bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the timing of surgery affect outcomes of gartland type III supracondylar fractures in children?
Authors: Shon Hyun-Chul , Kim Ji Wan , Shin Hun-Kyu , Kim Eugene , Park Se-Jin , Park Jong Kuen , Song Seungcheol , Park Jai Hyung
Published: June 2019

Background. Gartland type III supracondylar fractures in children are treated as emergency. But there are few studies about surgical timing and clinical outcomes.
Aim. To evaluate whether the time interval from injury to surgical treatment affects the treatment outcomes of Gartland type III supracondylar fractures in children.
Methods. The study population comprised all children presenting to our hospital between April 2003 and December 2013, who had Gartland type III supracondylar humerus fracture. Patients were divided into three groups: those who were treated within less than six hours from injury, those who were treated between six and twelve hours, and those who were treated between twelve and twenty four hours after injury. In this retrospective study, we checked whether the timing of surgery affected clinical outcomes such as bone union, range of motion, peri-operative complications, and operation time.
Results. All patients were treated with closed reduction and percutaneous pin fixation within 24 hours. This study showed a trend that the delay in the timing of surgery after traumatic injury increases operation time, however with no statistical differences. The neurological complications were similar in the three groups. There were 11 cases (14.7%) of preoperative neurologic deficit, however every patient recovered postoperatively. There was no difference between the three groups in terms of clinical outcomes such as range of motion of the elbow and bone union.
Conclusion. For Gartland III pediatric supracondylar humerus fractures, operation can be delayed for up to 24 hours, which may allow time for operation during regular hours, rather than late at night, with thorough evaluation of circulation, nerve injury, and swelling.
Evaluation of the results of functional prosthetics in children with congenital defects of the hand and fingers
Authors: Kruglov Anton V. , Shvedovchenko Igor V.
Published: June 2019

Background. Evaluation of the result of functional prosthetics in patients with different upper limb defects is a topical problem of modern prosthetics. Providing patients with non-functional hand stumps with functional prostheses is not wide-scale and refers to atypical and experimental prosthetics. While new functional prosthetic hands appear, there is no algorithm for evaluating the results of prosthetics.
Aim. This study aimed to evaluate the result of functional prosthetics in children with congenital defects of the hand and fingers by active prostheses.
Materials and methods. We observed 67 children with congenital hand defects, of which 22 were included in the experimental prosthetics group. Bench test station was used for an objective assessment of the residual function of the hand. The booth imitated the tasks of an international competition for the users of Cybathlon rehabilitation equipment and allowed users to perform a series of tests, for each of which a certain number of evaluation points were awarded. Samples at the stand were supplemented with a subjective assessment of the function of the hand using the DASH questionnaire validated in Russia.
Results. The best subjective assessment of the supply of an active prosthetic hand was determined in the patients with underdeveloped hand similar to the truncation of the hand proximal to the metacarpophalangeal joints. The lowest functionality score of the active prosthetic hand was obtained in cases of ectrodactyly and hypoplasia of 1–5 fingers, which was associated with a high residual functionality of the hand.
Conclusions. In addition to training functions, the developed bench test station serves a diagnostic function as it evaluates the results of functional prosthetics in patients with upper limb defects in different levels, including defects on the hand and fingers. The results of the study on the station correlate with the results of the DASH questionnaire.
The variability of the flatfoot frequency depending on the diagnostic criteria and the method of statistical analysis
Authors: Kenis Vladimir M. , Dimitrieva Alyona J. , Sapogovskiy Andrei V.
Published: June 2019

Background. Flatfoot frequency in children varies from 0.6% to 77.9%. This wide-range data is associated with lack of uniform diagnostic criteria and method of statistical analysis.
Aim. This study aimed to demonstrate the variability in flatfoot frequency in the same population using different indices of footprint and methods of statistical analysis.
Material and methods. This study included 317 school-age children. Children with orthopedic and foot pathology were excluded. The main evaluation methods were clinical examination, computer plantography with footprint index calculation (Staheli index, Chippaux–Smirak index, Clarke’s angle, podometric index, arch height index), and statistical analysis (descriptive statistics methods with Kolmogorov–Smirnov and Shapiro–Wilk criteria, data definition according to the law of normal distribution with standard deviation and quartile assessment).
Results. According to the law of normal distribution (with a double standard deviation), our study demonstrated that the flatfoot frequency using the plantar footprint indices varies from 1.6% to 4.8% in 7–17-year-old children and using the medial footprint indices, from 1.28% to 2.8% in the same age. Quartile assessment method showed a flatfoot frequency of 5.85%–28.33% with plantar foot indices and 5.7%–15.43% with medial footprint indices.
Conclusion. The different plantographic indices and methods of statistical analysis demonstrated that the frequency of a flattened longitudinal arch of the feet in a population may differ significantly. Thus, the frequency of flatfoot determined on the basis of indices calculated on the medial footprint is 1.7–1.8 times lower than that determined on the plantar footprint. In addition, the frequency of flatfoot is 5.5–5.9 times lower than that determined by the quartile assessment.
The influence of triple pelvic osteotomy on the spine-pelvis ratios in children with dysplastic subluxation of the hip
Authors: Bortulev Pavel I. , Vissarionov Sergei V. , Baskov Vladimir E. , Barsukov Dmitriy B. , Pozdnikin Ivan Y. , Poznovich Mahmud S.
Published: June 2019

