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The aim of the study was to evaluate the effectiveness of the preparations Optinol® Express Moisture (0.21 %) and Optinol® Deep Moisture (0.4 %) in the treatment of children with dry eye syndrome (DES) and to determine the indications for prescribing these drugs for various etiologies and clinical course of the disease.Patients and methods. The study involved 56 children aged 4–17 years with DES, which were divided into 3 groups, depending on its pathogenetic type. The first consisted of 24 children with DES, which developed on the basis of chronic blepharitis, the second — 12 children with neuroparalytic keratitis, and the third — 18 children with chronic uveitis, in whom DES was caused by prolonged instillations of eye drops with benzalkonium chloride. Each group was divided into 2 more equal subgroups, the first of which was prescribed the drug Optinol® Express Moisture, and the second — Optinol® Deep Moisture with a frequency of 4 times a day.Results. In all children, from the very first days of instillation of the studied drugs, a decrease in the severity of subjective signs of DES (OSDI) was noted, as well as a gradual decrease in the degree of xerotic changes in the ocular surface (severity of its staining with vital dyes) and an increase in the stability of the tear film (M.Norn). At the same time, the positive dynamics of the controlled parameters increased with the continuation of therapy, reaching a maximum by the 30th day of treatment. Moreover, the effectiveness of therapy depended on the severity of xerosis of the ocular surface: it was maximal in children with mild, and minimal in children with an extremely severe form of xerosis (with neuroparalytic keratitis). Moreover, the drug Optinol® Express Moisture was more effective in the treatment of children with mild and extremely severe forms of DES, and Optinol® Deep Moisture — with moderate and severe xerosis.Conclusion. The preparations Optinol® Express Moisture and Optinol® Deep Moisturization are effective in the treatment of children with DES, which has developed on the basis of pathology of the ocular surface of neurotrophic and artifact genesis, as well as increased volatility of the precorneal tear film against the background of chronic blepharitis.

The purpose: to evaluate the effectiveness of the Delfanto® in the complex therapy of patients with dry eye syndrome of various etiologies and severity of the clinical course.Patients and methods. 114 patients (228 eyes) with dry eye syndrome of various etiologies were examined: 72 patients with chronic meibomian blepharitis and dysfunction of the meibomian glands (xerosis due to increased evaporation of the tear film), 33 women with perimenopause (a mixed form of xerosis with a predominant decrease in the production of components of the tear film) and 9 persons with Syegren syndrome (xerosis due to a pronounced decrease in tear production). All patients received individually selected tear replacement therapy over the past weeks and the drug was not replaced throughout the study. At the same time, patients with mild and moderate clinical course of SSG for 30 days received Delfanto® at a dosage of 60 mg, and with severe course — 120 mg per day.Results. All patients on the background of complex therapy showed a significant decrease in the severity of subjective manifestations of the dry eye syndrome, an increase in the of the tear film stability and indicators of tear production. At the same time, the dynamics of changes in these parameters of the course of the xerotic process increased as the therapy continued, reaching a maximum by the 30th day. The maximum effect of Delfanto® in the complex therapy of patients with dry eye syndrome was observed in patients with chronic meibomian blepharitis. Moreover, patients with a mild clinical course of cornealconjunctival xerosis were the most susceptible to the therapy.Conclusion. The effectiveness of the complex therapy for patients with dry eye syndrome can be significantly increased by prescribing Delfanto® in a daily dose of 60 mg for mild and moderate xerosis and 120 mg — for severe disease. Delfante® can be recommended for widespread clinical use in complex treatment of patients with various clinical and pathogenetic forms of dry eye syndrome.

