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Modifying treatment of degenerative retinal diseases. Part 2. Conditioning therapy techniques and the problem of maximizing retinal plasticity 视网膜退行性疾病的改良治疗。第2部分。调节治疗技术和最大化视网膜可塑性的问题
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-165-172
N. V. Neroeva, M. V. Zueva, L. A. Katargina, V. I. Kotelin, A. N. Zhuravleva, I. V. Tsapenko, D. V. Fadeev
In the first part of the review [ROJ, 2023; 16 (2): 160–2], we discussed the common and specific features of adaptive and non-adaptive retinal plasticity characteristic of glaucoma, age-related macular degeneration, retinitis pigmentosa, diabetic retinopathy, and retinopathy of prematurity. The presented part of the review discusses the issues of axon regeneration of retinal ganglion cells and analyzes therapeutic approaches aimed at maximizing the plasticity and stimulating the reparative potential of the retina. The protective effects of "conditioning" stimuli in the modifying treatment of retinal diseases are considered. Some of the present-day visual rehabilitation strategies based on visual perception training and visual fixation training using biofeedback systems are reported.
第一部分综述[j], 2023;[16](2): 160-2],我们讨论了青光眼、年龄相关性黄斑变性、视网膜色素变性、糖尿病视网膜病变和早产儿视网膜病变的适应性和非适应性视网膜可塑性的共同特征和特异性。本文讨论了视网膜神经节细胞轴突再生的问题,并分析了旨在最大限度地提高可塑性和刺激视网膜修复潜力的治疗方法。“条件反射”刺激在视网膜疾病修饰治疗中的保护作用被考虑。本文报道了目前一些基于视觉感知训练和视觉固定训练的视觉康复策略。
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引用次数: 0
Secondary ametropia retreatment with flap lifting performed long after LASIK surgery: a clinical case LASIK术后长时间再植皮瓣治疗继发性屈光不正一例
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-136-140
N. V. Khodzhabekyan, A. T. Khandzhyan, A. V. Ivanova, A. S. Sklyarova, I. V. Manukyan
Purpose : to present a clinical case of secondary ametropia retreatment with flap lifting, which was performed long after a LASIK surgery. Material and methods . A female patient who experienced a regression of the refraction effect after a LASIK surgery, received a flap lifting with keratoablation 18 years after the primary LASIK surgery. 8 days following this procedure, the patient developed a complication, namely an epithelial ingrowth. Another flap lifting procedure was performed and the epithelial ingrowth was removed. Results . The expected refractive effect was achieved with binocular hypocorrection as planned. Conclusion . A repeated flap lifting undertaken 3 years or more after the first LASIK or FemtoLASIK surgery increases the risk of a complication — an epithelial ingrowth into the space under the flap. To avoid the complication in such cases, the retreatment by PRK is preferable. Scarification and elimination of the in-grown epithelial should be performed early after the surgery.
目的:报告一例在LASIK术后长期应用皮瓣提升术治疗继发性屈光不正的临床病例。材料和方法。一位女性患者在LASIK手术后屈光效果消退,在原发LASIK手术18年后接受了带角膜消融的皮瓣提升术。手术后8天,患者出现并发症,即上皮向内生长。进行另一次皮瓣提升手术,去除上皮向内生长。结果。预期的屈光效果在双眼矫正后如期实现。结论。在第一次LASIK或FemtoLASIK手术后3年或更长时间内重复皮瓣提升会增加并发症的风险-上皮向内生长到皮瓣下的空间。为了避免这种情况的并发症,PRK再治疗是可取的。手术后应尽早清除和清除生长的上皮组织。
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引用次数: 0
Ocular proton therapy: state-of-the-art 眼质子治疗:最先进的
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-147-151
V. O. Karpunin, D. G. Orlov, V. S. Khoroshkov
We present the current trends in proton therapy of patients with intraocular malignancies as reflected in the materials of the First PTCOG ocular proton therapy symposium, held on March 3–4, 2022.
