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Glaucoma is worldwide the most common cause of irreversible blindness. Its prevalence in the population older than 40 years is about 3.5 %, and correlates with age. The most common type is primary open-angle glaucoma (POAG). The global prevalence of POAG is expected to grow from 76.0 million in 2020 to 111.8 million by 2040. In 2022, a total of 1,250,558 patients with glaucoma were registered in the Russian Federation, of which 110,680 had newly diagnosed glaucoma. The overall glaucoma incidence rate in Russia shows a steady growth: in 2022, it increased by 30 % as compared to 2013. In order to meet the challenge, medical care of glaucomatous patients is on the rise: the contingent receiving dispensary observation increased by 6.8 % over the last 10 years, whilst surgical treatment involved 28.1 % more patients.

Purpose. Analysis of modern aspects of cataract surgery from the standpoint of the medical and social model of health.Methods. The analysis of literary data was performed in the RSCI and PubMed databases using the following keywords: “Medical model of health”, “Medical and social model of health”, “Phacoemulsification of cataracts” (PCE), “Quality of life” (QOL), “Calculation of intraocular lenses” (IOL), “Visually intense work”, “Ophthalmo-ergonomics”. The duration of the main retrospective analysis was 8 years (2017–2023) with citation (if necessary) of individual earlier sources.Results. Based on the analysis, the following main modern aspects of cataract surgery were identified from the standpoint of the medical and social model of health: QOL study; assessment of ophthalmo-ergonomic indicators; medical and psychological aspects (correction of postoperative pain syndrome and dry eye syndrome, neuroadaptation after implantation, primarily trifocal IOLs, patient anxiety level).Conclusion. Currently, the PCE procedure is almost completely optimized from a technical point of view. In this regard, consideration of the PCE effectiveness from the standpoint of the medical and social model of health seems relevant, since the main task of this model is the complete integration of an individual into society. The basic indicator reflecting the clinical effectiveness of PCE from the standpoint of the medical and social model of health is QOL. In this direction, the practical application of the «FEC-22» QOL assessment technique will ensure an increase in the level of clinical diagnostic research in cataract surgery when solving a number of urgent problems — comparative evaluation of IOLs, study of the effectiveness of postoperative rehabilitation methods for patients, selection of the optimal formula for calculating IOLs. In addition, from the standpoint of the medical and social model of health, further improvement of the ophthalmo-ergonomic indicators of the visual system and medical and psychological aspects associated with the patient is advisable. Ultimately, the development of a comprehensive system of measures to improve the clinical and diagnostic effectiveness of phacoemulsification based on the medical and social model of health will improve the level of ophthalmological care and prolong the professional longevity of patients (especially those with visual impairment) with cataracts.

Vitrectomy followed by endotamponade of the vitreal cavity with silicone oil (SO) is one of the main techniques of treating severe forms of regmatogenic retinal detachment (RRD). Endotamponade with SO, having numerous advantages and a huge potential, carries the risk of a number of complications arising at various times of application. The literature review analyzes the published data on the effect of tamponade SO on the retina and the function of central vision in RRD surgery: visual acuity, indicators of light and color sensitivity, data of electrophysiological test results. Possible causes of deteriorated central vision functions directly or indirectly related to tamponade with SO are discussed: changes in the thickness and structure of the retina or its individual layers as shown by optical coherence tomography (OCT) data, microcirculation disorders according to OCT angiography, fluorescein angiography, Doppler laser scanning, as well as pathohistological findings related to SO migration into the fundus of eye tissues.

The medical industry is undergoing an active digital transformation, including the creation of electronic databases, cloud security systems, mobile health monitoring devices, and telemedicine tools. Artificial intelligence (AI), one of the most important technological achievements of the last decade, is gradually gaining momentum in various areas of practical medicine. The cutting edge of AI, neural networks, offers promising approaches to the improvement of clinical examination quality. The review presents data of studies focusing on the use of AI tools in the diagnosis of the most common ophthalmic diseases: diabetic retinopathy, macular degeneration, retinopathy of prematurity, glaucoma, cataracts, and ophthalmic oncology. We discuss both the advantages of neural networks in the diagnosis and monitoring of eye diseases, and outline the difficulties of their implementation, including ethical and legal conflicts.

Justification and purpose of the study. Changes in the vessels of the ocular surface are often associated with the presence of various systemic or ocular diseases. Segmentation of the vessels of the ocular surface using artificial intelligence (AI) tools is highly relevant in terms of improving the quality of early diagnosis of pathology. Purpose: to develop a model of segmentation of the capillaries of the ocular surface based on images from an ophthalmic slit lamp using AI tools using Python.Materials and methods. The study used a dataset (700 eyes), which is publicly available on the Internet and includes photos from an ophthalmological slit lamp, marked up manually. With the help of the augmentation method, this set for research has been increased several times. The system of segmentation of the capillaries of the eye in the images from the ophthalmological slit lamp is based on the trained neural network Unet.Results. The main result of the study is the development of an algorithm for automatic segmentation of eye capillaries in images from an ophthalmic slit lamp. The metric reached 85% during the training of the neural network model.Conclusion. The high efficiency and potential of all methods in the construction of an automatic segmentation system of the capillaries of the ocular surface in the images within the framework of the developed in the Helmholtz National Medical Research Center of Eye Diseases automated system of medical decision-making. In the future, this service can be used to improve the effectiveness of early diagnosis and monitoring of treatment of eye diseases in conditions of reduced availability of primary ophthalmological care in part of the territories of the Russian Federation, including at the pre-medical stage.

