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Leber’s hereditary optic neuropathy (LHON) is a maternal inherited mitochondrial disease characterized by bilateral vision loss in working age population. Although this pathology affects the retinal ganglion cells, the main manifestation of the disease is visual loss, the disease in some cases can occur as LHON+ with additional neurological and cardiological symptoms. This article presents a clinical case of a 42-year-old female patient with central vision loss and neurological symptoms. In addition to visual impairments, the patient notes numbness of the feet and shins, which have progressed over time, periodic tremor of the hands, weakness in the legs. Since 2013, the patient has been observed by a neurologist with suspected multiple sclerosis, demyelinating optic neuritis, and therefore received treatment, including corticosteroid therapy, which did not give a positive result. The patient underwent a standard ophthalmological examination, optical coherence tomography (OCT) of the retina and optic nerve, and computer perimetry. The additional survey data were non-specific in nature. Taking into account the patient’s complaints, anamnesis of the disease, the data of the research methods, as well as the potential possibility of combining LHON with neurological symptoms, three years later the hereditary nature of the disease was suspected. Using MLPA (Multiplex Ligation-dependent Probe Amplification) and direct automatic sequencing, the patient was tested for frequent LHON mutations. Mutation m.11778 G>A was detected. In clinical practice, it is necessary to keep in mind the existence of patients with LHON in combination with neurological symptoms, both of them can manifest before and after vision acuity decline which could lead to misdiagnosis and, as a result, incorrectly prescribed treatment. The combination of symptoms of vision loss with the characteristic features of hereditary optical neuropathy in combination with neurological symptoms should encourage clinicians to prescribe a genetic analysis of patients for LHON mutations.

Neurodegenerative diseases (NDD) are a group of nosological forms, caused by excessive formation of protein molecules and their aggregates and leading to the death of brain cells. Classical pathophysiological mechanisms are associated with the accumulation of extracellular amyloid b -protein (A b) in Alzheimer's disease (AD) and a -synuclein protein in Parkinson's disease (PD), which are markers of neurodegenerative process. Signs of functional disorders in NDD include decreasing visual acuity, lower contrast light sensitivity with the most significant changes at the highest spatial frequencies (18 and 12 cycles per degree), and reduced color vision. These disorders correlate with the severity of cognitive impairment and duration of the disease. Changes in the indicators of psychophysical tests are accompanied by lower central retinal thickness (CRT), which is a consequence of inner layers degeneration. NDD progression is characterized by the stability of psychophysical tests, significant thinning of the peripapillary retinal nerve fiber layer (RNFL) and CRT thickening, which correlates with cognitive disfunction. A b and a -synuclein deposits in artery walls cause lumen narrowing and occlusion of blood vessels, reduced optic nerve disk perfusion density, superficial and deep capillary plexus depletion, expansion of the avascular foveolar zone. Microcirculatory disorders lead to retinal changes, which were proven to correlate negatively with the thickness of inner retinal layers and duration of the disease. An ever-growing need in the identification of specific and sensitive biomarkers at the preclinical stage of NDDs, differentiation of their causes, precise subtype classification, and assessment of progression risk is an evidence of the relevance of studying and identifying functional and structural changes in retinal neurons and axons. Non-invasive and informative methods of multimodal imaging appear to be valuable for NDD diagnosis and monitoring.

Purpose. Retrospective analysis of clinical, instrumental, cytological and pathological features of intraocular medulloepithelioma based on our own experience in the period from 2005 to 2018. Patients and Methods. For a specified period of time in the department of ocular oncology and radiology in Moscow Helmholtz Research Institute of Eye Diseases we examined 9 patients aged from 1 to 44 years (5 men and 4 women), with a confirmed histological diagnosis of intraocular medulloepithelioma (medulloblastoma). The average age of patients in assessing vital status was 15.8 ± 13.5 years, the average age at the time of making the diagnosis “intraocular neoplasm” was 9.5 ± 11 years. All patients underwent a comprehensive clinical and instrumental ophthalmologic examination, which included visometry, tonometry, perimetry, biomicroscopy, ophthalmoscopy, Doppler ultrasound (ACUSON, USA), as well as general physical examination. Analysis of the initial status (before hospitalization) was carried out retrospectively according to the data of outpatient records. In one case, iridocyclosclerectomy was performed, in eight cases — enucleation of the affected eye followed by histopathological examination, as well as analysis of long-term results of treatment. Results . A detailed analysis of nine clinical cases is presented, including typical clinical features, echographic signs of a meduloepithelioma (heterogeneous structure of the tumor, anechoic inclusions (cysts) in the thickness of the tumor) are presented. According to the localization, we observed the tumor of the ciliary body ( n = 3), the ciliary body and iris ( n = 2), the retina ( n = 1), the retina, the choroid and the optic nerve disc ( n = 1), the ciliary body and the choroid ( n = 1) and the choroid with invasion in extraocular muscles and optic nerve ( n = 1). In 8 cases, enucleation was performed, one case was preceded by an iridectomy and a fine- needle aspiration biopsy. One patient underwent local conservative treatment (iridocyclosclerectomy) in the presence of a tumor of the ciliary body and iris. Pathological and cytological features of the tumor were presented. 8 of 9 patients were alive and had no signs of metastases. One patient died 3 years after treatment. Conclusions . Despite the relative rarity, medulloepithelioma should be included in the differential-diagnostic series in patients with suspected retinoblastoma, non-pigmented uveal melanoma, adenocarcinoma of the retinal pigment epithelium, and other rare intraocular neoplasms.