我们在2022年3月3-4日举行的第一届PTCOG眼部质子治疗研讨会上介绍了目前眼内恶性肿瘤患者质子治疗的趋势。
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引用次数: 0
Telemedicine for glaucoma: the state-of-the-art and trends of development 青光眼远程医疗的现状及发展趋势
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-173-179
S. Yu. Petrov, T. N. Malishevskaya, E. E. Farikova, O. I. Markelova
Glaucoma is the top leading cause of ophthalmic-related disability in almost all Russian regions. It is a chronic lifelong disease which requires regular monitoring (once a year or more often) in a medical facility. Since the population is aging, the prevalence of glaucoma is steadily increasing, which hampers access to medical care. Advances in telecommunications and diagnostic technologies have given rise to programs of TV glaucoma, which are used to pass the basic glaucoma parameters on to a specialist working remotely for interpretation. The Federal Law No 242-FZ on telemedicine came into force on January 1, 2018, but the COVID-19 pandemic sped up the development of information technologies in medicine in general and telemedicine communication in particular. The review presents the data on TV glaucoma programs which point to their effectiveness and provides practical advice. Potentially, telemedicine can facilitate access to medical care. The analysis of the economic factors shows that remote consulting is more cost-effective than traditional face-to-face examination of the patient. TV glaucoma programs often help detect glaucomatous changes in the ONH, so more patients with suspicion of glaucoma are referred for screening.. Publications focused on the experience in using active programs contribute to their further development and introduction to the public health system, which will eventually facilitate the access to quality medical care for patients with glaucoma.
青光眼几乎在俄罗斯所有地区都是导致眼相关残疾的首要原因。这是一种慢性终身疾病,需要在医疗机构进行定期监测(每年一次或更频繁)。由于人口老龄化,青光眼的发病率正在稳步上升,这阻碍了获得医疗保健。电信和诊断技术的进步带来了电视青光眼的程序,该程序用于将青光眼的基本参数传递给远程工作的专家进行解释。关于远程医疗的第242-FZ号联邦法于2018年1月1日生效,但2019冠状病毒病大流行加速了医疗信息技术的发展,特别是远程医疗通信。本文回顾了电视青光眼节目的数据,指出了它们的有效性,并提供了实用的建议。远程医疗有可能促进人们获得医疗服务。经济因素分析表明,远程咨询比传统的面对面检查更具成本效益。电视青光眼项目经常有助于检测ONH青光眼的变化,因此更多的怀疑青光眼的患者被转介进行筛查。专注于使用主动项目经验的出版物有助于其进一步发展和引入公共卫生系统,这将最终促进青光眼患者获得高质量的医疗服务。
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引用次数: 0
Risk factors, diagnostics and treatment of corneal melting after cataract phacoemulsification 白内障超声乳化术后角膜融化的危险因素、诊断及治疗
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-127-135
S. N. Svetozarskiy, A. N. Andreev, A. V. Shvaikin, I. G. Smetankin
Inflammatory complications of cataract phacoemulsification are among the most urgent and potentially vision-threatening conditions. Corneal melting is a rare but clinically significant condition preceding corneal perforation. The main risk factors are the use of nonsteroidal anti-inflammatory drugs (NSAIDs), severe dry eye disease and rheumatic diseases. The paper presents a literature review and offers an analysis of a clinical case of corneal melting after cataract phacoemulsification in a female patient with severe dry eye disease, which was undiagnosed before surgery. The follow-up period was 5 years. The possibilities and limitations of multiple methods of corneal melting treatment at the stages of persistent epithelial defect and corneal ulcer are discussed. The mechanism of disease development and its link with the pathogenesis of dry eye disease and the role of topical NSAIDs as a trigger for the initiation and progression of corneal melting are considered.
