[Asteroid hyalosis]

The article analyzes existing information on clinical and experimental studies of vitreous changes in asteroid hyalosis, historical aspects of how this condition was studied over the past hundred years, its occurrence and pathogenesis. Results of various studies were used to evaluate current understanding of the forms and elemental composition of phospholipid mineral sedimentation on vitreous structures and methods of its examination. The problem of intravital assessment of the condition of vitreous body was analyzed, and a method was suggested for studying the macrostructure of hyaloid tracts and the state of the vitreous body by means of digital ultrasound in patients with asteroid hyalosis.

[Three-dimensional acoustic analysis in diagnostics of structural and morphological changes of the eye in certain congenital pathologies]

Changes in ocular anatomy and topography that occur due to congenital development anomalies are often of complex, composite nature. Such pathologies are accompanied by not only refractive errors, but also changes in eye's macrostructure. Careful analysis of the changes is necessary to better understand the clinical picture.

PURPOSE

To study the specifics of structural and morphological changes of the eye in certain ocular congenital pathologies and in some orphan diseases using the results of three-dimensional ultrasound analysis and digital acoustic imaging.

MATERIAL AND METHODS

The study included 60 patients (119 eyes) with congenital ocular changes, some of which are registered as independent orphan diseases, as well as with systemic manifestations including congenital changes in eye membranes, lens and the vitreous body. The examination involved three-dimensional scanning followed by digital processing of the imaging data obtained using general medical ultrasound systems Voluson 730 Pro Kretz and Voluson E8.

RESULTS

Digital ultrasound technologies significantly expand the scope of data on eye morphology in various congenital changes obtainable in vivo.

CONCLUSION

The advantage of this investigation method is the possibility to reliably detect congenital spatially complex morphological deformations in the eye tissues, which in some cases are impossible to observe with other methods.

[Ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome (a clinical case study)]

The article presents a clinical observation of ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome - a rare genetic disease characterized by systemic thrombosis caused by uncontrolled activation of alternative complement pathway. A typical manifestation of this ocular lesion in this disease is bilateral Purtscher-like retinopathy. Timely diagnostics of atypical hemolytic-uremic syndrome, including ophthalmologic examination, determines the early start of a highly effective pathogenetic therapy with complement inhibitor eculizumab.

[Combination therapy of refractory localized granulomatosis with polyangiitis and orbital involvement]

Granulomatous orbital cellulitis is one of the most common ocular manifestations of granulomatosis with polyangiitis (Wegener's). The process is often refractory to conventional immunosuppressive therapy and requires a more radical treatment approach. However, surgical experience with this type of patients is limited. There have been just a few reported cases of orbital decompression in such patients and many authors have doubted the appropriateness of the procedure, since it is associated with a high risk of potentially fatal complications. Our experience demonstrates the feasibility and effectiveness of orbital mass removal as to pain relief and exophthalmos reduction.

[Takayasu's disease in an IgG4-positive patient with tuberculosis, pulmonary hemorrhage, recurrent myocarditis, and transient bilateral visual impairments]

Takayasu's disease (nonspecific aortoarteritis) affects the absolute majority of 20-40-year-old women; its most common manifestations include aortic arch branch lesions. The specific features of the described case is the male gender of the patient, signs of mesenchymal dysplasia, a concurrence of tuberculosis, pulmonary hemorrhage, and myocarditis at onset, the presence of IgG4, peculiar ocular symptomatology, and its rapid regression after initiation of therapy.

[Core principles of treatment of corneal damage in patients with thyroid eye disease]

AIM

To develop a therapeutic approach and to estimate the efficiency of complex treatment of corneal damage in patients with thyroid eye disease (TED).

MATERIAL AND METHODS

The study enrolled 44 patients (52 eyes) divided into 2 groups depending on the severity of corneal damage. Treatment of those with severe involvement included pathogenetic measures (pulse steroid therapy and/or radiation therapy) and surgery (orbital decompression, eyelid and corneal surgery).

RESULTS

As the result of the treatment, orbital inflammation decreased and the state of the cornea improved in all patients.

CONCLUSION

The treatment of corneal damage in patients with TED may differ depending on numerous factors, such as the severity of corneal damage and activity of orbital inflammation. Taking into account the potential danger of corneal involvement, one should make efforts to early detection and management of the risk factors.