Purpose: to describe a clinical case of ocular complications of gastric stromal tumor treatment with imatinib mesylate. Material and methods . A patient aged 78 was examined by general ophthalmologic and instrumental methods, including ultrasound and spectral optical coherence tomography (SOCT). Results. Ophthalmoscopy helped diagnose a blunted foveal reflex of the right eye. In the left eye, fuzzy boundaries of the optic disc edema and the macular reflex, the presence of gray-yellow foci of an irregular shape with even distinct boundaries in the paramacular zone were revealed. In the lower part of the left eye fundus, a weakly pigmented gray-yellow focus with uneven indistinct boundaries and an uneven surface was to be seen. SOCT showed in the right eye a retinal edema in the macula and paramacular zones and an epiretinal membrane. In the left eye, SOCT showed vitreoretinal tractions and retinal edema on the edges of the optic nerve; in the paramacular zone and in the inner parts of the fundus, vitreoretinal tractions, epiretinal fibrosis, retinal edema was observed whilst in the lower parts of the fundus complete destruction of all retinal layers due to the hyperreflective focus with a small-shaped inner contour, an even choroidal profile with thinning of the choroid, vitreoretinal tractions, and epiretinal membrane in the left eye could be seen. Conclusions. The clinical case of eye complications of imatinib mesylate in the treatment of gastric stromal tumor necessitates an interdisciplinary integrated approach (involving an oncologist and an ocular oncologist) in the diagnosis and treatment of eye tumors. A complex of instrumental methods of diagnostics of eye fundus diseases involving additional refinement methods (SOCT) ensures differential diagnosis of retinopathy during the chemotherapy, secondary metastatic involvement, and vitreoretinal pathology of a different pathogenetic etiology. Early diagnosis facilitates providing adequate treatment aimed at preserving the patient’s vision, the eye, and life.

Purpose: to study the structural and microcirculatory changes in the optic nerve and retina in patients with primary open-angle glaucoma (POAG) in diabetes using OCT and OCT-A. Material and methods . The study involved 156 eyes of 104 patients, divided into 4 groups: group 1 — 47 eyes (26 patients aged 66.96 ± 6.05) with stage I POAG and diabetes, group 2 — 36 eyes (24 patients aged 64.64 ± 7.91) with stage I POAG; group 3 — 36 eyes (28 patients aged 63.03 ± 7.10) with stage III POAG and diabetes; group 4 — 37 eyes (26 patients, aged 69.70 ± 7.44) with stage III POAG. All patients underwent a complete ophthalmologic examination, spectral OCT, OCT-A of the optic disc and the macula. Results . In groups 1 and 3 (with POAG and diabetes), a decrease in the parameters of best corrected visual acuity and MD was revealed, which became worse as glaucoma progressed. A thinning of retinal nerve fiber layer (RNFL), neuroretinal rim, ganglion cells and inner plexiform layer (GCL + IPL) was noted, with the lowest values in patients with stage III POAG and diabetes. The analysis of hemodynamics showed a pronounced decrease in perfusion (39.04 ± 3.42 %) as well as vascular density of the optic disc (0.35 ± 0.04 / mm) and the macular area (22.96 ± 5.82 % and 12.19 ± 4.04 / mm) in stage III of POAG and diabetes. This decrease is strongly correlated with functional and structural changes, the stage of glaucoma and the presence of diabetes. Conclusion. A comparative analysis of structural, functional and vascular changes between groups of patients with stage I and III POAG, both accompanied and unaccompanied by diabetes, revealed signs of significant deterioration in perfusion of the optic nerve and retina in patients with diabetes. In combined glaucoma and diabetes, early diagnosis, monitoring and adequate timely therapy require careful attention of specialists.

