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Purpose: to evaluate visual functions, accommodation, and local tolerance in children instilled with Phenylephrine hydrochloride 2.5 % and sodium hyaluronate solution (Stelphrin Supra). Material and methods. 30 children (60 eyes) aged 8 to 12 (ave. 10.04 ± 0.24) with low (28 eyes) and moderate (32 eyes) myopia (ave. -2.96 ± 0.17 D) were tested. Refractometry, subjective and objective accommodation, optical biometry, anterior corneal surface examination, Norn test, and polling were performed prior to one-time instillation, 30 minutes after it, and after 1 month of daily bedtime instillations of Stelphrin Supra. Results. We noted a significant decrease in the tone of accommodation in the open field by 90 % from the initial value, an approximation of the nearest point of clear vision by 27 %, an increase in the volume of absolute accommodation by 57 % and the objective amplitude of accommodation by 20 %, which indicates an increase in the accommodation ability. The pupil width increased 30 minutes after a single instillation of Stelphrin Supra, which coincided with an increase in the relative accommodation reserve by 25 % from the initial one. After a month, the pupil width significantly decreased, and the positive relative accommodation reserve decreased to a level only 12 % higher than the original one. Tear film break time significantly increased by 0.89 sec, singular spot stainings disappeared in 2 out of 6 patients, lacrimation — in 6 out of 10, pain — in 1 out of 2, blurring in 4 out of 6, feeling of “sand” — in 7 out of 9 patients who had these symptoms before instillations. Conclusion. Regular instillations of Stelphrin Supra reduce the habitual tone of accommodation, increase the accommodation ability, and improve the condition of the eye surface.

Macular diseases are traditionally a serious issue in ophthalmology, which has great social impact due to widespread occurrence and significant vision loss, often irreversible. Over the past few decades, the possibilities for the diagnosis and treatment of pathologies of the retina and choroid have been significantly expanded. Randomized clinical trials provided ophthalmologists with valuable information on the natural course and treatment strategies of common retinal diseases from the viewpoint of evidence-based medicine. However, due to the large number of trials conducted, it is often difficult to make an adequate choice of data to be used in daily practice. In this review, we systematize the most valuable randomized clinical trials. To this end, we selected 42 randomized clinical studies conducted between 1979 and 2019 and focused on the treatment of age-related macular degeneration (AREDS 1, AREDS 2, ANCHOR, MARINA, PrONTO, CATT, IVAN, VIEW 1, VIEW 2, EVEREST II, PLANET, SEVEN-UP, ALTAIR, HAWK, HARRIER), choroidal neovascularization of multiple etiology (myopic, post-inflammatory, angioid-streak-related, etc. — RADIANCE, REPAIR, MYRROR, MINERVA), diabetic eye lesions (diabetic retinopathy and diabetic macular edema — ETDRS, DRCR.net Protocols B, I, S and T, RISE, RIDE, VIVID-DME, VISTA-DME, MEAD, FAME), retinal vein occlusions (BVOS, CVOS, SCORE-CRVO, SCORE-BRVO, BRAVO, CRUISE, GALILEO, COPERNICUS, VIBRANT), as well as retinopathy of prematurity (CRYO-ROP, ETROP, RAINBOW). The review summarizes the main results of these studies, which confirm the effectiveness and safety of such treatment methods as antiVEGF and photodynamic therapy, retinal laser photocoagulation, cryotherapy, corticosteroids and nutraceuticals from the viewpoint of evidence-based medicine. For greater clarity, we provide a table summarizing information on each of the randomized clinical trials considered.

Even though there are multiple diseases of the optic nerve and the retina in patients with hemoblastosis, their ophthalmoscopic picture is similar in many respects. The purpose of this study is to determine the role of optical coherence tomography (OCT) in the differential diagnosis of various manifestations of hemoblastosis in the fundus. Material and methods. From Jan. 2015 to Jan. 2019, 9 patients (5 men and 4 women aged 29 to 72) with hemoblastosis and lesions of the optic nerve and retina were examined. Results. 5 patients were diagnosed with leukemic infiltration of the optic nerve. The remaining 4 patients had, congestive optic discs (1), occlusion of the central retinal vein (1), anterior ischemic optic neuropathy (1), and bilateral occlusion of the central retinal artery with leukemic infiltration of eye membranes (1). The article describes the ophthalmoscopic pictures and OCT data for the specific diseases. Unlike other diseases of the optic nerve and retina, leukemic infiltration is characterized by a pronounced dense edema in the inner layers of the retina with shielding of the underlying outer layers of the retina. Conclusion. OCT is an important additional method for differential diagnosis of leukemic infiltration and other diseases of the optic nerve and retina in patients with hemoblastosis.

The atrophic form of late age-related macular degeneration (AMD) is a common cause of severe vision loss. Recently, a new classification system has been proposed, which identifies two types of atrophy in the late stage of AMD that require a more detailed study: (1) drusenassociated geographic atrophy (GA), which is the final stage of progression of dry AMD, and (2) macular atrophy (MA), which occurs in wet AMD, including the period of AMD treatment with angiogenesis inhibitors. Purpose: an integrated analysis of clinical and morphometric signs of atrophic AMD forms. Material and methods. 48 people (61eyes) aged 48–84 with GA (group 1) and MA (group 2) and a control group, recruited from age-matching 25 healthy volunteers (35 eyes), underwent standard ophthalmological examinations, fundus autofluorescence (FAF) with lesion area measurement, fundus photography, optical coherence tomography (OCT) in the standard mode and Enhanced Depth Imagine Mode, Multicolor, and OCT angiography. Results. The comparative analysis of two atrophic AMD forms showed that in GA eyes, foci of atrophy capturing the fovea were significantly more common, while, contrariwise in MA eyes atrophic foci not capturing the fovea were more frequent (p < 0.05). Photoreceptor tubulation was diagnosed mainly in eyes with GA (p < 0.05). The morphometric analysis showed a significant decrease in the subfoveal thickness of the choroid in the groups with GA and MA as compared to the control (p < 0.05), whilst no significant differences between two groups were noted. The assessment of the frequency of occurrence of types of fundus AF patterns in groups 1 and 2 followed by a comparative analysis, showed the presence of all types of patterns in GA patients, including the heterogeneous and the bordering pattern (p < 0.05). In the MA group, diffuse and focal types of patterns were revealed, while the frequency of the diffuse pattern turned out to be significantly more frequent (p < 0.05). Conclusion. The integrated analysis revealed the main semiological signs and morphometric parameters, their features and prevalence in GA and MA, which may have diagnostic and prognostic importance for the management and treatment of patients with AMD.

Purpose. To study the involvement of vascular and vegetative factors in the pathogenesis of glaucoma attack. Material and methods. 12 patients (24 eyes) aged 49 to 82 — 5 men and 7 women, including 3 patients with acute glaucoma and 9 patients with subacute glaucoma were subjected to an ophthalmological examination that included visometry, tonometry, automated static perimetry, OCT and OCT angiography. They were also tested for heart rate variability (HRV) using a Polar heart rate monitor, and for plasminogen content and products of fibrin/fibrinogen degradation in the tear. For comparison, the contralateral eyes of these patients were examined. Results. In the eyes with an acute glaucoma attack, the vascular network was noticeably weakened, especially in the area of the deep peripapillary vascular plexus at the lamina cribrosa level, and focal capillary loss was observed. The peripapillary density of the deep vascular plexus in the eyes with an acute attack was 33.0 ± 5.6 % (М ± m), which was significantly (p < 0.01) lower as compared to 50.0 ± 4.7 % in the unaffected eyes. This indicator correlated with the thickness of the ganglion cell complex (GCC) (p < 0.01). In unaffected eyes, no correlations were found between these glaucoma-related parameters. A significant amount of fibrin/fibrinogen degradation products was found in the tear of glaucoma patients, which may point to a violation of blood circulation in the optic nerve vessels. It has been established that glaucoma attack occurs with increased activity of sympathetic regulation of blood flow. Conclusion. When monitoring this contingent of patients, it is essential to determine the sympathetic-parasympathetic status of the patient. Taking into account the vascular component of the condition, it is expedient to introduce the necessary additions into its treatment plans

