[Functional rehabilitation of a patient with central opacification of the intraocular lens optic (clinical case)]. / Funktsional'naya reabilitatsiya pri pomutneniyakh v tsentral'noi zone opticheskoi chasti intraokulyarnoi linzy (klinicheskoe nablyudenie).

The authors present a clinical case of central opacification of the intraocular lens (IOL) optic associated with a significant uncorrectable visual acuity decrease. Due to high surgical risks of IOL exchange, corectopia was achieved through sectoral laser photomydriasis. Stable dilation of the lower nasal sector of the pupil enabled the optical zone to be shifted outside the opaque area of the IOL. As shown by the perimetry results, the visual field borders enlarged through sectoral laser photomydriasis were comparable with the topography of the asymmetrically dilated pupil.

[Assessing retinal photosensitivity in patients with central vision impairment using a portable perimeter (a preliminary report)]. / Issledovanie svetochuvstvitel'nosti setchatki pri narushenii tsentral'nogo zreniia s pomoshch'iu portativnogo perimetra (predvaritel'noe soobshchenie).

INTRODUCTION: The problem of reliably performing perimetry in people with impaired central vision who are unable to keep the gaze on the fixation point during the examination is yet to be resolved. PURPOSE: To develop a perimetry method for patients with impaired central vision using a portative perimeter based on a virtual reality device (p-VRD). MATERIAL AND METHODS: The study included 16 eyes (19 patients) without central vision (maximum visual acuity was from lateral light projection to 20/400). Each eye was examined in 3 ways and 3 groups were organized: 1st (control) - automatic static perimeter; 2nd (control) - Goldmann kinetic perimeter; 3-rd (experimental) - portable automatic static perimeter based on a virtual reality device (p-VRD). Patients of the experimental group used their sense of deep proprioception to keep the gaze on the screen center: putting p-VRD on, they were asked to lift a finger opposite their face on the eye level so that their line of sight went through the centre of the device's screen. RESULTS: Perimetry results in the 1st group were found to be unreliable due to frequent fixation loss. The contours of central scotoma could be determined in perimetry results of the 2nd and 3rd groups while achieving good comparability between the two respective methods (conformity coefficient K=73.7%). CONCLUSION: It is possible to assess light sensitivity of the eyes without central vision by performing perimetry with p-VRD. Satisfactory gaze fixation on the central zone of p-VRD screen is possible thanks to the human's sense of deep proprioception - the nonvisual sense of the exact location of the limbs.

[Comparative characteristics of the chemical composition of vitreal contents of cadaver eyes and eyes with terminal refractory glaucoma]. / Sravnitel'naia kharakteristika khimicheskogo sostava vitreal'nogo soderzhimogo kadavernykh glaz i glaz s refrakternoi terminal'noi glaukomoi.

PURPOSE: To compare the chemical elemental composition of vitreous cavity content taken from cadaveric eyes compared to samples taken from the eyes with terminal stage refractory glaucoma with decompensated intraocular pressure (IOP). MATERIAL AND METHODS: The vitreous contents of the eyes from 2 groups were studied. The 1st group included 15 cadaveric eyes; the 2nd group included 15 eyes with refractory glaucoma in the terminal stage of the disease with decompensated IOP in patients with hypertension pain. The vitreal content samples were taken in the course of antiglaucoma surgery aimed at preserving the eye as an organ and involving employment of drainage in the vitreous cavity. The study of virtual contents was carried out on energy dispersive spectrometer Oxford X-Max 50 integrated into scanning electron microscope Zeiss EVO LS10. RESULTS: Increased concentrations of Kalium and Phosphorus were detected in the vitreous content of cadaveric eyes compared with the vitreal content from the eyes with terminal glaucoma with decompensated IOP taken in vivo (K - 0.172/0.093; P - 0.045/0.025 mmol/L). In the vitreous cavity in the eyes with end-stage glaucoma with decompensated IOP, the concentration of Nitrogen was higher in comparison with human cadaver eyes (2.030/1.424 mmol/L). CONCLUSION: The increased concentrations of Kalium and Phosphorus in the vitreous content of cadaveric eyes is associated with postmortem autolytic processes and with the release of intracellular content in the destruction of cell membranes. The increased Nitrogen concentration in the vitreal contents of the eyes with terminal stage glaucoma with decompensated IOP may be associated with the presence of osmotically active nitrogen-containing compounds in the eyes with increased IOP.