Purpose: statistical evaluation of the diagnostic and differential diagnostic significance of spectral optical coherent tomography (SOCT) and microperimetry methods in patients with (1) optic neuritis (ON) with multiple sclerosis (MS) manifestation; (2) inflammation-related ON and (3) optic nerve atrophy (ONA) caused by MS. Materials and methods. The results of examination of the three groups of patients were processed by correlation and multivariate analysis and binary logistic regression. The threshold of electrical sensitivity (EST) and electrical lability (EL) were determined on a Fosphen-tester using a standard technique. S-OCT was performed on Cirrus HD-OCT (Carl Zeiss Meditec Inc., USA) using the RNFL Thickness Analysis, Ganglion Cell Analysis programs. Computer microperimetry was done on MP-1 (Nidek technologies, Vigonza, Italy) using the macula 12o 10 dB program. Results . EST of the retina was found to have a strong bilateral correlation with the average retinal sensitivity, RNFL thickness and thickness of the upper temporal and upper segments layer of the complex GCL + IPL. Diagnostic parameters significant for visual analyzer disorders caused by MS were revealed and confirmed, including the average retinal sensitivity drop within 6o from the center of the visual field according to microperimetry (p < 0.0005), the thinning of RNFL (p < 0.005) and complex GCL-S + IPL, according to SOCT (p = 0.004). intragroup comparisons revealed the diagnostic significance of SOCT in early diagnosis of ONA due to MS (p < 0.0005). It was found that if the RNFL was 62 microns or less, the GCL-S + IPL was 52 microns or less (in the inferior segment it was 50 microns or less, and in the upper segment it was 51 microns or less) then, with a sensitivity of 100 % and a specificity of 87.5–93 %, it is an evidence of the atrophy of the optic nerve. Conclusion: average retinal photosensitivity within 6o from the center of the visual field, RNFL thickness, thickness GCL-S + IPL, including that in the superior, superior temporal and inferior segments can be considered as diagnostically significant values in OH inflammatory-related and demyelinating OH and the development of ONA due to MS.

Purpose: To evaluate the effectiveness of a new modification of the vacuum-perimeter test (VPT) by V.V. Volkov in the early diagnosis of glaucoma in comparison with the results of the original test and its known modification — vacuum-compression automated test (VCAT) in an open comparative clinical research. Patients and Methods. The study involved 26 patients (47 eyes) (average age 52.9 ± 8.5 years) with suspected open-angle glaucoma (OAG). Patients were divided into three groups: 1-st — 19 eyes with preglaucoma, 2-nd — 18 eyes with the early stage of OAG, 3-rd — 10 eyes of five patients with unconfirmed glaucoma. The control group (4-th) included 20 eyes of 10 healthy people (average age 56.4 ± 4.4 years). Along with the standard ophthalmological examination, all patients underwent perimetry on Humphrey Visual Field Analyzer II 745i (Germany-USA), our modification of Frequency Doubling Technology (FDT) perimetry, evaluation of the optic nerve head (ONH) on Heidelberg Retina Tomograph (HRT 3, Germany) and three stress tests: VPT, VCAT and our modification — vacuum-contrast-frequency test (VCFT). VCFT was created on the base of FDT perimetry with the aim of increasing the sensitivity of the original test (VPT) for detection of preglaucoma through the use of non-standard stimulus and increasing the number of investigated points of central visual field. Results. According to the National classification (1975) the diagnosis of preglaucoma was determined on the basis of a positive result of at least one of three stress tests, taking into account the risk factors for the development of glaucoma in patients. The early stage of OAG was established on the base of International standards for structural and functional assessment of the ONH (2003). The specificity of all three compared stress tests was 100 %, which confirmed their negative results in all patients (10 eyes) from the 3-rd group. However, the sensitivity of VCFT (75 %) was significantly higher than VPT (21.05 %) and VCAT (21.05 %), which is due, we believe, to the specific nature of VCFT stimulus. Conclusion. According to the obtained data, the developed new modification of VPT — VCFT on the specificity of the results was not worse, and the sensitivity was better than the original VPT and VCAT in the diagnosis of preglaucoma. VCFT is quickly performed and comfortable for patients.

Drug dependence is one of important social problems in modern society. It became more actual because of the high morbidity in young working-age patients. The central nervous system is the main target for psychoactive substances. Long-term drug intoxication results in functional and structural brain alterations, it leads to cognitive impairment and disturbances of higher mental functions rendering patients’ disadapted in their work and daily life activities. Eye disorders due to drug abuse are multifaceted and can vary from conjunctival damage to severe endogenous endophthalmitis. Opioid dependence can result not only from intentional self-administration of narcotic drugs, but also from long-term prescribed use of these medicinal products owing to their potent analgesic effect exhibited in somatically ill patients with severe chronic pain. Opioid derivatives act as partial or full agonists of three types of opioid receptors (δ, κ, and µ) extensively expressed by the neurons of the central and, to a lesser extent, peripheral nervous system. The most dangerous complication of intoxication with this group narcotic drugs is opioid induced-respiratory depression resulting in hypoxaemia and hypercapnia. The paper presents a case report of bilateral optic nerve atrophy that developed in a young female patient after a long period of intravenous heroin use. There are practically no reports of optic nerve damage due to heroin intoxication in the current literature. Possible optic nerve atrophy mechanisms under discussion include generalized hypoxia developing against a background of chronic heroin intoxication and direct toxicity of admixtures used to dilute home-made narcotic drugs. In view of the growing use of these substances, physicians have to consider their effects in the differential diagnosis in patients with atypical eye disorders.

