Структура офтальмопатологии по данным НМИЦ «МНТК «Микрохирургия глаза» и развитие инновационных технологий

One of the main tasks of the children’s ophthalmological service in any region is to ensure the availability of high-tech medical care, however, personnel and technological shortages can negatively affect this indicator. Using the resources of a federal specialized clinic at the regional level can help resolve this issue. The goal is to reflect the participation of the federal specialized clinic in the work of the regional children’s ophthalmological service. Material and methods. The data used to assess the state of provision of ophthalmological care to children was taken from the electronic database of medical records of patients who received ophthalmological care at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from 2017 to 2023. Results. In 2005, a pediatric surgical department was organized at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. The work of the department’s ophthalmologists is primarily aimed at providing modern surgical treatment for children with various ophthalmological diseases. The leading scientific and practical direction is retinopathy of prematurity. To ensure optimal accessibility of specialized medical care, implementation of a system for early diagnosis and monitoring of the vision status of children, in the fall of 2020, a Children’s Ophthalmological Diagnostic Center (DOC) was opened within the structure of the Kaluga branch of the MNTK. The priority direction of the DOC is the introduction into clinical practice of innovative medical technologies aimed at early detection and formation of stages in the treatment of eye diseases in children and adolescents, and the determination of recommendations for preventive measures. From 2017 to 2023, the volume of ophthalmological care provided by the Kaluga branch of MNTK was within the range of 1,400–3,000 operations per year. Every year, ophthalmological care is provided directly to more than 1000 children at the Children’s Center. In total, over the entire period of operation of the center, conservative treatment was carried out in 3552 cases of amblyopia, myopia and other forms of ametropia, including severe forms. Using the new treatment method, 809 courses of treatment have been carried out at the Amblyokor complex since September 2020. During the work of the Center, 1908 orthokeratology lens sets were selected and issued. In addition to accepting patients living in the Kaluga region, we are actively accepting children from other regions. Conclusion. Thanks to the work of the branch of the MNTK «Eye Microsurgery» in the Kaluga region, the shortage of highly qualified medical personnel is compensated, the effective use of complex and unique diagnostic and treatment equipment is concentrated and implemented, the widespread introduction of progressive treatment methods into practice is ensured, the optimal route for patients is developed, taking into account the structure of medical organizations, participating in the implementation of the program of state guarantees of providing free assistance to the population. It should be noted that ophthalmological care for the children’s population through the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution is largely provided at the interregional level, affecting the territories of neighboring regions.

Purpose. To study the frequency and nosological structure of concomitant macular pathology in patients admitted for ophthalmic surgery. Material and methods. A study of the state of the macula was carried out in 337 eyes of 170 patients who underwent a diagnostic examination in the Khabarovsk Branch the S. Fyodorov Eye Microsurgery Federal State Institution in 2020. The patients' age was 58±15.2 years. The selection criterion was sufficient transparency of the optical media for viewing the macular zone. An in-depth examination of the macular zone was carried out using a forehead binocular reflex-free ophthalmoscope (Heine OMEGA500, Germany) and a non-contact lens (VOLK Double Aspheric 20D, USA), as well as optical coherence tomography (Cirrus HD-OCT 5000, «Carl Zeiss», Germany). The proportion of macular pathology among the patients who applied, the frequency and severity of its individual nosological forms were evaluated. Results. Various macular pathologies occurred in 28.2% of cases. Age-related macular degeneration (AMD) (47.9%) and epiretinal fibrosis (27.1%) accounted for a significant share in the structure of macular pathology. The frequency and structure of macular pathology in patients with age-related cataracts was analyzed. The incidence of macular pathology in them was 45.1%, of which AMD was detected in 65.2% of cases, epiretinal fibrosis – 7.8%. Conclusion. Among the group of patients selected by the method of continuous sampling with various ophthalmic surgical pathologies, 28.2% had various pathologies of the macular zone. The most common macular pathology occurred in the age group from 45 to 59 years old, accounting for 56.2% of cases. In the nosological structure of macular pathology, the share of AMD and epiretinal fibrosis prevailed. Key words: macular pathology, age-related macular degeneration, epiretinal fibrosis.

