[Photorefractive surgery in non-standard clinical situations].

The article discusses options for correction of residual ametropia after previous refractive surgeries (radial keratotomy, corneal transplantation) and treatment of corneal opacification resulting from excimer laser surgeries.

[The effect produced by vacuum compression created by micro-keratome in keratomileusis procedure on the condition of the retina]. / K voprosu o vliianii vakuumnoi kompressii, sozdavaemoi mikrokeratomom pri provedenii protsedury keratomileza, na sostoianie setchatki..

Described are the results of a clinical experiment involving 15 patients (30 eyes) with myopia ranging from 3.25 to 14.0 diopters. Vacuum compression (application of the vacuum ring from the "Moria" microkeratotome) was preliminarily made on one or both eyes for 30 sec. Computer perimetry and fluorescence angiography of the retina were performed before and after the procedure with an interval of 24 hours. Laser keratomylosis was subsequently made in all patients. According to fluorescence angiography, there were no differences before and after vacuum fixation. According to computer perimetry, the number of relative scotomas was higher, in 20% of cases, in high myopia after the procedure than before it; however this number was within the mean parameters.

[Accommodation in the implantation of phakic intraocular lenses for the correction of high myopia]. / K voprosu o problemakh akkomodatsii pri implantatsii fakichnykh intraokuliarnykh linz dlia korrektsii miopii vysokoi stepeni.

Implantations of 67 phacic intraocular lenses (IOL) in myopia ranging from 8 to 17 d were analyzed. The postoperative refraction was -0.97 +/- 0.45 d. The accommodation response, as a sharp reaction, and accommodation tracing were investigated in all patients. The "Nidek" AA2000 lens accommodograph was made use of. An inhibition and a higher threshold in the rapid accommodation response were registered in 86% of cases, tonic phase inhibition was found in 72% of cases and a limited maximal amplitude was noted in 45% of cases in accommodation tracing performed within examinations made 1 week after surgery. Inhibited accommodation response (86%), and stage-type relaxation in accommodation tracing (49%) were stated in examinations 3 weeks later. The implantation of phacic IOL for the correction of high myopia can bring about an accommodation dysfunction. The accommodation time of the "accommodation-IOL" system ranges from 1 to 3 months. Such adaptation is associated with an intensified accommodation reflex.

[Unified classification of conditions united by the notion of "diffusive lamellar keratitis (D.L.K.)" in the corneal refractive surgery]. / K voprosu o edinoi klassifikatsii sostoianii, ob"edinennykh poniatiem "diffuznyi lamelliarnyi keratit" (DLK, DLK), v refraktsionnoi khirurgii rogovitsy.

A total of 4810 laser keratomilase surgeries (LASIK) in myopia and hypermetropia were analyzed. The spherical equivalent of clinical refraction in myopia amounted to -6.56 +/- 1.34 diopters, in hypermetropia it amounted to +3.97 +/- 1.74 diopters. The refraction parameters in myopia ranged from 1.5 diopters to 12.0 diopters; in case of astigmatism they ranged from 0.5 diopters to 2.75 diopters, and in hypermetropia they varied from 1.5 to 6.25 diopters. The age of patients ranged from 18.5 to 52; there were 49.3% male patients and 50.7% female patients. The observation period was up to 2 years. The lamellar corneal incision was implemented by three types of microkeratomes: "Hansatome" (Germany), "Moria" (France) and "Nidek" (Japan). Photoablation was carried out by Keracor Techlas 217 (Germany) of the "flying dot" scanning type and by "Profil 500" (Russia). The primary DLK reaction of the dystrophic nature amounted, during the first year of using the method, to 1:75 cases, during the second year it was 1:350 cases. The share of secondary DLK manifestations ranged from 0.1 to 17% with regard for a type of complications. DLK can be characterized by various forms, phases and stages. The reaction can be primary (early) and secondary (delayed). Basically, it is a universal inflammatory response of keratocytes to a prolonged malfunction of lamellar flap due to disadaptation. It is described as a complication of the lamellar surgery as a whole and is, most probably, a response to the sutureless surgery. There are factors, which diminish the frequency of such complication. A new working classification of the DLK response is presented. A new clinical classification of DLK and DLK-like conditions in the corneal lamellar surgery is offered. Finally, notion "lamellar malfunction" is offered for a comprehensive usage in refraction surgery.

[Changes in the objective accommodation indices in myopia and the assessment of the results of accommodation training]. / Izmenenie ob''ektivnykh pokazatelei akkomodatsii pri miopii i otsenka rezul'tatov akkomodatsionnykh trenirovok.

Objective parameters of accommodation (amplitude, time of response, and stability) were evaluated in patients with myopia aged 7-22 years on an AA-2000 Nidek accommodographer. A decrease in accommodation response depended on age and degree of myopia. Rapid accommodation parameters were in high correlation with the relative accommodation reserve. Three groups of patients with different efficiency of accommodation training were distinguished: with positive effect (77.1%), no effect, and paradoxical effect.