Purpose: to study the features of the blood filling of the eye in patients with primary untreated hypothyroidism and primary untreated thyrotoxicosis by plethysmography. Materials and methods. The material of the study was the results of a comprehensive examination of 43 patients (86 eyes): 23 people (46 eyes) with primary untreated hypothyroidism and 20 people (40 eyes) with primary untreated hyperthyroidism. The ocular blood flow was assessed by ophthalmoplethysmography. Results. The obtained plethysmography data confirm that even in the absence of endocrine ophthalmopathy in patients with primary untreated hypothyroidism and primary untreated thyrotoxicosis, deep hemodynamic disturbances in the major vessels of the eye develop leading to ischemia of its anterior and posterior parts, which can lead to hydrodynamic disturbances in the eye, sensitivity of the visual analyzer to ischemia and hypoxia and to promote the development of secondary optic neuropathy. In this study, a significant reduction of 30–40 % from the norm of volume and consumption indicators of the blood filling of the eye with impaired placement of blood in the choriocapillaries, reduced elasticity of the choroidal vessel wall was detected, which can not but trigger the development of various pathological processes. For example, ischemia of the ciliary body and the trabecular meshwork, the presence of thyroid receptors on endothelial and smooth muscle cells of choroidal and orbital vessels, can lead to hydrodynamic disturbances, and ischemia of the optic nerve, which arises due to violation peripapillary flow having choroidal source of blood supply, can result in an optical neuropathy. In this aspect, thyroid disease is associated with an increased risk of developing glaucoma, endocrine ophthalmopathy. The conclusion. Despite the constant expansion of various innovative dopplerographic systems, plethysmography — as a method of examining the blood filling of the eye, remains in demand, reliable and highly informative. In patients with uncompensated thyroid dysfunctions, a violation of the blood supply to the anterior segment of the eye is observed, which can cause a low effect of antihypertensive monotherapy in the treatment of glaucoma.

In children’s neurology, problems of diagnosis and correction of the effects of perinatal lesions of the central nervous system, having a different structure and severity depending on the age of patients, are relevant. Comorbid conditions, to which, to a certain extent, neurological diseases in children associated with functional and structural disorders of the visual system can be attributed.Aim. To study the features of neurological pathology, concomitant to violation of visual functions in children of different age groups.Methods. A neurological examination of 549 children from 3 to 16 years old with various diseases of the visual system was performed. To assess the age characteristics the patients were divided into three groups of preschool, junior and senior school age. The study included a retrospective analysis of ambulatory cards, an interview with parents and an assessment of objective neurological status. If there were indications, additional examination was prescribed (spondylography with functional tests, electroencephalography and others).Results. The features of the structural distribution of neurological pathology in children, which differed from those in the general population, were identified. The dominant disorders are neuro-orthopedic disorders in the form of dorsopathies at the level of the cervical spine.Conclusion. In the structure of neurological pathology in children with structural and functional changes in the visual system, the symptom complex prevails, which is typical for minimal effects of natal damage to the cervical spine, confirmed by X-ray studies. Also a certain relationship of neurological and ophthalmic pathology was identified. The consequences of perinatal central nervous system damage and peripheral cervical insufficiency, as manifestations of dorsopathy, were more often associated with strabismus. In the same group, the maximum number of children with partial atrophy of the optic nerve was revealed.

This report is devoted to the problem of absence universal databases of patients with different chronic eye diseases and continuity of these patients between medical organizations. On the basis of MONIKI there has was held a prospective, observational cohort study of patients since 2016, with diagnoses: uveal melanoma — the first group of patients, degenerative States of the optic nerve and retina (multiple sclerosis, glaucoma) — the second group, — and vascular retinal diseases (venous occlusion, diabetic retinopathy) — the third group. There were 114 patients — in the first, 68 — in the second, 92 — in the third. There were developed statistically significant parameters of patients examination, adaptation of registers to application and increase of their efficiency continues to be corrected. All patients underwent standard ophthalmological examination, in addition-gonioscopy, ultrasound (ultrasound) in a and b-scan mode, including ultrasound biomicroscopy (UBM), optical coherence tomography (OCT), fluorescence angiography (FAG), computed tomography (CT) and/or magnetic resonance imaging (MRI) of the orbit. According to the indications, patients were examined by related specialists. For each patient group, prior results were obtained. They were late detection, untimely treatment and referral patients to other medical organizations, which proves the need to systematize patients with various pathologies and the subsequent continuity of medical organizations as for the timely detection of the disease, as for adequate and timely treatment not only at the local, but also at the regional or Federal levels. The integration of patients register with various ophthalmic diseases has a priority course in the development of healthcare in the Moscow region.

Purpose. To present the preliminary results of iridocapsular fixation of RSP-3 extracapsular IOL in patients with lens subluxation observed within the first year after surgery.Material and methods. 4 patients with cataracts and initial weakness of Zinn ligament fibers were followed up. YAG laser iridectomy was performed one day before facoemulsifcation surgery, which took account of Zinn ligament fiber weakness: it consisted in anterior continuous circular capsulorhexis with a diameter of about 5 mm, fixation of the capsular bag over the edge of capsulorhexis with four iris-capsular retractors (ICRs), phacoemulsification of the nucleus and aspiration of lens masses. The intracapsular ring and the RSP-3 IOL (the latter in the injector through the main incision) was implanted in such a way as to locate the rear support element in the capsular bag, and the front support element, in front of the pupil. After removing the ICRs, iridectomy was monitored.Results. The early postoperative period was uncomplicated. After 10 days, one patient was found to develop a relative pupillary block with the anterior chamber becoming shallower and IOP increased to reach 28 mm Hg. The reason was that iridectomy initially located in the projection area of the rear support element. An additional iridectomy arrested the situation. Visual acuity varied from 0.3 to 1.0 due to the initial state of the optic nerve and retina. The position of the IOL remained stable throughout the year, the capsular bag was unfolded.Conclusion. The possibility to use the capsular bag of the lens under the conditions that Zinn ligament fibers are weak should be considered as an advantage of the technology presented. An additional front support element serves to prevent dislocation of the IOL and the capsular bag as a whole. The obtained positive results of combined iridocapsular fixation of the IOL justify a more extensive clinical testing of the method in cases of weak Zinn ligament fibers.

