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Purpose: To evaluate the efficacy and safety of nonsteroid anti-inflammatory drugs (NSAIDs) in monotherapy and as part of combination therapy with glucocorticosteroids for the prevention of postoperative inflammation after cataract phacoemulsification.Material and methods. The study included 75 patients who underwent phacoemulsification with implantation of a posterior chamber intraocular lens. Patients were divided into groups depending on anti-inflammatory treatment: A1 — nepafenac (Nepafenac-Optic), A2 — bromfenac (Broxinac), A3 — dexamethasone (Dexamethasone), B1 — Nepafenac-Optic + dexamethasone, B2 — bromfenac + Dexamethasone. Postoperative inflammation was assessed by the severity of conjunctival hyperemia, pain, Tyndall effect and retinal thickness in the macular region.Results. The severity of the pain symptom was lower in the nepafenac group (A1) as compared to groups A2 and A3 by 49 and 74 %, respectively. A strong direct correlation with the Tyndall effect was revealed, which was more pronounced in group A3 and amounted to 0.73 points. An increase in the thickness of the retina in the macular region in the early stages after surgery was observed in groups A2 and A3, on average by 30 microns. In the groups of Nonpafenac Optic and combined therapy with GCS, the thickness of the retina remained stable. Cystic macular edema in the early postoperative period was observed in groups A2 and A3 and amounted to 2.6 and 1.3 %, respectively. There was a tendency to higher IOP rates in the GCS therapy groups.Conclusion. After surgical treatment of cataracts, the Nepafenac Optic significantly relieves the pain syndrome, as compared with monotherapy with bromfenac or dexamethasone. Nepafenac-Optic helps to reduce the severity of inflammation in the anterior and posterior segments of the eye, minimizes the changes in the retinal thickness of the macular region in the postoperative period. The severity of these effects is comparable to the combination therapy of NSAIDs + GCS. Nepafenac-Optic does not increase IOP, has a more favorable safety profile than in combinations with glucocorticosteroids, and reduces the risk of postoperative complications.

Blepharoptosis is an abnormally low position of the upper eyelid in relation to the eyeball due to its omission. The method of surgical treatment of blepharoptosis depends on the function of the levator.The aim. To analyze the results of surgical treatment of partial blepharoptosis of various etiology by the dosed muscle-conjunctival resection of the upper eyelid cartilage.Material and methods. We operated 78 patients (82 eyes) with blepharoptosis, among them with congenital blepharoptosis – 34 people (36 eyes), with acquired – 44 (46 eyes). The patients’ age was from 6 to 82 years.Inclusion criteria: the function of the upper eyelid levator – more than 5 mm, the width of the palpebral fissure – 3 mm or more.The patients underwent a dosed muscle-conjunctival resection of the upper eyelid cartilage in the period from 2018 to 2021. The follow-up period ranged from 2 months to 2 years.Results. Elimination of blepharoptosis was achieved in all patients. With congenital blepharoptosis, a good result was obtained in 33 people (91.7 %), satisfactory – in three patients (8.3 %), which was associated with the asymmetry of the palpebral fissure, for the correction of which these patients underwent additional intervention. In patients with acquired ptosis of the upper eyelid, a good result was achieved in 91.3 % of cases (42 eyes). One patient underwent repeated surgery due to hypocorrection and asymmetry of the palpebral fissure width after the first surgery.In all patients, the result remained stable throughout the observation period.Conclusion. The use of the method of dosed muscle-conjunctival resection of the upper eyelid cartilage in patients with partial ptosis of the upper eyelid and intact levator function made it possible to obtain a good cosmetic and functional result: with congenital blepharoptosis – in 91.7 % of cases, acquired ptosis of the upper eyelid – in 91.3 % patients.

In recent years, ophthalmologists have paid great attention to keratoconus, as the disease is socially significant and affects the young working-age population. According to the literature and in clinical practice, it was found that patients with keratoconus have similar character traits, which are manifested to a greater or lesser extent in each patient. According to a number of authors, these patients have less adaptability, passive aggression, and paranoia. In addition, there is a tendency to disorganization of thinking, substance abuse and anxiety. The article considers clinical cases of Association of keratoconus with mental disorders and diseases such as schizophrenia, obsessive-compulsive disorder, Tourette’s syndrome. Examples of the occurrence of the disease after mechanical damage to the eyeball are given. This paper also describes changes in the quality of life of patients with this pathology, identified using different questionnaire options. The use of 18 different, most frequently used questionnaires to determine the impact of keratoconus on the patient’s quality of life is considered: specialized for keratoconus, General for eye pathology, and General medical for assessing mental functions. Using a specialized questionnaire for keratoconus, changes in the quality of life were evaluated in the following categories: visual acuity assessment, problems with near or far vision, restrictions on social interaction due to low vision, restriction of physical activity, dependence on others due to eye problems, deterioration of mental health associated with changes in the visual organ, driving problems, restrictions on visual fields, color perception and eye pain. General ophthalmological questionnaires were also used, in particular, to assess dry eye syndrome, visual impairment, contact lens use and their impact on quality of life, etc. In patients with keratoconus, other questionnaires were also used, for example, to assess the indicator of the state anxiety scale, selfassessment of depression. This article discusses the advantages and disadvantages of the questionnaires, their applicability directly to patients with keratoconus.

Purpose. To evaluate the clinical and functional results of a combined intervention - one-stage cataract phacoemulsification and a newly developed version of partially fistulizing antiglaucoma surgery (PFS) of patients with primary open-angle glaucoma (POAG) as compared with those of phacoemulsification in combination with penetrating and non-penetrating antiglaucoma intervention.Material and methods. 61 patients (65 eyes) with a combination of incomplete complicated cataract and previously unoperated stages I–III POAG. were divided into 3 groups: group 1 (control, 17 patients, 17 eyes) with ultrasonic cataract phacoemulsification (PEC) and non-penetrating deep sclerectomy (NPDS); 2 group 2 (control, 25 patients, 28 eyes patients with PEC and trabeculectomy (TE); group 3 (main, 19 patients, 20 eyes) with PEC and the newly developed PFS.Results. The best long-term results, with approximately equal hypotensive parameters were achieved with combined operations, which included PEC with TE (the absolute effect achieved in 65% of cases) and PFS (in 60%). However, the number of early postoperative complications after PFS turned out to be almost 2 times as small as after a simultaneous intervention with penetrating TE, and was wholly comparable with that after NPDS (15 and 11.8%). At the same time, the best visual results over the relevant period were observed in the main (0.78 ± 0.06) group and the control group 1 (0.64± 0.05).Conclusion. Combined simultaneous intervention, including cataract phacoemulsification with the newly developed partially fistulizing antiglaucoma surgery, is an effective way to improve visual acuity, normalize intraocular pressure and stabilize glaucomatous optic neuropathy, as well as to reduce the drug load on the patient.

The density of macular pigment in the central retina is the total concentration of lutein, zeaxanthin and meso-zeaxanthin. Normally, the average value of the optical density of macular pigment can vary significantly as it depends on the person's lifestyle, the total amount of pigment in the body, nutrition, gender, age, as well as concomitant diseases such as diabetes, obesity, arterial hypertension. Differences in the level of optical density of macular pigment between different countries were revealed and it was showed that this parameter drops in cases of retinal pathology, cataract, glaucoma, myopia, macular degeneration, or diabetic macular edema. The level of macular pigment may be considered as a significant diagnostic criterion in many ophthalmic pathologies, so any changes of this parameter require attentive consideration.

The article presents an overview of modern publications on epidemiology, risk factors, and the main links of the etiology and pathogenesis of age-related macular degeneration (AMD). The nonexudative or “dry” form of age-related macular degeneration is a multifactorial progressive pathological process caused by hereditary predisposition, general and local disorders of lipid metabolism, negative changes in the blood supply to the eye, age-related destruction of the Bruch’s membrane and retinal pigment epithelium, the appearance of signs of local and systemic inflammation, the development of oxidative stress with the impact of toxic lipoperoxidation products on the structures of the posterior segment of the eye. Recent studies have discovered new ways of retinal pigment epithelial cell death in response to oxidative stress in AMD, in particular necroptosis, which, in addition to classical apoptosis, is considered the main mechanism of this process. It is noted that the development of AMD may be associated with an age-related decrease in the level of estrogen in women. The analysis of the data on the etiopathogenesis of age-related macular degeneration presented in the modern literature indicates the need for further research and generalization of local and general pathological processes developing in the dynamics of retinal visual function disorders by specialists of various scientific disciplines.