白内障超声乳化术的炎症并发症是最紧急和潜在的视力威胁条件之一。角膜融化是角膜穿孔前的一种罕见但有临床意义的疾病。主要的危险因素是使用非甾体抗炎药(NSAIDs)、严重的干眼病和风湿病。本文对1例重度干眼症女性白内障超声乳化术后角膜融化的临床病例进行文献回顾和分析,该病例术前未确诊。随访期为5年。本文讨论了在持续性上皮缺损和角膜溃疡阶段,多种角膜融化治疗方法的可能性和局限性。疾病发展的机制及其与干眼病发病机制的联系,以及局部非甾体抗炎药作为触发角膜融化的开始和进展的作用。
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引用次数: 0
Keratoprostheses: from the past to the future 角膜假体:从过去到未来
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-141-146
M. V. Grishchenko, V. V. Myasnikova, D. A. Nefedov
The review outlines the models of keratoprostheses currently used in various countries and their effectiveness, conceptual models under development, prospects and trends in keratoprosthetics observed in the world.
综述了目前各国使用的角膜修复模型及其有效性、正在开发的概念模型、世界上观察到的角膜修复的前景和趋势。
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引用次数: 0
Methodological aspects of statistical analysis in ophthalmology 眼科学统计分析的方法学方面
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-180-186
A. S. Sorokin, S. Yu. Petrov, N. V. Zvezdina, M. A. Golovanova
Statistics can be used to evaluate the prevalence of diseases, differences between patient groups, links between test results, compare the effectiveness of different types of treatment, test the hypothesis and model the interdependencies between variables. In medical universities, preference is given to special medical disciplines. Yet, a skilled medical specialist should have an adequate understanding of statistical data analysis. Purpose: to systematize and demonstrate statistical analysis techniques that could be useful for an ophthalmologist. Results. The major methodological aspects of statistical analysis in ophthalmology are considered. An overview of statistical techniques and an algorithm of choosing such techniques is given. Descriptive statistics and features of in-depth statistical analysis used in ophthalmological research are presented. Examples of scientific work using these methods are listed. Conclusion. The basics of statistical analysis expand the scope of instruments that ophthalmologists have at their disposal. The paper provides links to open sources in which statistical techniques and results achieved therewith are presented. These links increase the ophthalmologist’s awareness of the instruments considered.
统计可用于评估疾病的流行程度、患者群体之间的差异、检验结果之间的联系、比较不同类型治疗的有效性、检验假设并为变量之间的相互依赖性建立模型。在医科大学,优先考虑特殊医学学科。然而,一个熟练的医学专家应该对统计数据分析有足够的了解。目的:系统化和演示可能对眼科医生有用的统计分析技术。结果。主要的方法学方面的统计分析,在眼科考虑。概述了统计技术和选择这些技术的算法。介绍了眼科研究中使用的描述性统计和深度统计分析的特点。列举了使用这些方法进行科学工作的例子。结论。统计分析的基础扩展了眼科医生可以使用的仪器范围。本文提供了与开放资源的链接,其中介绍了统计技术和由此获得的结果。这些环节增加了眼科医生对所考虑的仪器的认识。
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引用次数: 0
Medical and technical aspects of using intraocular lenses with extended depth of field 使用大景深人工晶状体的医学和技术方面
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-159-164
M. E. Konovalov, A. V. Morenko
Purpose: to analyse the medical and technical aspects of intraocular lenses (IOLs) with extended depth of field (EDOF). Literature analysis was performed in the PubMed international database, the search keywords being “IOL with extended depth of field” (EDOF), “Optical Bench Evaluation of IOL”, “Preclinical evaluation of IOL”, “Aberrations”, “Monofocal IOL” (MOFIOL), “Multifocal IOLs” (MUFIOL). A total of 226 sources were analyzed, further using systematic review filters and the authors' knowledge of the topic. The duration of the retrospective analysis was 7 years (2016–2022), some of the considered work dates back to 2023. Unlike MUFIOL, EDOF lenses create a single elongated focal point to increase the depth of field, rather than several foci. Thus, EDOFs are aimed at reducing light phenomena, glare and halos, the occurrence of which is characteristic of MUFIOL. A potential disadvantage of EDOF is the reduction in retinal image quality with an excessive increase in the number of aberrations. The factors of the medical and technical assessment of the IOL indicate a high correlation with the predicted visual acuity (VA). EDOFs, whose design features are based on a higher order aspherical design, provide comparable optical quality for the far and extended intermediate ranges, while producing halo effects comparable to those of MOFIOL. Designed to improve depth of field with a full correction of corneal spherical aberration, EDOF provides intermediate-level pupil-independent improvement in VA and maintains visual acuity unlike conventional MOFIOLs. The quality of visual perception and the predicted VA of various types of EDOFs depend on the optical technology and the correction of corneal spherical aberrations. EDOFs can be expected to provide adequate vision at an intermediate distance (with a possibility of insufficient near vision). At the same time, the expansion of the depth of field varies between models, which should be taken into account when preoperatively choosing EDOF for a specific type of daily visual activity of the patient, especially for people with visually strenuous work. The results of the medical and technical assessment are widely used in the clinical testing of specific types of EDOF IOLs.
