Search

Purpose: to study the effect of various methods of intraoperative keratoprotection on morphological and functional state of ocularsurface system (OSS) in early period after phacoemulsification (PE) in senile cataract (SC). Patients and methods. 240 patients (240 eyes) who applied for surgical treatment of SC. Age: 65 ± 4 years. 109 men, 131 women. All patients were divided into three observation groups according to the method of intraoperative keratoprotection: 1st group — 60 patients, corneal irrigation with balanced solution; 2nd group — 60 patients, ophthalmic viscosurgical device was applied to the cornea; 3rd group: 3a subgroup — 60 patients, soft contact lens (SCL) was applied to the cornea; subgroup 3b — 60 patients, SCL impregnated with riboflavin solution was applied to the cornea. In addition to the standard ophthalmological examination, Schirmer I test, OCT-scanning were performed, and tear breakup time (TBUT) was determined. Results. Operations were performed without complications. On the 1st day after the operation, the parameters of the Schirmer I test were higher in the eyes of 1st and 2nd groups. On the 5th day after the operation, tear production decreased sharply in all eyes. On the 10th day, an increase in tear production was observed in all groups, the maximum increase — in 3b subgroup. On the 1st day after the operation, TBUT decreased in all examined eyes. The largest significant TBUT decrease was noted in 1st group, the smallest — in 3b subgroup. On 1st day, corneal epithelial thickness (CET) decreased in all eyes, the maximum decrease was detected in 1st group. On the 5th day, CET continued to decrease in all eyes, the minimum decrease occurred in the 3b subgroup. On the 10th day — a decrease in CET in all groups with minimal significant dynamics in 3b subgroup. Conclusion. The study showed that the state of OSS in the early period after PE in SC depends on the method of intraoperative keratoprotection. The most optimal method of intraoperative protection of corneal epithelium and prevention of negative morphological and functional state of OSS after PE in SC is using of SCL impregnated with riboflavin.

Purpose. Demonstration of non-standard clinical case of removing large fragment of metal wire from the eye. Patient and methods. Patient, 37 years old, with penetrating right eye injury with intraocular foreign body (IOFB) introduction — a fragment of metal wire. After unsuccessful attempt to remove IOFB during primary repair of eye injuries lacerations by ophthalmologist of the surgical department of the district hospital, he was sent to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. On admission: VIS OD — 0.01 uncorrected, intraocular pressure (IOP) — 16 mm Hg (noncontact tonometer TOMEY, Japan). OD — metal IOFB protrudes by 1.0 mm from the corneoscleral laceration in projection of corneal limbus at the 13 o’clock position, postoperative aphakia; according to B-scan ultrasonic data: metallic foreign body of linear shape, 14.3 mm long, about 1.5 mm thick. There is hemorrhage in the vitreous cavity. Results. Initially, conditions for visualization of the vitreous cavity were created by performing 25G vitrectomy. The course of wire location was specified: under the choroid and retina, going out through the sclera in the equatorial region. After conjunctival tweezers expanded wound edges, the embedded fragment of wire was delicately remove: 25 mm in length and 2 mm in diameter. A single retinal break was delimited by cryotherapy and laser photocoagulation. On the 2nd day: VIS OD — 0.3 with diaphragm, uncorrected; IOP — 13 mm Hg. After 3 months: VIS OD — 0.01 sph + 13.0 D = 0.7, IOP — 14 mm Hg. Silicone removal was combined with intraocular lens implantation model RSP-3 (+23D). The next day: VIS OD — 0.3 with diaphragm, 0.5 cyl — 6.0 D ax 170 = 0.5; IOP — 16 mm Hg. Conclusion. Use of 25G vitrectomy for removal IOFB localized between the inner membranes of the eye created optimal conditions for visualizing depth of its penetration, which minimized traumatic impact and avoided severe intra- and postoperative complications.