Objective : to analyze negative laboratory results of cadaver cornea donor screening during preparation of corneas for transplantation according to data from the internal registry of donors of the eye bank (EB) of the Fyodorov Eye Microsurgery Federal State Institution and the European Eye Bank Association (EEBA) from 2011 through 2015. Materials and methods . Data analysis was carried out using the internal registry of EB donors and the EEBA annual directories. The analyzed data included the number of eyeballs obtained, the frequency of incomplete tests (hemolysis for EB) and positive serological results for human immunodeficiency virus (HIV-1 and HIV-2), viral hepatitis B, viral hepatitis C and syphilis. Results . In just 5 years, the EB received 3,479 eyeballs. After hemolysis of donor blood samples, 13.9% (n = 486) of corneas were excluded from the EB. EEBA recorded fewer inconclusive tests during the same period. After hemolysis and positive serological tests, 19.4% (n = 676) of corneas were excluded from the EB. Overall, the number of positive serological tests in EBs was far higher than in the EEBA data. Frequency of positive HIV tests (HIV-1 and HIV-2) and syphilis in EB showed low variability annually, while incidence of hepatitis B increased in 2015. For the analyzed period, positive serology for hepatitis C was found to be prevalent among EB donors. Mixed infections were quite often recorded in blood samples. Conclusion . Based on analysis conducted, positive serology and hemolysis were the main contraindications and led to exclusion of 33.3% (n = 1162) of cadaver donor corneas received in EB. Frequency of positive serological tests for indicated infections in EB was higher than in the EEBA data, with significant predomination of hepatitis C.

Backgraund. Surgical treatment methods for active ROP generally achieve relatively good anatomical results, but visual function can be poor, especially in advanced stages, despite technological advances in vitreoretinal surgery. However, there are still no standards for the choice of methods and timing of ROP surgery depending on the stage and type of disease progression. Aim – to conduct a retrospective analysis of the results of vitreoretinal surgery in the active period of retinopathy of prematurity, followed by an assessment of the functional results in the cicatricial phase of the disease. Materials and methods. This study was conducted in two stages. The first stage consisted of a retrospective analysis of the results of vitreoretinal surgery performed at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution from 2012 to 2024 in 89 children (89 eyes) with ROP in the active phase of the disease. The second stage included an assessment of the functional outcomes in the same 89 children (89 eyes) in the cicatricial phase of ROP using standard ophthalmological examination data (visometry, refractometry, perimetry, tonometry, ophthalmoscopy, B-scan). Results. The retrospective study included a group of premature infants with a gestational age of 25-32 weeks and a birth weight of 700-1500 grams who underwent vitreoretinal surgery of varying extents depending on the severity of the pathological process. The most successful outcomes were observed in surgeries performed at stages 3 and 4a of active ROP, whereas the effectiveness of surgical treatment was significantly reduced at later stages (stages 4b and especially 5). Analysis of data from the cicatricial period of ROP revealed significant differences in functional outcomes depending on the stage of the disease and the type of surgical intervention performed. In children over four years of age, significant visual acuity deficits were observed, especially in the groups operated on at later stages of ROP (stages 4b and 5). Conclusions. The results of the study demonstrate that the final anatomical and functional outcome in each specific case depends on the surgical treatment method used during the active period of ROP to stabilize the pathological process, at what stage of the disease the treatment was carried out, the general condition of the child, the scope and timing of the surgical treatment, as well as the post-conceptual age at the time of its implementation.