Background. Pterygium is ubiquitous and multifactorial; today, information on the prevalence of pterygium, risk factors, the relationship of its development with concomitant pathology and the type of life activity of patients in various regions of Russia is limited. All of the above led to the conduct of this epidemiological study in the Republic of Bashkortostan.The aim of the study: to study the prevalence of pterygium, as well as to identify the relationship of risk factors for its development with the type of life activity and concomitant diseases in the urban and rural population of the Republic of Bashkortostan.Methods. On the basis of the Ufa Research Institute of Eye Diseases, within the framework of the Ural Eye and Medical Study (UEMS) research project, a population study of people living in urban and rural regions of the Republic of Bashkortostan was carried out. The study involved 5899 people, including men – 43.7 % (2585 people), women – 56.3 % (3314 people), urban residents made 42.3 % (2491 people), rural – 57.7 % (3408 people).Results. As a result of our study, pterygium was diagnosed in 138 people (204 eyes – 2.3 %) (95% CI: 2.0–2.7 %). One-way analysis showed a higher prevalence of pterygium associated (p˂0.10) with a number of systemic and ophthalmic parameters. However, according to the results of multivariate analysis, it was revealed that the prevalence of pterygium was significantly associated with older age (p = 0.006), rural area of residence (p = 0.001) and low educational level (p = 0.03).Conclusion. The prevalence of pterygium in Republic of Bashkortostan according to the UEMS study was 2.3 %, or 23 people per 1000 population among people over 40 years old. The nature of the settlement influences the prevalence of pterygium in the Republic of Bashkortostan. Pterygium was more common among older people among all respondents who took part in the study. In the study, pterygium was not a biomarker of general somatic diseases.

Keratoconus is a progressive bilateral corneal ectasia, accompanied by loss of vision due to high irregular astigmatism, which is the leading indication for corneal transplantation. The review presents a variety of surgical corneal transplantation techniques for keratoconus available today and discussed their advantages and disadvantages.

Objectives: to evaluate the effectiveness of photosensitizer solutions in the experiment in different modifications of standard UV corneal crosslinking. Materials and Methods. Experiments were performed on 32 enucleated porcine eyes ex vivo and 12 rabbits (24 eyes) in vivo, divided into 4 groups depending on instillations of the photosensitizer solutions: Dextralink, Ribolink, Hypolink and Riboflavin. Evaluation of corneal saturation was performed using two modifications of standard UV CXL: in the first case, instillation of the photosensitizer solution was performed during the entire crosslinking procedure (30 min - saturation and 30 min - ultraviolet irradiation); in the second case, instillations lasted only for the first 30 minutes, the precorneal riboflavin film was removed, and instillation of solution was not performed. Results and Discussion. Instillation of photosensitizer solutions within 60 minutes showed that Dextralink significantly reduced the thickness of the cornea by about 24 % ex vivo and 21 % in vivo, while Hypolink, on the contrary, caused its increase by 9 % ex vivo and 23 % in vivo, respectively. The use of Ribolink and Riboflavin did not change the linear parameters of the cornea during the entire follow-up period. The results of the 2nd series of studies showed that effects of solutions on the cornea during their instillation for 30 minutes were generally preserved during the entire observation period up to 60 minutes. In the group where Dextralink and Hypolink solutions were used, there was a slight tendency to normalization of the initial parameters of the cornea. Conclusion. Safe and effective implementation of UV crosslinking of the cornea is possible on the basis of a rational approach to the performing the stages of stroma saturation with photosensitizer solutions, depending on the initial state of the cornea: Dextralink is recommended for a thickness of more than 450 m, Ribolink - at 400-450 m, Hypolink - from 350 to 400 m. Halting of instillations on the saturated stroma during UV irradiation is advisable to be accompanied by intraoperative control of its thickness. When performing a standard crosslinking technique, where instillations of photosensitizer accompany the stage of UV irradiation of the cornea, it is necessary to take into account the presence of a precorneal film that can absorb some of the radiation energy. The peculiarity of this crosslinking technique can be considered as a potential way to protect intraocular tissues from excessive exposure to UV radiation.

Keratoconus (KC) is a progressive degenerative corneal disease, leads to the aberration of biomechanical and optical properties and thinning of the cornea, causes astigmatism and decreases visual acuity.Materials and methods. 33 patients (35 eyes) with stages II–III of non-progressive keratoconus and concomitant cataracts of various stages of maturity were operated on. The average age of the patients was 46.5 ± 2.7 (41–63) years old. The operations were performed according to our proposed two-stage method of treating ametropia in patients with KC and cataracts (Patent of the Russian Federation No. 2748634 of 28.05.2021). The first stage was the implantation of FERRARA intrastromal corneal ring segments (ICRS) with thickness from 150 to 350 μm. To correct residual refractive error in 5–7 months after stage 1, patients underwent stage 2: cloudy lens was removed and replaced with toric posterior chamber intraocular lens (TIOL) – AcrySof IQ Toric (Alcon, USA), T-fl ex Toric RayOne (Rayner, UK).Results and discussion. After stage 1 of the operation (ICRS implantation), the uncorrected visual acuity (NCVA) was 0.2 ± 0.03, the best corrected visual acuity (BCVA) was 0.4 ± 0.02. In 1 month after stage 2 (phacoemulsifi cation + TIOL) NCVA was 0.64 ± 0.11 and BCVA was 0.74 ± 0.12. During the entire follow-up period after the surgery visual functions, refraction, and rotational stability of TIOL were stable.Conclusions. Conducting a two-stage surgical intervention in patients with keratoconus and cataracts allows to stop the progression of the disease and effectively correct the ametropia concomitant with keratoconus.

Purpose. To conduct a comparative analysis of the effectiveness of intravitreal injection of dexamethasone-containing implant and aflibercept in macular edema in patients with diabetes mellitus.Material and methods. The study involved 80 patients (80 eyes) with macular edema. The group 1 included 38 patients (38 eyes) who underwent a single intravitreal injection of dexamethasone-containing biodegradable implant «Ozurdex» in a dose of 0.7 mg according to the standard technique. In the group 2, 42 patients (42 eyes) received 5 loading doses of aflibercept with an interval of one month. All patients underwent monthly spectral optical coherence tomography (OCT) of the macular area, as well as visometry and tonometry during the observation period.Results. One month after intravitreal injection of the studied drugs in both groups, no inflammatory reactions were detected in any case. According to OCT data, cystic edema of the macular area with a tendency to decrease the thickness in the fovea was preserved. After treatment with aflibercept, the average retinal thickness in the macula was 186.4±15.1 μm, and visual acuity averaged 0.48±0.05 in 85.7% of patients. During therapy with intravitreal injection of Ozurdex, an increase in visual acuity was noted in 89.4% of patients.Conclusion. This study found that intravitreal pharmacotherapy with an angiogenesis blocker and a dexamethasone implant in patients with diabetic macular edema are comparable in its effectiveness – 85.7 and 89.4% respectively. If systematic anti-angiogenesis therapy is not possible for a number of reasons, it is advisable to use a prolonged dexamethasone implant.