Purpose: to study the relationship between the parameters of reflex and tonic accommodation measured using various objective methods.Material and methods. A comprehensive parallel study of objective accommodation parameters of 57 children (114 eyes) with low and moderate myopia (average -2.6 ± 1.4 D) aged from 8 to 12 years (average 9.9 ± 1.6 years) was carried out on three devices: Grand Seiko WAM-5500K, Acomoref 2 K-model Righton; TONOREF III, Nidek.Results. Both coincidences and differences of the indicators obtained by different methods as well as their correlations were revealed: positive - between the values of AR in the open field and in the virtual space (r = 0.23, r = 0.2); between the virtual responses to Righton K-2 and Nidek (r = 0.38); direct correlations of the accommodation response with accommodation tones. A correlation of average strength (r = 0.44) was found between the HAT on the Grand Seiko WR-5100K and the CMF on the Righton K2, which allows us to consider them as synonymous indicators. A negative relationship of CMF with PRA and SE refraction was found. A positive correlation of CMF with the rate of progression of myopia and a negative one with PRA suggests that a high CMF is a bad prognostic sign. However, CMF positively correlates with the magnitude of the accommodative response on all three devices. In this case, it turns out that an increase in CMF accompanies an increase in the amplitude of accommodation and, therefore, is not always a troublesome factor. Perhaps we are dealing with the limits of the norm for this indicator, which still need to be studied.Conclusion. With the help of objective methods of studying qualitatively different characteristics of one process, it is possible to investigate the actual and prognostic parameters of accommodation, which will allow us to offer an individualized approach to the treatment of patients with myopia using optical and drug instruments.

Purpose: to assess the possibility of using thioctic acid and indomethacin tin eyedrops for the therapy of early stages of retinal neurodegeneration.Material and methods. The study was performed on 20 Chinchilla rabbits, including 16 rabbits in whom the neurodegenerative process in the retina was produced by intravitreal installation of 6-hydroxydopamine (6-OHDA), 0.25 mg per eye, and 4 rabbits (8 eyes) served as control. Thioctic acid 0.5% and Indocollir 0.1% were instilled separately and in combination 5 times daily for 7 days after the injection of 6-OHDA. Pupillary light reaction was estimated and eye fundus condition analyzed. Alpha2-macroglobuline ( 2-MG) and SOD activity, dopamine and protein concentrations were measured in retinal homogenates.Results. Instillations of thioctic acid reduced the retinal damage area almost by half as compared to the untreated group (p d 0.005). Indomethacin was less effective, but the combination of the two drugs brought about a maximal reduction of the damage area (p d 0.05 against the untreated group). Both preparations normalized the disturbed pupillary light reaction. The injection of 6-OHDA caused a decrease of dopamine concentration in the retina (0.050 ± 0.009 pg/mg as against 0.095 ± 0.031 pg/mg in healthy controls, р d 0,05). After instillations of indomethacin and thioctic acid, the concentration tended to increase, and it increased significantly after treatment with their combination (0.141 ± 0.037 pg/mg, p d 0.01 as against untreated animals). The activity of 2-MG in retina decreased after a 6-OHDA injection (2.93 ± 0.42 pg/mg as against 5.5 ± 1.2 pg/mg in healthy controls, р < 0 005) just as they increased the decreased SOD (13.30 ± 5.68 U/mg in healthy controls, 5.41 ± 1.50 U/mg in untreated animals, р < 0.05). Both preparations applied separately or in combination caused a significant increase of 2-MG activity (thioctic acid — 4.19 ± 0.91 pg/mg, indomethacin — 6.95 ± 1.09 pg/mg, combination — 7.25 ± 0.63 pg/mg, р < 0.05 as against the untreated animals) and SOD activity (thioctic acid — 8.25 ± 1.27 U/mg, indomethacin — 29.84 ± 6.63 U/mg, combination — 23.99 ± 3.78 U/mg, р < 0.01 as against the untreated animals).Conclusion. The combination of indomethacin and thioctic acid in eyedrops is the most effective for the prevention of eye damage caused by 6-OHDA, which makes this method promising for the treatment of eye diseases accompanied by neurodegeneration.

The high prevalence of primary open-angle glaucoma, its leading role in the structure of visual disability, and insufficient effectiveness of treatment, prevention and rehabilitation measures require new approaches to providing quality care of patients with glaucoma. It is important to analyze the epidemiological situation, human and technological resources in various regions of the Russian Federation. The paper evaluates the compliance of specialized medical care of patients with glaucoma with the approved clinical guidelines CR 96 “Primary open-angle glaucoma” in the regions of the Russian Federation monitored by the Helmholtz National Research Center for Eye Diseases, based on the material of on-site data collection visits. The epidemiological situation relating to glaucoma, the structure and performance indicators of ophthalmological service departments, preventive measures, human and material resources, and the correctness of statistical accounting and reporting were studied. In most regions, the times of examination and treatment correspond to the regional territorial programs covered by state guarantees. The cases when primary specialized care lags behind is associated with staff shortage at the outpatient level. Practically in all regions of the Russian Federation, diagnostic methods and conservative/surgical treatment techniques with proven high efficiency conform to CR 96/1 “Primary open-angle glaucoma”. Some of the regions, however, are insufficiently equipped for early diagnosis of glaucoma and monitoring its course.