The artificial tears on the basis hyaluronic acid is primary importance today in dry eye syndrome (DES) treatment. In recent years, they have been supplemented Optinol® Express Moisture (0.21 %) and Optinol® Deep Moisture (0.4 %) differing concentrations of sodium hyaluronate and viscosity. The study is devoted to assessing the effectiveness of these drugs in the treatment of patients with dry eye syndrome (DES) of various etiology and severities.There were 73 volunteers with DES of various etiology: 21 — Sjogren’s syndrome, 24 — meibomian blepharitis, and 28 — perimenopause in the study. All patients were divided into 2 groups: 36 patients of the first group received instillations into conjunctival cavity of the Optinol® Express Moisture (0.21 %) and 37 patients of the second group — Optinol® Deep moistening (0.4 %).Starting from the first days of therapy, all patients had a decrease in the severity of subjective signs of DES, estimated by the value of the ocular surface disease index (OSDI). At the same time, tendency to stop of the degenerative changes in the epithelium of the ocular surface was established. It is characterized by a decrease in the degree of staining. The increasement of the tear film stability and an index of the tear meniscus was found in all patients. The dynamics of the controlled parameters increased, as the instillation of the drugs took place and by the 30th day of therapy. There were significant differences from the baseline values. At the same time, the Optinol® Express Moisture (0.21 %) was more effective (mainly in terms of subjective discomfort and the severity of degenerative changes in the epithelium of the ocular surface) in patients with mild and extremely severe form of the xerosis process.The drug Optinol® Deep Moisture (0.4 %) was more effective in patients with xerosis of moderate severity and severe by the same parameters. In the course of research, we have not observed any side effects of both drugs. It allows us to recommend the drugs Optinol® Express Moisture (0.21 %) and Optinol® Deep Moisture (0.4 %) to widespread clinical use in treating patients with DES of various etiology.

The problems of resistance to modern antibiotics and fluoroquinolones naturally stimulate interest in the development of eye dosage forms based on antiseptics. Today, their list has successfully supplemented the domestic drug Okomistin eye, ear, nasal drops (0.01 % — benzyldimethyl-myristoylamino-propylammonium), the manufacturer of Infamed-K. Numerous clinical studies performed, however, on adult patients, indicate a high therapeutic efficacy of the drug Okomistin®. However, with respect to children, the efficacy of Okomistin® remains unclear, although the drug has been approved for use by children from birth today.Objective. To evaluate the effectiveness of the Okomistin® in the treatment of children with bilateral bacterial conjunctivitis.Patients and Methods. Material research consisted of 30 children aged 3–16 years with bilateral acute bacterial conjunctivitis. 15 of them (26 eyes) received six-time instillations of the Okomistin® and 15 (24) — 0.05 % — Рicloxidin. All were subjected to traditional clinical examination and examination of the microflora of the conjunctival cavity with the determination of its sensitivity to antibiotics using the disk method.Results. In the spectrum of microflora found in the examined children, Staphylococcus Аureus dominated (14 eyes (53.8 %) — in the group of patients receiving Okomistin® and 13 (54.2 %) — Picloxidin), and Еpidermal Staphylococcus — 12 (46, 2 %) and 12 (50.0 %), respectively. Against the background of six-fold instillations of the compared drugs, a pronounced positive dynamics was established in relation to the relief of objective and subjective clinical symptoms of bacterial conjunctivitis already in the first week of treatment. At the same time, on the 7th day of therapy, in both groups of children, a significant decrease in the frequency of detection of microflora in the conjunctival cavity was noted, and on the 10th day, all the examined people underwent the contents of the conjunctival cavity to be sterile.Conclusion. The clinical efficacy of the Okomistin®, in combination with the absence of side effects of the drug and the affordable cost, allows recommending it for widespread practical use in pediatric and adult ophthalmology in the treatment of eye diseases of a bacterial nature. It seems promising to study the effectiveness of the drug in order to reorganize the conjunctival cavity in infants with dacryocystitis.

Purpose. The objective of the present study was to obtain and investigate the tissue samples taken from the anterior chamber angle of the children of different gestational age under the normal conditions and in the presence of congenital glaucoma; the secondary objective was to carry out the histological study of the pieces of tissues removed from the glaucoma patients of different gestational age undergoing hypotensive filtration surgery (sinusotrabeculectomy). Materials and methods. The anterior chamber angle histological preparations from a total of five enucleated eyes were available for the intravital investigation of the trabecular meshwork (two of them were obtained from the full-term infants and one from a premature baby). Results. The histological study of the structures of the anterior chamber angle of the enucleated eyes has demonstrated the presence in all the cases of cornea, Descemet’s membrane, trabecular meshwork, Schlemm’s canal, and iris. The morphological structure of the anterior chamber angle associated with congenital glaucoma shows up some peculiar features compared with the normal one, such as its block by the permanent fibrous membrane which penetrates deep into the trabecular meshwork that, in its turn, is formed from the rough and thickened tissue. The histological picture of the fetal eye at different gestational age exhibits the open anterior chamber angle, the well developed porous trabecular meshwork, and fragmentation of Descemet’s membrane near the trabecular meshwork. No signs of fibrous degeneration of the trabecule have been apparent. Conclusion. The intravital investigation of the trabecular meshwork has demonstrated some peculiar features that differ depending on the gestational age in birth. In the full-term babies, it is hypoplastic and covered with the rough fibrous membrane at certain places. Its histological picture is similar to that of the preparations of the enucleated eyes. In the premature babies, the trabecular meshwork is fibrous and characterized by enhanced cellularity; it undergoes fibrous degeneration that becomes apparent after the birth of the premature child (it is supposed to be related to the proliferative processes inherent in such babies).

