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Purpose. To study the state of interface “intraocular lens (IOL) — posterior capsule (PC)” depending on diameter of capsulorhexis in phacoemulsification of senile cataract.Patients and methods. 227 patients (227 eyes) were examined after phacoemulsification of senile cataract at LenSx femtosecond laser (Alcon, USA). The study did not include patients with corneal opacities, signs of axial displacement of lens, with irido- and phacodonesis, glaucoma, axial length less than 22 mm and more than 26 mm. Depending on diameter of performed capsulorhexis, we formed 3 groups: 1st group — 76 eyes with diameter capsulorexis 5.5 mm; 2nd group — 73 eyes with 5.0 mm; 3rd group — 78 eyes with 4.5 mm. We studied type of interface “IOL — PC”, the maximum value of PC diastasis and the maximum depth of its folds using an RTVue-100 Optical Coherence Tomography (Optovue, USA) on the first day after the operation.Results. The maximum number of eyes with absence of contact between IOL and PC was noted in the 3rd group (62.8 %), the largest number of eyes with full contact between IOL and PC (63.2 %) was in the 1st group. The minimum average depth of the PC folds (111.1 ± 32.7 μm) was noted in the 1st group, and the maximum (165 ± 75.4 μm) — in the 2nd group.Conclusion. The analysis showed that type of interface “IOL — PC” in the first day after phacoemulsification of senile cataract depends on diameter of capsulorhexis. The largest number of eyes (64.6 %) with full contact between IOL and PC was observed in the group of patients with capsulorhexis 5.5 mm, and the smallest (6.4 %) — in eyes with diameter capsulorexis 4.5 mm. Presumably, the main reason for the absence or incomplete contact between IOL and PC is the presence of viscous dispersive between them. The deformation of PC in the form of folds does not directly depend on diameter of capsulorhexis and, obviously, is due to the uneven tension of the capsular bag by the IOL haptics.

Purpose. To assess increasing the functional effectiveness of the results of endovitreal surgery in patients with rhegmatogenous retinal detachment (RRD) by using modern pharmacotherapy drug in the postoperative rehabilitation. Materials and methods. 108 people (108 eyes) with RRD. All patients underwent standard three-port vitrectomy, after which tamponade of the vitreous cavity with silicone oil with its removal 3 months after operation was performed. Patients were divided into 2 groups: the first – 60 people who received Cytoflavin on the background of standard therapy, and the second – 48 people with postoperative treatment only with standard therapy. Depending on the visual prognosis calculated before the operation, both groups were represented patients with satisfactory (A subgroup) and low (B subgroup) visual prognosis. Laser Doppler fluometry (LDF) was used to study chorioretinal microcirculation: microcirculation index and microcirculation efficiency index were recorded. Using OCT angiography (OCT-A), signs of macular ischemia were investigated: choroidal thickness, area nonperfusion of foveal avascular zone, density in the superficial capillary plexuses and density in the deep capillary plexuses in the macular area. Results. The inclusion of Cytoflavin in the postoperative rehabilitation of patients with RRD increases the possibility of a favorable functional outcome of the operation, affects the positive dynamics in the state of the capillary plexus in the macula. In the aggregate of patients of the 1st group, the increase in visual acuity was 2 times higher than in patients of the 2nd group 6 months after surgery. Also, in patients of the 1st group there was a more significant activation of chorioretinal blood flow according to LDF and OCT-A. Conclusion. The prescription of Cytoflavin in the postoperative treatment of patients underwent endovitreal surgery of RRD, regardless of the visual prognosis, increases the functional outcome of the operation. Improvement in visual functions in patients receiving Cytoflavin therapy is directly related to improved intraocular blood flow and macular perfusion. Keywords: rhegmatogenous retinal detachment, chorioretinal microcirculation, ocular hemodynamics, Laser Doppler fluometry, optical coherence tomography angiography, Cytoflavin.