Purpose. Studying the prevalence and functional results of cataract surgery and factors that negatively affect postoperative visual functions in the population of the R epublic of Bashkortostan.Material and methods. The study was carried out on the basis of a pilot descriptive population study – Ural Eye and Medical Study (UEMS), conducted on the basis of the Ufa Research Institute of Eye Diseases. This analysis included 5 885 people aged 40 and over with data on performing cataract surgery. Poor visual outcome after cataract surgery was defined with uncorrected visual acuity below 0.3. Statistical data analysis was performed using the IBM SPSS Statistics application package.Results. The prevalence of cataract surgery was 6.1% (95% confidence interval (95% CI) 5.5–6.8%). A higher frequency of operations was associated with the age factor (odds ratio – OR 1.13, 95% CI 1.11– 1.15%, p

Ultraviolet crosslinking is a pathogenetically oriented method of treating primary and secondary corneal ectasias that cause irregular astigmatism and visual impairment. Advanced stage of the disease, when the initial thickness of the cornea is below 400 mc, is a contraindication to the use of the standard «Dresden» protocol of the procedure. In such cases, it is possible to use modified UV crosslinking protocols. This article presents the modern crosslinking methods used for progressive keratoconus in advanced stages with a thin cornea. The presented methods are combined taking into account principled approaches – using additional tools and without them. Both approaches are based on a temporary artificial increase in the thickness of the cornea during the procedure in order to reduce the likelihood of damage to the deep layers of the cornea. The evolution of crosslinking protocols for thin corneas began with the use of hypoosmolar solutions that increase the thickness of the cornea to safe values. However, such an approach was not stable and the change in pachymetry parameters during the procedure created difficulties in its standardization. The use of different staff to increase the thickness of the cornea by providing an additional layer like a contact or biological lens seemed more encouraging. At the same time, the low permeability of these additional layers to oxygen, much needed for the UV crosslinking process of macromolecules, limited the overall effectiveness of the procedure. As a result of the progressive development of technologies and the improvement of devices, the logical continuation of the trend of modifying the crosslinking protocol was the introduction of an individual approach to customization of the protocol. The described modified protocols, taking into account the different principles of the surgical approach in ultraviolet radiation, set forth the results, evaluate their effectiveness and safety when applied to patients with a thin cornea.

Purpose. To evaluate the effectiveness of intravitreal injection of biodegradable intravitreal implant containing dexamethasone (Ozurdex) in patients with resistant diabetic macular edema (DME).Material and methods. The study was conducted of 24 patients with diabetic macular edema resistant to therapy with angiogenesis inhibitors (3-5 intravitreal injections without a positive structural and functional result) on the background of compensated type 2 diabetes mellitus. A biodegradable intravitreal implant containing dexamethasone (Ozurdex) was injected once according to standard method at a dose of 0.7 mg. The follow-up period was 6 months.Results. According to optical coherence tomography of the macular area, within 6 months after intravitreal injection of Ozurdex implant, the retinal thickness in the fovea decreased on average from 558.4 ± 25.1 μm to 188.3 ± 18.4 μm, with partial restoration of the foveolar cavity. The maximum corrected visual acuity increased on average from 0,04±0,01 to 0,3±0,09, intraocular pressure did not exceed 18.0 mm Hg.Conclusion. If the anti-angiogenic therapy of DME is ineffective, the use of the biodegradable intravitreal implant containing dexamethasone (Ozurdex) is considered as an effective treatment method that provides a significant and stable (prolonged) improvement of the structural and functional parameters of the eye in 86,6% cases.

Purpose. To assess an association of markers near the COL5A1 gene and in its intron with keratoconus. To study the relationship between the presence of marker alleles and the level of expression of the COL5A1 gene in the cornea of patients with keratoconus.Material and methods.The study included 70 patients diagnosed with keratoconus, and 100 participants of the control group. All participants were genotyped for two markers associated with keratoconus: rs1536482 and rs7044529. The diagnostic indicators were calculated to assess a possibility of application of these markers as a keratoconus classifiers. In patients with keratoconus who underwent keratoplasty, corneal samples (n=9) were collected to isolate the RNA. The COL5A1 gene expression level was compared between the group of patient corneal samples with at least one marker allele (rs1536482 +) and the group of samples without marker alleles (rs1536482-) using real-time PCR coupled with reverse transcription.Results. A significant difference of the rs1536482 marker allele occurrence was found between the group of keratoconus patients and the control group (p=0.0004, Fisher test). At least one marker allele rs1536482 was found in 67.1% of patients (marker sensitivity) with keratoconus and in 46% of control group participants. Thus, the specificity of the marker is low (0.54). The odds ratio was 2.4, and the risk ratio was 1.69. Gene expression analysis in the keratoconus patients’ cornea did not reveal an association of the COL5A1 gene expression level with the genotype (p=0.9, Mann-Whitney test). Conclusion. In this study, an association of rs1536482 with keratoconus was identified in a cohort of patients from Russia. However, due to the low specificity of this marker, it cannot be used as a keratoconus classifier. The presence of a marker allele is not associated with the COL5A1 gene expression level.

Aim. To study of the prevalence of diabetes and diabetic retinopathy in the Republic of Bashkortostan among people over 40 years of age, depending on the stage of the disease, gender and the nature of the settlement of the respondents. Materials and methods. A population-based study “Ural Eye and Medical Study” on the basis of the Ufa Research Institute of Eye Diseases covered 5899 people, of whom 2581 (43.7 %) were men, 3318 (52.3 %) were women. There were 2501 (42.3 %) urban residents, 3398 (59.7 %) rural residents. Statistical data analysis was performed using the IBM SPSS Statistic application package.Results. According to the study, diabetes was observed in 687 people, among them – 221 (32.2 %) men, 466 (67.8 %) women; urban residents – 378 (55.0 %) people, rural – 309 (45.0 %) people. The prevalence of diabetes is 11.6 %. Diabetic retinopathy was observed in 102 people (27 men – 26.5 %, and 75 women – 73.5 %), urban residents – 60 (58.8 %), rural – 42 (41.2 %). The prevalence of diabetic retinopathy among the entire study population was 2.1 %, or 14.8 % in the diabetic population. Conclusions. The prevalence of diabetes in the Republic of Bashkortostan according to the results of the Ural Eye and Medical Study was 11.6 % among people over 40 years old. The prevalence of diabetic retinopathy in the general population of the republic was 2.1 %, and in the population with diabetes it was 14.8 %, which is, in general, less than the global average.

This review presents the characteristics and results of clinical studies of patients with age-related macular degeneration implanted with the developed for this purpose first macular IOL – intraocular macular telescope (IMT). This lens was designed specifically for patients with the most severe or terminal form of age-related macular degeneration and is designed for monocular implantation to provide central vision while maintaining peripheral vision of the paired eye, which is important for maintaining the balance and orientation of patients. This device allows patients to see both in dynamic and static situations in the near, intermediate and far ranges. The disadvantages of this lens are a decrease in the visual field and depth of focus (which excludes its bilateral implantation), the need for a large (10–12 mm) incision for implantation, which can cause an increase in corneal astigmatism and the risk of complications, in particular, the pupillary block with an increase in intraocular pressure. There are also difficulties in the study of the fundus after its implantation to assess the small changes in the macula or to identify possible postoperative complications after cataract surgery (macular oedema, etc.). Also after the implantation of this lens, there is need for special programs of visual rehabilitation. The patient’s commitment to the rehabilitation measures for the adaptation of the central visual field of the operated eye with the peripheral vision of the second eye is crucial for success of the IMT macular telescope implantation procedure.

The purpose of the study — to conduct a comparative analysis of structural and functional indicators of the central zone of the retina in patients with diabetic macular edema and epiretinal membrane in the remote period after surgical treatment. Patients and Methods. We examined 97 patients with diabetic macular edema in combination with the epiretinal membrane aged 53 to 68 years (mean age 61 ± 5.4 years). All patients underwent vitrectomy with an internal limiting membrane peeling (ILM). Patients were divided into 3 groups depending on the intravitreal use of an angiogenesis inhibitor. The analysis of the remote anatomical and functional results of patients of different groups during 1 year of observation was carried out. Results. In patients after treatment using the proposed technique, the central retinal thickness was reduced by 16.19 % (p = 0.031) compared with monotherapy and by 11.51 % (p = 0.039) compared with a phased treatment method. Visual acuity significantly increased in the treatment group by the single-step method by 1.53 times (p = 0.024) compared with the group where only vitrectomy was performed, and also 1.44 times (p = 0.029) compared with the delayed administration of angiogenesis inhibitor in avital eye. Patients in all groups have showed an improvement in central photosensitivity 1 month after surgery, followed by a slight decrease in performance. However, by 12 months, the level of central photosensitivity in group 2 was significantly higher than in other groups (p < 0.05). A comparative analysis of the spatial distribution of macular pigment has showed that, along with the development of the pathological process, macular pigments were dispersed in the retinal tissue. On the background of treatment, their concentration was normalized in the central zone of the retina, without increasing the quantitative composition. Conclusion Analysis of the morphofunctional parameters of the retina central section in patients with diabetic macular edema and epiretinal membrane in the dynamics of treatment with various techniques led to the creation of an algorithm for managing patients. It allows to achieve high clinical and functional results in an overwhelming percentage of cases and, thereby, significantly improve medical and social rehabilitation, and also the quality of life of this contingent.