Purpose: data analysis of Russia’s first register of neovascular age-related macular degeneration (nAMD) — a web-based system for clinical monitoring of nAMD patients designed to collect and accumulate the data on such patients, their demographic, social and clinical characteristics, on the existing practice of treating nAMD, assessing the effectiveness of anti-VEGF therapy and the burden inflicted by the disease. Material and methods. A non-interventional, multicenter prospective study (CRTH258ARU01) was undertaken, which involved primary collection and reuse of data. The study is referred to as “the Russian register of patients with neovascular age-related macular degeneration”. The patients’ case histories served as the primary source of information as the data contained therein were entered by the doctors into electronic individual registration cards (eIRC). The eIRC were used remotely for dynamic clinical observations and data analysis. 61 ophthalmologists from 34 Russia’s scientific or medical organizations engaged in diagnosing, follow-up and treatment of nAMD patients contributed to the register. The data for the register were collected from December 20, 2020 to December 5, 2022. The register has data on 2665 patients (3460 eyes). Results. The mean age (± standard deviation) of patients at the time of inclusion in the registry was 73.0 ± 8.8 years; the majority of patients (66.2%) were female. The average yearly number of follow-up visits per patient was 3.4 ± 2.7, while the average yearly number of injections of anti-VEGF drugs per eye was 2.0 ± 1.7. Conclusion. With the creation of the register, the main goals of the study have been achieved. On the other hand, the register showed that a significant share of nAMD patients/eyes evaded medical observation, and that the patients’ adherence to treatment was insufficient, which had a notable negative impact on the results of therapy in real clinical practice

Purpose: a comparative analysis of biometric parameters of the optic nerve obtained by different diagnostic ultrasound sensors.Material and methods. We examined 20 healthy volunteers with emmetropia aged 20 to 40 years (40 eyes), average age 30.5 ± 5.4 years, who had no complaints or ophthalmic pathologies. Ultrasound scanning was performed on a multifunctional Voluson E8 (GE) scanner (11–18 MHz linear sensor), ophthalmic ultrasound device Ellex Eyecubed (a conventional 10 MHz transducer) and an ophthalmic scanner Absolu «Quantel Medical» (a 20 MHz transducer). All examinations were carried out by one operator who used the same scanning technique and measured the optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) without sheaths in both eyes. Six consequent measurements of the ONSD and the OND parameters were performed to ascertain the reproducibility of the examinations and evaluate the variation coefficient.Results. The analysis revealed no statistically significant differences in the ONSD and in the OND obtained with 11–18 MHz, 10 MHz and 20 MHz transducers in the B-mode (р > 0.05). The minimum variation coefficient of the optic nerve thickness parameters was registered using a high-frequency 20 MHz transducer on the ophthalmic scanner. The biometry obtained with a high frequency 20 MHz transducer could be considered as the most reproducible.Conclusion. A high frequency 20 MHz transducer can be recommended for optimal visualization and precise evaluation of biometric parameters of the retrobulbar part of the optic nerve. Transducers of multifunctional scanners with the frequency range from 11 to 20 MHz can be used for measurements of the optic nerve sheath diameter.

Purpose: to evaluate the results of gene therapy by the recombinant adeno-associated viral vector voretigene neparvovec (VN) in children with follow-up periods of 1, 3, 6, and 12 months.Material and methods. The study included 6 children (12 eyes) aged 5 to 15 with a confirmed biallelic mutation in the RPE65 gene, treated with VN (Luxturna, USA). Treatment efficacy was assessed by surveying which included questions on spatial orientation under various types of illumination, Goldman perimetry, microperimetry, best corrected visual acuity (BCVA), electroretinogram (ERG), and visual evoked potentials (VEP). To assess the structure of the retina, the central retinal thickness (CRT) was evaluated by optical coherence tomography.Results. All children showed subjective changes in visual perception, including improved orientation in the dark and twilight, and improved contrast. In one case, the child with initially low visual acuity showed improved visual fixation. In 4 patients out of 6 (8 eyes), an expansion of the visual fields was noted, including 2 cases who displayed significant expansion thereof. In 2 patients (4 eyes), the visual fields were not narrowed and remained so throughout the entire observation period. Mean light sensitivity of the retina in 3 patients and fixation indices in 1 patient improved significantly as shown by microperimetry. BCVA remained stable throughout the study or changed insignificantly. Initially, ERG could not be detected in 8 eyes, but after an VN injection, 6 eyes demonstrated a partial recovery at different times — from 1 to 12 months. An increase in the amplitude of the P1 component to pattern VEP and P2 component to flash VEP was observed in all patients, which indicates an enhanced activity in the projection of the visual cortex after the restoration of the visual cycle. No significant changes were revealed in CRT (p = 0.9). Complications and adverse events were noted in 9 eyes (75 %): chorioretinal dystrophy at the injection site in 3 patients (5 eyes), multifocal nummular dystrophy in 2 patients (4 eyes), local episcleritis in 1 eye, transient increase in intraocular pressure in 2 patients (3 eyes).Conclusion. The results of a one-year post VN treatment follow-up of Russian patients with RPE65-associated inherited retinal disease demonstrate stabilization and improvement of visual functions, which is especially important for otherwise incurable patients with a progressive course of the disease.

In Russia, a complex approach to diabetes mellitus and diabetic retinopathy (DR) treatment is adopted, yet certain issues remain in the system of medical care for DR patients. The statistical data are important to assess the availability and quality of medical care in each region of the Russian Federation, to plan resource distribution, and determine the volume of medicinal and technical support. The article presents an analysis of the territorial differences of DR prevalence and of dispensary follow-up of DR patients. In order to eliminate certain territorial defects in the organization of medical care for such patients, an improvement of outpatient medical aid organization and a more effective interaction between ophthalmological and endocrinal health services is required.