Introduction. Triple pelvic osteotomy is an effective surgical treatment for dysplastic subluxation of the hip in children aged above 12 years. However, modern studies did not assess the indicators of spine-pelvis ratios, sagittal profile of the spine in children with dysplastic subluxation of the hip following surgical treatment, and possibility of change on these values during the operation.
Aim. This study aimed to evaluate the effectiveness of the improved technique of performing triple pelvic osteotomy on children with dysplastic subluxation of the hip.
Materials and methods. We analyzed the x-ray images and surgical treatment of 35 female patients (44 hip joints) aged 13 to 18 years with dysplastic subluxation of the hip between 2016 and 2018. The patients were divided into two groups: the main group consisted of 20 patients (25 hip joints) who underwent surgical treatment that had taken into account the state of sagittal spine-pelvis ratios according to the improved method using personalized navigation templates, and the control group consisted of 15 patients (19 hip joints) who received surgical treatment according to the generally accepted method.
Results. In addition to the typical clinical and radiological abnormalities of the dysplastic subluxation of the hip in 90% of patients in both groups, there were changes in the sagittal balance in the form of excessive pelvic anteversion and lumbar hyperlordosis. One year postoperatively, patients in the main group showed significant changes (p < 0.05) in the state of sagittal spine-pelvis ratios in the form of a decrease in the pelvic base angle, which led to the achievement of the average values of the angle of inclination of the sacral slope (SS) and the value of global lumbar lordosis. On the other hand, these radiological parameters in patients in the control group remained within the preoperative values.
Conclusion. The improved technique of triple pelvic osteotomy provides conditions for the reduction of pelvic anteversion and restoration of the sagittal profile of the spine (p < 0.05). The use of personalized navigation templates allows for the most accurate multiplane correction of the acetabulum. It is necessary to include a specialized x-ray examination in the preoperative planning to assess the state of sagittal spine-pelvis ratios.
Effectiveness of achillotomy in children with arthrogryposis
Authors: Trofimova Svetlana I. , Derevianko Denis V. , Kochenova Evgeniia A. , Petrova Ekaterina V.
Published: June 2019

Introduction. Ponseti method is a widespread treatment for clubfoot in children with arthrogryposis. Closed subcutaneous achillotomy in these patients could not completely rectify the equinus deformity due to tissue rigidity which often leads to reconsideration of the tenotomy principles.
Aim. This study aimed to formulate the anticipating criteria to assess the effectiveness of achillotomy in order to develop a different achillotomy approach for children with arthrogryposis.
Materials and methods. This study retrospectively analyzed closed subcutaneous achillotomy in 28 patients (56 feet) with arthrogryposis. The mean age of the patients was 5.4 months (range 2–8 months). The children were subdivided into two groups according to the residual equinus deformity after the completion of Ponseti serial casting. All patients were physically and radiographically examined.
Results and discussion. The first group included 12 patients (24 feet), which achieved foot neutral position or dorsiflexion ≥5° after achillotomy. The second group consisted of 16 patients (32 feet) with residual equinus after achillotomy who required surgery. X-ray images showed that the patients in the second group had significantly wider tibiocalcaneal angle and smaller talocalcaneal angle in lateral view (р < 0.01). The correction values of the equinus deformity after achillotomy in the children with arthrogryposis were greatly limited: 27° (20°–30°) and 19° (10°–30°) in the first and second groups, respectively.
Conclusion. Closed subcutaneous achillotomy for effective equinus elimination during clubfoot treatment by Ponseti method should be performed only after complete correction at the level of tarsal joints. X-ray examination of the feet is recommended for the children with arthrogryposis in order to evaluate the talocalcaneal divergence and heel position more comprehensively. Furthermore, the values of tibiocalcaneal and talocalcaneal angles in lateral view prior to achillotomy are essential prognostic factors of its effectiveness. Moreover, the severity of equinus contracture should be considered prior to achillotomy. Achilles tenotomy is inappropriate if equinus deformity exceeds 30°. In such cases, open surgery should be considered.
Abnormal hypersynchronization of body balance control system in children with post-burn foot deformity
Authors: Nikityuk Igor E. , Kononova Elizaveta L. , Nikitin Maksim S. , Afonichev Konstantin A.
Published: June 2019