Currently, the treatment of neovascular age-related macular degeneration (AMD) includes: intravitreal injections (bevacizumab, ranibizumab, aflibercept, pegaptanib, etc.), photodynamic therapy, surgical treatment (subretinal surgery, recombinant tissue plasminogen activator + gas, macula translocation) and etc. Rehabilitation of these patients is carried out using special optical tools (glasses, magnifying lenses, loupes, electronic devices). Classic external devices for the correction of very poor eyesight are not convenient to use: they are often lost or forgotten at home, not adapted for constant wear, people are embarrassed to use them in public places. This review presents the characteristics and clinical results of the implantation of two intraocular lenses, the Lipschitz Macular Implant (LMI-SI) and the Scharioth Macula lenses, in patients with age-related macular degeneration (AMD). These IOL can be implanted during standard phacoemulsification with the implantation of usual posterior chamber IOL or years after the cataract extraction, which makes them unique among other lenses that are implanted only during the cataract extraction procedure. The Lipschitz Macular Implant (Israel, 2013) is a rigid IOL made of polymethyl methacrylate (PMMA), implanted in a capsular bag, it requires an incision up to 6 mm. A positive feature of the Scharioth Macula lens (1stQ GmbH, Germany, 2017) is the smallest incision needed for implantation — no more than 3 mm. This lens consists of a biocompatible hydrophilic acryl with a UV filter, the peripheral zone of the lens is optically neutral, the square design excludes its free rotation. Also, this lens can be used as therapy for progressive macular dystrophy of various etiologies. The additional macular IOLs do not affect peripheral vision, reduce binocularity when reading, and require complex visual rehabilitation.

Purpose. To compare the results of traditional and modified fistulizing surgery for secondary refractory glaucoma. Material and methods. 39 patients (39 eyes) aged 25 to 79 (24 and 15 women) who received the surgery were divided into 2 groups: 17 patients of the control group underwent traditional trabeculectomy or deep sclerectomy while 22 patients of the main group received tunnel trabeculectomy with iridocycloretraction. 27 patients were followed up for up to 2 years. Results. No significant difference between the compared groups was found with regard to the incidence of early postoperative complications (hyphema, ciliochoroidal detachment). After surgery, which in some cases was supplemented by the course of additional antihypertensive therapy, IOP returned to normal in 77.8% of cases. For neovascular glaucoma, the results were worse both after modified and traditional trabeculectomy procedures (40.0%). The best sustained hypotensive and functional effect was achieved after tunnel trabeculectomy with iridocycloretraction (in 68.8% of cases), while after traditional trabeculectomy the effect was lower (45.5%). Conclusions. The obtained results show that the proposed modified operation may be considered, in some cases, as an alternative to drainage surgery in patients with refractory secondary glaucoma. Neovascular glaucoma is a contraindication to tunnel trabeculectomy with iridocycloretraction. Yet, modified trabeculectomy may be recommended also to patients with neovascular glaucoma, on condition that the procedure is preceded by effective surgery which eliminates or reduces neovascularization of the iris and the anterior chamber angle // Russian Ophthalmological Journal, 2016; 3: 5-11. doi: 10.21516/2072-0076-2016-9-3-5-11.

Purpose. To investigate the effects of the implant with the Dexamethasone on the structural parameters of the central retina in case of retinal vein occlusions porch occlusion complicated with macular edema.Material and methods. The study involved 13 individuals (9 female and 4 male, 13 eyes) with the firstly diagnosed thrombosis of the central retinal vein (6 eyes – the group I) or its branches (7 eyes – the group II). The average patient age was 60.8±2.1 years. The disease duration averaged 2±0.5 months. The control group included seven fellow eyes of the examined patients (the exclusion criterion was the presence of cornea and lens opacity, diseases of retina and optic nerve, except angiopathy). All patients of study groups underwent a single performed intravitreal input of the implant with dexamethason (0.7 mg) according to a standard technique, as well as a standard course of conservative treatment. The follow-up period was 1 month.Results. In the control group the visual acuity equaled 0.94±0.06, the total photosensitivity – 19.7±0.3 dB, the mean central foveal thickness was 224.5±5.38 μm, the total macular thickness – 299.41±3.73 μm, including external layers – 165.89±2.87 μm, and internal layers – 132.77±2.26 μm (in the ratio of 0.55/0.45). A month after the treatment patients reported an improvement in the best corrected visual acuity (BCVA) from 0.04±0.02 to 0.16±0.08 in the group I (compared to the control group, p

Purpose. To identify the features of macular pigment and sensitivity of the central retina in case of vitreoretinal surgery for diabetic macular edema. Material and methods. Vitreoretinal interventions were performed in 31 patients (31 eyes) with diabetic macular edema combined with vitreomacular traction syndrome. All patients underwent the seamless closed 3-port vitrectomy with peeling of internal limiting membrane using the 25G systems. The analysis of retinal changes was carried out according to results of evaluation of optical density of macular pigment and retinal sensitivity pre- and post-operatively. Results. There was revealed a sharp decrease in the parameters of the optical density of macular pigment (ODMP) associated, apparently, with their screening in case of vitreomacular traction syndrome combined with diabetic macular edema. Vitreoretinal intervention led to an increase in the average optical density of the macular pigment by 50.24% indicating a normalization of vitreoretinal interface. Correlative analysis between the parameters of retinal sensitivity and ODMP showed an average correlation (r=-0.66, p

Purpose: To assess the topographic location of the demarcation line in in different areas of the cornea after standard corneal crosslinking.Patients and methods. 12 patients (15 eyes) with keratoconus of stages 1–2 of Amsler-Kruimerich classification were observed. UV cross-linking was performed in all patients according to the standard Dresden protocol with 0.1% aqueous solution of riboflavin. The patients underwent optical coherence tomography of the anterior segment of the eye on “DRI OCT Triton” (“Topcon”, Japan) in different areas of the cornea to assess the location of the demarcation line. Results. Demarcation line was revealed in1 month after standard corneal cross-linking in most cases (87%). Biomicroscopy showed that DL limited the anterior and middlelaers of the stroma from the posterior one. The stromal demarcation line depth according to OCT averaged 305.73 ± 41.08 μm (range of 282–345 μm) at the center, nasally — 215.16 ± 35.5 μm (range of 160–289 μm) and temporally 205,23 ± 32.81 μm (range of 190–276 μm). A significant difference in the depth of DL localization in the central zone of the cornea and a 6 mm zone (p < 0.001) was noted. Conclusion. The corneal stromal (обычно) demarcation line is one of the indicators of the depth of photochemical process of corneal cross-linking. Optimal timing of detection of DL following corneal collagen crosslinking is 2 weeks — 3 months. The depth of DL in the corneal studied areas is different; it is deeper in the central zone than in the peripheral ones.

Purpose. To evaluate a safety of the scleral crosslinking with riboflavin/ultraviolet A for the structures of the eye in vivo.Material and methods. The study was conducted in 9 Chinchilla rabbits (18 eyes). Right eyes underwent the crosslinking procedure, left eyes were used as a control. Scleral crosslinking was performed according to an original technique through a small (about 1cm) paralimbal incision of the conjunctiva and Tenon’s capsule. Upper nasal sector of the sclera was saturated with 0.1% aqueous solution of riboflavin mononucleotide for 20 minutes. Irradiation with 3mW/cm² ultraviolet A was carried out within 30 minutes. Laboratory animals were killed 1 day, 1 week and 1 month after the surgery (3 rabbits for each period). The condition of irradiated portions of the sclera with adjacent inner layers and a part of the superior oblique muscle, as well as the optic nerve were evaluated using the light microscopy (hematoxylin-eosin staining).Results. The inflammatory reaction was observed in the cross-linked sclera and extraocular muscle 1 day after the procedure. It was transient and disappeared completely in the sclera 1 week later and in the muscle – 1 month after the surgery. There were no signs of tissue damage in the retina and optic nerve of the treated eyes.Conclusions. These parameters of the scleral crosslinking are safe for the structures of the eye. In the future this method could be applied in the clinic to enhance the biomechanical strength of the scleral tissue in progressive myopia.