Purpose. To study the dynamics of electrophysiological parameters of the retina and optic nerve after vitrectomy for a primary fullthickness macular hole.Patients and Methods. Electrophysiological examination was performed in 40 patients (40 eyes) before vitrectomy, on the 1st, 3rd, 7th, 14th, 30th, 60th, 180th day after the operation. Three groups of patients were formed depending on the intraocular tamponade: the first group — air tamponade, the second group — gas (C3F8) tamponade, the third group — silicone oil tamponade.Results. In the first, second and third groups significant decrease in the retinal and optic nerve electrogenesis was revealed on the 1st day (p < 0.001) after vitrectomy. By the end of observation period all electrophysiological indices in the first, second and third groups recover to normal levels, excluding the retinal cone system and optic nerve parameters in the third group. Electrophysiological indices recovered twice as slow in the second group, compared to the first group, due to C3F8 gas tamponade inhibitory effect. In the first and second groups the photoreceptors recovered twice as fast as bipolar cells.Conclusions. Vitrectomy causes significant inhibition of photoreceptors, bipolar and ganglion cells electrogenesis. The duration of vitrectomy is a significant negative factor determining retinal and optic nerve electrogenesis inhibition in the postop. Intraocular C3F8 gas, silicon oil tamponade (compared to air tamponade) is a significant adverse factor affecting retinal and optic nerve electrogenesis inhibition in the postop. The primary full-thickness macular hole diameter is a significant factor in inhibiting electrogenesis of the retinal cone system. Photoreceptors have a greater rehabilitation ability than bipolar cells.

Intracranial hypertension (ICH) is a frequent and serious complication that occurs in pa-tients with severe traumatic brain injury (TBI) and nontraumatic brain damage. Persistent ICH significantly worsens the prognosis of the disease course and increases the risk of adverse outcomes. In this regard, one of the main tasks of intensive care of patients with intracranial bleeding (ICB) is diagnosis and timely management of ICH. The gold standard is invasive intracranial pressure (ICP) monitoring. The advantages of direct measurement of ICP include accuracy and continuity of registration. The disadvantages are the invasiveness of the method, high cost, the risk of developing infectious and hemorrhagic complications and possible dislocation of sensors. It is necessary to search for a method of non-invasive assessment of the level of ICH most correlated with the data of direct measurement of ICP. Ultrasonography of the optic nerve structures can be such an alternative cheap way to assess ICP. Its advantages are the possibility of repeated dynamic use, no need for surgical intervention, simplicity and high accuracy of measurement. However, the results obtained with ultrasound vary, since this method is operator dependent and requires precise adherence to the technique of the study. When the optic nerve ultrasound is performed, a contact gel for ultrasound examinations is applied to the anterolateral surface of the closed upper eyelid, and a scanning plane is displayed behind the eyeball for visualization in the central part of the ultrasound image of the optic nerve, lens and retina. To visualize the vertical course of the ophthalmic artery (and the vertical course of the optic nerve), the color flow Doppler mode is used. The study includes measuring the diameter of the optic nerve and the optic nerve sheath diameter (ONSD). There is subarachnoid space with cerebrospinal fluid between the optic nerve and its sheath. With an increase in intracranial pressure, the expansion of this space occurs, ONSD grows as well. This article contains an analysis of the literature describing the anatomy of the optic nerve and various ultrasound techniques, as well as data from various authors on the threshold value of the optic nerve sheath diameter.

