The widespread introduction of intravitreal drug injections into clinical practice has highlighted a number of issues to be solved, including the risk of serious complications, the treatment burden on patients and the patient’s insufficient adherence to treatment, as well as a significant effect on the healthcare cost and effort. One of the ways to resolve the issues is to increase the patients’ awareness concerning the therapy they are about to receive, which contributes to the patients’ understanding of the details of treatment and enables them to make correct decisions. The best option of presenting such information to the patient is to provide them with a written document. The Expert Council on Retinal and Optic Nerve Diseases of the All-Russian Association of Ophthalmologists has developed, approved and tested an information brochure for patients who receive intravitreal injections. It offers brief information on what the procedure is, contraindications, details of preparation, and symptoms, both common ones and those requiring emergency assistance. The paper outlines the results of the study and presents a layout of an information leaflet for patients recommended for use in the Russian Federation.
1 ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург; 2 ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, Челябинск; 3 ГАУЗ Тюменской области «Областной офтальмологический диспансер», Тюмень; 4 ГБУ «Курганский областной госпиталь для ветеранов войн», Курган; 5 БУ Ханты-Мансийского автономного округа -Югры «Окружная клиническая больница», Ханты-Мансийск Для цитирования: Коротких С.А., Бобыкин Е.В., Экгардт В.Ф., и др. Интравитреальные инъекции в условиях реальной клинической практики: результаты опроса врачей-офтальмохирургов Уральского федерального округа // Офтальмологические ведомости." Интравитреальные инъекции (ИВИ) широко распространены в современной офтальмологической практике в качестве способа доставки лекарственных препаратов при различных патологиях заднего отрезка глаза. Несмотря на накопленный опыт, некоторые аспекты выполнения процедуры остаются дискутабельными. Кроме того, в литературе нет данных о практических аспектах проведения ИВИ в России в реальных клинических условиях. В данной работе проанализированы результаты анонимного опроса 74 офтальмологов Уральского федерального округа, осуществлённого в 2018 г. с помощью оригинальной анкеты, включавшей 20 вопросов. Установлено, что респонденты в целом разделяют традиционный для России подход к ИВИ как к полостной офтальмологической операции. В ходе опроса выявлено отсутствие единых подходов и неполное следование современным руководящим принципам в отдельных аспектах выполнения процедуры, в связи с чем предложены корректирующие мероприятия." Ключевые слова: интравитреальные инъекции; опрос; реальная клиническая практика; антиангиогенная терапия; профилактика эндофтальмита; руководящие указания.
Purpose: to evaluate the hypotensive effect and adverse reactions occurrence in patients with primary open angle glaucoma (POAG) who received Bimatoprost (Bimoptic Rompharm) monotherapy.Materials and methods. 46 patients (75 eyes) with stage I–III POAG were prescribed bimatoprost therapy. Of these, 16 patients (20 eyes) had newly diagnosed glaucoma, 15 patients (27 eyes) previously received treatment with prostaglandin analogs (APG — Latanoprost), and 15 patients (28 eyes) previously received treatment with a fixed combination (FC) composed of timolol B-blocker and brinzolamide carbonic anhydrase inhibitor. The reason for transferring the patient from therapy with APG and FC to monotherapy with Bimatoprost was insufficient hypotensive effect of APG/FC therapy, and the presence of dry eye syndrome of varying severity in most patients. The results were evaluated after 1, 4 and 12 weeks of Bimatoprost therapy. Results. A hypotensive effect of monotherapy with Bimatoprost was confirmed in patients with newly diagnosed POAG. An additional hypotensive effect was revealed when patients with POAG were transferred from APG and FC therapy to monotherapy with Bimatoprost. Adverse reactions: mild and moderate hyperaemia, periorbital manifestations such as skin pigmentation, deepening of upper eyelid folds, narrowing of the palpebral fissure (ptosis) were noted, respectively, in 8, 6.7, 1.3, 2.7, 2.7 % of cases respectively, but did not require a discontinuation of the therapy in any patient. Eyelash growth was noted by 3 patients (4 %). This effect was not considered to be a side effect, since none of the patients bothered. In 47 % of patients who had previously received APG and FC therapy and had dry eye syndrome of varying severity, objective and subjective positive changes relating to dry eye syndrome was noted. A positive dynamic of morphometric parameters of the optic nerve and cells of the retinal ganglion complex was revealed in patients of all groups of study.Conclusion. Monotherapy with Bimatoprost can be recommended as therapy of choice for patients with newly diagnosed glaucoma, and those previously receiving antihypertensive therapy with PGAs or fixed combinations (-blocker + carbonic anhydrase inhibitor) including those having dry eye syndrome of varying severity.
Sciences has a leading place in the Russian Federation in the development of medical ferroprobe pole indicators. Several models of ferroprobe pole indicators have been developed at the Institute over the last two decades, including FP-2, PFT-2, PF-1, and PF-01 devices [3, 7, 8, 10]. Besides, various comprehensive methods of preoperative and operative ferroprobe diagnosis were developed for general and ophthalmological surgery, boundary location of ferromagnetic foreign body in orbital cavity, etc. [2, 4, 5, 7]. These methods have been successfully tested in clinics and hospitals of Ekaterinburg, Moscow, and St. Petersburg.In the present state of surgery, it is not enough to merely remove the foreign body, but it is important to remove it with minimum possible damage to surrounding tissues. Therefore, maximum accuracy of foreign body location during the preoperative period and surgery itself is very important.In technical terms, this can be achieved by increasing the sensitivity of ferroprobe pole sensors, by eliminating false signals caused by a uniform static geomagnetic field and low quality of magnetosensitive elements of the ferroprobe sensor (FS) [1, 3, 7], and by improving the circuitry base of the ferroprobe pole indicator.Consider the problem of increasing the sensitivity of a ferroprobe pole sensor in more detail. Theoretically, the sensitivity of a ferroprobe pole sensor can be increased by decreasing the dysbalane between the magnetosensitive elements of the sensor or by increasing the gain of the electronic unit of the device. However, in practice, maximal sensitivity of a pole indicator is limited by the magnetic environment in the operating room (influence of devices, equipment, operating table, light sources, construction elements, etc.). Because the foreign body signal amplitude decreases as the fourth power of the distance from the free end of the probe, the problem of noise proofing places substantial limitations on further increase of the sensitivity of ferroprobe pole indicators.It should be noted that the sensitivity to gradient of static magnetic field strength of the PF-01 ferroprobe pole indicator, which is widely used in medical practice, reaches 4 mOe/cm full scale (0.0032 A/cm 2 in SI units). This allows sufficiently accurate preoperative location of ferromagnetic foreign bodies in living tissues, although if the depth of penetration of the foreign body exceeds 50 to 70 ram, such sensitivity proves insufficient for accurate preoperative location of the foreign body.Therefore, it seems that further increase in the accuracy of location of a ferromagnetic foreign body by significant increase in the sensitivity of the pole indicator is not a very promising approach to the problem.Consider the problem of increase of the accuracy of location of a ferromagnetic foreign body by means of elimination of false signals. Presently available models of pole indicators have a substantial disadvantage because variation of spatial orientation of the FS, e.g., rotation about its longitudinal (measuring) a...
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