Purpose. Finding out the frequency and structures posterior vitreous detachment (PVD), the proportion of local vitreoretinal adhesion in topographical zones of large retinal vessels of posterior pole of the eye in patients of different age groups with axial myopia. Material and methods. Clinical material was 82 eyes (41 patients). The age of patients ranged from 18 to 70 years. According to the age category, which is determined by the WHO classification, all patients were divided into 3 groups. The 1st group (18-44 years old) included 12 people (24 eyes); the 2nd group (45–59 years old) included 14 people (28 eyes); the 3rd group (60–74 years old) included 15 people (30 eyes). Results. In the 1st group PVD was not detected in 11 eyes (45.8%); in 13 eyes there were various variants of PVD (54.2%). In the 2nd group PVD was not detected in 9 eyes (32.1%); in 19 eyes there were various variants of PVD (67.9%). In the 3rd group PVD was not detected in 5 eyes (16.7%); in 25 eyes (83.3%) there were various variants of PVD. In this group, there was statistically significant predominance of partial PVD with fixation of the posterior hyaloid membrane to inner limiting membrane (PHM to ILM). Conclusion. In the group of elderly patients with axial myopia (60– 75 years), statistically significant increase in incidence of local adhesion of PHM to ILM in the projection of large retinal vessels was revealed in comparison with young and middle-aged groups (10 cases versus 1 and 2, respectively, p

Purpose. To study the correlation between pregnancy, complicated by preeclampsia and gestational hypertension (GH), and formation of retinal vascular and optic nerve disorders in the late postpartum period.Patients and methods. 231 women with different previous pregnancy variants of pathology. Exclusion criteria — presence of systemic endocrine, autoimmune, rheumatic pathology before pregnancy; bad habits. Four groups were formed. 1st main group: pregnancy with GH. 2nd main group: pregnancy with preeclampsia. 1st comparison group: pregnancy on the background of pre-existing hypertension, without proteinuria. 2nd comparison group: edema and/or proteinuria during pregnancy, without hypertension. The control group — physiological process of pregnancy. Period of ophthalmological examination after pregnancy is 6–12 years.Results. Development of various vascular and ischemic disorders of posterior eye segment occurred in 70 women (30.3 %). The periods of their formation after previous pregnancy varied from 3 to 11 years. Their frequency in the 1st and 2nd main groups was statistically significantly higher. The most common were retinal vein occlusion and post-thrombotic retinopathy. The negative outcomes of transferred GH and preeclampsia are no eliminated with delivery and can manifest next years and even decades after it.Conclusion. Нigh risk factors for development of vascular and ischemic disorders of posterior eye segment are transferred preeclampsia, especially with its early onset (20–24 weeks), or premature birth (26–28 weeks); pregnancy, complicated by GH. The risk of developing this eye pathology is highest in women aged 38–40 years and over.

Purpose . Development and analysis of effectiveness of predictive clinical-mathematical system of development of dry eye syndrome (DES) after phacoemulsification (PE) of senile cataract (SC). Material and methods . 120 patients (120 eyes) after SC surgery: 52 men and 68 women. Age: from 62 to 83 years (average 69.3±6.4 years). The main selection criteria for study were the absence of objective and subjective signs of DES, the presence of initial or immature SC and optimal conditions for surgery – absence of corneal pathology and mydriasis of 6 mm or more. Standard preoperative examination; 3 months after PE – Schirmer 1 test, tear break-up time, OCT mapping (Avanti RTVue XR, Optovue, USA). The above indicators were selected as potential predictors for development of algorithms for predicting of development of DES after PE of SC. Patients were divided into groups: 1st group consisted of 31 patients (31 eyes) with DES developed after PE, 2nd group consisted of 89 patients (89 eyes) without signs of DES. Results . Based on peculiarities of induced damage to structures of ocular surface in treatment of SC, two algorithms were developed to predict DES after FE of SC, which shown high prognostic characteristics: sensitivity – 80–90% and specificity – 80–87%, allowing to consider them reasonable and informative. Conclusion . The analysis of the developed clinical and mathematical system for predicting the development of DES after PE of SC showed its high efficiency. Application of developed technique in ophthalmic practice is advisable to ensure maximum medical and social rehabilitation of patients with SC.

This review examines the evolution of views and opinions on issues related to the management of pregnancy and childbirth in women with high myopia. Special attention is given to the threat of retinal detachment and its prevention during pregnancy and delivery; the need for improving the diagnosis of retinal abnormalities is also addressed. Our analysis indicates that since the early 1980s, pregnancy associated peripheral vitreochorioretinal dystrophy was considered a leading risk factor for rhegmatogenous retinal detachment during childbirth. Here, we present data on the eye hemodynamics and intraocular pressure in women at the time of delivery. We also discuss current strategies of pregnancy management in women with peripheral vitreochorioretinal dystrophy. In addition, absolute and relative indications for natural delivery in women with high myopia are presented together with ophthalmological requirements for natural delivery.

