1 СПбГБУЗ «Городская многопрофильная больница № 2», Санкт-Петербург; 2 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Минздрава России, Санкт-Петербург Для цитирования: Офтальмологические ведомости. Конфокальная микроскопия -современный метод исследования, позволяющий в режиме реального времени оценить неинвазивно in vivo структуру роговицы, лимба и конъюнктивы. При различных заболеваниях тканей глазной поверхности метод может быть использован как с диагностической целью, так и с целью мониторинга течения заболевания и оценки эффективности лечения. В рамках данной статьи рассмотрены основные изменения, наблюдаемые при конфокальной микроскопии у пациентов с синдромом сухого глаза (ССГ), и приведён составленный авторами алгоритм исследования тканей глазной поверхности при ССГ. Ключевые слова: конфокальная микроскопия; ткани глазной поверхности; синдром сухого глаза.
Phacoemulsification (PHACO) is the basic procedure of cataract extraction. Purpose. To assess the impact of PHACO on corneal epithelium layers in patients with pseudoexfoliation syndrome (PEX) by confocal in vivo microscopy. Methods. 24 patients with PEX syndrome and 18 patients without it were enrolled in the prospective study. In vivo confocal microscopy was performed with assessment of cellular density in corneal epithelial layers, degree of its desquamation, degree of Bowman membrane stiffening and dendritic cells density. Results. The epithelial cells density didn’t change significantly in groups. Confocal microscopy showed high density of dendritic cells and marked desquamation of the epithelium in patients with PEX (p < 0,05) after PHACO. (For citation: Potemkin VV, Varganova TS, Terekhova IV, Ageeva EV. The influence of phacoemulsification on various corneal layers in patients with pseudoexfoliation syndrome assessed with confocal in vivo microscopy. Ophthalmology Journal. 2017;10(3):29-34. doi: 10.17816/OV10329-34).
Конфокальная микроскопия -современный метод исследования, позволяющий в режиме реального времени оценить неинвазивно in vivo структуру роговицы, лимба и конъюнктивы. Цель -оценить основные морфологические изменения роговицы, наблюдаемые при конфокальной микроскопии у пациентов с псевдоэксфолиативным синдромом (ПЭС). Материалы и методы. Был обследован 21 пациент. Основную группу составили 12 пациентов с ПЭС, группу контроля -9 пациентов без ПЭС. Результаты. У пациентов с ПЭС наблюдалось снижение плотности клеток эпителия и стромы роговицы, большое количество гиперрефлективных межклеточных микровключений и дендритических клеток (p < 0,05). Ключевые слова: конфокальная микроскопия; псевдоэксфолиативный синдром. Confocal microscopy is a modern examination method, which provides in real-time mode a noninvasive in vivo imaging of the cornea, limb, and conjunctiva. Purpose. To evaluate main morphological changes observed by confocal microscopy in patients with pseudoexfoliation (PEX) syndrome. Methods. 21 patients were examined. 12 patients with PEX syndrome were enrolled as the main group, and 9 patients without PEX -as controls. Results. In patients with PEX, there was a decreased cell density in the epithelium and the stroma of the cornea, as well as a lot of hyperreflective intercellular microdeposits and dendritic cells (p < 0.05). THE INFLUENCE OF PSEUDOEXFOLIATIVE SYNDROME ON CORNEAL MORPHOLOGY BASED ON IN VIVO CONFOCAL MICROSCOPY Key words: confocal microscopy; pseudoexfoliation syndrome. ВВЕДЕНИЕПсевдоэксфолиативный синдром (ПЭС) -системное, ассоциированное с возрастом забо-левание, для которого характерна продукция и накопление внеклеточного амилоидподобного материала [3,[5][6][7]. ПЭС поражает множество тканей и органов, но именно офтальмологиче-ские проявления являются основой для поста-новки диагноза [3,4,6]. Это возможно благо-даря тому, что рутинного биомикроскопического исследования достаточно для обнаружения псев-доэксфолиативного материала (ПЭМ). Типичным
In this article, using a clinical case as example we report clinical features of keratopathy associated with pseudoexfoliation syndrome, as well as pathological changes found by confocal microscopy.
Phacoemulsification (PE) is the leading method of cataract surgery. Purpose. To assess the impact of PE on corneal subbasal nerve plexus in patients with pseudoexfoliation syndrome (PEX) using confocal in vivo microscopy. Methods. 42 patients (42 eyes) were enrolled in the study. The main group consisted of 24 patients (24 eyes) with PEX syndrome, and 18 patients (18 eyes) without it composed the control group. Confocal in vivo microscopy was performed before and after PHACO. Results. In patients with PEX after PE, an increase in number of nerve branches and pellet-like structures in them were noticed (p < 0,05).
