[The nosologic structure and rate of hospitalization in third level ophthalmologic center].

THE PURPOSE OF THE STUDY: To investigate nosologic structure and hospitalization rate in the National Center of Ophthalmology depending on accessibility of ophthalmologic care in the regions. MATERIALS AND METHODS: The data of hospitalization in the National Center of Ophthalmology in December 2019 was used (12 882 cases of in-patient treatment). The patients were allocated in groups according to living addresses considering degree of accessibility of primary and secondary ophthalmologic care (residents of Baku; cities of the Republican subordination (Ganja, Sumgayit, Mingachevir, Shirvan); district centers; rural settlements). RESULTS: The predominant cause of hospitalization is associated with cataract (39.43%), percentage of remaining causes of hospitalization is less than 10%. Among the causes of hospitalization in all groups of settlements the first place is for cataract. But percentage of this pathology is relatively low among residents of Baku (37.00±0.69%) and cities of the Republican subordination (37.5 ±1.88%). The corresponding indices are significantly higher (p≤0.05) among residents of rural settlements (39.40±0.68%) and district centers (45.09±1.03%). CONCLUSION: In the nosologic structure of the causes of hospitalization in third level ophthalmologic center dominate cataract (39.43%), retinal detachment with ruptured retina (8.65%), eye and retinal injuries (6.22%). The nosologic structure of causes and rate of hospitalization in third level ophthalmologic center depends on accessibility of primary and secondary ophthalmologic medical care to population. The residents of Baku, where the tertiary ophthalmologic center is located, (223.23±3.20) are hospitalized up to 1.6 times more often as compared with residents of other regions (≤131.71±2.74). The residents of cities of the Republican subordination with developed ophthalmologic care of primary and secondary level are hospitalized less (84.0±3.26).

[Late results of phaco-canaloplasty in patients with concomitant advanced pseudoexfoliation glaucoma and cataract]. / Otdalennye rezul'taty fakokanaloplastiki pri dalekozashedshei psevdoéksfoliativnoi glaukome i katarakte.

PURPOSE: To assess the safety and efficacy of phaco-canaloplasty in patients with concomitant advanced pseudoexfoliation glaucoma and cataract. MATERIAL AND METHODS: The study included 56 patients (57 eyes) who underwent phacoanaloplasty guided by Glaucolight microcatheter. All patients were followed up for 48 months. Visual acuity, changes of intraocular pressure (IOP), use of glaucoma medications, incidence of complications, as well as postsurgical interventions were examined. RESULTS: Mean preoperative IOP decreased significantly from 29.8 mmHg (15.8-61.6) with a mean of 1.92 (0-3) glaucoma drops to 12.9 mmHg (11.0-19.6) with a mean of 0.12 (0-3) drops respectively 48 months after phacocanaloplasty. Mean visual acuity increased from preoperative 0.15 (0.01-0.8) to 0.6 (0.01-1.2). The most frequent complications included intraoperative perforation of Descemet's membrane (4 eyes, 7%) and hyphema (37 eyes, 65%), IOP spikes (4 eyes, 7%) and inflammation (4 eyes, 7%) in the early postoperative period. CONCLUSION: Phacocanaloplasty in eyes with concomitant advanced pseudoexfoliation glaucoma and cataract re-establishes the natural outflow system and leads to significant IOP reduction with minimal risk of intra- and postoperative complications.

[Surgical treatment of rhegmatogenous retinal detachments with high risk of proliferative vitreoretinopathy]. / Khirurgicheskoe lechenie regmatogennykh otsloek setchatki s vysokim riskom razvitiia proliferativnoi vitreoretinopatii.

AIM: to analyze the effect of internal limiting membrane (ILM) peeling in patients undergoing 23-gauge pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) with a high risk of proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS: This was a prospective consecutive study of 231 eyes of 227 patients. All eyes underwent vitrectomy with silicone oil/gas tamponade for RRD with a high risk of PVR: in 42 eyes the ILM was peeled (group 1) and in the remaining 189 eyes - was not (group 2). The follow-up period was at least 3 months. RESULTS: In group 1, single-surgery anatomic success was achieved in 85.4% and definitive reattachment - in 95.2% of patients. In group 2, single-surgery anatomic success was achieved in 67.2% and definitive reattachment - in 89.4% of patients. None of the patients from group 1, who had their ILM peeled, developed epiretinal membrane. Final BCVA in groups 1 and 2 was 1.2±0.5 logMAR and 1.34±0.82 logMAR respectively (p=0.297). CONCLUSION: ILM peeling during vitrectomy in RRD patients at high risk of PVR provides high primary anatomic success rate.

[Cortisol levels in plasma and aqueous humour of patients with steroid induced and other glaucomas]. / Pokazateli kortizola v plazme krovi i vo vlage peredneĭ kamery pri glaukomakh.