Introduction. Retinopathy of prematurity remains one of the most challenging problems in neonatal ophthalmology and the leading cause of blindness and disability in the young children. Purpose. The objective of the present study was to evaluate the prevalence of retinopathy of prematurity and the effectiveness of its treatment under the present conditions of nursing the preterm infants. Materials and methods. We carried out the ophthalmological observations and treatment of 393 premature children admitted to the Perinatal Centre of the Saint Petersburg State Pediatric Medical University during the period from 2014 to 2016 for the provision of the specialized care needed to manage various obstetric and perinatal pathological conditions. The patients included the children born with a body weight from 450 to 2500 g (average weight of 1056 ± 301,9 g) at the 23d to 33d weeks of gestation (mean age at birth 28,77 ± 2,37 weeks). Results. The frequency of retinopathy of prematurity and dynamics of its clinical course as well as the need for its laser and surgical treatment in such patients differed during these three years. The number of children with retinopathy of prematurity in the group with the extremely low birth weight increased from 75.0% in 2014 to 96.3% in 2016 largely due to the rise in the occurrence of the early stages of the disease among the preterm infants in combination with severe concomitant cardiosurgical and neurosurgical pathologies. 77.8% of the children in this group needed to be treated with the use of preventive retinal laser photocoagulation. However, only every third infant born at the 28-33d week of gestation actually received the required surgical treatment. The effectiveness of retinal laser photocoagulation increased from 85% in 2014 to 95% in 2016. Conclusion. The management of the preterm children presenting with retinopathy of prematurity based at the perinatal centre with the integrated maternity hospital and the multidisciplinary children’s hospital creates the optimal conditions for the comprehensive treatment of such patients

Obturation of the lacrimal duct is a new method being developed in parallel to drug therapy for the treatment of patients with dry eye syndrome (DES). However, the abundance of methods of obturation and the lack of experience with them indicates the necessity of their comparative evaluation and development of a therapeutic algorithm.To compare the effectiveness of various ways of obturating the lacrimal duct, to determine their choice and the sequence of their application in the treatment of patients with DES.The study included 85 patients with DES: 23 - on the basis of disturbed tear production, with denervation and after extirpation of the lacrimal gland; 62 - due to the combination of disturbed tear production and increased tear film evaporation: with Sjogren syndrome, Graft-versus-host reaction, and scarring pemphigoid. All patients were examined using methods of functional evaluation of the ocular surface.The effect of artificial tear after 1 month of instillations was sufficient in 31 patients. The remaining 54 patients underwent lacrimal duct obturation: at first - temporary (with catgut thread), and after it proved effective (48 patients) - permanent: Punctal plugs® (FCI), conjunctiva coating, diathermocoagulation, and canals ligation (when previous methods were ineffective). The intervention was accompanied by a decrease in the severity of DES symptoms, increased stability of the tear film and high tear meniscus index values. However, none of the methods used was absolutely reliable: recanalization of the tear ducts was noted in 28.2% after their closure by Punctal plugs, in 25-60% after conjunctival coverage, and in 51.7% after diathermocoagulation.The least traumatic way of lacrimal duct obturation is the Punctal plugs. The most reliable, but also the most traumatic is canals ligation, which was effective in re-obturation. Covering lacrimal papillae with conjunctiva occupies an intermediate position in terms of traumatism and effectiveness. During the surgery, it is reasonable to consider blocking both canals, and not just obturating the lower one.