Relevance. Treatment of children with post-burn foot deformities is an important task of reconstructive plastic surgery. The scars formed on the back surface of the feet, even with adequate surgical approach, in the acute period of thermal injury, further often lead to deformities of the entire foot, which leads to a derangement of its support function. The importance of the problem lies in the fact that with the growth of the child, secondary abnormal changes develop on the part of the joints of the lower extremities and the spine, leading to impaired locomotor function, including deviations in the body balance control system.
Purpose of the study. To study postural stability in children with post-burn foot deformities before and after surgical treatment.
Material and methods. The stabilometric study was conducted in 12 patients with post-burn cicatricial foot deformity, the average age of the patients was 9.8 ± 0.93 years old. The control group consisted of 12 children of the same age with no signs of orthopedic abnormality. To assess the results, the methods of descriptive statistics with the inclusion of correlation and regression analysis were used.
Results. In patients with post-burn cicatricial deformity of the foot at the pre-treatment stage, a compensatory redistribution of the static load towards the intact lower limb was revealed. Analysis of postural control indicators in patients of the main group showed an abnormal increase in the synchronization of the system of body balance control. After reconstructive operations on the affected foot, symmetry of the distribution of the load and restoration of the support of the limb of the affected side were noted. Correlation analysis revealed a pronounced decrease in abnormal hypersynchronization between stabilometric parameters, which may indicate a trend towards normalization of the postural control strategy in patients after treatment.
Conclusion. Elimination of post-burn foot deformity contributed to the restoration of its anatomical shape and was accompanied by pronounced positive dynamics in the state of the system of vertical balance of the patient’s body.
Pes calcaneus deformity in children and methods of surgical correction
Authors: Kozhevnikov Oleg V. , Kralina Svetlana E. , Gribova Inna V. , Ivanov Alexey V.
Published: June 2019

Introduction. Pes calcaneus deformity is a rare pathology in children, which is due to the defect of long flexors of the foot caused by various neurological diseases. The treatment choice is based on the patient’s age, parameters of neuromuscular disorders, and degree of foot deformation.
Aim. This study aimed to analyze the results of operative correction of рes calcaneus deformities in children.
Material and methods. This analysis of surgical treatment involved 13 patients (21 feet) aged 1.5 to 15 years with рes calcaneus deformities. The different approaches and methods of surgical treatment were described. Children up to 12 years old were released joints of the foot with the elimination of deformation and tendon-muscle transposition with the transfer of functionally preserved muscles in the position of fallen muscle antagonists. Children over 12 years old underwent surgery on the bone apparatus of foot: three-articular arthrodesis or corrective osteotomy of the calcaneus, some cases were supplemented with tendon-muscle transpositions.
Results. Treatment results were evaluated based on the radiometric parameters on the system of AOFAS. All treated patients showed improvement in foot stability with reduced deformation; АОFAS at an average of 91.14 points was observed.
Conclusion. A record of all causes and strain components with a graded approach eliminates the pes calcaneus deformity in the long-term, despite persistent violation of neuromuscular conduction.
Surgical treatment of aggressive hemangiomas of the transitional cervical-thoracic spine in children (сlinical observations, preliminary results)
Authors: Zaretskov Vladimir V. , Arsenievich Vladislav B. , Likhachev Sergey V. , Stepukhovich Sergey V. , Mizyurov Sergey A.
Published: June 2019

Introduction. Vertebral hemangioma is a common pathology, in which 3.7% cases are aggressive. One of the pathogenetic factors contributing to the growth of vertebral hemangioma is mechanical overload. The transitional parts of the spine are the most loaded. Lesions of the transitional cervical-thoracic spine by hemangioma are rare (2%–4% of all vertebral hemangiomas). A common treatment for aggressive hemangiomas is puncture vertebroplasty. Currently, the number of pediatric patients with vertebral hemangiomas has increased, with an incidence close to 8% for individuals aged below 18 years. Exaggeration of the possibilities of conservative treatment for hemangiomas in children often leads to unsatisfactory results. Clinical research on this problem is relevant due to the lack information about the surgical tactics in aggressive spinal hemangiomas in children.
Clinical observation. Two patients aged 15 and 17 years old with aggressive hemangiomas of the transitional cervical-thoracic spine underwent operation with the use of open-puncture vertebroplasty. There were no postoperative complications, and good preliminary results were obtained.
Discussion. Various approaches in the treatment of aggressive hemangiomas of the transitional cervical-thoracic spine in children, including open-puncture vertebroplasty, were presented and analyzed.
Conclusion. Due to the limited information about surgical treatment for pediatric vertebral hemangiomas, the presented clinical cases of surgical treatment for aggressive hemangiomas of the transitional cervical-thoracic spine may be of interest to a wide audience.
Current approach to diagnosis and treatment of children with osteogenesis imperfecta
Authors: Burtsev Mikhail E. , Frolov Aleksandr V. , Logvinov Aleksei N. , Ilyin Dmitry O. , Korolev Andrey V.
Published: June 2019

Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. Approximately 85% of OI cases are caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2), which affect the quantity or structure of collagen. The remaining percentage of cases is caused by mutation in the proteins responsible for posttranslational modification, processing and crosslinking of collagen, bone mineralization, and osteoblast differentiation. In the past decade, new recessive, dominant, and X-linked inheritance. As a result, new types of OI were added to the Sillence classification, and a new genetic classification consisting of XVIII types is formed. Treatment of patients with OI is a complex task which requires a multidisciplinary care. Pharmacological treatment is based on bisphosphonate treatment, which increases the bone mineral density. In this article, we will describe other approaches in which the effectiveness is studied. Surgical treatment of the fractures and deformities of the extremities showed a positive effect on the patients’ quality of life, despite existing complications. There are a lot of debates about the choice between telescopic and non-telescopic fixators. Rehabilitation plays huge role in the recovery process after fracture and surgeries.
Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. Approximately 85% of OI cases are caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2), which affect the quantity or structure of collagen. The remaining percentage of cases is caused by mutation in the proteins responsible for posttranslational modification, processing and crosslinking of collagen, bone mineralization, and osteoblast differentiation. In the past decade, new recessive, dominant, and X-linked inheritance. As a result, new types of OI were added to the Sillence classification, and a new genetic classification consisting of XVIII types is formed. Treatment of patients with OI is a complex task which requires a multidisciplinary care. Pharmacological treatment is based on bisphosphonate treatment, which increases the bone mineral density. In this article, we will describe other approaches in which the effectiveness is studied. Surgical treatment of the fractures and deformities of the extremities showed a positive effect on the patients’ quality of life, despite existing complications. There are a lot of debates about the choice between telescopic and non-telescopic fixators. Rehabilitation plays huge role in the recovery process after fracture and surgeries.
Polypoidal Choroidal Vasculopathy Treatment: Photodynamic Therapy, Anti-VEGF Monotherapy or Combination. Review of Clinical Studies
Authors: Pedanova E. K. , Doga A. V.
Published: June 2019

Polypoidal choroidal vasculopathy (PCV) is a rare subtype of neovascular age-related macular degeneration (AMD), its specific features are abnormal branching vascular network with aneurysmal dilatations (polyps), it can be diagnosed in indocyanine green angiography. PCV differs from typical AMD by some ophthalmoscopic manifestations, multimodal imaging data as angiography, OCT with the ability to visualize the choroid, OCT-angiography and expression of VEGF. Despite the different response to antiangiogenic therapy, the presence of pathological neovascularization requires anti-VEGF treatment for both AMD types. In this review, we summarize the latest literature data on the treatment of polyphoidal choroidal vasculopathy: anti-VEGF monotherapy, photodynamic monotherapy, and their combinations. Special attention is paid to the results of multicenter randomized clinical trials with a large number of patients evaluating efficacy of Ranibizumab and Aflibercept (EVEREST 2 and PLANET). The short-term and long-term results of treatment are presented, taking into account the dosing regimens, the number of required injections and the requirement for a combination of anti-VEGF monotherapy with photodynamic therapy. The results of randomized clinical trial are providing high level evidence to guide clinical specialists in choosing the most appropriate therapy for PCV.
Visualization of the Lamina Cribrosa of Sclera Using Optical Coherence Tomography. The Opportunities and Prospects for Diagnostics (Review)
Authors: Kurenkov V. V. , Klyuganov V. S. , Kuznetsova N. V. , Chinenova K. V. , Konovalov M. E. , Pozharitsky M. D.
Published: June 2019

The lamina cribrosa of the sclera is a multilayer structure consisting of layers of connective tissue represented by collagen of various types. The ratio of collagen fibers I, II and IV types, as well as elastin protein provide support and elastic properties of the lamina cribrosa. Increased intraocular pressure on the background of involutional changes in the composition of the connective tissue of the lamina cribrosa leads to deformation of the latter, compression of nerve fibers passing through the holes in the lamina cribrosa and violation of the axoplasmic current. Modern high-resolution optical coherence tomographs allow to visualize the confines of the lamina cribrosa, and the standard software integrated into each device allows to measure the parameters of the lamina cribrosa. The visualization of the lamina cribrosa in the early stages of glaucoma due to the severity of the pre-laminar tissue and the screening of the surface of the lamina cribrosa is still a problem. The presented review contains the results of studies of various ophthalmologists from different countries. The dependence of such parameters of the lamina cribrosa as depth, thickness, angle of inclination and curvature on the increased of intraocular pressure and the stage of glaucoma process was found. These studies confirm the possibility of visualization of the lamina cribrosa, open prospects in the study of the pathogenesis of glaucoma and expand the possibilities in the search for new methods of treatment of glaucoma optical neuropathy based on pathogenetic aspects. However, a small number of articles on this subject, found in the literature, and a small sample of the study groups in most works require further study of the visualization of the lamina cribrosa using optical coherence tomography.
Prospects for the Botulinum Toxin Use in the Treatment of Children`s Strabismus. Review
Authors: Markova E. Y. , Dubrovina K. A. , Avakyants G. V. , Malayan E. A.
Published: June 2019