The paper describes the role of endogenous glucocorticoids in the pathogenesis of open-angle glaucoma. As to steroid-induced glaucoma (SG), however, indicators of systemic and local cortisol metabolism are yet underinvestigated. Aim - to determine and compare systemic (plasma) and local (aqueous humour) cortisol concentrations in patients with SG and other types of glaucoma (OTG). MATERIAL AND METHODS: A prospective analysis was conducted in 64 patients who underwent plasma and aqueous humor sampling. All the patients were divided into 4 groups: group 1 - 11 patients with steroid induced ocular hypertension (SOH) and SG; group 2 - 31 patients with OTG; group 3 - 10 patients on steroid therapy (ST) without a so called 'steroid response'; group 4 - the controls (12 patients with cataract). RESULTS: The mean cortisol levels in plasma and aqueous humour were the following: 177.5±29.4 ng/ml and 53.1±12.2 ng/ml in patients with SOH and SG; 277.7±33.6 ng/ml and 44.6±4.4 ng/ml in patients with OTG; 125.2±28.1 ng/ml in patients on ST; 147.2±19.1 ng/ml and 29.8±3.2 ng/ml in the controls. The highest plasma and aqueous humour cortisol levels were found in groups 2 and 1, respectively. CONCLUSION: Plasma and aqueous humour levels of cortisol appeared to be higher in glaucoma patients than in the controls. Taking into account the fact that plasma cortisol levels are higher in steroid responders, it is recommended that all patients on ST undergo cortisol testing.

[Nevi of conjunctiva as a risk factor of melanoma]. / Nevusy kon''yunktivy kak risk razvitiya melanomy.

UNLABELLED: Conjunctival nevi are the most common tumors of this location. They are usually unilateral, although bilateral cases may also be met. As to clinical presentation, all nevi are divided into: stationary or progressive nevi, blue nevi, and primary acquired melanosis. Color changes are acceptable, if they occur during pregnancy or puberty. However, if postpubertal, such changes should be considered alarming, as to possible malignization. Histopathologically, nevi are composed of melanocyte clusters in the skin stroma next to the basal layer of the epidermis. AIM: To analyze the significance of timely removal of conjunctival nevi for melanoma prevention. MATERIAL AND METHODS: A total of 52 patients were examined during 2009-2013. Of them, 48 patients had nevi of the conjunctiva and/or lacrimal caruncle, 1 patient was diagnosed with caruncular melanoma and 3 other - with conjunctival melanoma. RESULTS: Patients with stationary nevi are still being followed up. Of those who were surgically treated, none developed recurrence. Taking into account high metastatic activity of melanomas and that discovering metastases does not always happen together with diagnosing the primary lesion (often, years after treatment), the follow-up of melanoma patients must be lifelong. CONCLUSION: Timely removal of progressive conjunctival nevi is able to prevent malignancy, of which the outcome may be very unfavorable.

[Results of YAG-laser vitreolysis in proliferative diabetic retinopathy complicated by vitreous hemorrhage].

PURPOSE: To determine the efficiency of YAG-laser vitreolysis in patients with diabetic vitreous hemorrhage. MATERIAL AND METHODS: The study enrolled 56 patients (61 eyes) with proliferative diabetic retinopathy complicated by vitreous hemorrhage aged 36-69 years, including 31 women (34 eyes) and 25 men (27 eyes), who underwent YAG-laser vitreolysis. Assessment methods included visual acuity measurement, tonometry, ophthalmic biomicroscopy, glycated hemoglobin blood test and ultrasound exams (B-scan and quantitative echography). YAG-laser vitreolysis was performed with Alcon 3000 LE laser (USA). CONCLUSIONS: YAG-laser vitreolysis promotes resolution of vitreous hemorrhage in patients with complicated proliferative diabetic retinopathy. Clearance efficiency and the time required depend on the size and density of the hemorrhage as well as the time elapsed since the event. Ultrasound examination is the leading diagnostic method for diabetic vitreous hemorrhage. Density decrease at quantitative echography indicates clearing of the hemorrhage. For the maximal therapeutic effect of YAG-laser vitreolysis, carbohydrate metabolism has to be properly compensated. Few contraindications and minimal complications are benefits of YAG-laser vitreolysis.

Possibilities of regulating disorders in functional activity of the retina with antioxidants under conditions of high-intensity light exposure.

We studied the effects of natural (α-tocopherol and SOD) and synthetic (potassium phenosane and hydroxypyridine) antioxidants on the recovery of disordered parameters of the electroretinogram under conditions of high-intensity light exposure. Potassium phenosane and tocopherol acetate more effectively normalized parameters of electroretinogram in monotherapy. The use of a complex of antioxidants completely prevented the disorders in the electroretinogram parameters in retinopathy after exposure to intense light.

Regulation of lipid peroxidation in the retina under the effect of bright light.

Changes in LPO intensity under the effect of exposure to bright light and the possibility of their correction with antioxidants were studied on rabbits with diabetic retinopathy. It was found that enhanced LPO caused by exposure to bright light in rabbits with diabetic retinopathy can be corrected with antioxidants. Phenosan potassium salt, α-tocopherol, and oxypyridine were more effective than SOD and taurine in preventing MDA accumulation. A complex of natural and synthetic antioxidants was most efficient in correcting LPO under conditions of exposure to bright light.

[Treatment of inflammatory conditions of the iris and ciliary body, accompanying fibrin exudation]. / Lechenie vospalitel'nykh sostoianii raduzhki i tsiliarnogo tela, soprovozhdaiushchikhsia fibrinoidnoi ékssudatsiei.

The paper presents a description of a new method for treatment of iris and ciliary body inflammation accompanied with fibrin exudation. We used low-level blue laser destroying a fibrin clot in its initial stage of formation. We also used herapin and ascorbic acid. In the absence of the greatest impact urokinase was additionally administered.