Purpose. Revealing of the ocular risk factors in the formation of diabetic macular edema (ME) in type 2 diabetes mellitus (DM2).Patients and methods. A 3.5-year research of 80 patients (160 eyes) with DM2 without signs of ME at the beginning of the research was performed. The main group consisted of 46 patients with ME symptoms on one or both eyes during the research period, the comparison group included 34 patients without ME symptoms to the end of the research. The initial ocular characteristics were retrospect compared in groups.Results. The mean value of the axial lengths (AL) in the eyes of the main group was 23.12 ± 0.75 mm compared to 23.82 ± 0.62 mm in the comparison group (significant difference, p < 0.01). AL was less than 23.5 mm in 66 % of the eyes in the main group and only in 22 % of the eyes in the comparison group (p < 0.01). The mean value of the initial macular retina volume in the main group was significantly higher than in the comparison group — 7.51 ± 0.22 mm3 and 7.21 ± 0.12 mm3, respectively (p < 0.01). Initial background diabetic retinopathy (DR) was noted in 73 % of the eyes in the main group, which significantly differed from the comparison group, where this index was noted only in 13 % of the eyes (p < 0.01).Conclusion. Significant ocular risk factors for the formation of ME in patients with DM2 are: the initial macular retina volume more than 7.3 mm3, the value of the AL less than 23.5 mm; the initial background DR. The use of the detected morphometric parameters of eye and retina in combination with an adequate assessment of the risk factors in human organism makes it possible to assume with high degree of probability a high risk of the primary formation of diabetic ME in patients with DM2.

The purpose of study. To investigate efficiency of systematic monitoring of quality of treatment of patients in the ophthalmologic surgery clinic, its impact on minimization of number of cases of deviance from treatment standards. Materials and methods. The continuous statistic observation technique was applied to analyze outcomes of surgical operations and courses of treatment on one or both eyes simultaneously in 126,258 patients implemented in the Khabarovsk branch of the inter-branch scientific and technical complex «S.N. Fedorov Microsurgery of eye» during 2012-2016. The evaluation was applied to maintenance of treatment technology and functional result. The assessment of quality of maintenance of medical documentation was implemented during analysis of 108,143 medical patient records and record charts of patients completed treatment in the Branch during 2012-2016. The results were evaluated by 5 point scale. The assessment of satisfaction of patients by quality of medical care was implemented using anonymous questionnaire survey by evaluation scale. during analyzed period 2000 questionnaires were filled out. Results. During treatment, in the most of patients (99.1%) a maximal clinical result was achieved (10 or 12 points). The deviance from standard of clinical result of treatment was established in 0.9%. The monitoring of assessment of quality of treatment of patients with subsequent clinical analysis permitted to decrease rate of deviance from standard of clinical result of treatment during analyzed period up to 21.1%; rate of intra-operational complications - up to 63.6%. The results of systemic analysis of defects of maintenance of primary medical documentation permitted to decrease their number up to 1.5 times. The degree of satisfaction with quality of treatment according the sampled sociological questionnaire surveys of treated patients turned out high - 99.7%. Conclusion. The single system of assessment of quality of treatment of patients developed in the inter-branch scientific and technical complex «S.N. Fedorov Microsurgery of eye» permits to support a high level of treatment care provision and to detect on-the-fly defects of diagnostic examination and failures in technologies of treatment.