Эндофтальмиты после катарактальной хирургии в Чебоксарском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

Purpose. Based on a comparative analysis of the results of using various laser methods of cataract treatment in the process of developing energy surgery in the St. Petersburg branch The S. Fyodorov Eye Microsurgery Federal State Institution, to determine the advantages and disadvantages of the technologies used. Material and methods. Analysis of the results of laser cataract extraction, ultrasonic phacoemulsification and combined surgery is based on data from a study of 28 802 surgical interventions (Phacoemulsification (Phaco) – 15 520, laser cataract extraction (LCE) – 7945, FemtoPhaco – 5135, FemtoLCE – 202) performed over the period 1995–2022. Results.The operative complication rate was 0.6, 0.55, 0.5 and 0% for Phaco, LCE, FemtoPhaco and FemtoLCE respectively. Visual acuity after LCE and FemtoLCE >0.8 was observed in more than 70% of cases, and in other groups such a functional result was achieved in 57% of cases. Comparing the postoperative spherical equivalent, a significant difference was noted only between the FemtoPhaco and standard Phaco (p=0.03), and between FemtoLCE and LCE groups (p=0.01), it indicates the advantage of femtolaser support for cataract surgery getting in target refraction. Analysis of endothelial cells loss reflects a significant advantage in groups with femtolaser support (p=0.01; p=0.02), as well as in the group of LCE and FemtoLCE over standard Phaco (p=0.01; p=0.02, respectively). Conclusion. Laser cataract extraction is an effective and safe technology that can be compared to ultrasonic phacoemulsification. The use of femtosecond laser assistance provides significantly lower deviation from the planned postoperative refraction. Modern laser technologies are safe and can reduce the risk of endothelial loss more effectively than standard Phaco. Key words: laser cataract extraction, femtosecond laser, femto laser assisted cataract surgery, cataract phacoemulsification, endothelial cell density

Purpose. To demonstrate the effectiveness of single-step phacoemulsification of cataracts and antiglaucoma surgery in conditions of weakness of the zonular apparatus. Methods. Patient N., 67 years old, came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) with complaints of decreased vision, increased intraocular pressure (IOP), and narrowing of the fields of view of the right eye. The diagnoses: OD Primary open-angle glaucoma 3v, Subluxation of the lens grade 1 OS Primary open-angle glaucoma 1a, OU Complicated cataract, Pseudoexfoliation syndrome. Carried out: autorefractokeratometry, visual acuity testing, computerized perimetry, biomicroscopy, gonioscopy, pneumotonometry, tonometry according to Maklakov, optical biometry. Considering the weakness of the lens zonules, the method of fixation of the intraocular lens (IOL) by optic capture technique was used. Results. Examination and evaluation one week post-operation: Visus 0.6 unc, IOP (pneumotonometry) 11 mmHg without hypotensive therapy; biomicroscopy: a calm eye with a well-expressed filtration bleb at the 12 o’clock position, well-adapted sutures, a transparent cornea of average depth, clear aqueous humor, moderate iris atrophy, round 3 mm pupil with pseudophakia at the pupil’s edge, IOL located in the capsular bag with haptics in the iridociliary groove, stable positioning. Fundus examination shows a pale optic nerve head, excavated with 0.8 cup-to-disc ratio, well-defined borders, narrowed vessels. Macular region appears normal. Conclusion. Combined cataract and glaucoma surgery in a patient with subluxated crystalline lens using the «optic capture» technique and Non-penetrating Glaucoma Surgery allowed preserving the correct and stable position of the IOL with normalization of intraocular pressure without the need for hypotensive therapy during a 1-year follow-up period. Key words: one-stage surgery, primary angle-closure glaucoma complicated by cataract, «optic capture»

Purpose: To assess the pattern of common eye diseases in the children visitingtertiary eye hospital Karachi.Material and Methods: A random cross sectional survey was conducted duringtwo weeks and data was recorded through a performa containing details of biodata, personal history, presenting complains, aided and un aided visual acuity,refractive error and signs of eye and adnexa and ocular alignment. Data wasanalyzed using SPSS 16.0.Results: A total of 250 patients were examined out of which male patients were52.8% and females constitutes 47.2%. Majority of patients 40.8% belonged tothe age group 1 – 6 years. VKC 24.8% was the most common ocular morbidityfound followed by squint 15.2%, refractive error 14.8%, NLD blockage 14.0%,congenital cataract 6.0%, amblyopia 4.4%, infective conjunctivitis 4.4%,blephritis 4.0%, convergence insufficiency 4.0% ptosis 2.4%, traumatic cataract2.0%, chalazion 1.6%, corneal opacity 1.6%, keratitis and stye each 0.4%.Conclusion: Vernal catarrh was the most common ocular morbidity encounteredin the study with male preponderance. Further studies are required to find outthe etiology and risk factors associated with it.Key Words: Common Eyes, Congenital Cataract, Keratitis

