[First experience of implantation of extended depth of focus intraocular lenses in patients with glaucoma]. / Pervyi opyt implantatsii intraokulyarnykh linz s uvelichennoi glubinoi fokusa u patsientov s glaukomoi.

PURPOSE: This study evaluates the effectiveness of implantation of extended depth of focus (EDOF) intraocular lenses (IOL) in patients with cataract and glaucoma. MATERIAL AND METHODS: The study included 13 patients (16 eyes) who underwent implantation of the Lentis Comfort EDOF IOL (Teleon Surgical BV, Netherlands). Standard phacoemulsification cataract surgery with IOL implantation was performed in a planned manner after the hypotensive surgery stage in two eyes; a combined procedure was performed in 14 cases. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), near visual acuity, and intraocular pressure (IOP) measured with a Maklakov tonometer were assessed preoperatively, on the first day, and 3-6 months after surgery. Computer perimetry using the 30-2 program and spatial contrast sensitivity (SCS) assessment were also performed preoperatively and at the same follow-up time points. RESULTS: On the first day after surgery, UCVA was 0.53±0.65, BCVA was 0.85±0.45. Near UCVA (at 40 cm) was 0.5±0.14 on the first day after surgery and 0.56±0.18 at 3-6 months. According to computer perimetry data, retinal light sensitivity values increased in all patients in the long-term (-3.1±2.9 dB). SCS values increased for objects of all sizes compared to preoperative values. CONCLUSION: Implantation of EDOF IOL contributes to improved vision without reducing contrast sensitivity and retinal light sensitivity in patients with concomitant cataract and glaucoma.

[Rehabilitation of patients with posttraumatic aniridia and secondary glaucoma]. / Reabilitatsiya patsientov s posttravmaticheskoi aniridiei i vtorichnoi glaukomoi.

Secondary glaucoma is one of the main problems of rehabilitation of patients with traumatic damage of the iris. PURPOSE: This study analyzes the long-term results of rehabilitation of patients with posttraumatic aniridia and glaucoma. MATERIAL AND METHODS: The study included 310 patients (310 eyes) with posttraumatic aniridia who had artificial iris-lens diaphragm (ILD) MIOL-Raduzhka implanted in 2002-2022. Before ILD implantation, 61 patients (22.8%) had secondary glaucoma. Among them 35 patients (11.3%) underwent various modifications of glaucoma surgery. In 26 patients (8.6%), intraocular pressure (IOP) was compensated medically before ILD implantation. RESULTS: Until the third month after ILD implantation, there was a trend for IOP increase in some patients. Decompensation was noted in 8 (22.9%) out of 35 patients who had underwent glaucoma surgery. IOP decompensation was observed in 21 (80.8%) of 26 cases in patients with glaucoma compensated by drugs before ILD implantation. After ILD implantation, glaucoma appeared for the first time in 21 patients (6.8%) out of 310. In order to compensate IOP after ILD implantation, Ahmed valve implantation was performed most often - in 35 cases (70%) out of 50, deep sclerectomy - in 5 cases (10%), non-penetrating deep sclerectomy - in 4 cases (8%), micropulse transscleral laser cyclophotocoagulation (MP-TSCPC) - in 5 cases (10%), endoscopic cyclophotocoagulation (ECP) - in 1 case (2%). CONCLUSION: ILD implantation in patients with posttraumatic aniridia and secondary glaucoma should be performed with IOP compensated without hypotensive therapy and not earlier than 6-12 months after glaucoma surgery. The most optimal glaucoma surgery types in this group of patients are Ahmed valve implantation and MP-TSCPC.

[Long-term clinical and functional outcomes of high myopia correction by femtosecond laser-assisted implantation of an intrastromal ring]. / Otdalennye kliniko-funktsional'nye rezul'taty korrektsii miopii vysokoi stepeni metodom intrastromal'noi implantatsii kol'tsa s femtolazernym soprovozhdeniem.