[Influence of chemical compositions of anterior chamber aqueous humour and blood serum on the secretion of intraocular fluid]. / Vliianie khimicheskogo sostava vlagi perednei kamery glaza i syvorotki krovi na sekretsiiu vnutriglaznoi zhidkosti.

PURPOSE: to identify the standard chemical composition of anterior chamber aqueous humour (AH) using energy dispersive spectrometer (EDS) integrated in scanning electron microscope (SEM); to study the influence of concentration gradient of chemical elements between aqueous humor and blood serum (BS) on the secretion of intraocular fluid (IOF) at normal and increased intraocular pressure (IOP). MATERIAL AND METHODS: The study involved two groups of patients consisting of 33 people (33 eyes) each. The 1st group included patients with cataract and normal IOP (control), the 2nd group included patients with POAG and decompensated IOP. The samples (AH and BS) were taken during surgeries and studied using Oxford X-Max50 EDS integrated in EVO LS10 SEM. RESULTS: The concentration ratios (mmol/l) of AH/BS for Na at normal IOP was 1.472/1.278, for K - 0.106/0.035. In cases with POAG with decompensated IOP, the concentration ratio of Na was 1.424/1.248, K - 0.114/0.036. The concentration ratio of N between AH in cases with decompensated IOP and AH of normotonic eyes was 1.151/0.960, for S - 0.020/0.012. CONCLUSION: Consistent excess of Na and K concentrations in AH compared to BS indicates active participation of these osmotically active elements in the normal process of intraocular fluid secretion. The absence of significant differences in the ratios of Na and K in AH and BS at normal and decompensated IOP indicates low significance of these elements for pathological hypersecretion of intraocular fluid. Increased concentration of N in AH eyes with decompensated IOP compared with AH at normal IOP indicates possible involvement of nitrogen-containing osmotically active substances in the abnormal hypersecretion of intraocular fluid.

[New visual field testing possibilities (a preliminary report)]. / Novye vozmozhnosti issledovaniia polia zreniia (predvaritel'noe soobshchenie).

There are currently no portable mobile perimeters that allow visual field testing outside ophthalmologist's examination rooms. PURPOSE: To develop a mobile perimetry technique based on use of a virtual reality headset (VR). MATERIAL AND METHODS: The study involved 26 patients (30 eyes) with II-III stage primary open-angle glaucoma (POAG) with compensated IOP. Perimetry was performed for each patient twice - on Humphrey analyzer (test 30-2, 76 points) and employing similar strategy on a perimeter integrated into VR headset (Total Vision, Russia). Visual field testing was performed with an interval from 1 hour to 3 days. The results were comparatively analyzed. RESULTS AND CONCLUSION: Patients tolerated the examination well. Comparative analysis of preliminary perimetry results obtained with both methods showed high degree of identity, so the results were concluded to be comparable. By visually isolating the wearer, VR headset achieves elimination of distractions and stable light conditions for visual field testing. The headset-perimeter is compact, mobile, easily transportable, can be used in the work of visiting medical teams and for examination at home.

[Elemental composition of aqueous humour and blood serum at various levels of intraocular pressure]. / Elementnyi sostav vlagi perednei kamery i syvorotki krovi pri razlichnom urovne vnutriglaznogo davleniya.

AIM: To conduct a comparative study of element concentrations in the aqueous humour of human eye and blood serum at various levels of intraocular pressure (IOP). MATERIAL AND METHODS: The chemical composition of biological fluids was studied in two equal groups (33 patients/33 eyes each): group 1 - primary open-angle glaucoma (POAG) with decompensated IOP and group 2 - normal IOP (the controls). Sampling of the aqueous humour and blood was done during surgical procedures, namely, penetrating glaucoma surgery (group 1) and cataract phacoemulsification (group 2). Blood was taken from the cubital vein and centrifuged to obtain the supernatant for further analysis. The samples were studied with Zeiss EVO LS10 scanning electron microscope (SEM) equipped with Oxford X-Max50 energy dispersive spectrometer. RESULTS: In both groups, regardless of the IOP level, Na and K concentrations were found to be constantly higher in the aqueous humour than the blood serum. The ratio of Na concentrations in the aqueous humour and serum (measured in mmol/l) was 1.51/1.30 at normal IOP and 1.49/1.31 at decompensated IOP. The ratio of K concentrations was 0.11/0.03 and 0.12/0.03, respectively. Concentrations of N and S in the aqueous humour were higher in the group with decompensated IOP. CONCLUSION: Regardless of the IOP level, Na and K concentrations were found to be constantly higher in the aqueous humour than the blood serum. IOP elevation was accompanied by an increase in N and S concentrations in the aqueous humour.