目的:分析大景深人工晶状体(iol)的医学和技术问题。在PubMed国际数据库中进行文献分析,检索关键词为“扩展景深IOL”(EDOF)、“光学台架评价IOL”、“临床前评价IOL”、“像差”、“单焦点IOL”(MOFIOL)、“多焦点IOL”(MUFIOL)。共分析了226个来源,并进一步使用系统评价过滤器和作者对该主题的了解。回顾性分析的持续时间为7年(2016-2022年),其中一些被考虑的工作可以追溯到2023年。与MUFIOL不同,EDOF镜头创建一个细长的焦点来增加景深,而不是几个焦点。因此,edof旨在减少光现象,眩光和光晕,这是MUFIOL的特征。EDOF的一个潜在的缺点是视网膜图像质量的降低与过度增加的数量像差。人工晶状体的医学和技术评价因素与预测视力(VA)高度相关。EDOFs,其设计特点是基于高阶非球面设计,提供相当的远和扩展的中间范围的光学质量,同时产生光晕效果可媲美那些MOFIOL。EDOF的设计目的是通过完全矫正角膜球差来改善景深,与传统mofiol不同,EDOF提供了中等水平的不依赖瞳孔的VA改善,并保持了视力。不同类型EDOFs的视觉感知质量和预估视差取决于光学技术和角膜球差的校正。edof可以在中距离提供足够的视力(有可能近距视力不足)。同时,不同模型的景深扩展不同,在术前为患者的特定类型的日常视觉活动选择EDOF时应考虑到这一点,特别是对于视觉工作繁重的人。医学和技术评估的结果被广泛应用于特定类型的EDOF人工晶体的临床检测。
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引用次数: 0
State-of-the-art methods of qualitative and quantitative assessment of eye microcirculation 最先进的眼微循环定性和定量评估方法
Q4 Medicine Pub Date : 2023-10-12 DOI: 10.21516/2072-0076-2023-16-3-152-158
T. N. Kiseleva, S. Yu. Petrov, T. D. Okhotsimskaya, O. I. Markelova
Circulatory disorders in eye vessels play an important role in the development of ophthalmic pathologies, in particular socially significant diseases such as glaucoma, age-related macular degeneration, diabetic retinopathy, and retinal vascular occlusion. Eye hemodynamics features are an important diagnostic criterion for both ocular and systemic diseases. A comprehensive assessment of blood flow in various structures of the eyeball offers additional information on the pathogenesis of the diseases and helps develop new approaches to monitoring the effectiveness of treatment and vascular pathology prognostication. Thanks to the improved technologies, we have today a variety of invasive and non-invasive techniques for examining ocular hemoperfusion, including those intended for retrobulbar blood flow and intraocular blood circulation evaluation. The review article is focused on the state-of-the-art techniques: fluorescein angiography, ultrasound examination involving blood flow assessment by colour Doppler mapping and Dopplerography, optical coherence tomography in the angiographic mode and laser speckle flowgraphy. The role of these techniques in the diagnosis of vascular pathology and their advantages and disadvantages when used in ophthalmological practice is considered.