The importance of early detection and monitoring of retinal diseases determines the relevance of the study devoted to the diagnosis of retinal pathologies by OCT images using artificial intelligence (AI) tools.The purpose is to develop algorithms for diagnosing retinal pathologies from OCT images by machine learning methods.Material and methods. The study used a dataset (20,000 eyes), publicly available on the Internet, which contains OCT images of healthy retina (5,000 eyes) and retina affected by three different pathologies (choroid neovascularization, macular edema, multiple drusen, 15,000 eyes). The retinal pathology recognition system is based on a trained neural network VGG16 (developed by a visual geometry group of Oxford University).Results. The main result of the research is the development of an algorithm, implemented on Python, for the diagnosis of retinal diseases from OCT images based on convolutional neural network AI tool. The sensitivity and selectiveness of the neural network model during the diagnosis of retinal diseases were 97 and 98%, respectively.Conclusion. AI methods used in the retinal pathology automatic detection system developed at the Helmholtz National Medical Research Center of Eye Diseases as part of automated medical decision-making system have been shown to have high potential and efficiency. In the future, this service can be used to improve the effectiveness of early diagnosis and monitoring of retinal diseases in conditions of reduced availability of primary ophthalmological care in some of the territories of the Russian Federation, including that provided at the pre-doctoral stage.

Purpose: to study the prevalence of various chronic infections, the frequency of their reactivation and characteristic associations of microorganisms in patients with optic neuritis of various etiologies.Material and methods. 13 patients with optic neuritis (ON) and 12 patients with ON and multiple sclerosis were tested for a broad range of infectious agents in their blood serum.Results. All patients were shown to have mixed infections; 64 % of them had an association of 4 or more infectious agents. The patients of both groups were infected with Epstein-Barr virus (100 %), Cytomegalovirus (92 %) and Herpex simplex viruses (92 %) types 1 and/or 2 with serological signs of their reactivation. The combination of Herpes virus reactivation, Toxoplasma and urogenital infection was more often detected in patients with demyelinating ON. In patients with multiple sclerosis, a mutual correlation was detected: the higher the degree of infection (combination of 5 or more pathogens), the lower the visual acuity at the onset of the disease (p < 0.05) and the less favourable the vision prognosis.Conclusion. Possibly, mixed infection may play an important role in the pathogenesis of ON, including that of demyelinating etiology, as a trigger or an aggravating factor.

Purpose: to determine the efficacy and safety of fixed latanoprost/dorzolamide combination Dorzoprost in hypotensive treatment of primary open-angle glaucoma (POAG) patients previously treated with latanoprost.Material and methods. An observational study included 30 patients (37 eyes) with moderate and advanced POAG who had uncompensated elevated IOP receiving latanoprost monotherapy. During the screening visit, latanoprost was switched to Dorzoprost instilled once in the evening. The targets were IOP, visual acuity, MD and PSD perimetry indices, retinal nerve fiber layer thickness, minimum width of the neuroretinal rim, macula retinal nerve fiber layer thickness, and adverse events. The observation period lasted 12 weeks. IOP was measured at weeks 4 and 12.Results. After 4 weeks, a statistically significant decrease in IOP was noted, which remained stable at 12 weeks. The average additional IOP decrease of those treated with Dorzoprost was 17%. Statistically insignificant positive changes were registered in visual acuity, static perimetry and optical coherence tomography. By the end of the observation period, 6 cases revealed a decrease in the degree of conjunctival hyperemia, while all dry eye syndrome cases (5 patients) showed a decrease in the severity of the signs of the syndrome.Conclusion. Dorzoprost has a significant additive hypotensive effect and a favorable safety profile.

Purpose: сomparative clinical and diagnostic efficiency of the quality of life (QОL) according to the PHEC-22 and Catquest-9SF questionnaires after bilateral cataract phacoemulsification and monofocal IOL implantation. Patients and Methods. We observed 148 patients with binocular cataract (mean age 58.6 ± 1.8 years). All patients underwent standard cataract phacoemulsification with implantation of a monofocal IOL. Patients were examined before and after (one month after surgery on the second eye) surgery. The results of the survey on the questionnaires PHEC-22 and Catquest-9SF were evaluated by the general indicator of testing (GIT) as the sum of points for all questions (taking into account the “weight” coefficients in the questionnaire PHEC-22). Along with this, each of the patients underwent a study of binocular BCVA. Results. A statistically significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire compared to Catquest-9SF was established, which is confirmed by a higher (by 0.17 rel. units, p < 0.01) level of correlation with BCVA, as well as a higher probability of compliance of the QOL level with the BCVA range, especially at low (0.4 and less rel. units, by 18.5 %, p < 0.01) and medium (0.5–0,8 relative units, by 7.3 %, p < 0.05) values of BCVA, while in the range of BCVA 0.9–1.0 relative units, no significant differences between the questionnaires were found (p > 0.05). Conclusion. The results of a comparative study after bilateral cataract phacoemulsification and monofocal IOL implantation using the PHEC-22 and Catquest-9SF questionnaires revealed a significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire, which is associated with the methodological principles for developing a questionnaire based on the “social model” of health with the involvement of expert ophthalmologists and the use of the optimal procedure for scaling the patient’s responses. The results obtained (taking into account clinical normalization) allow us to recommend the PHEC-22 questionnaire for inclusion in the complex diagnosis of patients with cataracts both before and after surgery in solving a number of urgent problems — a comparative assessment of IOL, a study of the effectiveness of methods for postoperative rehabilitation of patients, the choice of the optimal formula for calculating IOL and some others.