В лечении больных с синдромом сухого глаза (ССГ), наряду с медикаментозной терапией, развитие получает обтурация слезоотводящих путей. Однако обилие способов обтурации и малый опыт использования требуют их сравнительной оценки и разработки лечебного алгоритма. Цель - сравнить эффективность различных способов обтурации слезоотводящих путей, определить их выбор и последовательность применения в лечении больных с ССГ. Материал и методы. Обследовано 85 больных с ССГ. Из них 23 человека на почве нарушения слезопродукции - с денервацией и после экстирпации слезной железы, 62 - вследствие комбинированного нарушения слезопродукции и повышения испаряемости слезной пленки - с синдромом Съегрена, реакцией 'трансплантат против хозяина' и рубцующим пемфигоидом. Все обследованы с использованием методов функциональной оценки глазной поверхности. Результаты. Через 1 мес инстилляций слезозаменителей их эффект оказался достаточным у 31 больного. Оставшимся 54 больным выполнена обтурация слезных точек: сначала - временная (отрезками кетгутовой нити), а при ее эффективности (48 больным) - постоянная: пробочками-окклюдерами Punctal plugs (FCI), покрытием конъюнктивой, диатермокоагуляцией и перевязкой канальцев (при неэффективности предшествующих методов). Вмешательство сопровождалось уменьшением выраженности симптомов ССГ, повышением стабильности слезной пленки и высокими показателями индекса слезного мениска. Однако ни один из использованных методов не оказался абсолютно надежным: реканализация слезоотводящих путей отмечена в 28,2% случаев после их закрытия окклюдерами, в 25-60% наблюдений после покрытия конъюнктивой, в 51,7% - после диатермокоагуляции. Заключение. Наименее травматичным способом обтурации слезоотводящих путей является закрытие слезных точек окклюдерами. Наиболее надежным, однако самым травматичным - перевязка канальцев, эффективная при повторной обтурации. Покрытие слезных сосочков конъюнктивой занимает промежуточное положение по травматичности и эффективности. В ходе вмешательства целесообразно блокировать оба канальца, не ограничиваясь обтурацией только нижнего.

In current understanding of the pathogenesis of xerotic changes of the ocular surface in patients with dry eye syndrome (DES), great importance is given to hyperosmolarity of the tear film, inflammatory process and oxidative stress. By now, no convincing data has been obtained on whether the oxidative stress is primary in relation to the inflammatory process in the ocular surface tissues, or if it is a complication. Furthermore, in the complex treatment of patients with DES, antioxidant therapy has so far received little attention. This problem can be solved with the 'artificial tears' preparation containing cyanocobalamin (vitamin B12), which antioxidant, anti-inflammatory and clinical effectiveness has been convincingly proved in a number of experimental and clinical studies of recent years. Improving the methods of vital diagnostics of xerosis of the ocular surface also enables detection of subclinical changes in epithelium of the cornea and conjunctiva, thus allowing timely prescription of metabolic therapy. One of the promising directions of such treatment is the use of 5% dexpanthenol, which stimulates the processes of reparative regeneration and possesses an anti-inflammatory effect.В патогенезе ксеротических изменений глазной поверхности у больных с синдромом 'сухого глаза' (ССГ) сегодня все большее значение придают гиперосмолярности слезной пленки, воспалительному процессу и оксидативному стрессу. Пока не получено убедительных данных о том, является ли оксидативный стресс первичным по отношению к воспалительному процессу в тканях глазной поверхности или же служит его осложнением. Вместе с тем в комплексном лечении больных с ССГ антиоксидантной терапии пока уделяется недостаточно внимания. Данную проблему возможно решить с помощью препарата 'искусственной слезы', содержащего цианокобаламин (витамин В12), антиоксидантный, противовоспалительный и клинический эффект которого убедительно доказан в ряде экспериментальных и клинических исследований последних лет. Совершенствование методов витальной диагностики ксероза глазной поверхности позволяет также выявлять субклинические изменения эпителия роговицы и конъюнктивы и, соответственно, своевременно назначать метаболическую терапию, одним из перспективных направлений которой служит применение 5% декспантенола, стимулирующего процессы репаративной регенерации и оказывающего противовоспалительный эффект.