The review presents information concerning the botulinum toxin use in the treatment of children`s strabismus; highlights aspects of the safety and the complications frequency. It contains information about the methods and doses of botulinum toxin injection, and also considers the cases of necessity of further surgery. There are several ways of introducing BTA: the traditional transconjunctival method of administration under the control of electromyography, used by most ophthalmologists, is not acceptable for treating pediatric patients, transconjunctivally into the subtenon space 10 mm from the limbus into the projection zone of the medial rectus muscle using a 1.0 ml tuberculin syringe with 27G needle, introduction to the muscle with the opening of the conjunctiva, which is safer, is carried out under complete visual control and with the release of extraocular muscle. According to the domestic and foreign literature data we can conclude that the injection of botulinum toxin may be an alternative or complement to surgical techniques, injection of botulinum toxin in the treatment of strabismus in children may be an alternative or complement to surgical and pleopto-orthopto-diploptic correction methods, although not in all clinical cases. The treatment approach of such patients should be comprehensive. There are reports that BoNT-A reduces eye deflection in more than 50 % of patients and provides satisfactory long-term results in infants and children. The average safe dose for Botox is 1-3 units for the muscle. The frequency of complications increases with higher doses (especially> 10 units) and with the transconjunctival route of administration without electromyographic control. This clinical example illustrates the effectiveness of botulinum toxin for the non-concomitant strabismus treatment.
Possibilities of Intralamellar Keratoplasty in Rehabilitation of Keratoconus Patients
Authors: Osipyan G. A. , Khrayst Kh.
Published: June 2019

Keratoconus is one of the topical problems in modern ophthalmology. Among the currently used treatment methods is intralamellar keratoplasty that utilizes allomaterials or homotransplants. The surgery technique has obvious advantages over penetrating and deep anterior lamellar keratoplasty. There is no risk of tissue incompatibility, the recovery period is shorter, and prolonged use of corticosteroids is not necessary. In recent years, technological development has made the application of femtosecond laser a standard procedure for various surgical interventions on the cornea, particularly for creation of intrastromal tunnels and corneal bags. This article presents an analysis of the modern literature data about different intralamellar keratoplasty techniques for treatment of keratoconus. The described techniques show its great clinical possibilities, especially the intrastromal keratoplasty variant with implantation of biological tissues. One of such techniques was developed and tried by a group of specialists at Research Institute of Eye Diseases in 2014. It involves recovery of corneal thickness in the ectatic area by intralamellar transplantation of a layered transplant of adequate size, which acts as a bandage. The surgery simultaneously affects the stabilization action, corrects refractive errors and eliminates the structural changes; it was accordingly named bandage therapeutic-optical keratoplasty (BTOK). The indication for its usage is progressing keratoconus in stage II–III patients. Among the described outcomes are cease of the disease progression in long-term follow-up, improvement of corrected and uncorrected visual acuity. The foreign analogue of the technique is Corneal Allogenic Intrastromal Ring Segments (CAIRS) by Jacob S. et al. His study included 20 patients with stages I to IV keratoconus; all patients undergone corneal cross-linking as the first stage, then they had CAIRS implanted into the intrastromal tunnels prepared with femtosecond laser. In both methods, the authors point at the improvement of corrected and uncorrected visual acuity. None of the patients had implant dislocation or keratoconus progression during the follow-up period.
Clinical Analyses of Efficiency of Multicomponental, Vitreoretinal Surgery of Eye Trauma
Authors: Aliev A.-G. D. , Aliev A. A.-G. , Abdulaev A. B. , Nurudinov M. M.
Published: June 2019

Eye trauma is one of the leading causes of blindness and low vision in young working age people. It gives this particular group of diseases a special social significance. The absence of a universal surgical treating tactic is explained by the variety of traumatic agents and the various types of injuries. Penetrating wounds with the introduction of a foreign body, accompanied by detachment of the retina, vascular membrane, hemorrhagic and infectious complications are the most difficult in the clinical plan.

Material and methods: 103 with penetrating eye injuries were operated during the period from 2015 to 2017. 29 of them were involving the introduction of foreign bodies, which were removed at different times: 18 eyes (62 %) — at 7–10 days, 8 eyes 27.5 %) — 14–28 days after injury and 3 eyes (10.3 %) — more than 1 month. In all cases, subtotal vitrectomy 25G (68.9 %) was performed, in some cases, 23-hedge vitrectomy was preferred (31 %) due to pronounced fibro-proliferative changes in the vitreous body. In the case of a foreign body impacted into the shells with dimensions greater than 4 mm, the real cavity was tamped with PFOS.

Results. The adherence of the detached retina was achieved in 14 cases, adherence of the choroid — 4 cases. Uveitis was observed in 5 cases, ophthalmic hypertension in 12 patients in the early postoperative period. Hypertension was compensated by using the antihypertensive regimen. 5 patients at the time of hospitalization had a Vis = 0, the operation was of a diaphragm-preserving nature, since a foreign body that was not removed was the cause of the development of subatrophy of the eyeball in 16 % of cases. The remaining patients had stable, positive dynamics of visual functions in the postoperative period.

Conclusion: Surgery tactics for extensive eye injuries are individual, and the amount of intervention depends largely on the parameters of the traumatic agent, so planned surgery is preferable to emergency because it allows for detailed preoperative examination and to get valuable information about the condition of the eye. The exceptions are injuries with symptoms of acute endophthalmitis. Multi-unit operations provide optimal conditions for the preservation of the eye as an organ and contribute to the restoration of visual functions.
Results of Cataract Extraction in Patients with Corneal Opacity
Authors: Ivachev E. A. , Anisimova E. V. , Denisova I. P.
Published: June 2019

Purpose. To evaluate the effectiveness of cataract extraction in patients with varying degrees of corneal opacity.