Background. Particular vigilance in timely detection of retinal dystrophies (RD) in children is necessary as effective measure to prevent formation of rhegmatogenous retinal detachment. Purpose. To study frequency and structure of clinical forms of RD in children of different age groups to find out most typical age of their primary formation, to assess the proportion of their prognostically hazardous forms. Materials and methods. Clinical material — 314 children aged 5 to 17 years, on average 11.0 ± 0.6 years, who applied with various ophthalmological pathologies in the Department of Pediatric Ophthalmology of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from July 2020 to April 2021. All children underwent biomicroscopy, ophthalmoscopy with in-depth examination of the state of the equatorial and periphery parts of the retina in condition of maximum cycloplegia. All 4 quadrants of the fundus were examined using binocular indirect ophthalmoscope with 20D lens. The presence and frequency of RD, their clinical varieties, according to the classification of E.O. Saksonova (1979), were ascertained in each of the studied age groups. Their localization, their length, and eye refraction were also assessed. Results. Presence of RD was revealed in 34 (11 %) children. In structure of identified clinical forms of RD, 11 children had its prognostically non-hazardous forms of RD, 23 children had prognostically hazardous forms (33 % and 67 % respectively). According to our data, the earliest age of detection of RD was 6 years. Further progression of RD was noted in 2 out of 6 children after restrictive photocoagulation of prognostically hazardous forms of RD. Conclusion. Formation of RD occurs not only at puberty, but also at an earlier age, according to our data, from 6 years of age. In view of this, it is necessary to conduct a thorough ophthalmoscopic examination of the periphery parts of the retina, even in young children.

Color Doppler imaging became widespread for study hemodynamics in patients with vascular eyes pathologies. A number of studies have shown changes in ocular blood flow velocity and Doppler indices in patients with diabetes mellitus in both the absence and presence of diabetic retinopathy. With the progression of diabetic retinopathy, an increase in parameters’ changes was revealed, variations in ocular blood flow were studied after conservative treatment, retinal laser photocoagulation, against the background of anti-VEGF therapy. Due to its non-invasiveness, color Doppler imaging is used to assess orbital blood flow in pregnant patients at any gestational age. The works of this direction concern the assessment the changes in orbital blood flow during the physiological course of pregnancy and preeclampsia. However, there is still no information on the state of ocular blood flow in pregnant women with diabetes mellitus, which can serve as a basis for further research.

An increase in the incidence of optic neuritis among the working-age population, as well as an unpromising prognosis for vision due to the development of optic nerve atrophy, determines the high social significance of this problem. The aim of the work is to analyze the effect of Imunofan at the parameters of cellular immunity and clinical symptoms of the disease in the complex treatment of optic neuritis associated with herpes virus infection. The study involved 37 people (37 eyes) with acute optic neuritis associated with herpes infection. The treatment regimen included the appointment of a dexamethasone solution according to a decreasing scheme, a 1% solution of the drug Emoxipin 0.5 mL and a 12.5% solution of the drug Dicynone 0.5 mL through an irrigation system implanted in the retrobulbar space, in combination with the neuroprotection drugs (Pikamilon and Semax) for 10 days. All patients were divided into 2 groups. The main group consisted of 20 patients who received Imunofan to the treatment regimen in addition. The comparison group included 17 patients who were treated only according to the method described above. The course of treatment lasted 10 days. The analysis of the data showed a more significant positive dynamics of cellular immunity parameters in those who received immunotherapy. Our studies showed the effectiveness of this drug in the complex treatment of optic neuritis associated with herpes infection, what is confirmed by the acceleration of inflammation relief, a more significant increase in visual functions of patients treated with Imunofan, and a lower percentage of optic nerve atrophy. In this group of patients, changes in the parameters of the cellular link of immunity occurred earlier and remained stable throughout the entire period of observation. According to our data, an intergroup assessment of the immunoregulatory index showed its faster increase in patients of the comparison group who received Imunofan, and reached normal values already 6 months after treatment. The clinical effectiveness of Imunofan in the complex therapy of optic neuritis associated with herpes infection was characterized by a reduction in the period of relief of signs of inflammation in the optic nerve by 2 times or more, by an increase in the maximum corrected visual acuity by 4.5 times, and by a decrease in the incidence of recurrence of optic neuritis by 2 times over a 12 months observation period.