眼部血管循环障碍在眼部病变的发展中起着重要作用,尤其是青光眼、年龄相关性黄斑变性、糖尿病视网膜病变和视网膜血管闭塞等社会重大疾病。眼血流动力学特征是眼部和全身疾病的重要诊断标准。对眼球各种结构的血流进行全面评估,可提供有关疾病发病机制的额外信息,并有助于开发监测治疗效果和血管病理预后的新方法。由于技术的进步,我们今天有各种各样的侵入性和非侵入性技术来检查眼球血液灌流,包括那些用于球后血流和眼内血液循环评估的技术。本文综述了荧光素血管造影、超声检查(包括通过彩色多普勒成像和多普勒成像评估血流)、血管成像模式下的光学相干断层扫描和激光散斑血流成像等最新技术。这些技术在血管病理诊断中的作用及其在眼科实践中应用的优缺点被考虑。
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引用次数: 0
A new method to treat persistent corneal erosions after high-risk keratoplasty 一种治疗高危角膜移植术后持续性角膜糜烂的新方法
Q4 Medicine Pub Date : 2023-10-11 DOI: 10.21516/2072-0076-2023-16-3-94-99
E. V. Chentsova, N. V. Borovkova, D. A. Bozhenko, I. N. Ponomarev, P. V. Makarov, M. V. Storozheva, M. S. Makarov
Purpose : to compare the effectiveness of conventional preserved amnion and amnion saturated with platelet-rich (PRP) plasma lysate for the treatment of persistent corneal erosions (PCE) after high-risk keratoplasty. Materials and methods . 40 patients with persistent corneal erosions after high-risk penetrating keratoplasty, followed up for 12 months, were divided into two clinical groups of 20 people each. The main group of patients, aged 34 to 84, received Flexamer amniotic membrane + PRP lysate, while the comparison group, aged 41 to 80, received Flexamer amniotic membrane only. Amniotic membrane coating was used in persistent corneal erosions of penetrating keratoplasty after unsuccessful conservative treatment. The amnion was sewn 2 mm from the limb with a continuous suture and covered with a soft contact lens. As a source of platelets, we used the blood of healthy volunteers, from which platelet-rich plasma with platelet concentration of over 1000 thousand/µl was taken, which was then frozen at -40 °C and defrosted at 0…4 °C to obtain PRP lysate. The criteria for evaluating the effectiveness of both groups were the times of epithelialization, the number of amniotic membrane coatings, and the number of preserved transplants at the end of the follow-up. Results . Lyophilized amniotic membrane saturated with autologous PRP lysate growth factors was shown to be biocompatible. It was found to be safe for the patients, to reduce the epithelialization time, to reduce the number of operations required to cover the PÑE with the amnion, and to increase the likelihood of successful transparent and translucent engraftment of a penetrating keratograft. Conclusion . The use of a lyophilized amniotic membrane enriched with growth factors of autologous PRP lysate is a promising method for the treatment of PCE of the penetrating corneal graft after high-risk keratoplasty.
目的:比较常规保存羊膜和饱和富血小板血浆裂解液羊膜治疗高危角膜移植术后持续性角膜糜烂(PCE)的疗效。材料和方法。将40例高危穿透性角膜移植术后持续性角膜糜烂患者分为两组,每组20人,随访12个月。主组患者年龄34 ~ 84岁,采用Flexamer羊膜+ PRP裂解液治疗,对照组患者年龄41 ~ 80岁,仅采用Flexamer羊膜治疗。应用羊膜涂层治疗穿透性角膜移植术后保守治疗不成功的持续性角膜糜烂。羊膜在距肢体2 mm处连续缝合,并用软性隐形眼镜覆盖。作为血小板的来源,我们使用健康志愿者的血液,从中提取血小板浓度超过100万个/µl的富血小板血浆,然后在-40°C冷冻,在0…4°C解冻,获得PRP裂解液。评价两组疗效的标准是随访结束时上皮化次数、羊膜涂层数量和保存移植数量。结果。冻干羊膜与自体PRP裂解物生长因子饱和,显示出生物相容性。对患者来说,这种方法是安全的,可以减少上皮化时间,减少用羊膜覆盖PÑE所需的手术次数,并增加透明和半透明穿透性角膜移植物成功植入的可能性。结论。利用富含自体PRP裂解物生长因子的冻干羊膜是治疗高风险角膜移植术后穿透性角膜移植后PCE的一种很有前途的方法。
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引用次数: 0
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Rossiiskii Oftal''mologicheskii Zhurnal
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