[Transciliary vitreous drainage as a treatment method for hypertensive pain syndrome in terminal glaucoma].

OBJECTIVE: To develop a surgical technique based on transciliary vitreous drainage and aimed at pain elimination in refractory glaucoma. MATERIAL AND METHODS: A total of 33 eyes with terminal painful glaucoma were assessed and surgically treated. RESULTS: A drain opening was made under the superficial scleral flap in the site of pars plana projection and was further used for local vitrectomy in the form of a wide well directed to the posterior pole of the eye. In 51.5% of cases normal ocular pressure was achieved without antihypertensive drops. In the rest of cases there was a tendency for ocular hypertension and therapeutic regimen was required. Pain relief after the surgery was achieved in all eyes. CONCLUSION: Vitreous drainage is an effective technique for pain elimination in terminal-stage refractory glaucoma. The presumable mechanism of action involves creating an opportunity for easy evacuation of osmotically active substances (urea in the first place) along with the humour from the vitreous cavity. The operation enables direct draining of the vitreous cavity regardless of organic changes in the anterior chamber that impede the outflow.

[On a connection of early manifestations of angle closure glaucoma and development of posterior vitreous detachment].

In author's opinion development of posterior vitreous detachment (PVD) is an involutional factor which participates in pathogenesis of primary angle closure glaucoma (PACG) in predisposed eyes. Initial increase of intraocular pressure in the eyes with narrow anterior chamber angle and predisposition to PACG is closely connected with the moment of PVD development, which can be detected with ultrasonography. The author supposes that ultrasonic examination of the posterior globe to detect PVD can be used as one of monitoring method in patients predisposed to PACG.

[Vitreous cavity drainage in absolute painful glaucoma (clinical case)].

A case of transciliary vitreous drainage with simultaneous local vitrectomy as surgical treatment for hypertensive pain syndrome (HPS) in absolute glaucoma is described and analyzed. The patient presented with severe eye pain, high intraocular pressure, corneal edema, and hyphema. During surgery a drain opening was made under the superficial scleral flap in the site of pars plana projection. This opening was further used for local vitrectomy with removal of a truncated cone-shaped fragment of the vitreous. The apex of the cone was located at the drain opening and its base (10 mm in diameter) was directed at the posterior pole of the eye. The authors consider the retrohyaloid space, which is always present in eyes with absolute glaucoma, as an enabling factor for such drainage. A surgical revision of the drain opening was performed due to its obstruction in the postoperative period. After the revision a durable pain relief was achieved. Vitreous drainage, in authors' opinion, is of good potential in refractory glaucoma treatment.

[Chemical composition features of vitreous in terminal glaucoma and hypertensive pain syndrome].

In patients with terminal glaucoma and hypertensive pain syndrome urea concentration in vitreous was 3,8-46,8 mmol/l and creatinine concentration was 0,036 - 0,126 mmol/l. Obtained values are comparable with those in blood serum and correlate with intensity of pain in damaged eye. Pain origin was found to be associated with elevation of urea concentration in vitreous compared with that in blood. It is proposed that urea accumulation in vitreous is one of significant factors of ocular pressure elevation in terminal glaucoma.

[Pathogenesis of hypertensive pain syndrome].

Comparative analysis of urea concentration in vitreous, vitreal fluid cavities and blood serum in patients with terminal painful glaucoma is performed based on laboratory data. Author proposes that pathogenesis of pain is related to "negative gradient of urea concentration", when urea concentration is higher in vitreous compared with blood serum. In the walls of ciliary processes where pain receptors are localized osmotic force causes tension provoking pain.

[Characteristics of the vitreous body in terminal glaucoma].

