbances. Aim: To assess color vision in patients with multiple sclerosis. 

Materials and methods: We examined 110 patients (age > 18 years old) with previously diagnosed multiple sclerosis. Neurological status was assessed using functional scales; results of neuroimaging, medical records and history were taken into account. Color vision was examined using Farnsworth dichotomous test. Control group included 20 healthy volunteers (8 men, 12 women, mean age 29.1 ± 1.4 years old). 

Results: In patients with multiple sclerosis, color vision defects were significantly more prevalent compared to the control group (89.1% vs. 65%, p < 0.05). Deuteranopia was found in 18.6% of patients with multiple sclerosis, protanopia in 17.3%, tritanopia in 7.3% of patients. Significant color vision defects positively correlated with disability level of the Expanded Disability Status Scale (EDSS) and were independent of disease duration and history of retrobulbar neuritis. 

Conclusion: In patients with multiple sclerosis, color vision defects were associated with the activity of pathological process. Severity of neurological disability level estimated by EDSS positively correlated with visual disturbances. Thus, Farnsworth dichotomous test may be recommended for dynamic monitoring of multiple sclerosis.

Aim: To analyze etiological structure of inflammatory diseases of ocular surface. 

Materials and methods: The study included outpatients (n = 49) who referred to Ophthalmological office at the Herpetic center during the period 2012 to 2014. Complaints duration was 60.65 ± 12.28 days. All patients underwent routine ophthalmologic examination; tear and/or conjunctival scraping PCR for type 1 and 2 herpes simplex viruses, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, type 6 human herpesvirus, adenoviruses, enteroviruses, ureaplasma, chlamydia; conjunctival swab microbiology; eyelash microscopy for eyelash mites. 

Results: After the examination, all patients were divided into three groups: 1) with herpesvirus infections of the eye (n = 24), 2) with non-herpetic infection of the eye (enterovirus, adenovirus, bacteria, fungi, n = 18), 3) with ocular surface lesions due to non-infectious causes (n = 7). In three cases U. urealyticum was detected, doxycycline was administrated. Identification of pathogens in the groups 1 and 2 resulted in effective causal treatment with subsequent clinical recovery. Exclusion of infection in the third group allowed to avoid inappropriate antibacterial or antiviral therapy. 

Conclusion: In patients with chronic red eye syndrome of unknown etiology, laboratory examination of tear and/or conjunctival scraping is essential for differentiating between infectious and non-infectious disease.

Background: Floppy eyelid syndrome is a rare disorder characterized by tarsal atonia, common spontaneous eversion of the upper eyelids in conjunction with chronic papillary conjunctivitis. Floppy eyelid syndrome is a frequent cause of recurrent keratitis of different severity up to corneal ulceration. 

Aim: To assess tear production, tear film and status of cornea in patients with floppy eyelid syndrome. Materials and methods: We examined 8 women aged 47–81 years (median 59 years) with clinical signs of floppy eyelid syndrome. For functional assessment, Schirmer and Norn tests were used. 

Results: All patients had dry eye syndrome due to increased evaporation and fluid loss from the ocular surface in combination with meibomian gland dysfunction. In all cases, keratitis of varied severity was diagnosed: pitted corneal erosions in 7 patients, severe keratitis on 1 patient. In this patient, untimely diagnosis of floppy eyelid syndrome and inadequate treatment resulted in the development of purulent corneal ulcer, endophthalmitis and subsequent eye enucleation. In all patients, medical treatment involved artificial tear, night gauze bandage and therapeutic eye gels. 

Conclusion: In patients with floppy eye syndrome, early diagnosis and timely treatment may prevent the development of corneal ulcer.

We report three cases of ‘blow-up’ orbital fractures before and after the surgery. Differential diagnosis of consequences and complications of orbital fractures as well as detection of oculomotor muscles damage are discussed. Restoration of function of oculomotor muscles was monitored after the surgery. To detect the causes of restricted motion of eye bulb and diplopia, coordimetry was used. Coordimetric method was useful in determining nature and localization of oculomotor muscles damage. Repeated coordimetry allowed monitoring of restoration of oculomotor muscles function during treatment and rehabilitation periods in patients with consequences and complications of mid-facial trauma.

Background: In the past decade, significant increase of pediatric morbidity was detected. Frequency of varied functional disorders tends to increase during school years. One in three school leavers has myopia and impaired posture; one in four has cardiovascular disorder. 

Materials and methods: We examined adolescents at the age of 14, in 5 schools inTyumen city in the period October – November 2012. Patients were examined by multidisciplinary team (ophthalmologist, neurologist, endocrinologist, dentist, pediatrician), functional methods were also used. 

Results: Of 184 adolescents enrolled, 83 were boys. General examination demonstrated no changes. Functional methods showed sex-associated distribution of refraction disorders: mild and moderate myopia predominated among girls, frequency of spasm of accomodation was significantly higher in boys. Children were divided into two groups: the first group included adolescents without vision disorders (n = 115), the second group involved those who had verified spasm of accomodation or myopia (n = 66). Abnormal abdominal ultrasound data (minor dysembryogenesis anomalies – folded gallbladder) were found in 22.6% of patients in the group 1 and in 50% of patients in the group 2. Endocrine disorders were also more prevalent in the group 2 (40.9% vs. 32% in the group 1). They included underweight (24.3% vs. 20% in the groups 2 and 1, respectively), overweight (in 13.6% vs. 7.6%, respectively). Overweight and underweight predominated in adolescents with myopia. 

Conclusion: Myopia develops earlier in girls, boys are in the risk group of myopia development. There have to be the constant control for somatic health of adolescents regardless of refraction.

Background: There are inconsistent data on the changes of functional performance in subcortical structures of visual system caused by early binocular vision impairment.

Aim: To study neuronal functional activity of the dorsal lateral geniculate nucleus (LGNd) in monocularly deprived cats and strabismic cats.

Materials and methods: 4 cats with monocular convergent strabismus, 7 cats with monocular divergent strabismus, 3 monocularly deprived cats and 4 intact cats were studied. Histochemical method was used to detect cytochrome oxidase – the mitochondrial enzyme of respiratory chain correlating with neuronal functional activity. Optical density in ocular-specific layers A and A1 was measured on the images of stained LGNd sections, and the contrast was calculated.

Results: Relative reduction of functional activity in the layers innervated from deprived and squinted eyes was demonstrated in LGNd bilaterally. In strabismic animals, the changes were observed only in the projection of the central part of the visual field, whereas in monocularly deprived animals the changes were in the projection of the whole visual field.

Conclusion: These findings indicate differences between the mechanisms determining the development of strabismic and deprivation amblyopia. Thus, in amblyopia, preservation of peripheral stereoscopic vision is possible.