Purpose: to study experimentally the wound-healing effect of ophthalmic drug films (ODF) with 6-methyl-3-(thietan-3-yl) uracil and methyluracil. Material and methods. The study involved 17 Chinchilla rabbits (34 eyes), whose corneas were histomorphologically studied after an experimental chemical acid burn and treatment. ODF with 6-methyl-3-(thietan-3-yl)uracil were deposited in the right eyes of 15 rabbits (15 eyes), and ODF with methyluracil — in the left eyes of these rabbits. Two rabbits served as control: their right eyes were left without wound healing therapy, while the left eyes received dexpanthenol 5 % gel (corneregel) 4 times a day. All animals were monitored daily for 21 days. The morphological changes in the cornea were recorded on the 2nd, 7th, 14th and 21st days after the experimental chemical burn.Results. The course of reparative processes of the chemical burns of the cornea was found to be different depending on the drugs used. Our results show that the ODF with methyluracil led to the resorption of the edema and the turbidity, as well as to a total closure of the desquamation sites of the corneal epithelium on the 7th day. With the ODF containing 6-methyl-3-(thietan-3-yl) uracil, the effect was achieved on the 14th day. In contrast to the control, ODF enhanced the growth and reproduction of cells, rapidly improved the trophism, and stimulated the regeneration process in damaged corneal tissues. ODFs produced no toxic reactions, such as destruction of the collagen framework, maceration, pronounced edema, and hyperemia. On the 21st day of observation, the microscopic picture of rabbit cornea showed the usual normal structure. Conclusion. ODF therapy with methyluracil and 6-methyl-3-(thietan-3-yl)uracil leads to accelerated centripetal epithelialization of corneal erosion, more structured and histologically correct restoration of the epithelial-stromal layer.

Neuromyelitis optica spectrum disorders are rare chronic autoimmune inflammatory demyelinating diseases of the central nervous system. Considering that the increase in neurological deficit in neuromyelitis optica spectrum disorders is mainly due to repeated exacerbations, the goals of pharmacotherapy are represented by the relief of relapses and the prevention of their development. Information about indications for therapy and side effects is necessary to identify the benefits and risks for patients with neuromyelitis optica spectrum disorders in each individual case.

The involvement of the visual pathway in multiple sclerosis (MS) pathology determines the importance of studying the structures of the retina for earlier diagnosis and monitoring the severity of the neurodegeneration. The introduction of the reference method of optical coherence tomography (OCT) allows high resolution in vivo visualization of the retinal structures.Objective: to identify changes in various retinal structures in remitting (RMS) and secondary-progressive (SPMS) MS phenotypes.Patients and methods. The study included 80 patients with RMS (n=48) and SPMS (n=32); the control group included 20 age- and sex-adjusted healthy individuals. Clinical assessment was carried out using the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS). All patients were examined by an ophthalmologist. To assess changes in the retina, OCT was performed using the RTVue XR Avanti apparatus (Optovue, USA).Results and discussion. We found a significant (pConclusion. As a domain of criteria for the MS course without signs of disease activity (No Evidence of Disease Activity, NEDA), it is advisable to use retinal OCT with analysis of the retinal thickness in the foveal region, the thickness of the retinal nerve fiber layer, the ganglion cell complex for dynamic monitoring of the inflammatory process activity in patients with RMS and assessment of its progression in patients with SPMS.

Relevance. It is well known that asthenopic complaints, such as increased visual fatigue when working at close range, lacrimation, eye pain and headache after corneal refractive operations in recent years are increasingly common at routine ophthalmological practice. They cause significant subjective discomfort in patients and reduce the satisfaction of the surgery. The pathogenesis of asthenopia is a violation of the coordinated work of the accommodation and binocular systems as a result of their overstrain with excessive visual loads.Purpose. To study the role of the lack of adequate optical correction before surgery in the development of asthenopia in patients with mild and moderate myopia after ReLEx SMILE surgery, as well as to evaluate the effectiveness of drug correction of this condition.Patients and methods. This study included 84 patients (128 eyes) who spend more than 8 hours at a computer due to their professional activity, without pathology of the visual organ that prevents keratorefractive operations, whose average age was 33.2 ± 1.9 years.Results and discussion. The ReLEx SMILE operations in all patients were carried out without complications with the achievement of uncorrected visual acuity equal to the preoperative values of the maximum corrected visual acuity in the period of 1 week and 1 month. In the group with a preoperative lack of adequate optical correction, signs of asthenopia were more often manifested than in patients using full eyeglass or contact correction before surgery. The appointment of the drug Mydrimax® allows to improve the subjective state of patients with asthenopia and leads to the normalization of functional parameters.Conclusion. Corneal refractive operations in patients with the lack of adequate correction of refractive disorders before surgery leads to a significantly significant increase in the initially impaired functional parameters compared to preoperative values, however, it does not reach normal values in most cases and is accompanied by a greater probability of developing postoperative asthenopia.

The aim: to evaluate the restoration features of the structural relationships of the retina and chorioretinal blood fl ow after surgical treatment of large-diameter macular hole (MH) using a modifi ed technology.Material and methods. A prospective study of 14 patients (14 eyes), 13 women and 1 man, with medium-and large-diameter MH was conducted. The mean age of the patients was 67.7 ± 5.38 (55–80) years. The study included patients with endto-end MH of the 3rd–4th stage according to the classifi cation of J. Gass. All patients underwent surgical treatment of macular rupture according to the proposed method of inverted fl ap of the internal limiting membrane (ILM) and fi lling it into a “pocket” formed between the retina and the ILM.Optical coherence tomography (OCT) was performed along with traditional research methods. The obtained images were used to measure manually the parameters of retinal MH, the thickness of the choroid in the projection of the rupture and the fovea zone before the operation and 1, 3 and 6 months after the operation. In the angio-mode, the foveal avascular zone (FAZ) was evaluated, as well as the density of capillaries of the superfi cial and deep retinal plexus in four quadrants, with the exception of the central zone.Results. In all patients, it was possible to achieve MH blocking. Visual acuity in the eyes with MH varied from 0.02 to 0.3, while in the comparison group, the best corrected visual acuity was from 0.3 to 1.0 (p = 0.002). An increase in the diameter of large choroidal vessels, as well as a pronounced decrease in the diameter of the posterior short ciliary artery, attracted attention. However, despite the improvement in visual acuity, patients retained a signifi cant expansion of the FAZ, which by 6 months exceeded the FAZ area of the paired eye by 25.8 % (p = 0.01).Conclusion. The results obtained indicate that the achievement of an anatomicalreconstructive effect and even a moderate improvement in visual acuity during surgical treatment of macular holes by the modifi ed inverted flap technology of the internal limiting membrane does not determine the restoration of retinal perfusion in full.

Background. At an appointment with an ophthalmologist, patients with pathological conditions of the eyelids are often dissatisfi ed with the effectiveness of the traditional surgical treatment.The aim: assessment of the functional state of the eye adnexa after cryodestruction of the chalazion with an increased risk of complications using modern cryosurgical equipment.Material and methods. Clinical studies were carried out in 254 patients (277 eyes) with chalazion, including a complicated course of the disease, with cryodestruction of the chalazion using an autonomous cryoapplicator made of porous-permeable titanium nickelide.Results. Cryosystems of the new generation, in comparison with the well-known industrial cryoapparatus, diff er in new properties. They can signifi cantly improve the quality of cryotherapy in surgery due to a clearer localization of cryotherapy and a high rate of heat removal from the surface of altered tissues without damaging the surrounding tissues. Depending on the size of the pathological formation, the duration of the exposure, the frequency of repetitions of the applications during the session, the regression of the chalazion occurred within 1–1.5 months with the preservation of the integrity of the intermarginal space and the functional state of the eyelid.Conclusion. Analysis of the data obtained indicates a high clinical and cosmetic effi ciency of cryosurgery of the eyelid chalazion using an autonomous cryoapplicator made of porous-permeable titanium nickelide.