Purpose: to evaluate the permeability of the scleral tissue for ultraviolet A (UVA).Materials and Methods. The study was conducted on 15 cadaver porcine eyes. Rectangular scleral flap 12*15 mm was cut out from each eyeball. The thickness of the sample was measured with a digital caliper. The outer surface of the scleral flap was irradiated with ultraviolet A. A sensor of the UV-radiometer was placed under the sample. It measured the UVA irradiance passing through the sclera. The absorption coefficient of ultraviolet A by the sclera was calculated from the formula derived from the Bouguer-Lambert Beer law: , where E0 — the absorption coefficient, mm-1; — irradiance of the transmitted light, mW/cm2; I0 — irradiance of the received light, mW/cm2; — thickness of the sclera, mm.Results. The absorption coefficient of ultraviolet A by the sclera was 4,91±0,43 mm-1. According literature the threshold damaging radiation for retina is 7.7 J/cm2. Substituting these values in the converted formula of the Bouguer-Lambert-Beer law, we can derive an equation for calculating the threshold UVA irradiation dose of the sclera: , where 0 — the threshold UVA irradiation dose of the sclera, J/cm2; — the base of the natural logarithm; — thickness of the sclera, mm.Conclusion. The absorption coefficient of ultraviolet A by the cadaver porcine sclera is 4,91±0,43 mm-1. The derived formula of the threshold UVA irradiation dose of the sclera calculating allows to avoid the threatening for the retina procedure parameters in the performance of the scleral crosslinking with riboflavin/UVA.

Purpose. To evaluate the effectiveness of vitrectomy in combination with internal limiting membrane peeling associated with the gas-air tamponade of the vitreous cavity at the advanced stage of proliferative diabetic retinopathy. Material and methods. The study involved 52 patients (52 eyes) with diabetes mellitus of type 2, who underwent the vitreoretinal surgery with a preliminary antivasoproliferative therapy. In all cases, a traction syndrome was found only from the side of posterior hyaloid proliferative tissue with gliosis of degree II-III, without signs of an epiretinal membrane. In the first group of patients (n=28) the 27-Gauge vitrectomy was performed, with the removal of only posterior hyaloid proliferative tissue followed by a tamponade of the vitreous cavity with a gas-air mixture, and in the second group (n=24) a similar volume of vitreoretinal surgery combined with peeling of the internal limiting membrane was carried out. Results. In all patients, before the combined surgical treatment, the visual acuity averaged 0.06±0.02. Before the treatment in patients of both groups according to optical coherence tomography the thickness of zone «nerve fibers layer – internal limiting membrane» in the macular area averaged 25.38±3.11μm, in the fovea and parafovea – 457.41±36μm and 701.51±24μm, respectively. The mean value of the optical density of the macular pigment before the treatment was 0.094±0.01 du. After the performed vitreoretinal intervention, the visual acuity in patients of the group 1 improved up to 0.10±0.02 (p< 0.05), in the group 2 – up to 0.25±0.05 (р1-2< 0.05). Six months after vitrectomy, the thickness of zone «nerve fibers layer – internal limiting membrane» in the macular area in patients of the group 1 increased 1.6 times (p< 0.05), due to the formation of a secondary epiretinal membrane, which occurred in 39.2% cases (11/28), 54.5% of cases (6/11) showed traction macular edema, and diabetic macular edema (without epiretinal membrane) was detercted in 28.5% of cases (8/28). In the group 2 of patients, the «nerve fibers layer» zone decreased by 1.5 times (р1-2< 0.05), the epiretinal membrane and the traction macular edema were not diagnosed in any case (0/24), but 5 patients (20.8%) had diabetic macular edema (5/24). According to the data of optical coherence tomography, the thickness of the retina in the fovea and parafovea after the combined surgical treatment in patients of the group 1 averaged 212.49±36μm and 365.74±28μm, in the group 2 – 190.11±24μm and 334.18±21μm, respectively (р1-2< 0.05). The average value of macular pigment optical density after treatment was 0.109±0.01 du in the group 1 and 0.122 ± 0.01 du in the group 2. Conclusion. Vitrectomy combined with peeling of the inner limiting membrane in patients with advanced proliferative diabetic retinopathy contributes to obtain a higher visual acuity minimizing a risk of secondary epiretinal membrane and diabetic macular edema.

The aim was to determine different possibilities and the operating principle of modern optical coherent tomographs OCT RETINASCAN-3000 and DRI OCT TRITON in automatic layer-by-layer segmentation of the retina and perioretinal structures. Methods. The study involved 31 patients (31 eyes) with no retinal pathology in the macular area. Of these, there were 13 men, 18 women. The average age of the patients was 55.8±3.65 years. Each patient was followed by a layered automatic structuring of the central retina with the help of RetinaScan-3000 (Nidek Technologies) (1st group, n = 31) and DRI OCT Triton (Topcon Japan) (2nd group, n = 31) of the right eye only. The OST device RetinaScan-3000 used the mode macula multi cross 6 mm, the DRI OCT Triton used the 5 line cross 6 mm mode.Results: The difference in the automatic layer-by-layer segmentation between the optical coherent tomographs DRI OCT TRITON and OCT RETINASCAN-3000 is, first of all, in the unequal coverage of the retina layers and the preand subretinal space and the number of automatically layered zones. For example, OCT RETINASCAN-3000 (SD-OCT) suggests the separation of the transverse optical section of the structures of the posterior segment of the eyeball into 5 structural zones when, as DRI OCT TRITON in (SSOCT), further clearly isolates the preretinal structures and the choroid, delineating the border of the sclero-choroidal Articulation. The DRI OCT Triton device in the SS-OCT system allowed for a more complete differentiation from the position of layered delimitation of the retina covering 6 retinal zones to obtain digital values for coverage of 5 layers on RetinaScan-3000 (SD OCT).Conclutions: The DRI OCT Triton device with SS-OCT technology has more possibilities for topical diagnostics of the posterior eyeball structures in the autonomous mode relative to the Retinascan-3000 with SD-OCT technology.

Purpose: to analyze the effectiveness of Ex-Press drainage device implantation for refractory glaucoma of different origin for 3 years.Patients and methods: The study consisted of 82 patients (86 eyes) with refractory glaucoma aged 26–86 years (67.37±0.53). Pre-operative IOP level averaged 37.8±1.04 mm Hg. Ex-Press drainage device implantation was rated according to the following criteria: IOP, time course of visual functions, the need for additional drug therapy and reoperation, the presence of intraoperative and postoperative complications. Examination of the patients was carried out from 1 to 8 days after the surgery and within 1, 3, 6, 12, 24 and 36 months.Results: According to our research results relative hypotensive effect equaled 74.4% (64/86) within a year after the surgery; 67.4% (58/86) — within 2 years; 65.1% (56/86) — after 3 years of follow-up period. The maximum decrease in IOP by 61.6% was observed immediately after the surgery. There was no effect of surgical treatment within3 years in 34.9% (30/86). Complications were observed in 23.2% (20/86) of cases: choroidal detachment — 12.8% (11/86), hyphema — 3.5% (3/86), eruption and dislocation — 3.5% (3 / 86), delayed expulsive hemorrhage — 2.3% (2/86), cyst of filtering bleb — 1.2% (1/86).Conclusion. Fistulizing operations with implantation of Ex-Press drainage device for refractory glaucoma provide normalization of IOP in 65.1% of cases (including 15.1% on the background of additional drug therapy) at follow-up period up to 3 years.