Purpose . To evaluate the efficiency and safety of three different techniques in the surgical treatment of epimacular fibrosis. Material and methods. A comparative evaluation of surgical treatment results was carried out in three groups of patients with epimacular fibrosis. In the first group – 20 patients (20 eyes), epiretinal membrane (ERM) was removed without vitrectomy. In the second group 30 patients (30 eyes), epiretinal membrane was removed after subtotal vitrectomy. In the third group – 30 patients (30 eyes), epiretinal membrane was removed after local vitrectomy. Local vitrectomy was performed by the following procedure: installing three 25G ports, induction of posterior hyaloids detachment in the macular area, local vitrectomy within the zone of vascular arcades (approximately 20% of the total vitreous volume), except for the area over the optic nerve head, layer-by-layer staining with MembraneBlueDual, removal of ERM, and then ILM. In all the groups a control of visual acuity was monitored, as well as intraocular pressure, the retinal thickness in the central zone, and the thickness of the retinal nerve fiber layer (RNFL) in different sectors. The OCT was used for a control the optic nerve head. The control of fusion of flickering frequency was made. The control of the optic nerve head was made using OCT and the control of fusion of flickering frequency (CFFF). Sensitivity of the macular zone of the retina was determined using the Maia microperimeter, and peripheral zones (Peripheral 60-4) were detected by means of the Humpfrey computer perimeter. The patients were examined before the surgery and 1, 3, 6 and 12 months after the sur gery. Results . The average duration of surgery was 8 minutes in the group without vitrectomy, 32 minutes in the group of subtotal vitrectomy and 18 minutes in the group of local vitrectomy. In the group of ERM removal without vitrectomy 6 patients out of 20 had a relapse of fibrosis found in follow-up period of 3 to 6 months. The groups showed a comparable improvement in visual acuity and photosensitivity of the central retina, as well as a decrease in the thickness of the r etina. In the group of subtotal vitrectomy, a significant IOP increase 1.6mmHg was recorded, as well as an increase in optic disc excavation, a more significant effect on the thickness of RNFL, indicators of the CFFF (drop from 38.4Hz to 34.3Hz), and a decrease in the light sensitivity of the retina periphery. In the local vitrectomy group, the IOP decreased significantly (from 16.5mmHg initially to 14.6mmHg). In addition, there was no decrease in the light sensitivity of the peripheral regions of the retina, and the changes in excavation of optic disc and RNFL were significantly smaller compared to the group of subtotal vitrectomy. Surgical cataract treatment was required in 47% of cases (14 patients) in the group of subtotal vitrectomy, and only 15% (5 patients) in the group of local vitrectomy. Patients of the first group did not require any cataract treatment. Conclusion . Subtotal vitrectomy with epiretinal membrane peeling is effective (30% increase in visual acuity), however, this intervention increases a risk of cataract development (47% of patients were operated on for cataract), negatively affects the optic nerve (CFFF decreased by 4Hz, increase of excavation of optic disk) and intraocular pressure (a 2mmHg persistent IOP increase 12 months later), and also, probably, reduces the sensitivity of the peripheral zone of the retina (-17dB in the upper-temporal quadrant). An alternative method of treatment is a removal of the membrane without vitrectomy. It allows to avoids the above-mentioned complications, but this method is associated with a high relapse rate (6 out of 20 patients had a relapse with a preservation complaints), due to the complexity of implementation and it significantly lim its the use of this method. Local vitrectomy demonstrated the most optimal balance between efficacy, safety, risk of recurrence and difficulty of implementation (no elevation of IOP, less pronounced negative impact on the optic disc and RNFL, no relapse, a low percentage of cataract development – 15%).

Age-related cataract is a major medical and social issue as it is the main cause of reversible blindness in the world. Age-related cataract is frequently accompanied by pseudoexfoliation syndrome (PXFS) - a systemic dystrophic process, clinically manifested in the eyeball. Dystrophic changes in XFS bring about a 5-fold increase of the risk of cataract surgery complications, amounting to 49.4 % of cases. Purpose: to study the clinical characteristics of ocular PXFS manifestations in age-related cataract among residents of the South of Russia. Material and methods. A total of 179 patients (277 eyes) with age-related cataract were tested. Of these, 75 patients (41.9 %, 114 eyes) were found to have PXFS while the remaining 104 patients (58.1 %, 163 eyes) had no PXFS. Testing included visometry, autokeratorefractometry, ophthalmic biomicroscopy, pneumotonometry, perimetry, ophthalmoscopy, ultrasound biometry, determination of electrical sensitivity threshold of the optic nerve, and critical flicker frequency. Results. It was found that age-related cataract patients with PXFS were significantly older than those without PXFS. The former showed a lower initial visual acuity and pronounced trophic changes in the anterior segment of the eye. PXFS patients developed iridodonesis 13 times as often as those without PXFS, while lens subluxation occurred 8 times as often. In more than one third of the cases, PXFS patients had dense or very dense lens nucleus. Conclusion. Age-related cataract of South Russia residents having pseudoexfoliation syndrome was found to be more severe and complication-prone than that of patients without PXFS. For citation: Polapina A.A., Komarovskikh E.N., Sakhnov S.N., Zabolotny A.G. Age-related cataract and pseudoexfoliation syndrome among residents of the south of Russia. Russian ophthalmological journal. 2018; 11(3): 19-24 (In Russian). doi: 10.21516/2072-0076-2018-11-3-19-24.