Background. In the available literature, there are isolated publications devoted to the topic of the possible effect of laser correction by the Femto LASIK method on the myopic eye choroid. In this connection, in our opinion, the relevance of continuing research in this direction remains.The aim of this study was to examine the volume of the retina in the macular zone, the thickness of the choroid and the ciliary body using optical coherence tomography on myopic eyes after femtosecond-assisted laser in situ keratomileusis in the short term.Material and methods. 30 patients (30 right eyes) aged 20 to 35 years, suffering from mild and moderate myopia, but without pathological changes in the retina according to OCT, made up the study group. All patients underwent myopia correction using the Femto LASIK method. Before the operation, after 4 hours and the next day, they underwent the examination of the retinal volume in the macular zone, the choroidal and the ciliary body thickness using OCTResults. The analysis of the obtained results of the studied parameters showed that the ciliary body thickness and the retinal volume in the macular zone did not undergo statistically signifi cant changes and remained within the preoperative values (p > 0.05). We observed a tendency to an increase in the thickness of the choroid 4 hours after the operation, but the carried out statistical analysis did not confi rm the reliability of its changes (p > 0.05). On the next day, the choroidal thickness indices practically recovered to the preoperative level (p > 0.05).Conclusion. A study of the retinal volume in the macular zone, the thickness of the choroid and ciliary body using OCT in myopic eyes in the short term after Femto LASIK showed the absence of statistically signifi cant changes in the studied parameters, which indirectly indicates the safety of this method of laser correction for the posterior segment of the eye.

Aim: to study genotype-phenotype correlations in patients with inherited retinal diseases with mutations in ABCA4 gene in Russian Federation.Patients and methods. 21 patients from Russian population aged from 7 to 51 years old (mean age 20 ± 11 years with best-corrected visual acuity from 0,02 to 0,6 (0,14 ± 0,11) with ABCA4-associated retinopathy, verified by molecular genetics methods. All patients besides standard ophthalmic examination and photodocumentation were performed Spectral-Domain OCT and fundus autofluorescence on Spectralis ®HRA+OCT (Heidelberg Engineering, Germany). Full-field electroretinogram (ERG), 30-Hz flicker ERG and macular chromatic ERG (MERG) to red stimulus were recorded on electroretinographic system MBN (MBN, Russia). (Russia) Molecular genetic studies were performed using Next Generation Sequencing (NGS) and Sandger direct sequencing. Results: In ABCA4-associated Stargardt disease 1 type (STGD1) genotype [p.L541P, p.A1038V] of «frequent» mutations was revealed in 9 patients, in 2 cases in was associated another “frequent” mutation p.G1961E. In 4 patients with genotype [p.L541P, p.A1038V] “severe” phenotype of Stargardt disease was found: with large defect of the ellipsoid zone and large zone of central reduced autofluorescence, severely subnormal macular ERG (MERG) to red stimulus and subnormal 30 Hz flicker and full-field maximal ERG. In one patient with these mutations in homozygous state ABCA4-associated cone-rod dystrophy (CORD3, clinically looking alike secondary retinal dystrophy is diagnosed. In 2 patients with genotype [p.L541P, p.A1038V] and mutation p.G1961E was found mild phenotype. One patient with homozygous mutation p.R653C autosomal recessive ABCA4-associated retinitis pigmentosa (RP19) was diagnosed. Clinical picture and autofluorescence were polymorphic in all patients.Conclusions. Our study with ophthalmological, molecular genetics and instrumental methods widens the spectrum of clinical signs of inherited eye diseases associated with mutations in АВСА4 gene, widens the spectrum mutations in Russian Federation and reveals clinicо-genetic genotype-phenotype correlations.

Purpose. To determine optimal criteria for reliable optical coherence tomography (OCT) measurements in patients with age-related cataract. Material and methods. We examined 83 patients (83 eyes) with age-related cataract before and after cataract surgery. The intensity of lens opacity was assessed by the Cirrus HD-OCT signal strength and Pentacam-based Scheimpflug images analysis. Clinical cataract grading was performed according to the WHO classification. Preoperative measurement was considered reliable if its’ difference with postoperative measurement did not exceed 5 µm for the peripapillary retinal nerve fiber layer thickness (pRNFL) and 8 µm for the central subfield thickness. Results. According to the ROC analysis, only the OCT signal strength allows to distinguish reliable OCT measurements: area under the ROC-curve (AUC) of the OCT signal strength was 0.815 (95% confidence interval 0.720–0.909) for the pRNFL and 0.756 (95% CI: 0.632–0.880) for the central subfield thickness. The best signal strength thresholds for reliable data were 5.5 for pRNFL and 4.5 for the central macular thickness (considering that the signal strength is measured in integers, these values should be rounded to 6 and 5 respectively). The rest of the studied parameters had AUC less than 0.6 so they cannot be used for evaluating OCT data. Conclusion. In patients with age-related cataract, only OCT signal strength can determine reliability of the OCT measurements. The lowest signal strength for reliable data on the Cirrus HD-OCT is 6 for pRNFL and 5 for central subfield thickness.

Purpose. To assess the results of penetrating keratoplasty and identify the risk factors for the graft disease (GD) development. Material and methods. Data of 582 patients after corneal transplantation performed in the period since 2011 to 2019 for keratoconus (41%), as well for corneal leucorrhoea and dystrophies (59%), aggravated by concomitant pathology, the so-called high-risk keratoplasty (HRK) were analyzed in a retrospective cohort study. We estimated the functional results and incidence of GD. The calculation of the t-criterion; cross-tabulation method; Kaplan–Meier survival analysis and multivariate analysis were applied.Results. As a result of penetrating keratoplasty, the BCVA (best corrected visual acuity) in patients with keratoconus increased by 20%; in patients with HRK – by 8%. In the general group the graft survival rate was 72%, while the 8-year successful graft engraftment in patients with keratoconus comprised 91%, with HRK – 60%. A significant relationship of the GD development with preoperative diagnosis and rekeratoplasty was determined. The risk of GD incidence was minimal in patients under 30 years of age and maximum in patients aged from 50 to 70 years. Survival rates for corneal transplants were better in men than in women.Conclusion. Penetrating keratoplasty in patients with keratoconus provides a good functional result with a minimal risk of GD development. With penetrating keratoplasty in high-risk patients, the effectiveness of surgical interventions is significantly lower (by ~30%).

Currently the ophthalmologists meet with corneal-conjunctival xerosis more often in their daily practice. The objective of this research is identifying a new alternative method of treatment of the dry eye syndrome of different severity. In this work there will be a demonstration and the results of usage of BAA Delphanto® in treatment of different cases of the dry eye syndrome. The data collected from a dynamic research of groups of patients reveals the effectiveness of the comprehensive therapy with the use of BAA Delphanto®. Consequently, the research results demonstrate an improvement of the initial data from the biomicroscopy, OSDI index, Schirmer-1 test and the tear break up time. The statistically significant results were received reveal the effectiveness of the use of BAA Delphanto® with a significant improvement of the quality of life. It can be used widely by ophthalmologists for the treatment of corneal-conjunctival xerosis of different severity.

Purpose. To study the dynamics of interhemispheric interactions in children with friendly strabismus as a result of functional treatment. Material and methods. The study included 135 children aged 6 to 8 (average 6.8±0.1) years with convergent non-paralytic operated strabismus in combination with hypermetropic refraction and 96 children of the same age in the control group (average 7.1±0.1 years) without ophthalmic pathology. In children with strabismus, the leading hand and dominant eye were determined before and after functional treatment. Characteristics of spatial perception were evaluated by copying of complex geometric shapes which were Taylor’s (right-handed) and Ray-Osterritz’s (left-handed). Results. After functional treatment in the group of children with non-paralytic strabismus, along with improved binocular functions and improved performance of the Taylor and Ray-Osterritz tests, there was an increase in the number of ambidextrous children and a significant decrease in the number of left-handers (p

The review assesses physical exercises as an additional non-pharmacological mean of combating the progression of primary open-angle glaucoma. The ophthalmic hypotensive effect is determined by the type of exercise, its duration and intensity. Moderate aerobic activity is preferred. Among dynamic exercises, jogging has the greatest hypotensive effect. Upper body isometric resistance training provides a more lasting decrease in ophthalmotonus. The decrease in intraocular pressure (IOP) in patients with glaucoma is several times more pronounced in comparison with healthy people and occurs regardless of the nature of the local drug antihypertensive therapy. After the termination of classes IOP returns to the previous level on average within a month. An increase in ocular perfusion pressure associated with physical activity dictates the appropriateness of physical exercise for patients with pseudo-normal pressure glaucoma. The combination of hypotensive, vascular, neuroprotective effects of physical activity with a high level of physical fi tness does not exclude a decrease in the risk of development and progression of primary open-angle glaucoma. The development of indications for the use of physical activity by patients with advanced glaucoma, including those who have undergone hypotensive surgery, remains relevant. The type, intensity, dosage and mode of performing the recommended physical exercises require an individual choice.