[Modern methods of minimally invasive glaucoma surgery]

Over the years, glaucoma surgery has improved from iridectomy by A. Graefe and traumatizing procedures performed without magnification tools or microsurgical instrument to high-technology interventions that are not only microscopic, but also pathogenetically oriented. Various modifications of trabeculectomy, initially introduced by J. Cairns back in 1968, had been the gold standard for several decades and were notable for pronounced and stable hypotensive effects. However, there was also a strong association with such complications as choroidal detachment and hyphema, thus, boosting the development of so called nonfistulizing surgeries. Of the latter, the most widely used are non-penetrating procedures, including deep sclerectomy and viscocanalostomy. Although very safe, they appear unable to produce a truly long-lasting hypotensive effect. Moreover, just as fistulizing trabeculectomy, non-penetrating procedures damage the limbus and adjacent conjunctiva reducing the possibility of a second intervention. This fact together with other drawbacks mentioned above, on the one hand, and technical progress, on the other, were essential prerequisites for the appearance of a new type of surgery - minimally invasive glaucoma surgery (MIGS). Parameters that should be met for a procedure to be considered minimally invasive are debated. The main requirement has, however, been established: ab interno approach through a corneal incision. As surgical tools are enhanced and new techniques arise, options for glaucoma treatment widen greatly, ensuring our future move to higher level standards in the field. This review contains all recent data on minimally invasive techniques currently in use in glaucoma surgery or those under investigation. The authors have also analyzed effectiveness reports and present their conclusions regarding the current state of MIGS worldwide.

[Static correction of lagophthalmos in chronic facial palsy]

Choice of surgical option for lagophthalmos correction (use of encircling allotendinous string or fixation of medial aspect of the lower tarsal plate) in patients with chronic facial palsy is proved. This technique was reinforced with dissection of the tendon or superior tarsal muscle resection and lateral canthopexy. The advantages of surgical methods considering clinical aspects (in particular the degree of medial canthal tendon laxity) are shown.

[Prospects for using the Mullerectomy for correcting ptosis of the upper eyelid]

New anatomic topographic and clinical validation of mullerectomy is presented and more comprehensive evaluation of preoperative adrenergic drug test is suggested. Morphological substantiation of an isolated resection of the superior tarsal muscle (Müller muscle) and orbital conjunctiva of the upper eyelid with subsequent fixation of the proximal part of Müller muscle to the tarsal plate is presented. The results of surgical treatment of 51 patients evidence high reliability, functional and cosmetic efficiency of mullerectomy which does not involve a skin incision, and a low incidence of complications (mean period of observation 35 months).

[Study of ocular hemodynamics and general somatic status of patients with primary open-angle glaucoma]

Ocular hemodynamics and general somatic status were studied in 50 patients with primary open-angle glaucoma. Complex ophthalmological and therapeutic examinations were carried out, macro- and microcirculatory hemodynamics of the eye was examined, case histories and therapeutic status of patients were analyzed with due regard for previous local hypotensive and general vascular therapy. Revised recommendations for glaucoma patients aimed at correcting their life style include diet, regular vascular and metabolic therapy, normalization of orbital circulation in order to improve ocular hemodynamics and increase the tolerance of the optic nerve to intraocular pressure fluctuations.

[An analysis of the prevalence of clinical refraction (based on data from the reciprocal dispensary care of students at the I. M. Sechenov Moscow Medical Academy)]

Results of mutual check-ups of 5-year students of therapeutic and medical prophylactic faculties of I. M. Sechenov Moscow Medical Academy in 1991-1994 are analyzed. A total of 584 case histories of students are reviewed. The data demonstrated correlation of many signs in the sample and statistical data of ophthalmological publications on refraction. Conclusions about errors in prescription and use of eyeglasses are made. Violation of visual loading regimen by these students are detected.

[Clinical and cytological parallels in inflammatory diseases of the conjunctiva]

The conjunctiva was examined in 52 patients with acute and chronic nonspecific conjunctivitis by impression cytology. Clinical course of conjunctivitis of different origin was correlated to the cytopathological changes in the conjunctival epithelium. The authors emphasize the high clinical value of the method in the diagnosis of inflammatory processes in the conjunctiva, monitoring of treatment, and prediction of the final result of therapy.