[Primary vitrectomy in the treatment of retinopathy of prematurity with unfavorable progression]. / Pervichnaya vitrektomiya v lechenii retinopatii nedonoshennykh neblagopriyatnogo tipa techeniya.

PURPOSE: The study aims to determine the indications and evaluate the results of primary vitrectomy in unfavorable progression of stage III active retinopathy of prematurity (ROP). MATERIAL AND METHODS: The control group consisted of 17 patients (28 eyes) with unfavorable progression of stage III ROP, who had the disease progress after coagulation of the avascular retina and underwent the second stage of treatment - vitrectomy. The main group consisted of 5 patients (10 eyes) with unfavorable progression of stage III ROP, who underwent primary vitrectomy. Gestational age at birth was 24-30 weeks, body weight ranged from 680 to 1250 g. According to spectral optical coherence tomography (SOCT) and OCT angiography (OCT-A), the initial state of the retina and vitreoretinal interface in patients of the main and control groups were identical. RESULTS: A retrospective analysis of control patients, according to SOCT and OCT-A data, showed the spread of neovascularization beyond the retinal plane, its interaction with the posterior hyaloid membrane and vitreous body structures in the early stages of the disease, traction changes in the underlying retina, areas of retinoschisis, as well as thickening of the posterior hyaloid membrane. The tactics of treating patients with unfavorable progression of stage III ROP has changed since 2020. Primary vitrectomy was performed in case the signs listed above were identified. The transition of the disease to the inactive stage was recorded in all cases one month after primary vitrectomy. After one year the pathological process did not reactivate in any of the cases, and no pathological changes were found in the projection of the former proliferation ridge. CONCLUSIONS: Extraretinal retinovitreal neovascularization, according to multimodal preoperative diagnostics, indicates the need for vitreoretinal surgery as a pathogenetically substantiated method of treatment for unfavorable progression of stage III active ROP.

[Venous blood flow in ocular vessels of patients with active retinopathy of prematurity]. / Osobennosti venoznogo krovotoka v sosudakh glaza pri aktivnoi retinopatii nedonoshennykh.

PURPOSE: To study the characteristics of venous circulation in the eyes with retinopathy of prematurity (ROP) observed in examination of blood flow in the central retinal vein and superior orbital vein in patients with different forms, stages and state of the disease. MATERIAL AND METHODS: Color duplex scanning of the central retinal vein and superior orbital vein was performed using color Doppler imaging and pulsed Doppler sonography in 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) with no signs of ROP. All babies included in the study were born at 25-32 weeks of gestation, their birth weight was 680-1760 g. RESULTS: A characteristic feature of hemodynamic parameters in the central retinal vein at stages 1-3 of active ROP was a decrease in both the maximum and minimum blood flow velocities (Vmax and Vmin), indicating a serious disorder of ocular hemodynamics in this category of patients. An increase in Vmax in the central retinal vein was recorded for patients with aggressive posterior ROP, which occurs in response to venous stasis that is common in this form of the disease. The performed statistical assessment of the prognostic significance of hemodynamic parameters of the central retinal vein in relation to the type of active ROP revealed a high information content of Vmin, which is promising for early detection of unfavorable course of the disease helping to ensure timely treatment. The blood flow in the superior orbital vein showed distinctive absence of any correlations with the course of the disease, disallowing any immediate conclusions on the informativeness and predictive value of its parameters. CONCLUSION: The revealed features of venous blood flow in patients with active ROP help expand the understanding of vascular changes in this pathology, and can also be applied in clinical practice to improve the accuracy of predicting the course of the disease.

[Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes]. / Metodika poetapnogo formirovaniya fragmenta vnutrennei pogranichnoi membrany v khirurgicheskom lechenii bol'shikh idiopaticheskikh makulyarnykh otverstii.

AIM: to develop a surgical procedure for large idiopathic macular holes (MH) that would involve creation of an original internal limiting membrane (ILM) flap to close the hole with. MATERIAL AND METHODS: Nineteen patients aged from 59 to 71 years with stage 3 idiopathic MH (by J. Gass) were enrolled. Besides standard ophthalmic examination, spectral optical coherence tomography and microperimetry were performed in all cases. The patients were followed up 2 weeks and then 1 and 3 months after surgery. Surgical procedure was notable for an original ILM flap created in a way that resembles removing petals from a flower. The new method implies that the ILM is peeled off all the way round the MH except for the foveolar area and one particular ILM fragment, which is only partially separated from the retina, from the periphery towards the MH, stopping at some 0.1-0.2 mm from its margin. This last fragment is then inverted to cover the MH. RESULTS: All surgeries were completed without complications. Visual acuity has gradually increased over the follow-up period in all patients: from 0.1-0.4 to 0.3-0.7 (0.39±0.15 on the average; Sivtsev-Golovin chart). Foveal anatomy has also improved: complete closure of the MH was achieved in 8 patients, partial - in 11. Moreover, all patients demonstrated a shift of the retinal fixation point towards the center of the fovea for 153-369 mm, at that, their fixation has stabilized and absolute central scotomas disappeared. CONCLUSION: The method developed is a promising treatment for large idiopathic macular holes. Further studies are required.

[Characteristics of measles epidemics in the Donetsk region population under conditions of regular immunization]. / Osobennosti épidemicheskogo protsessa kori u zhitelei Donetskoi oblasti v usloviiakh mnogoletnei planovoi immunizatsii.

With vaccination having become usual practice in health care, the incidence rate of measles in the Donetsk region has fallen 53.6-fold versus the prevaccination period. Bet there are also negative processes in the epidemiology of measles; of these, ever more frequent occurrence of the infection under consideration in persons of mature years is worthy of particular mention. The specific weight of juveniles and grown ups had come to be 68.65% in 1998 vs 6.3% in 1975. Since 1993 the case rate of measles is noted to be at its greatest among children less than two years of age and among adolescents, which fact can be referred to effects on the level of immunity of different factors including that of time of more than five years having elapsed since the previous immunization. The administration in 1997-1998 of vaccines to non-vaccinated persons and to unprotected ones permitted the incidence rate of measles to be kept down in juveniles and adults but the age brackets of sick persons were in fact the same as before the additional vaccinations done. The state of things discribed above attests to the need for development of cardinal measures to raise the level of individual and collective immunity in juveniles and adults.

[The effect of the initial level of immunity on the efficacy of antidiphtheria inoculations in children and adults]. / Vliianie iskhodnogo urovnia immuniteta na éffektivnost' protivodifteriinykh privivok u detei i vzroslykh.

Based on results of examination in the passive hemagglutination test of 1440 subjects at different ages, several distinguishing features were revealed of formation of artificial active antidiphtheria immunity depending on the basic level of immunity. Single revaccination of those subjects presenting with the basic immunity of less than 0.03 IU/ml provides defence against diphtheria in only 33.3 percent of adults and 50 percent of children, in those subjects presenting with immunity between 0.03 to 0.99 IU/ml it is highly effective, in the immunity 1 IU/ml and beyond the effect of further immunization is very low since 25 to 33.3 percent of subjects demonstrate enhancement of immunity, whereas 16.7 to 25 percent show lowering of it. The analysis of the immunological structure of the population shows that 45 to 60 percent of adults in different age groups need to be exposed to single revaccination, 14 to 37 present will find it insufficient, 3 to 36 percent redundant. We suggest that revaccination against diphtheria be conducted under control of the level of antitoxic immunity.