Purpose: to compare anatomical and optical parameters and aberrations of both eyes in patients with acquired and congenital anisometropic myopia.Material and methods. 22 patients (44 eyes) aged 18–35 (averagely, 25.2) with acquired and congenital anisometropic myopia were examined using the Galilei G6 optical eye system analyzer (Ziemer, Switzerland). The analysis of total, corneal and internal aberrations of the eye was carried out on an OPD-Scan III (Nidek) aberrometer.Results. In both groups with acquired and congenital anisometropic myopia, the axial length of the higher myopic eye was greater than that of the fellow eye. A greater asphericity and higher astigmatism of the cornea were revealed in higher myopic eyes of patients with congenital myopia as compared to acquired myopia. The total RMS HOA in congenital myopia was significantly greater in the higher myopic eye compared to the fellow eye (1.07 D and 0.68 D, respectively) and greater than in cases of acquired myopia. All HOA were greater in higher myopic eyes as compared to the fellow ones in cases of congenital myopia. In case of acquired myopia only the total coma appeared to be greater in the higher myopic eye. Corneal aberrations in acquired anisometropic myopia did not differ in the paired eyes. In case of congenital myopia, the total tilt was significantly greater in the higher myopic eye, and total coma and spherical aberration have lower values, even with a transition to negative ones (p < 0.05).Conclusion. The revealed differences of the wavefront of the eyes with anisometropic congenital and acquired myopia are rather a consequence of anatomical and optical differences (the axial length of the eyes and the topography of the cornea), than the cause of anisometropia.

Purpose: to determine objective echographic criteria for the differential diagnosis of anterior ischemic optic neuropathy (AION) and optic neuritis (ON).Material and methods. The research involved 60 patients aged 40 to 60 years, including 30 patients with suspected AION and 30 patients with suspected ON. The control group consisted of 40 healthy volunteers. In addition to the standard ophthalmological examination, all patients underwent ultrasound optic nerve s examination with measurement of the optic nerve thickness and acoustic density (AD) of the parenchyma and optic nerve sheets. Assessment of blood flow in retrobulbar vessels was carried out in the modes of Color Doppler Imaging and pulse dopplerography.Results. There were no statistically significant differences in average echographic parameters of the optic nerve s thickness between the groups of patients with AION and ON. In patients with ON there was a statistically significant decrease in the average AD index compared to that in patients with AION and in healthy volunteers (106.02 ± 5.40 y. e., 146.58 ± 9.70 y.e. and 135.3 ± 2.1 y. e., accordingly). The AD values in all patients with AION exceeded 133 y. e., in patients with ON this index was less than 132 y. e. Evaluation of hemodynamic parameters in the vessels of the eye demonstrated a statistically significant decrease in the peak systolic velocity (Vsyst) and end-diastolic velocity (Vdiast) blood flow in the central retinal artery and medial and lateral short posterior ciliary arteries in patients with AION (in 2-fold) compared with ON and normal indices (p < 0.001). There were no statistically significant differences between parameters of blood flow in patients with ON and in healthy volunteers. In addition, there were no significant intergroup differences of hemodynamic parameters of the ophthalmic artery (p > 0.05).Conclusions. AD of the optic nerve and parameters of blood flow velocities (Vsyst and Vdiast) in medial and lateral short posterior ciliary arteries can be attributed to the diagnostic criteria of the AION and ON.

In the ground sealed station crew, during the 8 months international experiment SIRIUS 20/21 simulating an interplanetary flight, electrically induced phosphene (EIP) thresholds, which reflected the electrical sensitivity (ES) of the retina, and the optic nerve. ES&L was assessed using the “ESOM” device (“Neuron”, Ufa, Russia) once a month, twice a day (morning/evening), under mesopic conditions. An increase in ES and other patterns of changes in ES&L parameters during period of isolation were established, reflecting the adaptation of the crew to the conditions of the experiment and the reaction of the visual system to physical and psycho-emotional stress. Further study of the thresholds of the EIP and L of the optic nerve in experiments of increasing duration will make it possible to determine the biomarkers that differentiate the individual adaptive reaction of astronauts from dysfunction of the retina and optic nerve under real space flight conditions. The L of the optic nerve showed greater resistance to experimental conditions than the ES of the retina. The results suggest that the determination of the L in the ES&L test can become an express test on board the ISS to assess the functional state of the papillomacular bundle of optic nerve fibers, the risk of developing or diagnosing SANS (flight-associated neuro-ocular syndrome) in long-term space missions.

Neurodegenerative ophthalmopathology is one of the main causes of irreversible blindness and disability in the world. In the pathogenesis of diseases of this group, more and more attention has recently been paid to the role of local inflammation caused by the activation of innate immunity and the mechanisms of its genetic regulation. In recent years, works have appeared in the field of experimental ophthalmology that have demonstrated the possibility of NLRP1, NLRP3 inflammasome complexes assembling when exposed to hyperglycemia, oxygen deprivation of retinal cells, as well as modeling compressive stress similar to that in glaucoma [15]. However, the mechanism of inflammasome involvement in the development of neurodegenerative eye diseases remains unclear. The aim of the study was to investigate the local expression of genes encoding proteins of the NLRP3 inflammasome complex (NLRP3, CASP-1) in an experimental model of retinal degeneration in rabbits. The studies were performed on samples of tissue complex (TC) of the retina/retinal pigment epithelium (RPE) (retina/RPE TC), isolated from the eyes of 14 New Zealand albino rabbits, in which degenerative retinal lesion was modeled by a single subretinal injection of 0.01 mL of 0.9% sodium chloride solution, and 7 healthy rabbits without eye damage. The formation of retinal degeneration was judged on the basis of changes in morphofunctional parameters obtained during specialized ophthalmological research methods (optical coherence tomography, fundus autofluorescence, electroretinography) at follow-up periods of 1, 3 and 6 months. The level of expression of NLRP3 and CASP-1 genes in the retina/RPE TC was evaluated by reverse transcription polymerase chain reaction (RT-PCR). According to the results of the study, a statistically significant increase in NLRP3 gene expression (p < 0.001) was noted in the retina/RPE TC of experimental animals, which may indicate the involvement of NLRP-3 inflammasome components in the development of neurodegenerative retinal lesions. At the same time, the expression of the gene encoding CASP-1 was detected only in the retina/RPE TC of experimental eyes and is probably due to local inflammatory mechanisms in the retinal tissue.The high level of NLRP3, CASP-1 mRNA, detected in all retina/RPE TC samples of experimental eyes at late stages of the experiment (3 and 6 months), allows us to assume the formation of mechanisms (for example, activated glial phenotype) that support inflammation in retinal tissue. This should be taken into account in actively developing transplantation methods for the treatment of retinal degeneration.