Purpose: To assess the capsular tension ring implantation effect on the IOL position according to different devices in the long term period after uncomplicated phacoemulsification.Patients and methods. The study enrolled 234 patients (273 eyes) with cataract without zonular weakness. A standard examination, optical biometry and Sheimpflug imaging were performed preoperatively. In all cases phacoemulsification with IOL implantation, supported by CTR in 11 % of cases (30 eyes) was performed in 1, 3, and 6 months after surgery autorefractometry, visual acuity, biometry, OCT of anterior segment and ultrasound biomicroscopy were provided.Results. By the 3rd month a small shift of IOL towards the retina was revealed without any refraction changes. In cases with CTR implantation the anterior chamber depth was stable. According to OCT data the angle of IOL tilt in the horizontal meridian gradually decreased, the dynamics was significant from 3 months (p = 0.032). There were no changes in the vertical direction. After CTR implantation IOL position did not significantly change. There was no difference between the groups (p > 0.05) by 6 month. The phenomenon of IOL “deflection” according to OCT data was observed in 20.87 % of cases was in 1 month after operation. In the presence of CTR its frequency decreased to 15.00 %, and in the absence, it increased to 21.63 %. In every fifth case of deformation the measurements did not give us a definite reason to further consider it a “deflection” by 6 months after the operation. In 4.24 % of cases fact of IOL “deflection” was absent at the first month but appeared by the 6 month. There was not any case of CTR implantation among described cases of IOL position change.Conclusion. Fluctuation of anterior chamber depth is observed up to 3 months after uncomplicated phacoemulsification. Changes in IOL tilt angle occur throughout the observation period with a significant decrease in the horizontal plane by 6 month. Implantation of the CTR should stabilize anterior chamber depth, block the IOL tilt and also reduce the percentage of IOL deflection cases in the defined group.

Purpose. To study the effectiveness of vascular, anti-inflammatory and fibrinolytic therapy, to conduct a comparative assessment with treatment without vascular therapy in patients with angle-closure (ACG) and mixed glaucoma.Methods. A total of 55 patients with angle-closure and mixed glaucoma, mainly with hypermetropic refraction of varying degrees, were examined: 7 people with acute glaucoma attack, 6 people with subacute glaucoma attack (group 1, with anti-inflammatory treatment), 7 people with acute glaucoma attack and 6 people with subacute glaucoma attack (group 2, with vascular treatment), 14 people with chronic angle-closure glaucoma (group 3) and 15 people with mixed glaucoma (group 4). All patients underwent an ophthalmological examination, which included visometry, refractometry, tonometry, computer perimetry, OCT and OCT angiography, and an ELISA analysis to determine cytokines.Results. The administration of the drug Pentoxifylline as a cytokine blocker and antiplatelet agent in ACG contributed, in our opinion, to an improvement in visual acuity, perimetry (MD), an increase in the density of capillaries of the deep vascular plexus at the level of lamina cribrosa in the peripapillary zone (%), i.e. improved blood circulation in the vessels of the optic nerve disc and also contributed to the blockade of cytokines, mainly in the 2-nd group of patients. In our opinion, a personalized approach to the treatment of ACG is to maintain the improvement of blood circulation in the peripapillary zone by prescribing a course of treatment with Pentoxifylline for 6 months after surgery. After phacoemulsification, there was a significant increase in the density of capillaries of the deep peripapillary vascular plexus at the level of lamina cribrosa (p ≤ 0.05) (51.0 ± 3.5 %), and after further treatment with Pentoxifylline, the capillary density continued to increase in 2–4 groups in the next 6 months of follow-up. The thickness of RNFL (Retinal nerve fiber layer, structural parameter) decreased due to a decrease in edema in 1–2 groups, slightly increased in 3–4 groups, in our opinion, due to improved blood circulation. Increased reperfusion in the capillaries of the deep plexus during normalization of IOP in glaucoma patients and further treatment with pentoxifylline indicates the effectiveness of the proposed treatment in addition to surgical treatment. The results obtained emphasize the advantages of the proposed therapy for the treatment of patients with angle-closure and mixed glaucoma.Conclusion. To date, there are no clear recommendations of vascular therapy for the treatment of patients with ACG and mixed glaucoma, which creates the need for its addition to treatment regimens, taking into account the vascular component of ACG and mixed glaucoma.

Background. Choroid plays an important role in the pathogenesis of retinal pathology. Choroidal cavern, a recently identifi ed fi nding of optical coherent tomography (OCT), has been described in some degenerative and atrophic forms of retinal pathology. In the literature, there are only a few studies of choroidal cavers in pachychoroid neovasculopathy, newly described form of age related macular degeneration.The aim: to perform a detailed analysis of choroidal structure on OCT scans of patients with pachychoroid neovasculopathy and to reveal the frequency of choroidal caverns identifi cation.Material and methods. The data of 30 patients (30 eyes) aged 64.4 ± 5.6 years with pachychoroid neovascularization were retrospectively analyzed. The patients underwent spectral OCT and OCT-angiography (OCTA) using a Spectralis device (Heidelberg Engineering, Germany). The protocol was “Posterior Pole”, consisting of 61 scans. To assess the structure of the choroid, an enhanced image depth (EDI) module was used. OCT angiography was performed with a scan area of 6 × 6 mm. These methods were compared to identify choroidal caverns.Results. On OCT subretinal type 1 neovascularization was revealed as a fl at detachment of the pigment epithelium and visualization of blood flow on OCTA in the lesion as angled vessels (21 eyes) or a seafan (9 eyes). On OCT-EDI scans, there was diffuse or local choroidal thickening of choroid with an increase in the vessels of the Haller’s layer and thinning of the choriocapillaries. Choroidal caverns appeared on OCT and en-face OCT as areas with low optical density, round or irregular, located in different layers of the chorioid, without hyperrefl ective boundaries. A typical sign of choroidal cavern is the tail of hypertransmission after the cavern toward the sclera. Choroidal caverns were found in 4 of 30 eyes (13.3 %) and were located both near the choroidal neovascularization lesion and beyond this area.Conclusion. The prevalence of choroidal cavities, a new choroidal biomarker, in pachychoroid neovasculopathy was 13.3 %. Identification of these changes is possible with the use of modern diagnostic techniques (OCT-EDI, OCTA and en-face OCT) that allow visualization the state of the choroid. The prognostic signifi cance of choroidal cavities requires further study.

A literature review is presented on the comparative assessment of two options for conducting cataract phacoemulsification — monocular phacoemulsification of cataract, (delayed sequential bilateral cataract surgery, DSBCS) and binocular phacoemulsification of cataract (immediate sequential bilateral cataract surgery, ISBCS). It has been established that to date in the literature there is a sufficient amount of data indicating the positive aspects of ISBCS, associated with faster rehabilitation, better functional results, as well as time, financial, and economic aspects. The safety of ISBCS is determined by the minimum likelihood of postoperative bilateral endophthalmitis with careful selection of patients, the required surgeon qualifications and strict adherence to the surgical protocol. Comparatively, in accordance with the results obtained, postoperative refractive indices, the value of the maximum corrected distance visual acuity, the frequency of complications and the degree of patient satisfaction were the same regardless of whether the bilateral cataract surgery was performed simultaneously or sequentially. The effectiveness of ISBCS is determined by quick rehabilitation, the need for only one pair of glasses, a decrease in visits to the clinic, the absence of anisometropia between operations, as well as only one general anesthesia (if necessary). The experience of clinics where such procedures were carried out shows that after ISBCS, minor refractive errors occur, while they are almost always symmetrical, characterized by a slight deviation from the target refraction and rapid recovery of binocular and stereoscopic vision. In financial terms, in accordance with the calculations carried out, the cost of DSBCS in various countries may be higher than the cost of ISBCS by 10.8–47.9 %. In absolute terms, simultaneous cataract surgery on two eyes (Finland) saved €449 per patient in medical costs and €739 after travel and home care costs were included. Taking into account the cost of lost work time, the savings were €849 per patient. The wider distribution of ISBCS is associated with the approval of the ophthalmological community and insurance companies, as well as the development of standardized teaching materials for practicing ophthalmologists.