Purpose — to determine the effect of fistulizing operations with Glautex drainage and Ahmed valve implantation in the cases with neovascular glaucoma within 3 years.Patients and methods. We observed 44 patients (44 eyes) with secondary neovascular glaucoma on the background of post-thrombotic and proliferative diabetic retinopathy. Patient age averaged 60,84±1,29 years. Males — 19, females — 25. The patients were divided into two groups depending on the used drainages and drainage devices. In Group I the standard sinus trabeculectomy with Glautex drainage was performed in 23 patients. The II group included 21 patients who were implanted Ahmed valve.Results. According to the results of our research the relative hypotensive effect was in groups I and II, respectively, 52.2% (12/23) and 79.4% (17/21) 1 year after surgery; 43.5% (10/23) and 71.4% (15/21) — 2 years after surgery; 39.1% (9/23) and 66.7% (14/21) — after 3 years of follow up. The maximum decrease in IOP was observed immediately after surgery in the analyzed groups, 66.8% and 64.5%, respectively. There was no surgical treatment effect for 3 years in Group I in 60.8% (14/23), in group II — 33.3% (7/21) of the cases.Conclusion. The analysis of clinical and functional results of surgical treatment of patients with neovascular glaucoma in terms of 3 years follow up showed that the most lasting preservation of visual function and the hypotensive effect was achieved after implantation of the Ahmed valve — in 66.7% of the cases. In the cases of sinus trabeculectomy with Glautex drainage — in 39.1% of the cases. The incidence of postoperative complications in both groups was comparable: as hyphema, hypotension, and the eruption of implants developed after sinus trabeculectomy with Glautex drainage in 26.1%, 21.7% and 4.3%, respectively, after Ahmed valve implantation in 23 8%, 19.1% and 9.6% of the cases.

Purpose. To determine the long-term status of the corneal endothelium after anterior radial keratotomy. Patients and methods. The main group consisted of 69 patients (104 eyes) who underwent radial or radial-tangential keratotomy to correct myopia and myopic astigmatism an average of 23,1±2,8 years ago (range 16 to 30 years). The average age of patients was 53,8±5,7 years (range 39 to 65 years). The number of keratotomy scars ranged from 4 to 14. Repeated keratotomy was performed on 8 eyes. The control group consisted of 56 patients (110 eyes) aged from 39 to 64 years(average 54,2±4,3 years) with refractive-axial myopia from medium to high stage, whom potentially could be done anterior keratotomy in the 90th of the last century. Patients with concomitant pathology and ocular trauma that could lead to loss ofendothelial cells were excluded from both groups. Corneal endothelium cell densit y, polimegatizm, pleomorphism in addition to standard eye examination were performed to all patients with the help of contactless endothelial microscope «EM-3000» company Tomey (Japan). Results. In the control group endothelial cell densit y averaged 2734,8±121,2 cells /mm2, in the main group — 2134,2±299,1 cells/mm2 (p

The purpose of the study was to compare the efficacy of Ex-Press and Ahmed drainage devices for the secondary neo-vascular glaucoma (NVG) in patients with diabetes mellitus. We observed 25 patients (25 eyes) with secondary NVG in the setting of proliferative diabetic retinopathy. The first group consisted of 10 patients (10 eyes) who underwent Ex-Press drainage implantation. The second group consisted of 15 patients (15 eyes) who were implanted Ahmed valve FP7 model. As a result the maximum value of 1OP in the analyzed groups decreased by 66.8 % and 64.2 % respectively immediately after the surgery. By the end of 18 months follow-up period, the absolute hypotensive effect in patients of group 1 was 20 % (2/10) whereas in group 2 - 60 % (9/15). Normal intraocular tension during treatment with glaucoma medications established in 30 % of cases in group 1 (3/10) and in 80 % of patients in group 2 (12/15). Thus, the use of Ex-Press drainage device for secondary NVG in patients with diabetes was ineffective in 70 % of cases. We can recommend choosing implantation of Ahmed valve for secondary NVG in patients with diabetes mellitus as the number of unsuccessful outcomes using Ahmed valve was observed only in 20 % of cases.

Objective: to analyze the structural state of the central area of the retina in diabetic macular edema in the background anti-VEGF therapy. Methods. The study included 38 patients (40 eyes) with diabetic macular edema. All patients received anti-VEGF-ranibizumab therapy at a dose of 0.05 ml. The results were analyzed after three intravitreal injections with 1 month interval. We assessed visual acuity, morphological and anatomical structure of the macular area, the sensitivity of the retina and macular pigment optical density Results. Analyzing optical density of the macular pigment we revealed a significant increase of all parameters in 73 % of patients after the therapy. The average value of the optical density before treatment was at 0.102 ± 0.01 du, on the background of anti-VEGF-therapy this figure went up to 0.213 ± 0.01 (p < 0.05). According to the optical coherence tomography average retinal thickness before treatment made 404.62 ± 15.23 ßm, after the treatment - 300.91 ± 6.43 ßm (р < 0,05). When comparing data of optical coherence tomography and macular pigment optical density we revealed more pronounced decrease in the macular pigment optical density in the area of the retinal edema and a significant increase in the basic parameters on the background of the therapy. Conclusion. Anti-VEGF-therapy significantly improves visual acuity, the recovery profile of macular edema and reduces the zone in patients with diabetic macular edema.

The article provides the review of domestic and foreign literature on the use of the Ex-Press drainage device in patients with refractory and primary open-angle glaucoma. We conducted a detailed analysis of hypotensive effectiveness of Ex-Press implantation combined with anti-VEGF drugs, antimetabolites (5-Fluorouracil, Mitomycin C), Glautex and Ologen drainages. We described the results of drainage device usage for neovascular, aphakic, pseudophakic glaucoma. We determined indications, modified methods of Ex-Press implantation and best options of combinations with drainages; established safe conditions of magnetic resonance imaging in patients with the implanted device. We presented all possible complications both in the early and late postoperative period. The influence of Ex-Press on endothelial layer of the cornea in dynamics was shown. Оп the basis of literature review it can be noted that Ex-press drainage device has proved to have a long hypotensive effect in patients with PОAG and pseudophakia. Whereas in refractory glaucoma it requires a combination with drainage and anti-metabolites. Implantation of Ex-press requires dynamic monitoring of patients due to the risk of long-term postoperative complications.

Purpose: To study the short- and long-term results of modified sinus trabeculotomy (STT) in primary open-angle glaucoma (POAG).Patients and methods: We observed 42 patients (47 eyes) with POAG at 1‑3 stages aged 47‑85 (average age — 67.5 years). There were 27 women (64,3 %) and 15 men (35,7 %). The I stage of glaucoma was diagnosed in 17.0 % (8 eyes), II stage — in 44.7 % (21 eyes) and III stage in 38.3 % (18 eyes) patients. The average level of intraocular pressure (IOP) at the drug therapy was 29.2±1.5 mmHg (results obtained by pneumotonometer). All patients underwent a routine ophthalmic examination before and after surgery. Long-term results for period of 6‑24 months (13.1 months average) were assessed in 39 patients (43 eyes).Results. The most common early complications were hyphema (10.6 % patients) and ciliochoroidal detachment (6.4 % patents). Long-term results showed normalization of IOP in 93.0 % cases including 7.0 % against the background of additional therapy. Visual acuity preserved in 88.4 % cases, its reduction was observed in 11.6 % and was associated with the progression of glaucoma (7.0 %) and lens opacity (4.6 %). The field of view remained at the preoperative level in 90.7 % patients and narrowed in 9.3 %, mainly due to the progression of glaucoma process.Conclusion. Cruciate STT with anchoring of the scleral flap apex in suprauveal space in POAG in long-term results (up to 2 years) has a sufficiently high and sustained hypotensive effect (93.0 %), cataractogenic effect (4.6 %) and a relatively small number of complications (especially in case of ciliochoroidal detachment — just 6.4 %). We suggest this surgery in I‑III stages of POAG when the degree of expected postoperative scarring is small.

