[Mortality in patients with proximal femur fractures undergoing conservative and surgical treatment]. / Letal'nost' u patsientov s perelomami proksimal'nogo otdela bedrennoi kosti pri konservativnom i operativnom lechenii.

OBJECTIVE: To study the incidence of proximal femur fractures (PFF) in St. Petersburg and survival rate depending on treatment strategy. MATERIAL AND METHODS: Considering the data of long-term monitoring of traumatology and orthopedic service in St. Petersburg, we assessed the incidence of PFF in adults and various treatment options. Moreover, we have studied all patients admitted to 2 large hospitals in St. Petersburg between December 2017 and December 2018 for at least 14 months. There were 914 requests for medical care for PFF from 903 patients. RESULTS: Mean incidence of PFF in St. Petersburg is 0.88 per 1000. The discharged patients without surgical care make up 20%. About 37.5% and 42.4% of patients require hip arthroplasty or osteosynthesis, respectively. Postoperative mortality was 3.5%, in-hospital mortality after therapeutic management - 9.1% (p=0.016). Two-year mortality after osteosynthesis was 27.2%, after hip arthroplasty - 19.3%, after conservative treatment - 43.9% (p<0.001).

[Clinical significance of aberrations of the ocular optical system in glaucoma surgery and the capabilities of minimizing them]. / Klinicheskoe znachenie aberratsii opticheskoi sistemy glaza v khirurgii glaukomy i vozmozhnosti ikh minimizatsii.

INTRODUCTION: Despite the achievements of modern pharmacology and laser surgery, traditional glaucoma surgery remains the main method of reducing intraocular pressure (IOP). After successful glaucoma surgery, some of the patients are observed to have a decrease in visual functions not associated with progression of the glaucomatous process. This phenomenon is explained by the effect glaucoma surgery can have on eye refraction; detailed understanding of such changes would significantly speed up functional rehabilitation of these patients. PURPOSE: To study the time course of clinical manifestations of aberrations of the ocular optical system in the surgical treatment of glaucoma and to assess the effectiveness of the method used to minimize them. MATERIAL AND METHODS: The study included 32 patients (32 eyes), aged from 52 to 73 years. The patients were divided into 2 groups. Patients of the first group (20 eyes) were treated with standard non-penetrating deep sclerectomy (NPDS). In the second group (12 eyes), patients underwent a modified NPDS according to an original method proposed by us. All patients were examined before and monitored after the surgery including precision visometry and corneal topography. RESULTS: A significant change in the studied parameters was observed in the first group in the early postoperative period (3rd day) - the average value of corneal astigmatism increased from 0.83±0.12 D to 2.86±0.07 D, while in the second group it increased from 0.86±0.20 D to 1.36±0.12 D. CONCLUSION: Non-penetrating deep sclerectomy according to the modified method proposed by us helps achieve higher functional results in the early postoperative period due to the reduction of induced changes in eye refraction.

[Investigation of the impact of pterygium on ocular optic system aberration. Communication 1. Relationship of induced aberrations to the stage of pterygium].

The authors made a study in two areas: they investigated corneal aberrations in patients from different age groups in health; analyzed the corneal aberration pattern at different stages of pterygium in the matched age groups; and comparatively estimated values in pterygium and in health in the similar age groups. High-order aberrations (HOA) of the corneal were studied in 45 patients (84 eyes) aged 20 to 76 years. The corneal aberration pattern was analyzed in 44 patients (55 eyes) aged 25 to 74 years who had pterygium of different stages. The study covered patients with Stages II (24 eyes), III (n=20), and IV (n=11). The results of corneal HOA in health suggest that coma aberrations significantly increase with age while the rise of spherical aberrations is not decisive. Comparative analysis of aberrations in health and in pterygium of different stages showed that its stage II causes no significant changes in the corneal aberration pattern; the characteristic features of the latter in Stages III and IV pterygium are increases in trefoil and aberrations of the fourth and fifth orders: tetra- and pentafoil, secondary trefoil. The increase in the above parameters is proportional to the stage of pterygium. The comprehensive examination of patients with pterygium of different stages should comprise a study of corneal HOA, it is required for more detailed evaluation of disorders induced by the extent of pterygium, which in turn makes it possible to optimize the latter's removing technology.