Two-dimensional echographic study was conducted in 54 patients (54 eyes) with terminal glaucoma. Posterior vitreous detachment was found in all the study eyes. Kinetic echographic testing revealed a uniform instantaneous displacement of structures in the vitreal cavity, which indirectly indicates the evenness of pressure distribution in the fluid media of the posterior eye segment in terminal glaucoma.

[Vitreous space drainage in hypertensive pain syndrome on the eyes with terminal glaucoma].

For organ preservation, an operation involving drainage of the posterior part of the vitreous cavity was performed on 16 eyes with terminal glaucoma in the presence of hypertension pain syndrome. Hypertensive effect with permanent relief of the pain syndrome persisted during 12-month follow-up. The findings support the viewpoint of liquid accumulation in the retrovitreous space in terminal glaucoma, which may be one of the factors leading to the formation of a cyclovitreolenticular block, with a subsequent malignant rise in intraocular pressure.

[Trabeculotomy ab interno combined with extracapsular cataract extraction and IOL implantation]. / Trabekulotomiia ab interno v kombinatsii s odnomomentnoi ékstraktsiei katarakty.

We made a total of 96 surgeries of extracapsular cataract extraction and IOL implantation combined with trabeculotomy ab interno during a period of 7 years. Patients with both open-angle and narrow-angle glaucoma of stages I and II and with the intraocular pressure (IOP) below or equal to 23 mm Hg according to Goldman under the conditions of hypotensive medicamental regimen were selected for surgery. After IOL was implanted into the lens bag, trabeculotomy ab interno was implemented as stage 2. A special mirror, introduced through the cataract incision, was used for direct gonioscopic monitoring. The trabecula was incised by the edge of a curved surgical knife under direct visual control. We regarded bleeding from the opened sinus as a favorable sign indicative of that the intrascleral collectors were intact. Only minor hyphemas were registered as postoperative complications; there was not a single case of ciliary-and-choroidal detachment. IOP was compensated for, in 6 months after surgery, in 94% of patients--69.8% of them did not use any hypotensive drops.

[An accessible system of creating a database of photo- and video information in ophthalmology]. / Dostupnaia sistema sozdaniia banka tsifrovoi foto- i videoinformatsii v oftal'mologii.

A system was set up to store images in the digital format; such system is a structural teleconference unit with comprehensive research, practical and educational performance capabilities, which is promising in sense of promoting the telemedicine in ophthalmology and which is accessible to broad circles of practitioners. The system, little dependable on a computer power, is assembled on the basis of "Pentium 1 (MMX)". The obtained digital image with a resolution of 600 x 800 dots is sufficient for a qualitative photo-documentation.

[Some aspects of endocapsular microsurgery in extracapsular cataract extraction]. / Nekotorye aspekty éndokapsuliarnoi mikrkhirurgii pri ékstrakapsuliarnoi ekstraktsii katarakty.

Discusses the advantages of preparing the lens sac like an envelope for extracapsular cataract extraction with implantation of intraocular lens into the lens sac. Aspiration-irrigation evacuation of the lenticular mass from the equatorial zone of the lens sac is the cardinal moment in endocapsular microsurgery. The authors recommend a common glass syringe with a modified piston for evacuating the lenticular mass. The parameters of the piston groove for the tightening silicon ring pad are changed, which appreciably improves the aspiration characteristics of the syringe and permits effectively and rapidly clear the lens sac "envelope" using just 5-10 ml of irrigation solution.

[Possibilities of intracapsular implantation of intraocular lenses in eye injuries]. / Vozmozhnosti éndokapsuliarnoi implantatsii intraokuliarnykh linz pri travmakh glaza.

The authors analyze the results of 63 surgeries for implantation of intraocular lenses, V. N. Alexeyev's design, in patients with traumatic cataracts and other injuries after perforating and contusion injuries. The results evidence a high efficacy of intracapsular implantation. Vision acuity with correction has improved in 36 eyes to make up 0.5 and more diopters. In the rest cases (27 eyes) vision acuity with correction has made up 0.1-0.4. The implantation was simple and the course of the postoperative period smooth in the patients with membranous and semiresolved cataracts, with primary and secondary glaucoma, and implantation into the posterior chamber.