Purpose. Comparative evaluation of patients’ rehabilitation using less traumatic STRABO care technique and traditional methods of strabismus surgery. Material and methods. Sixty-two patients with esotropia were included in the study. All participants underwent medial rectus muscle recession and lateral rectus muscle plication. Patients were divided into two groups. In the main group (38 patients), the surgery was performed with less traumatic technique. Radio-wave knife was used for dissecting the connective tissues. Vicryl 7-0 was used as suture material. Traditional surgical technique was used in control group (24 patients). Scissors were used as a cutting tool and Vicryl 6-0 as a suture material. In the postoperative period conjunctival hyperemia, and width of the palpebral fissure were assessed after the surgery. Conjunctival flap edema (thickness) was measured one day after surgery by the anterior segment optical coherence tomography (AS-OCT). Results. The 1st day after surgery the median thickness of the conjunctival flap above the recession site according to AS-OCT was on average 1.5 times thinner in the main group than in the control group: 405 (351–555) µm vs. 618 (513–732) µm; p

The “gold standard” of modern vitreoretinal surgery is silicone oil tamponade of the vitreous cavity. The lens opacity development is in the list of complications of prolonged silicone oil eye filling (from 2 weeks to 2 years). Polydimethylsiloxanes hydrophobicity, direct contact with the front of the silicone bladder, macrophage and toxic reaction, trophic disturbances are the causes leading to the cataract initiation. This makes the problem of cataract surgery and preliminary intraocular lens calculation in silicone oil filled eyes before its removing very relevant as well as cloudy retina visualization and the necessity of minimization of number of operations through their combination. Certainly, the main error in IOL power calculation is associated with axial length measurement inaccuracy, as the most significant term of an equation. Silicone oil filled eyes biometry errors, and, consequently, postoperative refraction biases remain unresolved problem until now. To date authors report only 58 % of cases in which target refraction was achieved after combined surgery. Some researchers figure out that average calculation error after phacoemulsification with IOL implantation in avitreal eyes was 0.8 D despite of the optical biometry usage. Today it is represented by several methods: partial coherent interferometry, optical low-coherence reflectometry and optical coherence tomography, which are implemented in devices such as IOLMaster 500, Lenstar LS 900 and IOLMaster 700, which have their own characteristics and measurement accuracy. Their advantages as well as creation an accurate IOL calculation method for silicone oil filled eyes could reduce postoperative refraction error that outline significant medical and social problem.

In domestic and foreign medical periodical literature, highlighting the problem of ophthalmopathology against the background of coronavirus infection, the lesion of the anterior segment of the eye is most often described. It is extremely hard to find reports about pathology of the retina, optic nerve or central parts of the visual analyzer. However, it is widely acknowledged that there is a high risk of developing coagulopathy against the background of COVID-19 infection, which leads to occlusion and thrombosis of retinal vessels, ischemic neuropathies. The problem of irreversible loss of vision due to circulatory disorders of the retinal vessels was urgent even before the wide spread of coronavirus infection due to the high prevalence of atherosclerosis, hypertension and type 1 and 2 diabetes in the population. Also, it is widely known that occlusions and thrombosis of retinal vessels can be formidable harbingers of the developing life-threatening conditions. Knowledge about the high risk of vascular ophthalmopatology against the background of a previous COVID-19 infection by the primary echelon ophthalmologists, early diagnostics and treatment of ischemic conditions of the posterior segment of the eye will reduce the frequency of irreversible vision loss due to these diseases, secondary neovascular glaucoma cases, and will also help to send patients to the multidisciplinary hospitals in a timely manner for the prevention of fatal complications of coagulopathy. The article provides a brief overview of foreign literary sources regarding the history of outbreaks of coronavirus infection in the world, as well as possible ways of damage to the organ of vision by the coronavirus. A clinical case of damage to the vascular bed of the retina in both eyes due to coagulopathy against the background of pneumonia caused by COVID-19 is presented, which is actual due to the low illumination of similarly cases.

Background. The characteristic optical coherence tomography (OCT) changes in the optic nerve head in patients with multiple sclerosis are known and have been described many times, however, the state of the macular area is described in a small number of publications.The aim: to analyze the changes in the macular area of the retina in patients with multiple sclerosis, to identify the OCT signs pathognomonic for this disease and to trace their changes over time as the disease progresses.Material and methods. In addition to the standard ophthalmological examination, 28 patients (55 eyes) diagnosed with multiple sclerosis underwent OCT of the macular zone to determine the thickness of the fovea and the volume of the macula in the 6 mm zone. The follow-up period was 6–12 years. The endpoints were the primary treatment and the most recent inspection.Results. At the initial examination, the visual acuity was 0.96 ± 0.24 (95% CI: 0.9–1.03), fovea thickness – 253.0 μm (Q1–Q3: 233.0–264.0), macular volume – 5.471 mm3 (Q1–Q3: 5.281–5.625). In 37 cases (67.3 %), the macular volume was below normal. The initial fovea thickness was below normal in 9 cases (16.4 %). At the end of the study, visual acuity did not change statistically (p = 0.824) and amounted to 0.96 ± 0.25 (95% CI: 0.90–1.04). The fi nal thickness of the fovea was 247.5 μm (Q1–Q3: 233.0–260.0), changes are statistically significant (p = 0.02). Number of cases with a thickness below normal in the fi nal study was 11 (20 %), change of frequency of cases was not statistically signifi cant (p = 0.5). The fi nal macular volume was 5.393 mm3 (Q1–Q3: 5.197–5.565), the changes are statistically significant (p = 0.023). The final number of cases with a volume below the norm was 42 (76.4 %), the change in the frequency of cases is close to statistically signifi cant (p = 0.063). At all stages of the study, there was no case of an isolated decrease in the thickness of the fovea without a decrease in the volume of the macula.Conclusion. The decrease in the volume of the macula with time while maintaining the thickness of the fovea within the normal range can be attributed to the pathognomonic OCT signs of multiple sclerosis. This criterion can be used for a comprehensive assessment of the course and therapy of this disease.

The aim: to develop a mathematical model for predicting macular edema based on the informativeness of clinical and instrumental predictors of its occurrence.Materials and methods. To determine the risk factors for macular edema 64 patients (64 eyes) with macula-off rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (grade Cp 1–2) were selected. A retrospective analysis of the surgical treatment results was carried out. The age of the patients ranged from 30 to 81 years (28 women and 36 men).Results. Using regression analysis, two signifi cant factors were identifi ed: the sum of 8 meridians of the visual fi eld before surgery (p = 0.015) and the number of detached quadrants (p = 0.021). Based on the identifi ed factors, a model was obtained for predicting the occurrence of macular edema in the postoperative period for the patients with rhegmatogenous retinal detachment. Conclusion. Based on the analysis of clinical and instrumental indicators in patients with rhegmatogenous retinal detachment, a mathematical model has been developed that allows predicting the occurrence of macular edema in the postoperative period.The application of the proposed prediction model makes it possible to determine the tactics of treatment (peeling of internal limiting membrane) and predict the appearance of macular edema at the preoperative stage.