OBJECTIVE: To analyze remote clinical and functional outcomes of correcting high myopia in patients with thin cornea by the method of femtosecond laser-assisted implantation of intracorneal implant MyoRing. MATERIAL AND METHODS: The study included 22 patients (22 eyes; the mean age of study patients was 30.2±5.37 years). Mean spherical equivalent (SE) of refraction was -11.52±1.96 D, cylindrical component (cyl) of refraction was -2.04±1.64 D, minimal pachymetry index in the center was 491.6±20 µm, corneal hysteresis (CH) amounted to 8.6±1.19 mm Hg. The average pupil diameter in mesopic conditions was 5.6±0.23 mm. All patients had a history of mild amblyopia. The follow-up period lasted 2 years. RESULTS: Two years after the surgery uncorrected visual acuity was 0.6±1.22, corrected visual acuity 0.7±0.20. Mean spherical equivalent (SE) of refraction was 0.61±1.43 D, cylindrical component of refraction was -0.13±0.5 D. Predictability of SE within ±0.5 D was recorded in 84% of cases, ±1.0 - also in 84% of cases. Index of safety was 1.16, index of efficacy - 1.0. CH was 9.5±0.03 mm Hg. Mean pachymetry at the center did not change statistically significantly after the surgery in comparison to the initial data (p=1.00). CONCLUSION: MyoRing implantation is an effective and safe method, which ensures correction of the spherical component of refraction, as well as correction of astigmatism, improvement of biomechanical properties of the cornea, and an increase in corneal hysteresis (p=0.01).

[Concentration of VEGF-A in the intraocular fluid of rats with alloxan model of diabetes mellitus]. / Kontsentratsiya VEGF-A vo vnutriglaznoi zhidkosti krys s alloksanovoi model'yu sakharnogo diabeta.

PURPOSE: To study the changes in the concentration of vascular endothelial growth factor A (VEGF-A) in the intraocular fluid (IOF) of rats with alloxan model of diabetes mellitus (DM) on insulin therapy at different time points. MATERIAL AND METHODS: The alloxan model of DM was simulated in 197 rats by a single intraperitoneal injection of 100 mg/kg alloxan hydrate. The animals were divided into 3 groups 7 days after administration of alloxan hydrate. The main group consisted of animals with alloxan model of DM, which begain receiving single daily intraperitoneal injections of insulin at a dose of 0.9 U/kg body weight. The comparison group included animals with alloxan model of DM, which did not receive the therapy. The control group consisted of healthy animals. The experimental animals were withdrawn from the study 1 and 4 months after the start of insulin therapy. The concentration of VEGF-A was determined in 80-90 µL of intraocular fluid collected from both eyes of each animal. RESULTS: At 1 month, the VEGF-A concentration in the intraocular fluid in the study group (n=17; 140 [136; 210] pg/mL) was statistically significantly higher than in the comparison group (n=20; 72 [58; 86] pg/mL; pm-u<0.0004), and in the control group (n=16; 76 [62.5; 88] pg/mL; pm-u=0.0045). The comparison group did not have statistically significant differences from the control group (pm-u=0.9979). At 4 months, the VEGF-A concentration in the intraocular fluid in the study group (n=18) was 84.8 [61.1; 93.2] pg/mL, in the comparison group (n=16) - 66.4 [54.4; 73.75] pg/mL. The VEGF-A concentration in the intraocular fluid in the study group at 4 months was statistically significantly lower than in the study group at 1 month (pm-u<0.0044). CONCLUSION: Insulin therapy causes a statistically significant increase in the concentration of VEGF-A in the intraocular fluid of rats with alloxan model of DM after 1 month, but after 4 months of the therapy the VEGF-A concentration falls back to the initial values.

[Effects of artificial gravity on perimetry results]. / Vliyanie iskusstvennoi gravitatsii na izmenenie perimetricheskikh pokazatelei organa zreniya.

