[Diagnostic capabilities of ultrasound biomicroscopy in phaco surgery].

Capabilities of ultrasound biomicroscopy (UBM) as a diagnostic method for surgical planning and outcome analysis in nonstandard situations in phaco surgery have been investigated. The study enrolled 270 patients (278 eyes) with pseudophakia and 26 patients (33 eyes) with aphakia. The scanning was done on OTI HF 35-50 Ultrasound System biomicroscope (UBM) - OTI, Canada. An original method of intraocular lens (IOL) position evaluation by means of UBM, providing precise information on relative position of the IOL and ocular axes, planes, and anatomical structures, has been developed. The proposed technique has been applied to determine both whether the position of the IOL is correct (46 eyes) and, if not, which of three types of its dislocation is present (232 eyes). Clinical and functional features of each of the dislocation types have been analyzed. Detailed analysis of UBM scans of 47 patients (47 eyes) showed that secondary glaucoma development was triggered by loss of proper endocapsular fixation of the IOL with consequent traumatic contact between IOL haptics and uveal tract. This contact, on the one hand, leads to excessive wash-out of pigment and obstruction of outflow routes. On the other hand, it causes subacute reactive uveitis which aggravates preexisting ocular hypertension and glaucoma course. It has been demonstrated that UBM performed prior to IOL implantation enables adequate assessment of the implant bed, accounting for lens capsule integrity, ciliary sulcus configuration and parameters, as well as the extent of structural changes in the globe, which may result from trauma, uveitis or improper evacuation of lens matter during cataract removal. Authors recommend to include UBM into assessment of aphakic patients planned for secondary IOL implantation and to decide on IOL model and its fixation type depending on the UBM results.

[Ultrasound biomicroscopy in diagnosis of uveal tumors].

Detailed analysis of ultrasound biomicroscopy (UBM) scanogrammes of 232 patients (232 eyes), aged 4-78 years old, with various uveal lesions was performed including comparison with morphologic study of specimens obtained after tumor removal. Results of the study showed UBM to allow to obtain objective data on location, configuration, size and structure of lesions of iris, ciliary body and preequatorial choroid. In a number of cases UBM virtually is the only option of vital visualization of the whole tumor.

[Ultrasound biomicroscopy in evaluation of conditions for secondary intraocular lens implantation in aphakia].

In order to evaluate conditions for secondary intraocular lens (IOL) implantation detailed analysis of ultrasound biomicroscopy (UBM) images of 26 patients (33 eyes) with aphakia was performed. The etiology of cataract was congenital (12 eyes), traumatic (9 eyes), senile (8 eyes) and uveal (4 eyes). The results showed that UBM provides an opportunity to evaluate the implantation site considering capsule integrity, configuration and parameters of ciliary line. The authors have demonstrated that UBM is scarcely the only visualization method in aphakic eyes that lets find and evaluate structural changes of the globe, induced by trauma, uveitis or improper lens removing during cataract surgery (iridocapsular or iridocorneal synechiae, iris defects, pupillar membranes, lens remnants, vitreoretinal proliferation and others). The authors propose UBM to be included into diagnostic examination of patients with aphakia before secondary IOL implantation and consider the results of UBM in choice of lens model and type of fixation.

[Potential of ultrasound biomicroscopy in diagnosis of ocular trauma with intraocular metallic foreign bodies].

A detailed analysis of ultrasound biomicroscopy (UBM) scanogramms of 4 patients with a history of trauma and signs of metallosis is performed. In all cases foreign body was found and its precise localization in relation to anterior segment structures was identified. The following changes were revealed and described: pathological changes of cornea, lens and its fibers, uveal tract in silent zone, zone of retinal periphery and secondary vitreous changes due to trauma itself and chemically active foreign body invasion and long persistence. UBM is recommended to be the part of examination algorithm in patients with penetrating ocular trauma and screening of latent metallosis.

[Ultrasonographic visualization of ciliary pars plana cysts].

On a basis of detailed analysis of ultrasound biomicroscopy (UBM) scanograms of 617 patients (823 eyes) ciliary pars plana cysts were found in 8.9% (55 patients, 66 eyes). The main types of ciliary pars plana cyst were revealed: solitary isolated and multiple (isolated and confluent). The results of the study confirmed topographic and morphologic correlation of ciliary pars plana cysts and peripheral retinoschisis. Authors demonstrated the value of UBM for visualization not ciliary pars plana cysts only but oral and peripheral retinal degenerative changes as well, that can lead to retinoschisis and retinal detachment.