Purpose: to evaluate the effectiveness of surgical treatment of acute retinal necrosis. Material and methods. The study involves 34 patients aged 18 to 74 with acute retinal necrosis. Surgeries were performed on 41 eyes. All patients received microinvasive (23 Ga) vitrectomy with membrane peeling, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. Operated eyes were divided into 3 groups. Group 1 included 25 eyes which had retinal detachment and vitreous fibrosis at the time of surgical treatment. Group 2 consisted of 9 eyes with retinal detachment but no vitreous fibrosis, and group 3 of 7 eyes with vitreous fibrosis and no retinal detachment. Prior to surgery, visual acuity varied from wrong light perception up to 0.15 with correction. Results. A stable anatomical and optical result was achieved in all cases, complete attachment of the detached retina amounted to 94.1 %, and partial attachment to 5.9 % of the eyes. In group 1, improved visual acuity was observed in 56 % of cases, whereby visual acuity of 0.1 or higher was obtained only in 24 % of the eyes. In groups 2 and 3, visual acuity improved in all cases and proved to be 0.1 or higher, which was due to the predominance of the peripheral necrotic lesion zone, as well as to lower frequency of macular edema and optical neuropathy. In retinal detachment with vitreous fibrosis, a high frequency (72 %) of necrosis spread to the posterior pole of the eye with irreversible damage to the macula and optic nerve was detected. Conclusion. Modern technologies of surgical treatment allow achieving good anatomical results in all patients with acute retinal necrosis. The highest functional results are achieved with peripheral or paracentral lesions, absence of macular edema and optical neuropathy, and macula affected by retinal detachment prior to surgery, which was observed in groups with isolated vitreous fibrosis or retinal detachment. For citation: Neroev V.V., Ilyukhin P.A., Fedotov R.A., Tankovsky V.E. Results of surgical treatment of acute retinal necrosis. Russian ophthalmological journal. 2018; 11 (1): 5-11. doi: 10.21516/2072-0076-2018-11-1-5-11 (In Russian).

Choroidal melanoma is a primary malignant intraocular tumor with unfavorable vital prognosis. Factors predisposing to invasion of choroidal melanoma into the optic nerve include its juxtapapillary localization, the large tumor size, its diffuse growth, the presence of necrosis in the tumor, increased intraocular pressure and the epithelioid cell type of the tumor. The authors describe the clinical case of a 31-year-old patient with a primary diagnosis of an optic nerve neoplasm. Peripapillary edema and indistinct optic disc margins were found by ophthalmoscopy. There was a slightly protruding gray-slate lesion with indistinct boundaries near the optic nerve disc. The retina was edematous with multiple merging hemorrhages. The data obtained by echography (the focus protruding both inside the eye and along the optic nerve trunk), color Doppler mapping (single own vessels in the projection of the orbital part of the mass) and computed tomography allowed for the suspicion of the primary choroidal melanoma. To clarify the nature of the process, a trans-conjunctival orbitotomy with a revision of the orbit and the optic nerve was performed. The expansion of the proximal part of the optic nerve with partial breakthrough of the optic nerve shells was revealed intraoperatively. The patient underwent enucleation with morphological and molecular genetic verification of the primary choroidal melanoma with invasion of the optic nerve. The data obtained (absence of chromosome 3 monosomy, deletion of the short arm of chromosome 1, methylation of promoter regions of the RASSF1A gene, mutations in the 4 and 5 exons of the GNAQ gene, CT genotype of the polymorphic marker C3435T of the ABCB1 gene) indicate a relatively favorable vital prognosis, despite the extrascleral growth of the tumor and its mixed cell type. The patient underwent a course of anti-relapse proton irradiation of the orbit with a total dose of 58.8 Gy at 80–90% isodose. Currently, 7 years after the treatment, the patient continues to be followed up by ophthalmologists and oncologists, without any signs of local recurrence and distant metastases. This clinical example demonstrates the possibility of extraocular extension of a small intraocular choroidal melanoma simulating an optic nerve tumor, and confirms the need for a thorough clinical and instrumental examination for a correct diagnosis and adequate management of the patient.

The first histological and clinical description of the optic nerve drusens was given in the 19th century. Then authors considered drusens as congenital pathologies, and a study of 1999 showed that drusen is not the primary pathology, but the dysplasia of the optic nerve disk and its circulation predisposes to the formation of drusen. Central vision in patients with drusens of the optic nerve disc is reduced rarely, and their diagnosis is reduced to ascertaining of the fact of having drusen without taking into account the structural and functional changes in the visual system.Purpose of the work: to identify the pattern of changes in visual functions in children and adolescents with druses of the optic nerve disk, the development and addition of classification criteria.Patients and methods. 45 children with drusens were examined, a comprehensive analysis of the visual system included a standard ophthalmological examination, a comprehensive study of visual system with ultrasound scanning, OCT and OCTA, standard automated and pulsarperimetry.Based on the results of the cluster analysis, a graph of the distribution of patients into three groups (control group and two clinical groups) was constructed, and the structural and functional state of the visual system was analyzed. Drusens in children in the second group we marked as “peripheral”, and in the third — “central”. The carried out researches have shown, that the revealed disturbances are more expressed in the third clinical group. All this determines the need to complement the clinical classification of drusens and their separation depending on the location relative to the vessels of the optic nerve disk to the central and peripheral. The compression effect of drusen is accompanied with changes in the volume of the optic nerve disc, a violation of retinal hemodynamics, damage to the neuroglia and ganglion cells, which allows treating this pathology as a progressive neuroopticopathy, and the revealed dependence of changes on the localization of druses requires supplementing the existing classification.