Purpose. Comparative assessment of frequency and structure of patients who underwent inpatient treatment for acute eye pathology before and during the coronavirus infection (COVID-19) pandemic. Material and methods. A quantitative analysis was carried out in 826 patients treated for various acute eye pathologies in the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (the Branch) for the time periods: from May 2018 to February 2020 (the first) and from March 2020 to the end of December 2021 (the second). An assessment of frequency and nosological forms of diseases was carried out, examples of most severe cases of diseases and injuries were given.Results. For the first period, 318 patients were treated, for the second period - 508 patients. In the second period, there was significant increase in number of patients with acute eye pathology by 1.6 times. In both periods, patients with inflammatory lesions of tuveal tract prevailed: before the pandemic - 179 eyes, during the pandemic - 243 eyes. Also in the second period, 29 cases of severe burns of the cornea - II and III degrees were registered. Conclusion. All patients who applied to the Branch during study periods and needed emergency ophthalmic care were provided in timely manner and in full. The COVID-19 pandemic has made significant adjustments to work of the entire Branch, including work of Complex Rehabilitation Treatment Department in form of increase in number of patients with acute eye pathology by 1.6 times.

Purpose. To analyze changes in work of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (the Khabarovsk branch) caused by combination of elective and emergency ophthalmic care in the context of a pandemic of the novel coronavirus disease (COVID-19). Material and methods. The article presents the organizational restructuring of activities medical units of the Khabarovsk branch, due to need for additional performance of functions emergency ophthalmological service in connection with closure of the regional ophthalmological center of City Clinical Hospital named after Professor A.M. Voyno-Yasenetsky, which previously performed this function. Complex of organizational anti-epidemic measures taken to prevent the spread of COVID-19 in pandemic is presented, their feasibility is analyzed, the results of the clinic's activities in new conditions of the COVID-19 pandemic are reflected. Results. The COVID-19 epidemic required a significant organizational restructuring of the Khabarovsk branch. In addition to large volumes of elective surgery, emergency ophthalmosurgical care was added, performed in a round-theclock hospital. All this was superimposed on the organizational restructuring of patient flows, created to minimize their interpersonal contacts. Conclusions. The Khabarovsk branch fully coped with the tasks set, stable work was organized in the new pandemic conditions, effectively combining planned and emergency algorithms of ophthalmic surgical care. The measures taken made it possible to provide emergency ophthalmic care in full throughout the entire period of the epidemic, to resume the provision of planned ophthalmic care in full, without compromising the safety of patients' stay in the clinic. Keywords: COVID-19; SARS-CoV-2, pandemic, emergency care, eye emergency department, Eye casualty, coronavirus disease, organization of medical care

Purposе. Тo present the stages of development of laser technologies for the treatment of active retinopathy of prematurity at the S. Fyodorov Eye Microsurgery Federal State Institution, the Kaluga Branch. Material and methods. Transpupillary laser photocoagulation of the retina was performed in 1546 children (2523 eyes) with active ROP from 2004 to 2021. Laser coagulation of the retina was carried out on various stationary laser ophthalmocoagulators acting in green and yellow spectra with a wavelength of 532 nm, 561 nm and 577 nm. Indications for laser treatment were the 2 nd and the 3 rd stage of the disease with an unfavorable course, the stage of early clinical manifestations, and the stage of manifestation of aggressive posterior ROP. Results. As the technology of retinal laser photocoagulation improved in patients with active ROP, the efficiency naturally increased and the duration of laser treatment decreased. Currently, the effectiveness of transpupillary laser coagulation of the retina using a hexagonal pattern has made it possible to achieve regression of the disease at the 2 nd stage with an unfavorable course in 100 % of cases, at the 3 rd stage with an unfavorable course type – in 97 %. The time for laser coagulation of the retina for the 2 nd stage was 6 ± 2 minutes, for the 3 rd stage it was 8 ± 3 minutes. Navigation assisted laser coagulation of the retina is the latest trend in laser treatment of active ROP. Conclusion. Permanent improvement of laser ophthalmocoagulators and the introduction of new methods of laser coagulation into clinical practice determine their continuous progress in achieving the maximum percentage of regression of active ROP with a minimum duration of the treatment session. Keywords: retinal laser photocoagulation, retinopathy of prematurity, ophthalmocoagulator.