The active exploration of space requires minimizing negative effects induced by weightlessness (microgravity). Risk reduction can be achieved with the use of artificial gravity created by short-radius centrifuge (SRC). Short-radius centrifuge causes redistribution of body liquids towards the caudal portion of the body imitating a vertical human pose. Presently, studying the safety of this prevention method for the human body in general, and for the visual system in particular, is one of the priority tasks of space medicine. PURPOSE: To study the effects of artificial gravity on the perimetry measurements of the eye. MATERIAL AND METHODS: The study included 9 volunteers (men) aged 31.2±6 years (from 25 to 40 years). Each man was subjected to three rotations on SRC. The operative factor in the tests was overloads in the «head-pelvis¼ direction. Rotations were carried out in three different modes with varying maximum overload value at the feet level of up to 2.0; 2.4; 2.9 G. Pulsar-perimetry was carried out before and 1-2 hours after the rotations estimating the mean threshold of retinal photosensitivity Mean Sensitivity (MS), mean loss of sensitivity Mean Defect (MD), square root of Loss Variance (sLV); the Bebie curve; additionally, cluster analysis was performed. RESULTS: Mean threshold of retinal photosensitivity, mean loss of photosensitivity, square root of Loss Variance by Pulsar-perimetry before (MS=22.75 dB; MD= -0.6 dB; sLV=1.5) and after rotations on SRC (in Mode 1: 23.4; -0.2; 1.5, Mode 2: 23.2; -0.4; 1.4 and Mode 3: 23.5; -0.8; 1.4 respectively) did not change significantly. No adverse phenomena were detected in the eyes. CONCLUSIONS: There were no significant changes in the visual fields of the test subjects after rotations in three different modes according to Pulsar-perimetry data, which gives reason to tentatively conclude that using SCR in these modes is safe for the visual sensory system. According to preliminary data, this method can be successfully used to reduce the risk of long-term space flights and prevent unwanted phenomena caused by weightlessness.

[Clinical results of posterior lamellar femto-keratoplasty in patients with corneal endothelial dystrophies]. / Klinicheskie rezul'taty zadnei posloinoi femtokeratoplastiki pri endotelial'noi distrofii rogovitsy.

PURPOSE: To evaluate clinical results of posterior lamellar keratoplasty performed with Russian femtosecond laser «Vizum¼ for treating patients with primary and secondary corneal endothelial dystrophies. MATERIAL AND METHODS: The study included 30 operated eyes: 10 with Fuch's primary endothelial dystrophy of the cornea and 20 with secondary endothelial dystrophy. Patients were examined on the 7th day, as well as at 3, 6, 12 and 24 months after the surgery. All 28 patients (30 eyes) were followed-up for 12 months, 12 patients (14 eyes) were followed-up for 24 months. RESULTS: In 3 months after the surgery, transparent engraftment was observed in most cases. In 1 case, its primary failure was diagnosed and repeated keratoplasty was performed. Postoperative haze in host-donor interface was observed in 1 case. Central corneal thickness (CCT) was 554±43 µm. Transplant thickness in the central zone was 80±13 µm. The amount of eyes with Best Spectacle-Corrected Visual Acuity (BSCVA) of 0.3 was 43%. Endothelial cells density (ECD) was 1538±500 cells/mm2. Endothelial cells loss amounted to 30.4%. By the 12th month, recipient's cornea and the transplant remained transparent in all cases. Haze in the host-donor interface was still observed in 1 case. CCT was 581±47 µm, transplant thickness was 80±16 µm. The amount of eyes with BSCVA of 0.3 was 53%. Keratometry astigmatism was 2.08±1.47 D, refractive astigmatism - 1.72±0.83 D. ECD was 1324±383 cells/mm2. Endothelial cells loss amounted to 40.1%. At 24th months after the surgery (12 patients, 14 eyes) the recipient's cornea and the transplant remained clear in all cases. CCT was 591±48 µm, transplant thickness was 81±15 µm. Amount of eyes with BSCVA of 0.3 was 71.4%. ECD was 1426±422 cells/mm2. Endothelial cells loss - 35.1%. CONCLUSIONS: The predictability of applanation and high quality of cutting of the «Vizum¼ femtosecond laser assure the predictability of the process of preparing an ultrathin cornel graft from the endothelial side. Clinical results have demonstrated its effectiveness for rehabilitation of visual functions (up to BSCVA 1.0).