Relevance. The ability of antiglaucoma drugs to improve ocular hemoperfusion is an important aspect of their action. Tafluprost is the first prostaglandin analogue (PA) containing no preservatives. The efficacy and safety of tafluprost, as well as tafluprost/timolol fixed combination (FC), was demonstrated in randomized multicenter trials. However, there is no literature on the effect of tafluprost and it’s FC on peripapillary and macular blood flow.Purpose. to assess the effect of tafluprost and tafloprost/timolol on the microcirculation in the optic nerve head, peripapillary area and macula in patients with primary open-angle glaucoma (POAG) according to OCT angiography (OCT-A).Patients and methods. OCT-A was performed in dynamics with an interval of a week in 36 patients (36 eyes) with a newly diagnosed initial stage of POAG, 12 received tafluprost, 12 — tafluprost/timolol FCs, 12 eyes represented control group (no drugs were prescribed). The change in IOP, mean perfusion pressure (PP) of the eye, and vessel density (VD) inside the optic nerve head (ONH) (inside disc), as well as in the peripapillary retina and macula were evaluated by comparing paired repeated observations using the median growth analysis.Results. In the tafluprost group there was a decrease in IOP by 19.4 % and an increase in PP by 8.7 % from the reference level. In the tafluprost/timolol group, these figures were 43 % and 30.1 %, respectively. OCT-A values did not change reliably, except for VD inside Disc: in the tafluprost group, the median growth was –2.28 (p = 0.02), for the tafluprost/ timolol group — –1.82 (p = 0.03). These changes were obtained in 11 patients of 12 in each group under treatment. In patients who did not receive treatment, all indicators remained unchanged.Conclusions. The results of this study showed a decrease in the density of the microcirculatory bed in the ONH in patients with initial glaucoma against the background of the tafluprost and tafluprost/timolol treatment, which can be explained by the restoration of autoregulation of the ocular blood flow in conditions of pronounced hypotensive drugs effect.

Purpose. To study the efficiency of a combined method for laser treatment – the laser iridectomy in combination with the selective laser trabeculoplasty (LIE+SLTP) – in patients with primary narrow-angle (mixed) glaucoma. Material and methods . The study included 72 patients (72 eyes) with initial stage of primary narrow-angle (mixed) glaucoma. The average age of the patients was 65.1±6.56 years: 27 males, 43 females. The followup period was up to 4 years after laser treatment. The level of intraocular pressure (Р 0 ) before the treatment was on average 24.47±1.85mmHg. The mean quantity of antihypertensive drugs used by the patients before the laser operation was 2.2±0.4. Stages of the combined treatment: laser iridectomy and selective laser trabeculoplasty were performed immediately one after the other in all patients. Results. All laser interventions were carried out without complications.An extension of the anterior chamber angle (ACA) was achieved in all patients, which was confirmed by data of gonioscopy and anterior optical coherence tomography (OCT). On the 1st day after the combined laser treatment, the reactive elevation of IOP was observed in 9.7% of cases and was stopped by an additional antihypertensive therapy within 1-2 days. Other complications such as inflammatory, hemorrhagic were not detected. A week after laser treatment there was a significant decrease (p

Purpose. To study hemodynamic of optic nerve (ON) in process of complex pathogenetic direct treatment in patients with anterior ischemic optic neuropathy (AION). Patients and methods. 43 patients with acute phase AION were exanimated and treated. Besides the functional results (visual acuity, visual field), the diagnosis AION was based on indicators of ophthalmologic and angiographic researches of ON. Patients were divided into two groups. 23 patients were in the main group. They received neurometabolic medicinal preparations (MP) through a silicone retrobulbar catheter. The control group consisted of 20 patients who had the traditional method of medicines injection. Indexes of hemodynamic were estimated according to Doppler ultrasound of local blood flow at the short posterior ciliary arteries (SPCA). At the same time following indexes were estimated: Peak Systolic Velocity (PSV, cm/sec), End Diastolic Velocity (EDV, cm/sec), Average Blood Velocity (ABV, cm/sec), Index of peripheral vascular resistance (R1, M ± m). Results. After the end of hospitalization of patients with AION, more favorable shifts in indexes of hemodynamic in SPCA were reached in patients of main group of research that authentically exceeded the similar data obtained at patients in the control group. Improvement of blood flow of ON was followed by positive changes of thickness of the retinal nerve fiber layer and condition of disk ON. To the final stage of researches (12 months from beginning of treatment) according to degrees of functional disorders severity in the main group of patients prevailed I (14 patients, 60%), less often II degrees (9 patients, 40%) of optic nerve atrophy and absented patients with III degrees of defeat of ON. Among patients of control group II–III degree optic nerve atrophy (12 patients, 60%) met more often, less often I degrees (8 patients, 40%). Conclusion. The conducted research showed that at patients with AION receiving sub-Tenon's infusions of MP more significant favorable functional results were reached thanks to increase of indicators of blood flow in SPCA: PSV — on 24.5%, EDV — on 16.2%, ABV — on 32.2% that significantly exceeds similar data at patients in control group with traditional methods of MP injections.