Purpose. To analyze changes in binocular vision functions in patients with acutely acquired esotropia after preoperative correction by prisms. Material and methods. The study included 16 patients with acutely acquired esotropia with diplopia. Depending on the tactics of preoperative case management, two groups were distinguished. Eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years old (mean age, M±sd – 17.5±1.9 years). This group underwent preoperative prismatic correction of diplopia and the deviation angle, as well as eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years (18.5±1.9 years). Patients in this group underwent surgery without prior prismatic correction. Fresnel prisms were used to select and assign prismatic correction. The patien s were monitored dynamically. Results. In the course of treatment 1 group (prismatic correction followed by surgical correction) according to the indicator of Worth’s four-dot test color test, revealed a statistically significant increase in the frequency of value of the binocular single vision (p=0.041), the frequency of the presence of stereovision according to the Fly-test (p=0.013), fusion amplitude in the distance by 1.11 times (p=0.033) and near fusion amplitude by 1.15 times (p=0.003). Significant differences between the groups were observed only in the frequency of stereovision presence according to the Fly-test after treatment, which was 2.0 times higher in group 1 (p=0.041). Conclusion. Prismatic correction in combination with surgical treatment had better curative benefits than surgery itself in improving both binocular and stereoscopic visual functions.

Objective. In February 2019, we completed work on creating a unified database of the population cancer registry of the NorthWestern Federal district of the Russian Federation. The development of data on the material of a large area significantly increases the reliability of the material under study, especially for RARE localities of malignant tumors, which include tumors of the eye and and adnexa.For the first time in Russia to present an analysis of the effectiveness of anti-cancer activities in relation to malignant tumors of the eye and adnexa (C69) at the Federal district level with calculations of 5-year survival rates of patients taking into account sex, age and histological structure of tumors.Methods. The development of the 5-year survival rate of patients with malignant tumors of the eye (C69) included information from the database created by us Population cancer register of all administrative territories of the North-Western Federal district of Russia for the period from 1999 to 2013, more than 1000 observations (1022).Results. The study revealed a positive dynamics of survival in patients of the North-Western Federal district of Russia with malignant tumors of the eye. The 5-year survival rate increased among males from 58.8 to 63.1 %, and among females from 64.7 to 69.6 %. A significant overestimation of the proportion of early stages among primary patients with malignant tumors of the eye and adnexa (C69) was found, which may be due to medical errors. Calculations of patient survival (with careful tracking of the deceased) allow us to get a more objective picture.Conclusion. Excellent achievements in the treatment of patients of advanced research centers and institutes can be welcomed only if similar successes are recorded at the population level and are available to all patients. Our in-depth development of population data in the Federal district confirmed the success in the treatment of patients with the malignant tumors of the eye and adnexa (C69), and the patterns we found first in the database of the Population cancer register of St. Petersburg, and now in the North-Western Federal district of the Russian Federation. Similar studies in other Federal districts could be an important component in the planning, monitoring and evaluation of anti-cancer measures in relation to the malignant tumors of the eye and adnexa (C69).

Literature data confirm the existence of different opinions about the nature of changes in intraocular pressure after cataract extraction. However, assessment of the risk factors significance for complications and prediction their occurrence in the postoperative period are still unresolved issues. Average statistical norm can still entail a persistent increase in IOP after cataract surgery.Purpose: to study the frequency of persistent increase in IOP after cataract surgery with a statistically normal level of IOP depending on the ratio of the preoperative level of IOP with its individual norm.Methods: The clinical study was based on the analysis of 69 phacoemulsifications and posterior chamber intraocular lens implantations with a preoperative IOP level within the average statistical norm (IOP Results. GROUP 1. The initial IOP value before surgery in group 1 averaged 15.7 ± 3.6, after a year a decrease in IOP was recorded in 15 eyes (57.7 %). In 11 eyes (42.3 %) IOP remained unchanged. However, IOP changes in this group were statistically insignificant (p > 0.5). GROUP 2. After a year decrease in IOP was recorded in 11 eyes (52.4 %). In 10 eyes (47.6 %) IOP remained unchanged. GROUP 3 The initial IOP level before surgery was on average 17.9 ± 1.4. One year later, a decrease in IOP was recorded in 6 eyes (40.9 %). In 8 eyes (22.7 %) IOP remained unchanged.Conclusions. When planning cataract surgery the indicator of real compensation is the level of ophthalmotonus, which does not exceed the individual norm. IOP exceeding the individual norm indicates a high probability of a persistent increase in IOP after cataract surgery.

The review reflects the current data on unmodified risk factors for cataract development; most prominent are genetic factors and age. Research shows that about half of nuclear and two-thirds of cortical cataracts can be hereditary. Congenital cataracts are hereditary in 25 % of cases, of which 75 % are autosomal dominant. From 30 % to 50 % of congenital cataracts are caused by mutations in genes encoding proteins in the structure of the lens. To date, 115 genes have been identified associated with syndromic and non-syndromic cataracts. Proof of the genetic theory is the development of nuclear cataract in Stickler syndrome (SS), a relatively rare multisystem connective tissue disease inherited in an autosomal dominant manner. The syndrome is characterized by structural abnormalities in collagens of types 2, 9 and 11 and manifests itself in various clinical signs, including the development of facial skeleton anomalies, damage to the vision organ, the musculoskeletal system and the auditory system. Ophthalmic complications of SS are represented by a combination of pathological myopia, retinal detachment, ocular hypertension, early vitreous liquefaction and premature cataract development. Age is the main unmodified risk factor for developing cataracts. The most common form of cataract is age-related nuclear cataract, which in developing countries accounts for 50 % to 90 % of the total number of cases (> 70 versus ≤ 65 years, OR = 12.7). The pathogenesis of age-related nuclear cataract is associated with oxidative damage to proteins under certain conditions: a decrease in the concentration of glutathione (GSH) and vitamin C in the lens nucleus. When examining the frequency of cortical cataract, there was also a relationship with an increase in the age of patients (> 70 years versus ≤ 65 years, OR = 5.96). With age, a barrier is created for the advancement of GSH from the site of its synthesis and regeneration in the cortical layer of the lens towards the nucleus. Numerous experimental and morphological studies confirm the accommodative theory of the development of age-related cortical cataract.Lens deformations caused by accommodation forces lead to heterogeneity of the lens density at the border of the nucleus and cortical layers, an increase in light scattering and damage to the lens fibers. Genetic predisposition and age are interactions of many complex factors that can contribute to the development of cataracts.

Cataracts and age-related macular degeneration (AMD) are the leading causes of blindness worldwide. The main symptoms of AMD are: a gradual decrease in visual acuity to the hundredth, metamorphosis, the appearance of a central scotoma, which reduces the quality of life of the patients and leads to disability. Prosthetic and stationary means of optical rehabilitation, such as magnifiers for the visually impaired, glasses, video systems are cumbersome and poorly functional. An alternative correction option is intraocular vision devices that improve the patient’s quality of life. The review considers various types of intraocular implants, in particular, the intraocular telescope system (intraocular miniature telescope-IMT, IOL-VIP, IOL-AMD), Fresnel lens, Lipschitz lens, Scharioth macular lens (Scharioth macula lens, SML), EyeMax Mono, LENTIS ® MAX IOL LS-313 MF80. The use of high-tech devices for the correction of visual disturbances in AMD has opened a new direction in the rehabilitation of low vision. Further study and implementation of the latest generation of “macular” lenses will improve the quality of life of patients with advanced stages of AMD.

Optical coherence tomography (OCT) is a modern non-contact real-time imaging of anterior and posterior eye’s segments. Based on the principle of low-coherence interferometry, it provides the analysis of tissue structures. In this review, we discuss technical aspects of two different OCT platforms: Time-Domain OCT (TD-OCT), and Spectral-Domain (SD-OCT) with the use of Fourier transformation — Fourier-Domain (FD-OCT). Over the last several years, the development of OCT has increased the resolution of images by different ways of optical filtering. The usage of tunable swept laser instead of superluminescent diode in modern Swept-Source OCT (SS-OCT) provides the sufficient quality of image. Anterior segment OCT can detect the pathological changes in different ocular structures and may be a key tool for monitoring of their progression. In pterygium OCT shows the true extent of fibrovascular granulation tissue in stromal layers, whereas in keratitis it provides imaging of corneal infiltration. Frequently, OCT-pachymetry can be advantageous in the detection of subclinical keratectasias. In patients with bullous keratopathy OCT can help to distinguish corneal edema and fibrosis. The new era of OCT is characterized by application of this method in keratorefractive surgery. Microscope-mounted (portable) and microscopeintegrated OCT systems have been developed. During LASIK surgery intraoperative OCT (iOCT) helps to assess flap interface, measure flap and residual bed thickness. It is a useful tool to reveal the structural changes during corneal collagen crosslinking. At the beginning of keratoplasty, iOCT helps to determine the corneal thickness, extent and depth of opacity, Descemet membrane perforation. iOCT guides decision-making regarding keratoplasty modification, depth and diameter of trephination. Furthermore, a real-time visualization of ocular structures during keratoplasty decreases the frequency of intra- and postsurgical complications.