[Effect of acute insulin therapy on the concentration of vascular endothelial growth factor A (VEGF-A) in the intraocular fluid in an experiment]. / Vliyanie kratkosrochnoi insulinoterapii na kontsentratsiyu sosudistogo endotelial'nogo faktora rosta A (VEGF-A) vo vnutriglaznoi zhidkosti v eksperimente.

PURPOSE: To study the effect of insulin therapy on the concentration of vascular endothelial growth factor A (VEGF-A) in the intraocular fluid of rats with alloxan model of diabetes mellitus. MATERIAL AND METHODS: The experiment was conducted on 80 mongrel rats. In 65 rats, the alloxan model of diabetes mellitus was simulated by a single intraperitoneal injection of 100 mg/kg alloxan hydrate saluted in 0.4 ml of citrate buffer. 72 hours after intraperitoneal administration of alloxan monohydrate, these animals were divided into 2 groups. The main group (group 1) consisted of animals with alloxan model of diabetes mellitus, who started daily single intraperitoneal administration of prolonged-acting insulin at a therapeutic dose of 0.9 U/kg Body weight. The comparison group (group 2) consisted of animals with alloxan model of diabetes mellitus who did not receive specific therapy. 15 healthy rats constituted the control group (group 3). Experimental animals were removed from the study on day 31 of insulin therapy. The concentration of VEGF-A was determined in 80-90 µl of intraocular fluid collected from both eyes of each animal. RESULTS: In the main group, the median of VEGF-A concentration [25th; 75th percentiles] in the intraocular fluid was 140 [136; 210] pg/ml, which is 1.94 times higher than in the comparison group (72 [58; 86] pg/ml) and 1.84 times higher than in the control group (76 [62.5; 88] pg/ml). The concentration of VEGF-A in the intraocular fluid in the main group was statistically significantly higher, as compared with the comparison group (pm-u<0.0004), and compared with the control group (pm-u=0.0045). The comparison group had no statistically significant differences when compared with the control group (pm-u=0.9979). CONCLUSION: Insulin therapy for 31 days increases the concentration of VEGF-A in the intraocular fluid of rats with alloxan model of diabetes mellitus.

Molecular analysis of patients with aniridia in Russian Federation broadens the spectrum of PAX6 mutations.

Congenital aniridia is a severe autosomal dominant congenital panocular disorder, mainly associated with pathogenic variants in the PAX6 gene. The objective of the study was to investigate the mutational and clinical spectra of congenital aniridia in a cohort of 117 patients from Russia. Each patient underwent detailed ophthalmological examination. From 91 unrelated families, 110 patients were diagnosed with congenital aniridia and 7 with WAGR syndrome (Wilms tumor, Aniridia, Genitourinary anomalies, and mental Retardation syndrome). The clinical presentation in aniridia patients varied from the complete bilateral absence of the iris (75.5%) to partial aniridia or iris hypoplasia (24.5%). Additional ocular abnormalities were consistent with previous reports. In our cohort, we saw a previously not described high percentage of patients (45%) who showed non-ocular phenotypes. Prevalence of deletions coherent with WAGR syndrome appeared to be 19.4% out of sporadic patients. Among the other aniridia cases, PAX6 deletions were identified in 18 probands, and small intragenic changes were detected in 58 probands with 27 of these mutations being novel and 21 previously reported. In 3 families mosaic mutation was transmitted from a subtly affected parent. Therefore, PAX6 mutations explained 96.7% of aniridia phenotypes in this study with only 3 of 91 probands lacking pathogenic variants in the gene.