Purpose. Revealing of the intraocular risk factors in the diabetic macular edema (ME) formatis in diabetes mellitus type II (DM2). Patients and methods. A 3.5-year research of 80 patients (160 eyes) with DM2 without signs of ME at the beginning of the research was performed. The main group consisted of 46 patients with ME symptoms on one or both eyes during the research period, the comparison group included 34 patients without ME symptoms to the end of the research. The initial ocular characteristics were retrospectively compared in groups.Results. The mean value of the axial lengths (AL) in the eyes of the main group was 23.12 ± 0.75 mm compared to 23.82 ± 0.62 mm in the comparison group (significant difference, p < 0.01). AL was less than 23.5 mm in 66 % eyes in the main group and only in 22 % of the eyes in the comparison group (p < 0.01). The mean value of the initial macular retina volume in the main group was significantly higher than in the comparison group — 7.51 ± 0.22 mm3 and 7.21 ± 0.12 mm3, respectively (p < 0.01). Initial background diabetic retinopathy (DR) was noted in 73 % eyes in the main group, which significantly differed from the comparison group, where this index was noted only in 13 % of the eyes (p < 0.01).Conclusion. Significant ocular risk factors for the formation of ME in patients with DM2 are: the initial macular retina volume more than 7.3 mm3, the value of the AL less than 23.5 mm; the initial background DR. The use of the detected morphometric parameters of eye and retina in combination with an adequate assessment of the risk factors in human organism makes it possible to assume a high risk of the primary formation of diabetic ME in patients with DM2 with high degree of probability.

The textbook examines the most common diagnostic errors of ophthalmologists when making a clinical diagnosis of "cataract". Clinical examples point to a more critical view of the cataract diagnosis. Due to the fact that most of the errors are based on a superficial examination of the eye, clear recommendations are given for conducting a clinical ophthalmological examination of cataracts. At the same time, special attention is paid to the types of examination of the lens with the help of a slit lamp, to the peculiarities of performing various types of ophthalmoscopy with moderate opacity of optical media.

O.V. Kolenko1,2, E.L. Sorokin1,3, N.S. Khodzhaev4, N.V. Pomytkina1, G.V. Chizhova2, A.A. Fil1, Ya.E. Pashentsev1 1Khabarovsk branch of S.N.Fedorov NMRC “MNTK “Eye Microsurgery”, Khabarovsk, Russian Federation 2Postgraduate Institute for Public Health Professionals, Khabarovsk, Russian Federation 3Far Eastern State Medical University, Khabarovsk, Russian Federation 4S.N. Fedorov NMRC “MNTK “Eye Microsurgery”, Moscow, Russian Federation Background: in recent years, retinal vascular diseases occur more frequently, in particular, in younger individuals. Aim: to assess choroidal blood flow in pregnant women with preeclampsia and after birth. Materials and Methods: 42 pregnant women with preeclampsia aged 21–40 years were included in the study group. 30 women with normal pregnancy aged 19–38 years were included in comparison group 1. 27 women without pregnancy aged 35–57 years with vascular diseases of posterior eye segment were included in comparison group 2. Controls were 25 healthy age-matched (19–43 years) women without pregnancy. Linear blood flow velocity in short posterior ciliary arteries and prothrombin index were measured in all women. Results: reduced linear blood flow velocity in short posterior ciliary arteries in the third trimester of pregnancy was revealed in pregnant women with preeclampsia. However, in 6 to 8 months after birth these parameters have returned to normal values. In 12 women, these parameters were still low while prothrombin index was high. Retinal vein occlusions occurred in all these women after 6.5 to 8.5 years. Conclusion: our findings demonstrate that measurin g linear blood flow velocity in short posterior ciliary arteries and prothrombin index in pregnancy complicated with preeclampsia as well as within a year after birth may help to identify risk groups for vascular retinal diseases. Keywords: choroidal blood flow, short posterior ciliary arteries, pregnancy, preeclampsia, prothrombin index, vascular retinal diseases, retinal vein occlusion. For citation: Kolenko O.V., Sorokin E.L., Khodzhaev N.S. et al. Predictors of the development of retinal vascular diseases in women after preeclampsia. Russian Journal of Clinical Ophthalmology. 2019;19(4):189–194.

Purpose.Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP.

The article analyzes the organization and clinical efficacy of keratoplasty for visual purpose, conducted in the Khabarovsk branch of the FSAI NMRC ISTC «Eye Microsurgery named after academician S.N. Fedorov» of the Russian Federation. 111 patients (111 eyes) were operated on for: bullosa keratopathy 3-4 degrees - 55 eyes; stage 4 keratoconus - 37 eyes; posttraumatic cornea belmas of 3-4 categories - 14 eyes; hereditary corneal degeneration - 5 eyes. In 88 eyes, the technique of penetrating keratoplasty was applied, in 19 eyes - anterior deep layered keratoplasty, in 4 eyes - descemet membrane transplantation.