Axial myopia is a risk factor for the development of many concomitant pathological conditions, including those likely to lead to an irreversible loss of visual functions. Until now, specialists disagree about the terminology and the approaches to classification of pathological myopia. We propose a critical analysis of the state-of-the-art research and use them to offer, the definitions of such conditions as “myopic macular degeneration (myopic maculopathy)”, “myopic choroidal neovascularization” and “myopic traction maculopathy” and recommend them for use in the healthcare system of the Russian Federation

High myopia is a common ametropia associated with a significant risk of multiple comorbidities. Decreased visual functions of myopic patients may be caused by non-specific diseases such as cataracts, glaucoma and rhegmatogenous retinal detachment, which are very likely in myopia. Yet especially important are the specific changes such as atrophic, traction and neovascular manifestations of pathological myopia, the totality of which is defined as myopic macular degeneration or myopic maculopathy. The review highlights current approaches to the diagnosis and treatment of various diseases associated with high myopia, including original schemes for managing patients with myopic choroidal neovascularization and myopic traction maculopathy, developed by experts from the Expert Council on Retinal and Optic Nerve Diseases of the Russian nationwide public body Association of ophthalmologists, and includes an information leaflet for patients.

Myopic refraction is the most common ocular pathology, currently affecting about 1.5 billion people worldwide. Recent decades have seen a trend towards a significant increase in myopia prevalence, which is likely to continue in the near future. Therefore, we observe some kind of an epidemic of myopia. The greatest concern is caused by cases of uncorrectable visual impairment associated with myopia, which make pathological (degenerative) myopia one of the leading causes of low vision and blindness in many countries. At the same time, there is still no uniform interpretation of such important concepts as “high myopia” and “pathological myopia”, which can negatively affect various aspects of clinical and scientific interaction among ophthalmologists. The article provides an overview of modern work on the above issues and proposes definitions of terms to be used in the healthcare system of the Russian Federation

Purpose: to analyze social media messages of patients with neovascular age-related macular degeneration (nAMD) and diabetic retinopathy (DR), or their careers in order to investigates the patients’ opinion in the condition of real clinical routine. Material and methods. Real-life anonymized stories of patients from Russian-language open Internet sources (forums, social networks in Russia) were processed by artificial intelligence techniques: the technologies of automated analysis of unstructured natural language texts, including semantic technologies. In these messages, patients and their careers (mainly, family members) openly and in an ‘uncensored’ way share their experience in diagnostics and treatment while looking for a second opinion or supporting each other. They use general social networks as well as specific disease-related forums or Q&A portals. We identified 73 098 DR/nAMD-related posts, including 13 138 posts by 844 DR patients and 358 posts by 212 nAMD patients. The posts were analyzed in several steps with the technologies of automated analysis of unstructured natural language texts including semantic technologies aimed at processing large volumes of data. The semantic analysis of texts dealt with the whole meaning rather than individual keywords. Results. We obtained information on the patients’ characteristics and treatment plans of retinal diseases in real practice but also on the patients’ attitude to their condition, diagnostic and curative procedures, their needs and difficulties experienced during treatment. The nAMD and DR patients have a low level of Internet activity and poor awareness of these diseases as compared with the patients suffering from non-ophthalmological diseases with lower prevalence (breast cancer, multiple sclerosis, etc.) or other ophthalmological disorders. Most of the content for DR was produced by the patients’ relatives (82.6 % of messages), and for nAMD — by the patients themselves (65 %). The key item for DR patients was diabetic microvascular manifestations (over 42 000 posts discussed ‘diabetic foot’ and only 681 ‘diabetic retinopathy’). Quality of life (QoL) was shown to be significantly affected with inability to work as a major burden for 30 % of nAMD patients, and diabetes-associated comorbidities as a key factor compromising QoL in 20 % of DR patients. In nAMD patients, the average time-to-diagnosis after disease manifestation was 1 year (35 % patients reported 1–2 months), in DR, over a half of the messages mentioned 1–2 years. The key reasons for visiting the clinics included in-depth eye exams (OCT mentioned by 59 % of nAMD patients) and treatment (24.1 %). Only 33.2 % of nAMD patients and 7 % of DR patients noted that they received anti-VEGFs. Treatment unaffordability is one of the key barriers. The patients lack clear understanding of the prognosis and effective treatment options. Conclusion. The study revealed low activity and awareness of nAMD and DR patients with regard to their diseases. This justifies the need of increasing computer literacy and awareness of effective treatment options and efficacy criteria not only in patients, but also in their younger relatives. The results confirm that, among the studied group of retinal patients, vision-related quality of life is compromised. We need to change at least several aspects of nAMD and DR patients’ management: reducing the time to diagnosis, prescribing effective treatment options and increasing the availability of these options.