Background. Primary open-angle glaucoma (POAG) is optic neuropathy, the etiology of which is associated with genetic and non-genetic factors. IL-10 and MMP2 SNPs are associated with POAG, but the nature of the association depends on the ethnic profile of the population. For the Russian Federation, whose population includes 190 nationalities, this issue is relevant.Aim. To perform a multicenter comparative analysis of the IL-10 and MMP2 SNPs as potential factors for predicting the development of POAG in patients in four regions of the Russian Federation: the Novosibirsk, Leningrad, and Orenburg Regions, and the Chuvash Republic.Materials and мethods. We examined 499 POAG patients from 4 branches of S. Fyodorov Eye Microsurgery Federal State Institution (main group), 530 people without visual pathology (control 1), and 100 patients with cataracts (control 2). Genotyping of IL10 (rs1800896 and rs1800872 SNPs) and MMP-2 (rs243865) was performed by real-time polymerase chain reaction (RT-PCR) according to the manufacturer’s instructions (Lytex and Syntol, Russia). The differences were considered statistically significant at the Bonferroni-corrected p < 0.05.Results. An increase in the incidence of IL-10-1082 A was revealed in POAG patients compared to patients with cataract and healthy individuals. An increase in the incidence of IL-10 AA in both regions and a decrease in the frequency of MMP2-1306 TT were found. Similar patterns were established for interlocus IL-10 and MMP2 genotypes. The group of patients in the Leningrad Region differed the most compared to other regions, which may be due to their long-term residence together with the indigenous Finno – Ugric peoples.Conclusion. The data obtained should be taken into account when developing additional criteria for predicting predisposition to POAG, which is important in case of POAG in the family history.

S. Fyodorov Eye Microsurgery Federal State Institution, Cheboksary Branch, Cheboksary

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Tactics of surgical treatment of a patient with non-penetrating corneal trauma after previous FemtoLASIK V.A. Breev, E.G. Solodkova, D.D. Sibakin S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd Branch, Volgograd, Russian Federation Purpose. To present the tactics of surgical treatment of the patient with non-penetrating corneal trauma after previously undergone FemtoLasik. Methods. The patient, operated by FemtoLASIK for middle degree myopia, had non-penetrating corneal trauma of the right eye. When applying to the Clinic of Volgograd branch he underwent corneal flap repositioning with removal of multiple corneal foreign bodies. Before and after the operation the patient underwent standard ophthalmologic examination. Results. According to the examination data, the uncorrected visual acuity of the right eye was reduced to 0.3 due to dislocation and linear defect of the corneal flap, multiple corneal foreign bodies, corneal opacity and mixed astigmatism. In 1 month after the surgical treatment there was noted restoration of transparency, correct position and integrity of the corneal flap, absence of corneal foreign bodies and increase of uncorrected visual acuity of the right eye up to 0.5. Conclusion. The correct sequence of surgical actions after trauma against the background of previously performed FemtolASIK provides qualitative corneal flap repositioning and restoration of visual functions. Key words: non-penetrating corneal trauma, corneal flap repositioning, FemtoLASIK For citation: Breev V.A., Solodkova E.G., Sibakin D.D. Tactics of surgical treatment of a patient with non-penetrating corneal trauma after previous FemtoLASIK.