Монография посвящена изучению морфометрических критериев риска раз-вития тракционного макулярного отека после факоэмульсификации по поводу возрастной катаракты. Авторами изучены варианты витреомакулярной адгезии, показаны закономерности развития тракционного макулярного отека в зависимости от толщины хрусталика, длины передне-задней оси и формы глазного яблока. На основе выявленных статистически значимых критериев ими разработана прогностическая модель определения вероятности формирования тракционного макулярного отека после факоэмульсификации по поводу возрастной катаракты, показавшая высокую клиническую эффективность. Книга рассчитана на врачей-офтальмологов, офтальмохирургов, аспирантов, интернов и клинических ординаторов

Information about relationship between biochemical indexes of endothelial dysfunction in preeclampsia and morphometric parameters of macula is necessary for prediction of the risk of retinal vascular disorders.To study the relationship between biochemical indexes of blood serum, lacrimal fluid (LF) and the macular retinal volume (MRV) in pregnant women with preeclampsia.The study included 42 pregnant women aged 21 to 40 years with preeclampsia of different severity (the main group): 1st subgroup - mild degree (22 people); 2nd subgroup - average degree (12 people); 3rd subgroup - severe degree (8 people). The comparison group included 20 pregnant women aged 19 to 38 years experiencing physiologically natural pregnancy.By the 3rd trimester, in the 1st subgroup the index of MRV was between 6.4 and 9.5 mmA trend of increase of MRV by the 3rd trimester correlating with the degrees of preeclampsia severity was found. In the main group (r from 0.71 to 0.83), strong, direct, statistically significant association was found between the increase of ET levels in LF, vWF and MRV on the one side, and FRO on the other side.Сведения о взаимосвязи между биохимическими показателями эндотелиальной дисфункции при преэклампсии и морфометрическими параметрами макулы необходимы для прогнозирования риска ретинальных сосудистых расстройств. Цель - изучить взаимосвязь между биохимическими показателями сыворотки крови, слезной жидкости (СЖ) и объемом макулярной сетчатки (ОМС) у беременных женщин с преэклампсией. Материал и методы. Обследованы 42 беременные женщины от 21 года до 40 лет с преэклампсией разной степени тяжести (основная группа): 1-я подгруппа - легкая степень преэклампсии (22 человека); 2-я подгруппа - средняя степень (12 человек), 3-я подгруппа - тяжелая степень (8 человек). Группу сравнения составили 20 беременных женщин с физиологическим течением беременности. Результаты. К III триместру ОМС в 1-й подгруппе составил от 6,4 до 9,5 мм

Purpose. Analysis of the quality of a medical ophthalmic care (QMOC), provided to patients at the Branch from 2010 to 2014. Material and methods . Evaluation of the QMOC was carried out on continuous selection of inpatients and outpatients for the period 2010-2014. Two basic components of clinical outcomes were assessed: the technology of treatment and functional results. The total quantity of the studied patients was 115394 persons. The assessment of quality in maintaining medical documentation was performed in the analysis of 106347 medical anamnesis and files of the patients who finished treatment at the Branch during 2010-2014. The patients’ satisfaction with QMOC was checked by an anonymous questionnaire using the assessment scale. Results. The maximum clinical outcome (10 or 12 points) was achieved in the treatment process in the vast majority of patients (98.8%). The deviation from a standard of clinical result of treatment took place in 1.2% of cases. The review and analysis of the causes of deviations of the clinical outcome of treatment from the standard allowed significantly to reduce the quantity of complications within the postoperative follow-up period – 1.7 times. A systematic analysis of completeness of diagnostic examination, adequately chosen treatment allowed to reduce the number of complications in the postoperative period in 2 times. Analysis of all types of defects in maintaining primary medical documentation allowed to decrease them during 2010-2014 in 1.5 times. Despite the available defects, in general the QMOC was always highly evaluated by all categories of respondents and was fluctuated from 98.8% to 100%. Conclusion. The system of an assessment of clinical result of treatment of patients applied at the Branch and developed at the S. Fyodorov Eye Microsurgery Federal State Institution allows to reveal effectively defects of diagnostic examination and disturbance of technology in the treatment. Its use, according to the analysis for the period 2010-2014, allowed to reduce the frequency intra- and post-operative complications twice.