Purpose: to develop objective acoustic criteria of the condition of the optic nerve and its sheaths for an early diagnosis of intracranial hypertension (IH). Material and methods. The research involved 24 patients (average age 35.8 ± 8.5 years) with suspected IH. The control group consisted of 48 healthy subjects (average age 28.5 ± 9.5 years). Ultrasound examination of the retrobulbar part of the optic nerve (ON) included the measurement of the ON thickness with sheaths (ONSD) and without sheaths (OND) and the calculation of the ratio K = ONSD/ OND. Echodensitometry was used to evaluate the echographic density of the parenchyma and the sheaths of the optic nerve. All patients were tested with magnetic resonance imaging (MRI) to analyse brain images. Results. The biometrical parameters of ON in healthy subjects were as follows: ONS 2.64 ± 0.21 mm and ONSD — 4.60 ± 0.34 mm. In patients with suspected IH the average parameters of the ON diameter were as follows: ONS — 2.57 ± 0.25 mm and ONSD — 5.81 ± 0.42 mm. A comparative assessment of the ON thickness with and without sheaths showed that in the control group the values of ONS did not exceed 3.5 mm and ONSD did not exceed 5.0 mm. In patients with IH, the values of ONSD were significantly higher than those in the control group (p < 0.05). The ratio coefficient (K)=ONSD/ONS in the group of healthy subjects ranged from 1.53 to 2.0 and averaged 1.75 ± 0.14. In patients with IH the values of K exceeded 2.0 (2,40 ± 0.18). The analysis of acoustic density data showed a significant variability in the parameters of the ON sheaths echodensitometry in IH patients as compared to the norm. Conclusion. The echography of the ON makes it possible to determine the acoustic and biometric parameters of the ON with high accuracy, to assess its structure and relationship with the surrounding tissues. The ratio coefficient (K) of ONSD/ONS makes it possible to determine IH in the early stages of the disease, even in the absence of objective clinical criteria.

Purpose. To study the possible impact of human herpes viruses (HHV) reactivation: herpes simplex virus type 1 (HSV 1), type 2 (HSV 2), cytomegalovirus (CMV) and Epstein — Barr virus (EBV) on the clinical course of uveitis in Behcet's disease (BD). Material and methods. Serum samples of 106 BD patients (ave. age 39) with uveitis were examined for the presence of antibodies — serological markers of chronic HHV infection and reactivation. Results. In 65 patients (25 with active uveitis (UA), 40 with uveitis remission (UR)), HHV reactivation was detected (mainly HSV 1, less often HSV 2, CMV and EBV — in individual cases), 41 patients had chronic HHV (17 with UA, 24 with UR). Certain clinical symptoms of uveitis were found to depend on HHV activity. Clinical signs of active uveitis (cells in the vitreous body), as well as severe irreversible changes (social blindness and low vision) were significantly more frequently detected in cases of HHV reactivation (p < 0.05) than in chronic HHV. The data obtained allow us to suggest, with some caution, that a subclinical HHV reactivation which stays after the onset of clinical uveitis remission, is an important factor of postuveal complications that are mainly manifested during remission. These complications include epiretinal fibrosis, pronounced optic nerve atrophy, and vasculitis (arterial and venous occlusion). Conclusion. The remission period in patients with subclinical herpesvirus activity is less favorable than in patients without serological markers of HHV reactivation. HHV reactivation that persists after uveitis activity is stopped can contribute to sudden exacerbations of uveitis.

Purpose: to investigate the changes of electrophysiological activity of healthy rabbit retina occurring in courses of fractal stimulation (FS) of varied duration in order to obtain new scientific data on how fractal visual signals of low intensity, self-similar with respect to time, affect the retina.Material and methods. 12 healthy Chinchilla rabbits (24 eyes), were examined before and after FS courses that lasted 1, 4 or 12 weeks, using electroretinographic (ERG), morphometric (optical coherence tomography) and biochemical methods (detection of dopamine in the tear). For FS of rabbits, a device with an LED emitter was developed, which generates nonlinear brightness fluctuation based on the Weierstrass — Mandelbrot fractal functions. The choice of fractal signal parameters used in the work was substantiated. Pattern ERG and ganzfeld ERG were registered according to ISCEV standards; also, photopic flicker ERG was recorded at 8.3, 10, 12, and 24 Hz.Results. No negative effects of a 12-month FS course on the activity and morphology of the retina, or on dopaminergic processes in the eye of a healthy animal were found, which confirms the safety of using low-intensity FS in the clinic. A statistically significant increase in the amplitude of low-frequency flicker ERGs, a shortening of peak latency, and an increase in the amplitude of the b-wave of the scotopic and photopic ERGs was noted.Conclusion. To assess possible therapeutic effects of FS, we need to continue the investigation on animal models and human patients with retinal pathology. Considering the changes of retinal activity as revealed in the present paper, we recommend the duration of FS courses from 1 week to 1 month for future studies.

Purpose. Conduct extended analysis of cytokine status and its role in inflammatory processes in uveal melanoma based on multiplex analysis of blood serum.Patients and methods. Immunological studies of blood serum and lacrimal fluid were performed in 80 patients with uveal melanoma and 38 healthy donors (control group). The average age of the surveyed was 53.7 ± 12.2 years. Group 1 included 32 patients with small-sized choroidal melanoma (T1NoMo), group 2 consisted of 26 patients with medium-sized tumors (T2NoMo), group 3 — 22 patients with large tumor size (T3NoMo). Cytokine content was determined in blood serum by the method of multiplex analysis on the xMAP platform in the Luminex xPONENT 3.1 program using 47 plex kits (ProcartaPlex, eBioscience, Austria).Results. In blood serum — increase of pro-inflammatory (LIF, RANTES, IP-10), anti-inflammatory (TGF-1β), proliferative (IL-15), pro-tumor (EGF), angiogenic (PIGF-1 and SDF-1α) cytokines compared with control group, p < 0.05.Conclusion. In response to the manifestation and growth of uveal melanoma, many chemoattractant mediators of proinflammatory, angiogenic, proliferative action are produced that promote metastasis. The study of cytokines at the systemic level in serum leads to a deeper understanding of the pathophysiology of carcinogenesis and to facilitate the development of targeted therapies for inhibiting tumor growth.