Purpose: To evaluate the clinical results of transepithelial corneal collagen crosslinking (CXL) compared with the standard CXL in patients with keratoconus.Patients and methods. There were 94 patients (119 eyes) with I‑III stage keratoconus (according to the Amsler classification) under observation since 2011 to 2013. The first group included 43 patients(56 eyes) among them 11 patients (11 eyes) with an initially thin cornea (380‑430 microns) underwent transepithelial CXL. 51 patients (63 eyes) in the second group — the standard CXL. Saturation of the cornea with a photosensitizer during transepithelial CXL was performed via electrophoresis using the «Potok-1» device, in the amperage of 1 mA for 10 minutes. CXL was performed with the use of «UFalink» device and «Dextralink» photosensitizer.Results. Pseudo haze of corneal stroma was diagnosed on biomicroscopy after both methods of CXL. In the 1st group in 38 % of cases (30 eyes) it disappeared in 2‑4 weeks after the CXL, in the 2nd group in 100 % of cases (63 eyes) it resolved in 3‑4 months, on average, after the treatment. According to optical coherence tomography (OCT) in two weeks after transepithelial CXL there was a demarcation line in 27 eyes (48.2 %) after 1 month — in 15 (26.7 %), at a later stage — has not been determined. After a standard CXL demarcation line was determined during the first two weeks in all patients (100 %) and persisted until 12 months in 2 eyes (3.5 %). Indicator of cornea’s refractive power in 2 years after transepithelial CXL decreased by 1.5 D (p> 0.05) compared to baseline values after standard CXL decreased by 1.8 D (p>0.05). Uncorrected visual acuity after transepithelial CXL increased from 0,31±0,01 to 0,45± 0,05 (p

Acanthamoeba keratitis (AK) — corneal inflammation caused by protozoa — Acanthamoeba. The disease is related mainly with wearing of contact lens, pathogen — Acanthamoeba penetrates under the contact lenses. The cases of AK after Lasik are described. Corneal epithelium microtrauma and contact with sources of environmental pollution are the risk factors of the invasion of Acanthamoeba into the cornea.Acanthamoebas affect soil, stagnant reservoirs, swimming pools, drain pipes, tap water, etc. Diagnosis can be confirmed only when cysts are detected in cornea material, plate count, smear, and the containers where such material is stored. Long life cycle including cyst stage helps keratitis relapsing course last for months. It is not always possible to detect cysts. Assessment of etiology presents certain difficulties.Such aspects as history taking, monitoring the clinical course of disease, confocal microscopy that enables to reveal acanthamoebas in vivo help to determine a diagnosis.Disease is characterized by a long chronic course with the development descemetocele and cornea perforation. The sequence of remissions and exacerbations of inflammation, apparently, occurs due to peculiarities of Acanthamoeba life cycle. Acanthamoeba keratitis is difficult to treat, it’s resistant to antibiotics. Untimely diagnosed disease and delayed initiation of treatment in patients with AK promote corneal perforation and inflammatory process in deep eye structures what often leads to eye enucleation.Severe pain is typical for AK in onset of disease. It is caused by emergence of subepithelial infiltrates and defects along the nerve fibers located in the most sensitive surface layer of the cornea. Conservative treatment is conducted with the use of antiseptics. The most effective one against cysts is 0.02% chlorhexidine which is prepared ex. temporae.The article presents the peculiarities of clinical course of Acanthamoeba keratitis, clinical cases of the disease and the results of penetrating keratoplasty as the main method of treatment of severe AK.

Crosslinking is a formation of chemical bonds between large molecules. It makes material stronger. Corneal crosslinking with riboflavin and ultraviolet A (UVA) has been successfully used in keratectasia treatment since 2003. There are some presuppositions of the scleral crosslinking successful using in the progressive myopia, characterized by thinning and mechanical strength decrease of the sclera, as well as in corneal ectasia. Experimental investigations showed an increase in the mechanical strength of the sclera after crosslinking with riboflavin and UVA in vitro. At the same time there were no changes in the thickness of the sclera. Achieved biomechanical effect was constant over a time with interval during up to 8 months in rabbits in vivo. Scleral structure changes after crosslinking were studied with light, electron and atomic force microscopy. Dense collagen bundle at the same time with fibers diameter increase was observed. The spatial pattern of fibrils within crosslinked scleral tissue was tangled and running in different directions. Some authors found such side effects of the procedure as damage of the retina and cornea on the irradiation side because of the high irradiance and thinning of the sclera as a result of dehydration. The optimal duration of riboflavin instillation (20 minutes) and irradiation with 3 mW/cm² (40 minutes) were determined in the experiments. It was shown in vivo, that crosslinking of the sclera with riboflavin and UVA prevented the growth of the rabbit eyes in occlusion-induced myopia. There are several data about successful clinical using of the scleral crosslinking. However, only 6 patients (12 eyes) were observed, procedure parameters are not clear, follow-up period was only 6 months. Thus, now there are many unsolved questions about efficacy and safety of the scleral crosslinking with riboflavin and UVA. Experimental results encourage for a new method of the progressive myopia treatment will be created.

Results of clinical trial and information about new developed medical devices for UV corneal collagen cross-linking at Ufa eye research institute are given.

Purpose. Aim of the work was a comparative study of the results of cataract surgery with IOL implantation in children with congenital cataracts, complicated with microphthalmia operated on in the age from 1 to 12 months using the 20G and 25G technology. Materials and methods. A comparative study of cataract extraction with IOL implantation and pars plana removal of posterior capsule with a limited anterior vitrectomy were performed in 54 children with congenital cataracts, complicated with microphthalmia operated on in the age from 1 to 12 months (79 eyes). The children were divided into two subgroups: in the first group after the IOL implantation the pars plana removal of posterior capsule with a limited anterior vitrectomy 20G was carried in 26 children (41 eyes), and in the second group – with an access through pars plana using extremely small incisions 25G (28 patients, 38 eyes). Results. In the first subgroup in the early postoperative follow-up the complication rate was higher due to a more frequent occurrence of hyphema and a development of inflammatory reaction, the difference is statistically significant (34.1 and 10.5% respectively, p

Purpose. The aim is to assess the results and features of keratectasia treatment in children and teenagers by the method of corneal collagen cross-linking.Material and methods. The study included 14 children (17 eyes) with keratectasia aged from 11 to 18 years, who underwent corneal cross-linking surgery using the UFalink device with a photo-sensitizer according to the standard Dresden protocol. The diagnosis of keratoconus was detected in 14 eyes, marginal degeneration of cornea – in 3 eyes, among them the stage I of disease occurred in 2 patients (2 eyes ), the stage II – in 12 cases (12 eyes). The examination of patients used the following ophthalmic research methods: visometry, bio-microscopy, ophthalmoscopy, autorefractometry, tonometry, keratometry, corneal topography, pachymetry, confocal microscopy.Results. There were no complications intra-operatively as well as in early and late postoperative periods. A pseudo-haze of various severity degree was observed in all patients, starting from the first week. In the confocal microscopy, many of hyperreflexogenic keratocytes and phenomena of apoptosis in the corneal area, exposed to UV-irradiation at a depth of 280±40μm, polymorphic hyper-reflecting structures were noted on the second day after the cross-linking procedure. The refractive power of the cornea decreased on an average by 1.14±2.13D, the thickness of the cornea in the center - by 28.04±0.14μm 6 months after surgery. Corneal astigmatism decreased on an average by 1.55±1.4D 24 months after the cross-linking procedure. The uncorrected visual acuity (UCVA) of patients 6 months after the surgery increased on an average up to 0.45±0.16 (preoperatively 0.32±0.14) and 24 months later – up to 0.5±0.14. The best corrected visual acuity (BCVA) improved as well, 6 months later and was 0.6±0.12 (preoperatively 0.5±0.16), 24 months later – 0.7±0.14.Conclusions. The cross-linking of corneal collagen is a safe and effective treatment method for progressive forms of keratectasia in children and teenagers and contributes to the stabilization of the disease.