To study possibilities of using the medication Ophthalmoferon in the treatment of children with chronic allergic and Demodex blepharoconjunctivitis.We examined 40 children (80 eyes) aged 3 to 17 years with chronic allergic (group I) and Demodex (group II) blepharoconjunctivitis. Each group was divided into two subgroups ('A' and 'B') respectively based on the treatment regimen used. Subgroup 'A' patients received Ophtalmoferon instillations (four times per day for four weeks) in addition to the standard therapy, whereas subgroup 'B' patients got only basic treatment of blepharoconjunctivitis. The latter included eyelids' ciliary edge massage, eyelids' free edge hygienic treatment, artificial tears instillations and oral intake of the medications, like enterosorbents, probiotics, enzymes and anti-allergic remedies. We evaluated the dynamics of subjective and objective blepharoconjunctivitis signs at 1,2,4 and 6 follow-up weeks. The dynamics of eosinophils content in cytograms as well as the dynamics of acarograms were also assessed.From the first treatment week in all patients, regardless of the treatment regimen used, we noted a statistically significant positive change in all subjective and the majority of objective blepharoconjunctivitis clinical manifestations, such as eyelids' edge and conjunctiva hyperemia and eyelid swelling. In patients with allergic and Demodex blepharoconjunctivitis, who received the medication Ophtalmoferon, a significantly more positive result was observed after the first treatment week, by comparing with the control group (p0,01). The significant difference in the parameters of both comparison subgroups persisted for two weeks. There was a significant difference in the acarogram values, when Ophtalmoferon was used. A further decrease in the cellular infiltration of the conjunctiva by eosinophils was revealed in patients, who additionally used Ophthalmoferon, but without significant differences in parameters. There were no adverse effects in all cases, when the given medication was used.Our study results allow us to recommend the medication Ophtalmoferon for a wide clinical use in children with chronic allergic and Demodex blepharoconjunctivitis.Цель - изучить возможности использования препарата 'Офтальмоферон' в лечении хронического аллергического и демодекозного блефароконъюнктивита у детей. Материал и методы. Обследованы 40 детей (80 глаз) в возрасте от 3 до 17 лет с хроническим аллергическим (1-я группа) и демодекозным (2-я группа) блефароконъюнктивитом. Каждая группа в зависимости от использованной схемы лечения включала 2 подгруппы (А и Б). Пациенты подгруппы А на фоне базовой терапии получали инстилляции Офтальмоферона (4 раза в день на протяжении 4 нед), а подгруппы Б - только базовую схему лечения блефароконъюнктивита. Последняя включала массаж ресничного края век, гигиеническую обработку свободных краев век, инстилляции препаратов искусственной слезы и пероральный прием комплекса препаратов (энтеросорбентов, пробиотиков, ферментов, противоаллергических средств). Оценивали динамику субъективных и объективных признаков блефароконъюнктивита у школьников на 1, 2, 4 и 6-й неделях наблюдения, динамику содержания эозинофилов в цитограммах, а также динамику акарограмм. Результаты. У всех больных независимо от использованной схемы лечения уже с 1-й недели терапии наблюдалась положительная динамика всех субъективных и большинства объективных (гиперемия краев век и конъюнктивы, пастозность век) клинических проявлений блефароконъюнктивита, статистически значимая в сравнении с исходными показателями. При этом у больных и с аллергическим, и с демодекозным блефароконъюнктивитом, получавших Офтальмоферон, был отмечен достоверно более выраженный позитивный результат после 1-й недели терапии в сравнении с показателями контрольной группы (p0,01). Достоверная разница в показателях обеих подгрупп сравнения сохранялась в течение 2 нед. Обнаружена существенная разница в значениях акарограмм на фоне использования Офтальмоферона. Выявлено дальнейшее снижение клеточной инфильтрации конъюнктивы эозинофилами у больных, использовавших дополнительно Офтальмоферон, однако без достоверной разницы в показателях. Ни в одном из наблюдений не было зафиксировано нежелательных эффектов на фоне использования исследуемого препарата. Заключение. Полученные данные позволяют рекомендовать препарат 'Офтальмоферон' к широкому клиническому применению у детей с хроническим аллергическим и демодекозным блефароконъюнктивитом.