G Факоэмульсификация (ФЭ) на сегодняшний день представляет собой основную методику хирургиче-ского лечения катаракты, которая обеспечивает раннюю клинико-функциональную реабилитацию па-циентов. Послеоперационный отёк роговицы является частой и нежелательной клинической ситуацией. Целью клинического исследования стало изучение терапевтического эффекта гипертонического раство-ра (3 %) хлорида натрия «Окусалин» на отёк роговицы в раннем послеоперационном периоде. материалы и методы. В исследование включено 60 пациентов (65 глаз) с послеоперационным отёком ро-говицы. Основную группу составили 35 глаз, контрольную -30 глаз. Пациенты первой группы в после-операционном периоде дополнительно использовали 3 % гипертонические глазные капли хлорида натрия («Окусалин»), пациенты второй группы получали стандартную схему лечения. У всех пациентов до и после операции (через 1, 7 дней и 1 месяц) оценивали субъективные и объективные (остроту зрения, толщину ро-говицы в центральном отделе и в зоне туннельного разреза) показатели функционального состояния глаз. Результаты исследования продемонстрировали, что применение 3 % раствора хлорида натрия способ-ствует улучшению остроты зрения за счёт уменьшения толщины роговицы в центральном отделе уже к 7-му дню после операции. Использование «Окусалина» в раннем послеоперационном периоде позволяет сократить сроки клинико-функциональной реабилитации пациентов и уменьшить субъективные жалобы.G ключевые слова: факоэмульсификация; отёк роговицы; гипертонический раствор; пахиметрия. G Currently phacoemulsification (PE) is the main technique of cataract surgery, which provides for patients early clinical and functional rehabilitation. Post-operative corneal edema is a frequent and undesirable clinical situation. The purpose of the study was to evaluate clinical efficacy of 3% sodium chloride ("Ocusaline") treatment in patients with corneal edema in the early post-operative period. Materials and methods. 60 patients (65 eyes) with post-operative corneal edema were included in the study. The main group consisted of 35 eyes; 30 eyes were included into the control group. Patients in the group 1 in addition to the routine post-operative treatment were treated with 3% sodium chloride hypertonic eye drops ("Ocusaline"); and patients in group 2 were treated according to the standard protocol. In all patients before and after surgery (in 1 day, 7 days and 1 month), subjective and objective indices of functional ophthalmic state (visual acuity, pachymetry in the central area and in the tunnel incision zone) were estimated. Results. The study results demonstrated that 3% sodium chloride hypertonic solution use facilitates visual acuity improvement due to the decrease of corneal thickness in the central area already at one week after surgery. The use of "Ocusaline" in the early post-operative period allows to decrease clinical and functional rehabilitation terms and to reduce subjective complaints of patients.
Glaucoma is one of the leading causes of irreversible blindness worldwide, being an age-related disease. Its pathogenesis still is not fully understood. A particular interest is attracted to evaluation of the cytokine concentrations in the trabecular meshwork cell culture, and in the aqueous humor (AH) taken from the same patient, since such data may allow to describe more completely the glaucomatous trabecular changes and to clarify the mechanisms of intercellular interactions in pseudoexfoliative (PEX) glaucoma. The purpose of this study was a comparative analysis of cytokine contents in AH and in trabecular tissue (TT) supernatants in the patients with PEX glaucoma. The study included 23 eyes of patients with PEX glaucoma. The material studied was AH and supernatant of TT cell culture. The cytokine concentration was measured using a flow cytofluorimeter FacsCantoII (BD, USA) using the CBA method. SPSS version 19 software (IBM, USA) was used for the statistical data processing. Concentrations of cytokines (TNFα, IFNγ, IL-1β, IL-6, IL-8, IL- 10, VEGF, GM-CSF) were determined in AH and in the TT supernatant for each of the patients with PEX glaucoma. Only IL-6 and VEGF concentrations in AH were higher than those in the TT supernatant in patients with PEX glaucoma. The IL-6 concentration positively correlated with the VEGF and IL-8 concentrations in the TT supernatant. Correlations between other cytokines in the TT supernatant and AH were also identified and analyzed. Multiple regression analysis revealed that the duration of glaucoma and the IFNγ and TNFα concentrations in AH may have a significant influence on the corneal endothelial cells, being associated with density reduction in patients with PEX glaucoma. The correlation analysis did not reveal any links between other clinical data (corneal thickness in the optical center, IOP level, age) and the cytokine concentrations in the studied tissues. The obtained results suggest that only simultaneous analysis of the cytokine concentrations in the TT supernatant and AH taken from the same patient may provide a more complete description of the cytokine imbalance and pathological processes occurring in the trabecular meshwork in PEX glaucoma patients. It has been shown that the changing cytokine ratios observed in PEX glaucoma may be associated with development of uniform structural and functional changes in all tissues of the anterior eye segment.
Introduction. Surgically induced astigmatism (SIA) is one of the reasons of the patient’s dissatisfaction with the refractive result after phacoemulsification (PHACO). The degree of SIA depends mainly on the type, length, shape and location of the tunnel, the distance to the optical center of the cornea, as well as the biomechanical properties of the cornea. Pseudoexfoliation syndrome (PEX) is associated with a change of the biomechanical properties of the cornea. The issue of the effect of these changes on the degree of SIA remains unexplored.The objectiveis to assess the influence of PEX on the degree of SIA after PHACO.Material and methods. The study included 42 patients (42 eyes) admitted for surgical treatment of cataracts to the V micro-surgical Department of the HMB № 2. The main group consisted of 20 patients (20 eyes) with PEX, the control group consisted of 22 patients (22 eyes) without PEX.The groups were of equal sex and age. The main selection criterion for the main group was the detection of pseudoexfoliative material on the anterior lens capsule, along the pupillary edge edge or in the corner of the anterior chamber. The exclusion criteria were the traumatic and uveal cataracts, glaucoma and laser vision correction in the anamnesis. All patients underwent keratotopography (TMS-3, Tomey, Japan) preoperatively and in 4 to 6 weeks after surgery.Results. There was no significant difference in the degree of SIA (limbal incision, 2.4 mm) among the groups provided the formation of a 2.4 mm limbal tunnel. Moreover, there was no significant difference in the degree of SIA between the nasal and temporal limbal tunnels within the groups.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.