Patients and methods. We performed cataract extraction with implantation of the intraocular lenses of 14 eyes (9 patients) with varying degree of corneal opacity. The causes of corneal opacities were: keratitis in anamnesis — 6 cases, the result of wearing soft contact lenses — 2 eyes, eye injury — 2, the outcome of dermatitis of unspecified genesis with eye damage — 3, perforation of the corneal ulcer — 1 case. In 9 eyes, opacity of the cornea occupied the optic part of the cornea, in 5 cases, the opacity of the cornea was in the paraoptic zone. The middle uncorrected visual acuity of all cases is 0.05 ± 0.03, and the middle best corrected visual acuity is 0.14 ± 0.07. The phacoemulsification of the cataract with implantation of the intraocular lens was performed for all the patients.

Results. There were no complications during the operation, in the early and late postoperative periods. As a result of cataract extraction, all patients, regardless of the degree of cornea opacity, noted vision improvement. On the first day after the operation, the middle best corrected visual acuity was 0.06 ± 0.02 in 4 eyes, in 10 cases the middle best corrected visual acuity was 0.09 ± 0.03. The middle best corrected visual acuity 7 days after the surgery was 0.31 ± 0.07. After 6 months of observation of patients with corneal opacity after phacoemulsification of the cataract with implantation of the intraocular lens, the most corrected visual acuity was 0.27 ± 0.19.

Conclusions. All patients with corneal opacity of varying degrees of intensity after cataract extraction noted improved vision. The central location of the opacity of the cornea significantly reduced visual acuity, and paraoptic — influenced the vision to a lesser extent. The degree of cornea turbidity was also affected the initial visual acuity — the more clouding and the depth of the cornea, the lower the vision. The result of the lens extraction also depended on the maturity of the cataract — with a more turbid lens the result was higher in relation to preoperative indices.
The Analysis of Risk Factors of Development of Macular Edema after Phacoemulsification
Authors: Kokorev V. L.
Published: June 2019

Purpose: To identify and analyze factors contributing to the development of macular edema after cataract phacoemulsification (FEC).

Methods: over 3 years of follow-up, 6218 surgeries were performed in 4608 patients. They were divided into three groups, taking into account the specifics of the surgery: operated on with 2.2 mm access without posterior capsulorhexis (РC), operated on using MICS technology through access 1.6–1.8 mm without РC, patients operated on with MICS technology through access of 1.6–1.8 mm from РC. The study included patients with persistent cystic macular edema (СMЕ), whose treatment required invasive interventions. During the observation period, 28 cases of persistent CME were identified, which were divided into groups corresponding to the time of onset, type of surgery and comorbidities.

Results: a comparative analysis in groups without posterior capsulorhexis with access of 2.2 mm (n = 513) and 1.6–1.8 mm (n = 2588) using the Student’s statistical confidence coefficient (P) showed that a decrease in surgical access was significantly reduces the risk of СМЕ, which confirms its connection with the invasiveness of the intervention.

Conclusion: Identified groups of factors that influence the nature of the macula response to the FEC, in particular, the occurrence of macular edema. All factors were analyzed. It was revealed that such factors as comorbidities (diabetes mellitus, age-related macular degeneration), type of surgical approach, and the presence of the epiretinal membrane directly affected the development and progression of macular edema. All factors were analyzed. It was revealed that such factors as comorbidities (diabetes mellitus, age related macular degeneration), type of surgical approach, and the presence of the epiretinal membrane directly affected the development and progression of macular edema. At the same time, revealed a direct relationship between the time of occurrence of CME and its effectiveness, as well as the volume of its invasive treatment. A significant increase in visual acuity in patients suggests a high efficacy of CME treatment associated with surgery.
Spectral OCT-Angiography in En Face Mode for Detection of Morphological Changes in the Retinal Pigment Epithelium before and after Selective Micro-Pulse Laser Exposure in Patients with Central Serous Chorioretinopathy
Authors: Volodin P. L. , Ivanova E. V. , Polyakova E. Iu. , Fomin A. V.
Published: June 2019

Purpose — to study the morphological changes of the retinal pigment epithelium (RPE) by optical coherence tomography-angiography (OCT-A) in En Face mode before and after selective micropulse laser irradiation in patients with central serous chorioretinopathy (CSC), determine the correspondence between the topographic location of RPE defects and detachment on the OCT-angiogram in En Face mode and points of leakage on the FAG.

Patients and methods. There were 20 patients (21 eyes) with CSC before and after laser treatment under the observation. All patients underwent high-resolution FAG and OCT-A using Angio Retina 2×2 or 3×3 mm protocol and Angio Retina HD 6×6 mm. The treatment was carried out in a selective micropulse mode with individual selection of parameters using the Navilas 577s navigation laser system (OD-OS, Germany) or the IQ 577 laser system (IRIDEX, USA).