Cataract is the most common cause of blindness worldwide. The standard treatment for cataracts is phacoemulsification with implantation of an intraocular lens (IOL). Removing cataracts can significantly improve vision and the quality of life associated with vision. The review considers the necessary biometric studies before phacoemulsification of patients with macular pathology, the long-term effects of phacoemulsification in patients with various macular pathologies, the features of implantation of mono- and multifocal IOLs in such patients, as well as possible complications after phacoemulsification in patients with macular pathology. The importance of examination of the macula before phacoemulsification of cataract has been shown. A review of changes in different eye’s parts after phacoemulsification in patients with various pathologies: with the progression of myotic traction, with combined cataract and glaucoma, in patients with diabetes, with an epiretinal membrane, and the features of implantation of multifocal lenses and IOLs with UV protection are considered. Not only the postoperative condition is assessed, but also the changes between the preoperative and postoperative conditions. In addition, the review demonstrates the dynamic healing processes and changes in macular parameters (after different times — from several days to several years) in order to obtain a rational analysis result.

Purpose. To describe the clinical cases and surgery results in patients with concomitant of keratoconus and Fuchs' corneal endothelial dystrophy. Material and methods. Retrospective analysis of 3 patients using different surgical techniques. All patients were female, they underwent diagnostic procedures including: keratotopography, optical coherence tomography of the anterior segment of the eye, Scheimpflug keratotomography, endothelial microscopy. First patient underwent penetrating keratoplasty (PKP), the second one – descemet stripping automated endothelial keratoplasty (DSEK), and the third one – descemet membrane endothelial keratoplasty (DMEK). Results. In all cases the combination of keratoconus and fuchs endothelial corneal dystrophy occurred in one eye, while cornea guttata was observed in both eyes. The diagnosis of keratoconus was complicated by the presence of corneal edema due to endothelial dysfunction. As a result, visual rehabilitation was achieved in 2 patients after PKP and DSEK, and in the third case (DMEK), the presence of pronounced opacities of the stroma in the central zone did not result in increase of visual acuity, despite the good function of the graft endothelium, which required the PKP. Conclusion. Surgical tactics should be based primary on the replacement of the pathologically altered endothelial monolayer (DSEK, DMEK). As for the simultaneous replacement of the corneal stroma (PKP), the decision is based on the progression of keratoconus, the degree of corneal thinning, and the presence of its surface irregularity. Key words: Fuchs' endothelial corneal dystrophy, keratoconus, endothelial keratoplasty, penetrating keratoplasty, Descemet's membrane endothelial keratoplasty, corneal endothelium

Relevance. Corneal refractive surgery is a modern, dynamically developing segment of ophthalmology that provides highly predictable, safe and stable refractive results in patients with a wide range of ametropias. Corneal refractive surgery, usually is chosen by patients who lead an active lifestyle and need rapid medical and social rehabilitation, people with high requirements for the quality of life and showing increased expectations for the result of correction. Perhaps this is due to the fact that, according to a survey at the exit of the Department of refractive laser Surgery of the S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, Moscow, conducted after consulting a surgeon with a description of the course of the operation and the postoperative course, about 1 % of patients refuse surgery, fearing painful sensations in the postoperative period, and 23.4 % of the expected postoperative discomfort causes strong concerns.Purpose. To study the clinical efficacy and safety of Broxinac (0.09 % bromfenac solution) in the early postoperative period of corneal refractive surgery.Materials and methods. The study included 168 patients (168 eyes) with moderate and high myopia after PRK (24 eyes), FemtoLASIK (78 eyes) and ReLEx SMILE (66 eyes), divided into equal subgroups: in the main group, Broxinac was instilled once 30 minutes after the operation, and in the control group — placebo. In the PRK subgroup of the main group, daily instillations of Broxinac were continued until complete reepithelization. The severity of the indicators “eye pain”, “photophobia”, “lacrimation”, “foreign body sensation” was evaluated on a five-point scale, the state of the corneal epithelium when stained with fluorescein, and overall satisfaction with the operation.Results and discussion. It is established that the analgesic effect occurred on average after 4.4 ± 0.6 minutes. Broxinac had a rapid, pronounced analgesic effect in patients in the early postoperative period after keratorefractive surgery, without slowing of corneal reepithelization, and can be recommended for use in clinical practice for analgesia and relief of aseptic inflammatory reaction in the early postoperative period after FemtoLASIK and PRK. The ReLEx SMILE does not require pain relief.Conclusion. Analgesia of the early postoperative period increases patient satisfaction with the result of the operation, popularizes it and helps to attract patients who previously refused surgical correction of ametropia due to fear of painful sensations.

Purpose : to present analysis a case reports of 17 patients who had an acute transient macular edema appeared straight after uncomplicated cataract surgery. Patients and Methods . Working with literature and retrospective observational case series reviewing clinical and imaging data from 17 patients (17 eyes) with acute transient macular edema. Results . There are several cases of acute macular hole development after cataract surgery (complicated and uncomplicated). Also there are reports of macular odema development after several weeks after uncomplicated phacoemulsification due to pseudophakic cystoid macular oedema (Irvine-Gass syndrome) or due to vitreomacular traction syndrome. We observed a series of transient macular oedema with 3.8 % incidence occurring on the first days after uncomplicated phacoemulsification with IOL implantation that had no signs of vitreomacular traction or aqute inflammation. Men suffer frequently than women (14:3). Systemic hypertension prevailed among these patients (15 from 17). Optical coherence tomography (OCT) was made in patients complaining on blure vision and who had signs of macular edema by ophthalmoscopy. By OCT high neuroepithelium detachment was observed at the first day after uneventful cataract phacoemulsification with intraocular lens implantation in 17 patients with quiet postoperative condition of the eye. The edema resolved on the 3–6-th day by standard phaco accompanying pharmacological treatment. In most cases posterior vitreous cortex was adjacent to the retina except 3 patients with posterior vitreous detachment (PVD) in macular area. We found a paper by Costen M.T.J. et al. (2007) about the same striking appearance of maculopathy called by authors “A-sign” maculopathy because of A-shaped pattern on OCT images in 3 patients after routine cataract surgery. Yaman A (2008) and Panagiotidis D (2010) also reported same findings after uncomplicated cataract surgery. We compared our findings with 3 papers mentioned above, as well as with typical pseudophakic cystoid macular edema (CME or Irvine-Gass syndrome) and vitreomacular traction syndrome. We also discussed possible ethiopathogenesis of thеse cases in terms of morphology of the macula region. Conclusion . This article could improve our understanding of mechanisms of the interstitial fluid flow in the eye tissues.