Purpose. To study the morphometric features of macular edema in occlusions of the retinal veins, to determine and systematize the conditional gradations of the degrees of its severity.Patients and methods. 67 patients (67 eyes) were recruited using a continuous sampling method. Their age ranged from 38 to 84 years (on average 60.0 ± 10.5 years). Among them there were 27 men and 41 women. In 19 patients, there was an occlusion of the central retinal vein (28 %), in 48 people — occlusion of its branches (72 %). The lesions of the superior temporal branch prevailed — 32 people (65 %), 16 patients had occlusion of the inferior temporal branch (35 %). Systematization of the obtained data was carried out with the allocation of morphometric gradations of the severity of macular edema against the background of retinal vein occlusions.Results. According to our data, the morphometric parameters of the macular retina in the presence of macular edema were characterized by a wide range of gradations in the thickness of the foveal retina and the volume of the macular retina (from 239 to 861 μm and from 10,4 to 17,4 mm3 respectively).The morphological features of macular edema in retinal vein occlusions are the formation of cystic cavities in the outer and inner layers of the retina, convex deformation of the retinal profile, and the development of neuroepithelial detachment in 21 % of cases. Taking into account the data obtained, we proposed a conditional morphometric classification of the severity of macular edema in retinal vein occlusions. A mild degree of macular edema was characterized by values of the foveal retinal thickness index up to 400 μm; for medium — from 401 to 600 microns; for severe macular edema — over 600 microns. In accordance with our own conditional clinical morphometric classification of the severity of macular edema, mild macular edema was determined in 32 %, medium degree — in 43 %, severe — in 25 % of patients’ eyes.Conclusion. The identification of various clinical and morphometric degrees of severity of macular edema, in our opinion, is of practical importance, since it will allow more optimal and objective selection of the most optimal treatment tactics, taking into account the individual morphometric characteristics of the patient’s macular region.

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan® in combined treatment of ON associated with herpesvirus infection (HVI).Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine® preparation 0.5 ml and 12.5 % Dicynone® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon® and Semax®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.Conclusion. The clinical efficacy of the drug Imunofan® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

Purpose. To analyze changes in work of the Khabarovsk branch of the Fyodorov Eye Microsurgery Federal State Institution (Khabarovsk branch) caused by combination of elective and emergency ophthalmic care in the context of a pandemic of the novel coronavirus disease (COVID-19).Material and methods. The article presents the organizational restructuring of activities medical units of the Khabarovsk branch, due to need for additional performance of functions emergency ophthalmological service in connection with closure of the regional ophthalmological center of the City Clinical Hospital no. 10, which previously performed this function. Complex of organizational anti-epidemic measures taken to prevent the spread of COVID-19 in pandemic is presented, their feasibility is analyzed, the results of the clinic’s activities in new conditions of the COVID-19 pandemic are reflected. Results. The COVID-19 epidemic required a significant organizational restructuring of the Khabarovsk branch. In addition to large volumes of elective surgery, emergency ophthalmosurgical care was added, performed in a round-the-clock hospital. All this was superimposed on the organizational restructuring of patient flows, created to minimize their interpersonal contacts.Conclusion. The Khabarovsk branch fully coped with the tasks set, stable work was organized in the new pandemic conditions, effectively combining planned and emergency algorithms of ophthalmic surgical care. The measures taken made it possible to provide emergency ophthalmic care in full throughout the entire period of the epidemic, to resume the provision of planned ophthalmic care in full, without compromising the safety of patients’ stay in the clinic.

Purpose. Evaluation of the first experience in organizing systematic telemedicine consultations/conciliums between the national medical research center and medical organizations in the territory of the Far Eastern Federal District (FEFD) of the Russian Federation. Material and methods. The analysis of organizational and technical difficulties in creating of stable system of planned and unscheduled telecommunication events between the Khabarovsk branch of the Fyodorov Eye Microsurgery Federal State Institution (Khabarovsk branch) and assigned to it medical organizations of the 3rd level, providing ophthalmological care for patients from 8 administrative territories of the FEFD. Results. Organizational and methodological department was created in the Khabarovsk branch, which clarified and eliminated the factors that impeded of telemedicine consultations/conciliums for ophthalmologists of medical organizations of the 3rd level; a set of organizational measures was taken to register these medical organizations in the Federal Register of Medical Organizations, in the Unified State Information System in the Field of Healthcare; the equipment necessary for communication was purchased and technically prepared; methodological assistance was provided in setting up equipment in the regions, including on-site visits; backup connections of several providers have been created; an algorithm for preliminary notification of regional ophthalmologists about the knowledge transmission has been worked out; an organizational algorithm for forming a request for telemedicine consultations has been tested. For 2019–2020 the Khabarovsk branch conducted 32 knowledge transmissions, 560 telemedicine consultations on patients living in the FEFD. Conclusion. The introduction into the daily clinical ophthalmologists practice in the FEFD of system of periodic telecommunication events between the Khabarovsk branch and assigned medical organizations of the 3rd level after the elimination of organizational and technical difficulties showed a high demand, allowing consultations on patient management in accordance with modern standards of ophthalmological care.