Results were evaluated at 2 weeks and 1 month after treatment. Results. In all cases, the leaking points of the subretinal fluid on FAG corresponded to the topographic location of defects and detachments of RPE detachment on OKT-A En Face. According to OCT-A En Face, the following morphological changes were revealed: in 5 cases — single defects of RPE, in 7 cases — multiple defects of RPE, in 9 cases of slit-like detachment of RPE, in 3 patients a combination of slit-like detachment and defect RPE. The sizes of RPE defects varied in the range from 21 to 159 microns, while their rounded shape prevailed. 1 month after the selective micropulse laser effect on OCT-A in the En Face mode, the defects were closed and the RPE detachments fit in all patients, which resulted in resorption of the subretinal fluid and the neurosensory retina attachment.

Findings. OCT-A in En Face mode is a highly informative diagnostic method that allows noninvasive detection of morphological changes in RPE with a clear topographic localization relative to the retinal vascular network, as well as evaluating the effectiveness of selective micropulse laser treatment in patients with CSC.
The Role of the Complex Clinical-Anamnestic and the Laboratory Examination in Establishing the Etiology of Endogenous Uveitis
Authors: Konkova A. Yu. , Horowitz E. S. , Gavrilova T. V. , Pozharitsky M. D. , Chereshneva M. V.
Published: June 2019

Purpose: to estimate the results of the clinical and laboratory survey among patients with uveites for refinement of the disease’s etiology.

Patients and Methods. 107 patients with uveites (114 eyes) were under control. A standard ophthalmologic survey was done with them; a serodiagnosis (immunoassay analysis) towards Toxoplasma gondii, Herpes simplex virus Ist, IInd types, Citomegalovirus, Chlamidia trachomatis; a bacteriological examination of tear fluid, some material from nose and cavity to definite factors of virulence and antibiotic sensitivity of exuded microorganisms. A molecular and genetic survey (PCR) of tear fluid towards Toxoplasma gondii , Herpes simplex virus Ist, IInd types, Citomegalovirus was done among 30 people.

The results. Provocative factors of the disease were detected in 42 % of cases. Concomitant diseases were in 77 %. Diseases of cardiovascular system prevailed in 49 %; ceiling of mouth cavity in 42 %; systemic diseases in 29.3 %. The most widespread were anterior uveites in 60.5 %; recur character prevailed in 51 %; deteriorations progressed in 58.8 % of cases. A chronic infection with herpes viruses was among almost all the patients (HSV I, II — 100 %, CMV — 96.3 %). To Toxoplasma gondii specific IgG were detected in 44.9 %, IgM in 2.8 %; to Clamidia trachomatis specific IgG in 21.5 %. 66 strains of bacteria were selected: from tear fluid — 34, from mouth — 17, from nasal cavity — 15; gram-positive bacteria of Staphylococcus prevailed in 83.3 %. In some cases of revealing S. aureus, which were isolated from all three biotypes, they were close to their phenotypic characteristics, which indicates to their etiologic importance in uveites’ progress. The research of tear fluid in PTSR turned to be less informative. Based on the anamnesis and the results of a complex survey it managed to become possible to decipher the etiology of the disease in 74.6 %. Among them were 67.1 % of infectious and infectious-allergic uveites; 80.7 % of bacterial uveites; 15.8 % of virus uveites and 3.5 % of parasitic uveites. 28.2 % of inflammations occurred on a background of system and syndromic diseases, the majority of diseases were on a background of Behterev’s disease and rheumatoid arthritis, 45.5 % for each. Non-infectious autoimmune and toxical-allergic reasons were set in 4.7 % of cases.

Conclusion. It is more expediently to use a complex diagnostic approach with taking into account clinical and anamnestic information and laboratory information of the survey in the investigation of uveitis etiology.
Wide-Field Imaging with NAVILAS Laser System
Authors: Kulikov A. N. , Maltsev D. S. , Burnasheva M. A. , Volkov V. V. , Danilichev V. F. , Troyanovskiy R. L.
Published: June 2019

Purpose: to study the potential of wide-field imaging with NAVILAS laser system.

Material and methods. In this study we included patients diagnosed with indirect ophthalmoscopy as having one of the follows: diabetic retinopathy (6 eyes), central retinal vein occlusion (5 eyes), choroidal melanoma (3 eyes), rhegmatogenous retinal detachment (4 eyes), and peripheral chorioretinal degeneration (10 eyes). Using NAVILAS 532 laser system and a wide-field contact lens (HR Wide Field (VOLK)) a wide-field central image and a panoramic (consisted of 4 to 6 images) images were obtained in all patients. Fundus images were evaluated according to their diagnostic value versus indirect ophthalmoscopy and wideness of the viewing angle versus standard color fundus photography (55°). In each patient within a single session were obtained: 1) a central fundus image and 2) panoramic image (4-field and in dynamic mode). In a subgroup of patients with central retinal vein occlusion and lattice retinal degeneration, we studied the ability of simultaneous laser photocoagulation wide-field imaging.

Results. A single field images obtained with NAVILAS allows to visualize up to 130.3 ± 9.6° of the eye fundus while four-field and dynamic acquisition up to 150.1 ± 8.9° and 171.3 ± 17.0°, respectively. Representative findings of diabetic retinopathy, central retinal vein occlusion, choroidal melanoma, rhegmatogenous retinal detachment, and peripheral lattice degeneration were identified in all cases. Insufficient visualization was found for “snail track” degeneration because the subtle retina and choroid changes were hardly seen on the low magnified image. In 4 patients with lattice retinal degeneration and 3 patients with central retinal vein occlusion within a single session, both wide-field imaging and laser photocoagulation were performed. Surgical goals were achieved in all cases.