Purpose. The aim of the study was to evaluate functional results of Keraring implantation with for keratoconus. Material and methods. Keraring implantation were performed in 46 patients (52 eyes) aged from 16 to 49 years, with progressive keratoconus of the degree I-III of Amsler classification with intolerance of contact correction. To assess the results before and after operation the patients received standard and special methods of research: computer keratotopography («ODPscan», Nidek, Japan), optical coherence tomography («OCT-3», Visante, Germany), corneal confocal microscopy (Heidelberg Retinal Tomographer HRT-III, «Heidelberg Engineering» (Germany) in pre- and post-operative follow-up: 10 days, 1, 3, 6 and 12 months. Results. Uncorrected visual acuity increased from 0.14±0.03 to 0.45±0.15, immediately after the operation. Keratometry value decreased from 54.27±0.91D to 43.61±1.24D. The magnitude of corneal astigmatism decreased from 6.45±1.23D pre-operatively to 4.25±0.96D one month after surgery, with a gradual decrease to 2.91±0.42D and 2.5±0.22D at 6 months and a year after implantation. Conclusions. The intrastromal corneal segments Keraring implantation is a technically simple, effective method of keratoconus treatment, which allows to adjust the associated keratoconic ametropia.

Background. The qualitative anterior capsulorhexis in cataract surgery in children with intraocular lens implantation is an important and crucial moment. Difficulties in carrying out capsulorhexis arise from the structural features of the lens capsule at this age. A search of new methods of the capsulorhexis formation in congenital cataract surgery with a more predictable result is an actual problem.Purpose. To study an effectiveness and a safety of the femtosecond laser in cataract surgery in children.Material and methods. The study was conducted in 29 children (30 eyes) with congenital cataracts aged from 2 to 6 years. In the group I the femtolaser capsulorhexis followed by aspiration-irrigation and IOL implantation was used in 14 children (15 eyes). In the group II, 15 children (15 eyes) underwent the manual circular continuous capsulorhexis followed by aspiration-irrigation of congenital cataract and lens implantation. The uncorrected visual acuity (UCVA) preoperatively in both (I and II) groups averaged 0.03±0.01 and 0.08±0.01, respectively.Results. In patients of the group I the femtolaser stage was unremarkable. Single subconjunctival microhemorrages were observed in 46.6% of the cases in the contact area of the vacuum ring. In 4 (26.6%) eyes after femtosecond capsulotomy a constriction of the pupil was observed.A centered anterior capsulorhexis of perfect round shape was obtained in all patients of the group I. In assessing the capsulorhexis diameter a slight increase around 100-200 microns was found intraoperatively. Single bridges that did not affect the shape, location and size of the capsulotomy were revealed during the removal of capsular flap in one case. During the manual capsulorhexis there was a tendency to runaway without going to the posterior capsule and the formation of a slightly decentered and oval capsulorhexis in patients of group II in 7 cases. Improvement of visual acuity was noted on the first day after surgery in both groups (p

Common association of keratoconus and connective tissue dysplasia indicates that these disorders possibly share etiology and pathogenesis. Connective tissue dysplasia is characterized by the decrease in certain types of collagen, abnormalities of their proportion, alteration of collagen synthesis and assembly, immature collagen synthesis, abnormalities of collagen fiber structure, defects of type III collagen synthesis, peptidase deficiency, and increase in pro-collagen as compared with collagen. The latter accounts for immature collagen level increase in tissues and organs and systemic congenital laxity of connective tissue. This results in the abnormalities of biomechanical properties of organs and tissues which are composed of collagen fibers. Corneal stroma consists of collagen fibers and glycoprotein matrix. Hence, quantitative and qualitative changes in connective tissue dysplasia affect corneal biomechanics. Abnormalities of collagen fibril orientation result in their reorganization thus influencing corneal shape and transparency. In keratoconus, decreased total collagen and type I, type III, and type IV collagen, increased type XV collagen, and abnormalities of their proportion in corneal stroma as well as allele differences in COL4A3 and CoL4A4 genes encoding 2 of 6 α-chains of type IV collagen were demonstrated. Nucleotide polymorphisms in LOX genes encoding lysyl oxidase and lysyl oxidase-like enzymes which are responsible for cross-linking of collagen polypeptide chains (and, therefore, mechanical strength of fibrils) were revealed as well. LOX gene deficiency that accounts for systemic biomechanical abnormalities was also recognized in certain connective tissue dysplasia. Further studies will provide early diagnosis and pathogenically target therapy of genetic disorders associated with tissue abnormalities

Photochemical crosslinking is widely applied in ophthalmology. Its biochemical effect is due to the release of singlet oxygen that promotes anaerobic photochemical reaction. Keratoconus is one of the most common corneal ectasia affecting 1 in 250 to 250 000 persons. Currently, the rate of iatrogenic ectasia following eximer laser refractive surgery increases due to biomechanical weakening of the cornea. Morphologically and biochemically, ectasia is characterized by corneal layers thinning, contact between the stroma and epithelium resulting from Bowman’s membrane rupture, chromatin fragmentation in keratocyte nuclei, phagocytosis, abnormal staining and arrangement of collagen fibers, enzyme system disorders, and keratocyte apoptosis. In corneal ectasia, altered enzymatic processes result in the synthesis of abnormal collagen. Collagen packing is determined by the activity of various extracellular matrix enzymes which bind amines and aldehydes of collagen fiber amino acids. In the late stage, morphological changes of Descemet’s membrane (i.e., rupture and detachment) develop. Abnormal hexagonal-shaped keratocytes and their apoptosis are the signs of endothelial dystrophy. The lack of analogs in domestic ophthalmology encouraged the scientists of Ufa Eye Research Institute to develop a device for corneal collagen crosslinking. The parameters of ultraviolet (i.e., wavelength, exposure time, power) to achieve the desired effect were identified. The specifics of some photosensitizers in the course of the procedure were studied. UFalink, a device for UV irradiation of cornea, and photosensitizer Dextralink were developed and adopted. Due to the high risk of endothelial damage, this treatment is contraindicated in severe keratoconus (CCT less than 400 microns). Major effects of corneal collagen crosslinking are the following: Young’s modulus (modulus of elasticity) increase by 328.9 % (on average), temperature tolerance increase by 5°C, and collagen fiber diameter increase by 12.2 % (anterior stroma) and 4.6 % (posterior stroma). In mild bullous keratopathy, corneal crosslinking provides antimicrobial effect. In moderate and severe keratopathy, crosslinking reduces pain and corneal edema and improves visual acuity immediately after the procedure. A case of HSV keratitis exacerbation was described. Amongst the complications, infection, halos, and posterior segment damage should be mentioned. Poor refractive results can be improved by the implantation of intrastromal corneal ring segments.

Purpose: To study complications at carrying out posterior capsulorhexis during phacoemulsification, clinical and ultrastructural features of a posterior len’s capsule.Methods: 82 patients (82 eyes) with an age cataract underwent phacoemulsification, IOL implantation and posterior capsulorhexisin the Ufa Scientific Research Institute of Eye Diseases. The technique of operation was traditional. The research of a capsular bag by electron microscopy was carried out on 8 cadaver eyes of the person of different ages (range 24 to 83 years).Results: The operational and postoperative complications, the received functional results in supervision terms till 3.5 years are described. Development of a secondary cataract and retina detachment was not registered. Laser interventions on a len’s bag was not required. High visual acuity was received. Researches of cadaver eyes of the person of different ages by electron microscopy revealed thinning and destruction of a len’s capsule at persons at senile age (after 75 years).Conclusion: Stable visual functions in the remote period allows to recommend posterior capsulorhexis during phacoemulsification. The fibrosis of posterior len’s capsule should be a compulsory procedure of phacoemulsification.

Aim. To analyze the efficacy of Ologen® Collagen Matrix Implant in refractory glaucoma surgery.Materials and methods. Classical non-penetrating deep sclerectomy (NPDS) with Ologen® implantation in the scleral bed was performed.Results. Post-op, implant was visualized underneath the conjunctiva and moved within the scleral flap. Implant was resolved in 3 months with moderate filtering bleb formation. Following 12 months, visual acuity and visual fields were stable, IOP level was 12‑17 mm Hg.Conclusion. Within 12‑months follow-up, Ologen® implantation in the course of glaucoma surgery prevents scleral conjunctival scarring, provides long-term IOP-lowering effect and preserves residual visual functions.