Background. Recently, more and more attention has been paid to the development of vascular retinal disorders after suffering preeclampsia. It is noted that the key role in this process is assigned to the systemic endothelial dysfunction that persists for a long time after delivery.Aim: to elucidate the features of vascular-platelet and coagulation hemostasis in relation to the indicators of blood flow in the macular region in women with preeclampsia.Materials and methods. The main group included 45 women with preeclampsia in the third trimester of pregnancy (35–36 weeks). Their age ranged from 19 to 40 years (27 ± 5.2 years). The comparison group was represented by 20 women with physiological pregnancy in the third trimester (35–36 weeks). Their age averaged 26 ± 5.1 years (18–38 years). Somatically healthy non-pregnant women (20 people) were included in the control group. Their age ranged from 19 to 38 years (26 ± 5.4 years). A comparative analysis of the studied parameters of macular blood fl ow, vascular-platelet and coagulation hemostasis between the groups was carried out.Results. When studying the number of platelets in pregnant women, it turned out that in patients with preeclampsia, this indicator was statistically signifi cantly lower compared to the comparison and control groups (p < 0.05). The level of fi brinogen in women with complicated pregnancies was statistically significantly higher than in women with physiological pregnancy and in somatically healthy nonpregnant women (p < 0.05). In addition, retinal microcirculation disorders were observed in women of the main group.Conclusions. The revealed disorders of vascular-platelet and coagulation hemostasis in women during the period of complicated pregnancy were accompanied by disorders of macular blood fl ow in the form of a decrease in the total average density of vessels in the superfi cial vascular plexus, subfoveolar thickness of the choroid and an increase in the area of the avascular zone relative to the group of women with physiological pregnancy and somatically healthy nonpregnant women.

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

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

Purpose. To study the influence of various types of «intraocular lens – posterior lens capsule» (IOL–PLC) interface on visual acuity (VA) and refraction pseudophakic eyes in early postoperative period after femtosecond laser-assisted cataract surgery in patients with senile cataract.Material and methods. The study included 133 pseudophakic eyes of 133 patients after femtosecond laser-assisted cataract surgery. The study did not include patients with uncorrected VA less than 0.8 on the first day after surgery; with eye axial length less than 22 and more than 26 mm; with initial posterior capsule opacification in the central area; with corneal pathology; with corneal astigmatism more than 1 diopters; with pseudoexfoliation, rigid pupil and zonal weakness and with severe somatic pathology and cognitive impairment.On the first day and one month after the surgery, corneal astigmatism, the spherical and cylindrical component of objective refraction, uncorrelated and best corrected VA were studied and the type of IOL– PLC interface was determined.Results. On the first day after the surgery, all studied eyes were divided into 3 groups depending on the type of IOL–PLC interface and dependence of postoperative refraction on relations between IOL and PLC was revealed. The greatest changes in astigmatism during month after surgery were detected in eyes with initial incomplete contact IOL with PLC and presence of folds of the latter. The most stable indexes of VA and refraction in pseudophakic eyes were in presence full contact IOL and PLC.Conclusion. Initial incomplete contact IOL and PLC was exerted greatest negative influence on VA and refraction, which led to deformation PLC in form of residual folds and local sections of fibrosis in the central area in 51 eyes (66.2%) duri ng month after surgery.