Conclusion. Wide-field imaging with NAVILAS laser system demonstrated high potential in the documentation of the most widely spread eye fundus disease the and represents an adequate alternative for wide-field fundus cameras. Aside from wide-field imaging this approach also allows for simultaneous laser photocoagulation in entire eye fundus including far peripheral retina.
Optical Correction of Keratoconus with a Scleral Gas-Permeable Lenses
Authors: Myagkov A. V. , Slonimskiy Yu. B. , Belousova E. V. , Mitichkina T. S. , Bunyatova L. R.
Published: June 2019

The optical properties of the cornea are determined by its ability to refract and transmit light. Keratoconus changes cornea’s shape, the surface of the cornea becomes irregular, which leads to a violation of light refraction and the occurrence of optical aberrations. The progressing course of the disease and its late detection lead to a delayed start of therapeutic measures, which affects the prognosis of the disease progression and reduces the patient’s quality of life. The quality of visual functions depends on the stage of the process. There are 4 stages of keratoconus (according to M. Asler), each of which corresponds to certain changes in refraction and degree of deformation of the cornea. Early biomicroscopic signs are: “dilution” of the stroma (inhomogeneity of the cornea and a grayish tint in the zone of the developing apex), change in the shape of endothelial cells and clearly visible nerve endings due to longitudinal thickening. In the second stage of keratoconus, the biomicroscopic picture is complemented by the appearance of keratoconus lines (Vogt’s striae). The opacities of the Bowman’s membrane indicate the beginning of the scarring process and the transition of the disease to its third stage. The fourth stage of the disease is characterized by further development of stromal opacities and the occurrence of gross changes of the Descemet’s membrane. Advanced medical equipment for topographic mapping and measuring the cornea makes it much easier for ophthalmologists to diagnose keratoconus and choose more effective treatment methods: crosslinking or surgical treatment. Later it allows to stabilize keratoconus, but does not provide high visual acuity due to the induction of optical aberrations, including high order optical aberrations. Contact lens vision correction is the main way to correct the refractive error resulting from keratoconus. However, the use of corneal gas permeable or soft contact lenses cannot provide high quality vision, additionally causing discomfort associated with their excessive mobility. The use of scleral gas permeable contact lenses is the most effective method of optical correction of all stages of keratoconus and after keratoplasty.
Experimental Model of Recurrent Corneal Erosion
Authors: Kulikov A. N. , Churashov S. V. , Gavrilyuk I. O. , Tarabrina V. A. , Platonov N. I. , Muravyeva O. A. , Troianovskiy R. L.
Published: June 2019

Introduction. In a number of pathological conditions accompanied by the basement membrane defects, such as chemical or thermal burns, mechanical trauma, Sjögren’s syndrome, neurotrophic keratopathy or some corneal dystrophies, in which conditions are created independent epithelialization is weakened or becomes impossible. This condition was named recurrent corneal erosion (RCE). For the experimental study of the regenerative processes and evaluation of the effectiveness of new treatments, a standardized and reproducible RCE model is needed. Several RCE models are known: chemical, bacterial. The disadvantages of such models are the labour intensity of their implementation and a relatively high cost. The proposed method makes it possible to create the necessary conditions for local inflammation and destruction of adhesive molecules using the energy of ultraviolet (UV) irradiation. In this study, an experimental RCE model in rabbits has been proposed.

Purpose. To create a reproducible standardized experimental model of recurrent corneal erosion.

Materials and methods. The studies were conducted in 8 chinchilla rabbits (16 eyes). After local instillation (0.5 % alkaine solution) and retrobulbar anesthesia (2 % lidocaine solution), superficial deepithelialization of the cornea was performed by mechanical removal of its epithelium with a blunt scraper; and the quality of deepithelialization was assessed by staining the surface with 2 % fluorescein solution. In the optical zone with a diameter of 4 mm, local UV irradiation of the cornea was performed with exposures of 30 and 45 minutes.

Results. In case of 30-minute exposures, the epithelialization of the cornea subjected only to mechanical deepithelialization was observed since Day 3 in the form of concentric epithelial growth. On Day 14, a complete epithelialization of the cornea was observed, along with the formation of superficial newly formed vessels along the limbus. On Day 24, the vascular injection significantly decreased; and no erosion was observed. After 45-minute exposure without treatment, the regeneration occurred much slower; and a complete epithelialization had been achieved by Day 34 of the experiment, by the time the newly formed vessels grew to the epithelial defect zone. It was noted that since Day 86, the turbidity in the irradiation area persisted, as well as the inflammatory infiltrate.

Conclusions. The proposed method makes it possible to reproduce RCE, in which there is an alternation of epithelialization and deepithelialization of the irradiated corneal area through 30 days of the experiment and is arrested only after the ingrowth of surface vessels into the affected area. At that, the non-irradiated cornea is epithelialized by Day 7 of the experiment.