[Investigation of the impact of pterygium on ocular optic system aberration. Communication 2. New approaches to reducing aberrations during surgical treatment for pterygium].

The authors made a detailed comparative analysis of the aberration pattern of the cornea as a result of surgical treatment for pterygium, by applying various technologies. Forty-four patients (55 eyes) with primary Stages II to IV pterygium were examined. According to the surgical techniques, the patients were divided into 2 groups: (1) those in whom pterygium was surgically removed, followed by abrasive microsurgery and plastic repair with an autoconjunctiva (29 eyes) (a control group); (2) those who had undergone surgical pterygium removal, abrasive microsurgery, and plastic repair with an autoconjunctiva, followed by phototherapeutic eximer laser keratoablation (26 eyes). The study has revealed that phototherapeutic eximer laser ablation of the cornea after surgical excision and abrasive treatment of the corneal bed in Stages II to IV pterygium causes a considerable reduction in the level of aberrations of higher orders. The expedience of phototherapeutic keratoablation as part of multimodality treatment for Stages III and IV pterygium, which has been shown by the aberration analysis, is only one of the first steps in evaluating the efficiency of this technology of surgical treatment for pterygium. Studies involving an integrated clinicofunctional and ophthalmoergonomic assessment of this treatment technology should be continued, which makes it possible to evaluate the clinical efficiency of this procedure and to define a place of the presented technology in the surgical treatment of pterygium.

[The possibilities for optimizing the surgical prevention of the progression of myopia]. / Vozmozhnosti optimizatsii khirurgicheskoi profilaktiki progressirovaniia blizorukosti.

Progressive myopia is a pressing problem of ophthalmology. Scleroplastic surgery is a pathogenetically validated method for treating this condition. The authors propose a new method for allotissue preservation, ensuring preservation of biological characteristics of tissues for any period without restriction, so that the material for transplantation were constantly available. A new shape of the graft is proposed: with a duplicature pouch and lateral incisions on one end, like a fur-tree. Such a design ensures a reliable position of the graft on scleral surface with an accent on the posterior pole and prevents pushing out of the graft from Tenon's space, which often occurs with common grafts. Transplants of a new shape were used in 2050 patients; the operation is easy to perform and its results are highly effective.

[Spectral filters as a method of therapeutic correction]. / Spektral'nye fil'try kak vid lechebnoi korrektsii.

Spectral filters were used for additional correction of vision in 67 patients: in 15 adults with initial cataracts (intensive yellow filter), 26 children with albinism (yellow-brown filter), 14 children with macular hypoplasia (orange filter), and 12 children with aphakia after removal of congenital cataracts (yellow filter). Selection of the filter density is carried out using a special method including visocontrastometry, examination of sensitivity to lateral light, and study of color perception thresholds. Use of filters resulted in improvement of the vision acuity by 43.5% in patients with initial cataracts, by 10% in those with albinism, by 20% in those with macular hypoplasia, and by 22% in those with aphakia; moreover, an improvement of the frequency-contrast characteristics was observed, as well as a reduction of photophobia, and a reduction of vision amplitude in patients with nystagmus. The possible applications of spectral correction are discussed.

[An instrument for ophthalmologic surgical measurements]. / Instrument dlia oftalmokhirurgicheskikh izmerenii.

Intensively improving the techniques of eye microsurgery presents higher requirements for the accuracy of intraoperative measurements of the eyeball and accessory ocular apparatus. A unit has been proposed for intraoperative ophthalmosurgical measurements, which will increase measurement accuracy up to 0.1 mm, which is beyond the reach of the conventional units.

[Improved modification of "Vitreotome" tip for intraocular surgeries]. / Usovershenstvovannaia modifikatsiia nakonechnika k apparatu dlia vnutriglaznykh operatsii "Vitreotom".

An improved designed of the tip of the ABO-I vitreotome manufactured at the Russian plants has been proposed. The modification consists in that the tip combines irrigation and aspiration systems, as well as the rate of irrigative solution infusion can be controlled. The clinical trials of the improved modification of the vitreotome tip have indicated that it is easy-to-use and minimizes surgical and hydraulic injuries to the ocular tunica and structures.