[Biometry of anterior segment structures: comparative study].

We studied different methods of biometry (spatial ultrasonography, ultrasound biomicroscopy, optical principles) of anterior segment structures: lens, anterior chamber and its angle. 20 patients (40 eyes) with immature cataract were examined. Ultrasonography showed to be the most informative method. Some subjectivity of this technique due to echogram analysis has slightly influenced the estimation of linear and volumetric biometric parameters. Spatial ultrasonography may be recommended as a unique biometry technique for anterior segment structures.

[Ultrasound biomicroscopy in the monitoring of iridocorneal endothelial syndrome].

Detailed analysis of scanning images obtained at ultrasound biomicroscopy (USBM) in 11 patients with iridocorneal endothelial syndrome revealed the USBM signs reflecting pathological changes in the anterior eyeball. The value of USBM is that the technique permits evaluation of the involvement of anatomic structures into the pathological process in corpore as this is the only mode of lifetime imaging of high-resolution silent eyeball areas. It is also important that USBM can differentiate the iridocorneal endothelial syndrome from other abnormalities with the same clinical picture. The authors recommend that USBM be used to diagnose and to monitor different types of the iridocorneal endothelial syndrome.

[Differential diagnosis of treatment of episcleritis and scleritis].

The purpose of the present investigation was to develop an optimal approach to rehabilitating patients with episcleritis and scleritis of various etiology. The paper summarizes the results of examination and treatment in 128 patients (142 eyes) with the acute chronic course of the diseases. To specify the etiopathogenesis of a disease, the patients were examined by a rheumatologist, an immunologist, a virologist, a phthisiatrician, an ENT specialist, and a roentgenologist. Rhinofrequency ultrasound biomicroscopy was made in the diagnosis of scleral inflammatory diseases. Ultrasound studies (ultrasound biomicroscopy and B-scanning of the eye) were additionally conducted. Complex therapy produced a marked positive clinical effect in 124 patients (138 eyes). During 5 years, immunological parameters improved in all the examined. Thus, episcleritis and scleritis are an overall immunological disorder and frequently associated with infections. Current laboratory clinical and instrumental studies considerably enhance the efficiency of the diagnosis and, hence, treatment of these diseases.

[Potentialities of high-frequency ultrasound biomicroscopy in the diagnosis of scleral inflammatory diseases].

Detailed analysis of scanning images obtained at ultrasound biomicroscopy (USBM) in 11 patients with episcleritis and scleritis revealed USBM signs reflecting an inflammatory process in the anterior sclera and established differential diagnostic criteria for scleritis and episcleritis. Due to the high resolution of this diagnostic technique, the USBM pattern correlates with the actual picture of abnormal changes well in different types of scleral inflammatory processes as the histopathological changes known from the literature are embodied in scanning images. The authors recommend USBM for the diagnosis and monitoring of scleral inflammatory diseases.

[Acute uveitis in nonspecific ulcerative colitis].

The paper describes a case of a type of the manifestation of aveitis associated with an exacerbation of nonspecific ulcerative colitis. Ultrasound diagnostic techniques, such as ultrasound biomicroscopy and B-scanning, evaluate the uveal tract that can no longer be imaged, by using the traditional examination methods. These methods extend diagnostic capabilities and permit an objective monitoring of the status of a patient.

[Phacoemulsification of cataract in patients with high myopia]. / Fakoemul'sifikatsiia katarakty u patsientov s vysokoi stepen'iu miopii.

We conducted a study for the purpose of developing a phacoemulsification technique for patients with high myopia optimized for the specificity of myopic eye. The study involved 124 (165 eyes) patients with high myopia and cataract. The lens density in operated patients was of degrees II-IV according to Buratto. The anterior-posterior axis of the eyeball ranged from 26.5 to 34.00 mm. the patients were shared between the experimental (92 eyes) and control (73 eyes) groups with respect to a used surgical technique. A modified procedure was applied in the experimental groups and the basic technique was used in the control group. The time of lens extraction, the volume of used irrigation liquid and the frequency rate of intra- and postoperative complications were the criteria in efficiency evaluation. The study showed the modified surgical procedure of phacoemulsification to ensure a better visualization, to reduce the load on the lens ligamentous apparatus and to facilitate, as much as possible, manipulations made on the lens nucleus of myopic eye; it also cuts the time of cataract lens extraction, which ensures a less volume of used irrigation liquid.