Purpose. Analysis A-VEGF therapy for wet form age-related macular degeneration (AMD) complicated by retinal pigment epithelium tear (RPET), different in involvement of macular zone (MZ), with different time of RPET regarding A-VEGF therapy. Material and methods. The results of treatment 18 patients with wet AMD complicated by RPET during monthly A-VEGF injection were analyzed. In first group (10 eyes) – RPET occurred before treatment, the second (8 eyes) – RPET arisen during A-VEGF. Visometry, ophthalmoscopy, fundus photoregistration, MZ OCT before and in month after each injection. Age – 65–83 years. Results. RPET (1,5 DD) captured fovea in 7 first group patients, in 3 patients RPET (0,5 DD) didn't affect fovea, In macula registered subretinal fluid (SRF) and hemorrhage (SRH). After 2 A-VEGF injections, resorption of SRF and SRH was observed. VA increased from 0,2 to 0,7 in cases RPET without capture of the fovea. RPET involving fovea occurred in 8 patients of the second group after the first A-VEGF injection. SRH and SRF resorbed. VA of patients decreased from 0,7 to 0,15. In both groups relapses of the SRF in macula after the development of RPET were not observed. Conclusion. Wet AMD complicated by RPET as a result of the pathological process and on the background of A-VEGF therapy. When RPET is involved fovea, VA decreases to 0.15. In case of preservation RPE in fovea – VA is high. A-VEGF therapy for wet AMD with RPET leads to resorption of SRH and SRF, to stop SRF for a long time. Key words: wet form macular degeneration, Anti-VEGF therapy, retinal pigment epithelium tear, macular zone

The presence of a balance between the production and outflow of intraocular fluid ensures stability of the level of intraocular pressure (IOP). To reduce IOP means to affect one of these variables. For many decades, transscleral technologies in the treatment of glaucoma were considered exclusively as traumatic cyclodestructive interventions that only affect the reduction of intraocular pressure (IOP). These methods have recently been considered as possible ways to influence uveoscleral outflow. This became possible due to the appearance of new lasers, the development of new modes of their operation, points of application in the projection of the pars plana of the ciliary body (for example, TRANS-scleral CFC in micro-pulse mode at λ = 810 µm and CFC using pulsed periodic laser radiation at λ = 1.56 µm). They have a gentler effect and, accordingly, cause fewer side effects and undesirable effects. This explains the increasing shift towards the use of transscleral technologies in the earlier stages of glaucoma, not only for end-stage painful glaucoma resistant to conventional treatment (so-called “last resort surgery”).

Introduction. Vitreous opacities are quite common, occurring in 76% of cases and significantly reducing quality of life in 33% of them. YAG-laser vitreolysis is considered as an alternative treatment option for patients with floating vitreous opacities. Purpose. To develop an optimized YAG-laser vitreolysis technology based on the assessment of the acoustic density of the vitreous opacities. Material and methods. The results of YAG-laser vitreolysis of vitreous opacities in 318 patients (318 eyes) were analyzed. A photo-optical method has been developed for visualizing opacities of the vitreous body, registering the area of opacities and the dimming intensity index. A method has been developed for the personalized selection of laser energy taking into account the acoustic density of the vitreous opacities. Results. After performing multi-stage laser treatment, a significant decrease in the area of opacities and the dimming intensity index, an increase in the threshold of retinal photosensitivity according to microperimetry data and a decrease in the acoustic density of opacities were noted. Conclusions. Application of optimized YAG-laser vitreolysis technology for vitreous opacities allows to achieve the best values of clinical and functional parameters (p

Striae may form on the skin due to a number of factors: rapid weight gain, muscle hypertrophy, endocrinopathies, breast enlargement, as a side effect of long-term topical use of strong corticosteroids. However, in some rare circumstances, striae can develop as a complication due to the use of tissue expanders. This cosmetic defect develops most often on the skin of the thighs, abdomen, mammary glands in women and the shoulders in men. Striae of pregnancy are a common cosmetic skin defect. The development of striae is associated with stretching and rupture of connective tissue in susceptible individuals against the background of influence of genetic and hormonal factors. The appearance of striae gravidarum does not have a significant effect on the health of patients, however, a cosmetic defect caused by the appearance of striae can generate psychoemotional (psychoemotional) stress and lead to a decrease in quality of life. The striae development occurs in certain stages. The initial period of striae development – red (immature) striae – is characterized by the absence of changes in the epidermis and signs of inflammation in the dermis. The appearance of white (mature) striae is accompanied by the architectural distortion of elastic fibre net and changes in the viscoelastic properties of the affected skin, which becomes much less elastic. The correction of striae requires topical treatment that help moisturize and soften the skin, stimulate the processes of collagen production, as well as physiotherapy techniques. However, many of them have contraindications for use during pregnancy. The article discusses the issues of the use of cosmetic products that can be used during pregnancy.

Degenerative-dystrophic retinal diseases, particularly age-related macular degeneration (AMD), are now considered to be the lead cause of blindness and low vision in developed countries, with a steadily increasing trend. Recent publications provide evidence for the involvement of inflammatory mechanisms in TMD development and progression unveiled due to advances in innate and adaptive immunity research. However, the immunopathogenesis of atrophic AMD form, “geographic atrophy” (GA) remains largely unstudied. Objective: to investigate local mRNA expression of inflammatory cytokines IL-1β, IL-18, CCL2/MCP-1 in a model of RPE atrophy induced after subretinal injection of 0.9% sodium chloride solution in experimental rabbits. The investigation was carried out in tissue complex retina-RPE-choroid (TC) samples isolated from eyes of 23 albino New Zealand rabbits after modeling RPE atrophy by subretinal injection of 0.9% sodium chloride solution and 5 healthy rabbits lacking eye lesions. Animals in the experimental group (one week before surgical intervention, in the early period, and in the period of sustained RPE atrophy formation) and controls were subjected to optical coherence tomography (OCT) and ocular fundus autofluorescence (FAF). Evaluation of proinflammatory cytokine gene expression levels in TC was performed by RT-PCR. Results. Subretinal injection of 0.01 ml of 0.9% sodium chloride solution induced experimental RPE atrophy development in rabbits vs. control that was associated with multidirectional changes of IL-1β, IL-18, MCP-1/CCL2 gene mRNA expression. Three types of response in the TC, formed during development of atrophic changes and determined by the value of local cytokine gene expression were characterized: 1) hypo/ no response – decreased/no expression; 2) normal response – moderate increase; 3) hyper response – overexpression. 69.6% of animals with persistent atrophy had a moderate to hypertrophic increase in locally expressed mRNA MCP-1/CCL2, whereas 30% cases had significantly increased IL-1β mRNA expression – factors damaging the blood-retinal barrier and contributing to posterior segment immune privilege. It should be taken into account while developing new strategies for treatment of ophthalmic pathology, in particular the currently actively studied and tested options for RPE stem cell transplantation into subretinal space. The data obtained may be useful to investigate various types of RPE atrophy and develop new strategies of ophthalmopathology treatment in preclinical studies.

Glaucoma is the most severe eye disease that leads to irreversible blindness, and is a widespread pathology among the population of different countries and especially in the elderly. The urgency of the problem increases in connection with the demographic processes occurring in industrial countries, characterized by aging of the population. The development of glaucoma in the elderly exacerbates the image and quality of life of these patients, which must be taken into account in the implementation of medical and social and specialized ophthalmological care. However, the study of the quality of life in elderly glaucoma patients by a specific questionnaire was not carried out.The purpose: to analyze the quality of life of elderly patients suffering from glaucoma for a long time.Material and methods. The study of quality of life was carried out in the Tambov branch of the S. Fyodorov Eye Microsurgery Federal State Institution. In clinical conditions, a survey of 228 patients with glaucoma aged 60–75 years, who made up the main group. The survey was conducted on a special questionnaire-National Eye Institute Visual Functioning Questionnaire among patients of the above group by direct interviewing. The results were integrated into 122 scales for processing and analysis in accordance with the requirements of this questionnaire. Similarly, for comparison, the quality of life was studied in 178 patients of the same age with no history of glaucoma and at the present time. In assessing the quality of life, arithmetic averages and their errors were calculated, and the nonparametric t-white criterion was used to determine the reliability of the differences.Results. It was found that the development of glaucoma in the elderly causes a significant decrease in the quality of life on all scales of the questionnaire, reflecting the specific manifestations due to visual impairment. At the same time, the most pronounced effect of glaucoma has on the reduction of distant vision — 19.5 ± 1.3 points against 69.5 ± 1.8 points (p < 0.001) in the control group. The defeat of glaucoma leads to a significant decrease in the quality of life of elderly patients and other indicators. In the main group, the overall score of vision (23.5 ± 1.5 points vs. 75.2 ± 1.9 points in the control), near vision (26.8 ± 1.6 points vs. 73.5 ± 2.0 points in the control), high dependence on outsiders in solving everyday problems (30.5 ± 1.6 points vs. 79.3 ± 1.8 points in the control) were significantly lower. To a lesser extent, with the development of glaucoma, color perception suffers.Conclusion. The analysis of the quality of life in elderly patients with glaucoma is of practical importance for the organization of an individual treatment and prevention plan, since it takes into account the opinion of each patient about the perception of the disease.