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

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

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

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

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

The purpose of study is to assess the clinical significance of microalbuminuria (MAU) in pregnant women with preeclampsia in formation of vascular eye pathology in long-term postpartum period.Material and methods. In retrospect, according to medical records, analysis of somatic condition of 114 women who had preeclampsia during pregnancy was carried out, and presence / absence of MAU during pregnancy were determined. MAU was detected in the 3rd trimester of pregnancy using test strips «Woerhringer Ingelheim» (Austria), considering the test to be positive with a value of 30 mg/day and more. The age of women at time of research was from 24 to 52 years, the period after suffering preeclampsia was 12.5 ± 6.5 years. Two groups were formed: the main – 35 women with initial MAU during pregnancy; the comparison – 79 women who had no MAU during pregnancy. The controls were 36 women with physiological pregnancy and delivery.Results and discussion. In period after delivery, vascular diseases of posterior eye segment occurred in 14 people in the main group (40 %) and 15 people in the comparison group (19 %). In the control group in this period, vascular pathology of posterior eye segment was formed in 2 women.Conclusion. Statistically significant increase of frequency of formation of vascular pathology of posterior eye segment in postpartum period was revealed in women, who had pregnancy complicated by preeclampsia and MAU in the 3rd trimester, which increased through 10 and more years after delivery. The initial presence of MAU during pregnancy can be the marker of increased risk of formation of vascular pathology of posterior eye segment at different periods of the postpartum period.

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

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

Purpose. Assessment of optimum quality in the work organization of the diagnostic department at the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, a detection of opportunities of its further development.Material and methods. The analysis of organizational structure and activity algorithms of the diagnostic department of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution was carried out in interrelations with various forms of payment.Results. Intensity of a daily flow of patients was 170-200 people. In their structure 80-90 individuals were invited for a treatment, 30-40 patients for a repeated appointment. Organizational measures allowed to reduce a duration of patients stay on the diagnostic examination line up to 10-15 min. In structure of a daily flow of patients the coordination department planned to invite 80-90 individuals for the surgery and conservative treatment, 30-40 patients – for the re-appointment after their performed treatment (surgery). A number of organizational arrangements allowed to reduce the duration of stay for one patient on the diagnostic line from 30- 60 min. to 10-15 min. (5-7 diagnostic examinations). Duration of passing of the diagnostic line in case of doctor consultations proceeded from 1 to 1.5 hours. The daily loading of diagnostic department already reached the maximum functional handling capacity (up to 200 patients a day) and now works at a peak of throughput opportunities. Frequency of refusal cases to perform the surgery was 13-15%.Conclusions. The Diagnostic Department of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution has accumulated a considerable experience; the optimum organization of work allows to increase its capacity up to 200 patients a day.

This review provides information on the evolution of ophthalmic and obstetric approaches to management of pregnancy, childbirth in women with high myopia. It shows the problem of prevention in the threat of development of rhegmatogenous retinal detachment in childbirth in conjunction with the development of the diagnostic capabilities of retinal disease. It gives an assessment to a role of peripheral vitreochorioretinal dystrophies (PVCRD), as a leading pathogenetic risk factor for retinal detachment in childbirth. The principal modern strategies of active management of pregnant women with PVCRD during pregnancy and childbirth are given. Indications for vaginal birth, or to the exclusion of vaginal birth if PVCRD are specified; there is given a modern assessment for the importance of the availability of high myopia in pregnant women.

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

Purpose: To research of frequency and structure of the complicated myopia among patients with myopia refraction.Methods: The myopia share was studied among all patients who have addressed in clinic in 2011. Profound survey of all cases of the complicated myopia was conducted, its structure and frequency of separate stages was analyzed.Results: In total in 2011, 1516 patients with myopia refraction (3028 eyes) addressed in clinic — 16 % of all patients. Signs of myopiachanges of eyeground were noted in 2225 eyes (73.4 %). Age: from 18 to 82 years (men — 463, women — 660). The I stage took place in 57.1 % of the cases, II and the III stages — in 7.2 % and 11 % of cases respectively. The IV stage is noted in 4.1 % of eyes, the V stage — in 3.3 % of eyes. Morphological implications of the expressed visual acuity decrease were extensive myopia staphylomas, macular neovascularization and its outcomes.Conclusion: Frequency of myopia made 16 % among all patients. 73.4 % of them had signs of various clinical implications of the complicated myopia, including 7.4 % with grave changes of an eyeground (the IV‑V stage).