Purpose: to analyze the results of a survey aimed at assessing the patients’satisfaction with the results of excimer laser or orthokeratological correction of myopia. Materials and methods. 135 patients aged 35 to 50 took part in a satisfaction survey: 105 after excimer laser and 30 after orthokeratological correction of myopia. Excimer laser surgery was performed with planned binocular hypocorrection within -0.75 — 1.5 D depending on age. To participate in the survey, the patients signed a preliminary consent. The questionnaire asked for age, gender, occupation, self-assessment of visual functions under a variety of conditions (vision at dusk, at close distance, at far distance, while driving a vehicle, etc.), self-assessment of satisfaction with the result. The questionnaire required to answer 15 questions on a multiplechoice basis. Results. Over 50 % of the patients have no difficulty working at close distance, at far distance, or when driving a vehicle, and do not restrict themselves in professional or everyday activities. More than 90 % of the patients would recommend excimer laser correction in binocular format with a planned hypo effect or orthokeratological correction to others. 125 out of 135 patients gave the maximum satisfaction score points. Conclusion: excimer laser correction of myopia with a planned hypoeffect in binocular format and orthokeratological correction can be recommended for patients over 35.

Перенести в английский вариант Purpose. To assess the effect of adequate laser coagulation (LC) of peripheral vitreochorioretinal dystrophy (PVCRD) on the clinical and functional state of the retina and the microcirculation of the macular region. Material and methods. Ganzfeld electroretinogram (ERG), multifocal ERG (mfERG), and optical coherent tomography with a function of angiography (OCTA) were performed for the retina of 22 patients (37 eyes), aged 20 to 62, who had been given an adequate volume of LC to treat dangerous types of PVCRD. The tests took place before LC and 1, 3, 6, 9, 12 months after it. To analyze the results, two groups were formed: (1) 27 eyes with LC volume of less than 200 coagulates and (2) 10 eyes with LC volume of more than 200 coagulates. Results. After LC, we observed a moderate decrease in the amplitudes of scotopic ERGs and the a-wavepeak latency lengthening in the maximal ERG. In the 2 ndsubgroup, the amplitude of the second wave of oscillatory potentials (OP2) and the OP index decreased more significantly than in the 1st, subgroup (by 17 and 21 % from the initial values, respectively, p

We present a brief description of acute retinal necrosis, a rare and severe condition that is accompanied by a rapid development of inflammatory and occlusive events in the retinal vasculature preceding peripheral necrotizing retinitis. Despite successful etiotropic conservative therapy, the disease is complicated by proliferative vitreoretinopathy with a high risk of retinal detachment, leading to irreversible loss of sight. We present a clinical case of acute retinal necrosis in a patient with one seeing eye who experienced a reactivation of herpes simplex virus type 2 infection, discussing the treatment details and result.

Purpose. Conduct an extended analysis of the cytokine status and its role in inflammatory processes in uveal melanoma based on multiplex analysis of the tear fluid.Patients and methods. Immunological studies of blood serum and lacrimal fluid were performed in 80 patients with uveal melanoma and 38 healthy donors (control group). The average age of the surveyed was 53.7 ± 12.2 years. Group 1 included 32 patients with small-sized choroidal melanoma (T1NoMo), group 2 consisted of 26 patients with medium-sized lesions (T2NoMo), group 3 — 22 patients with large tumor sizes (T3NoMo). The cytokine content in the tear fluid was determined by the method of multiplex analysis on the xMAP platform in the Luminex xPONENT 3.1 software using 47 plex kits (ProcartaPlex, eBioscience, Austria).Results. In the lacrimal fluid of the patient and the paired eye — an increase in pro-inflammatory (IL-1α, IL-2, IL-6, IL-17A, IL-18, TNF-α, MCP-1, MIP-1α, RANTES, GRO-α, IL-8, IP-10), anti-inflammatory (IL-1RA, IL-4, IL-10, IL-5, TGF-1β), proliferative (FGF-2, HGF, IL-15, PDGF-BB, Eotaxin), pro-tumor (NGF-β, IL-7), antitumor (IL-21), angiogenic (VEGF-A, SDF-1α) cytokines in the initial stage of uveal melanoma compared with the control group, p < 0.05.Conclusion. In response to the manifestation and growth of uveal melanoma, many chemoattractant mediators are produced, including pro-inflammatory and angiogenic effects, which promote tumor progression and affect the body’s immune response. The study of the lacrimal fluid proved the imbalance of the local immunity not only of the patient, but also of the paired «healthy eye». Research into cytokines leads to a deeper understanding of the pathophysiology of carcinogenesis and may contribute to the development of targeted therapies for inhibiting tumor growth.

Purpose. To study the parameters of visual fixation, photosensitivity of the retina in the macular region, thickness of the central region of the retina and the choroid and their relationship with the best corrected visual acuity (BCVA) and refraction in nystagmus and various types of amblyopia.Material and methods. 65 patients aged 5 to 44 (mean age 12.61 ± 7.12 years) were divided into 6 groups depending on the type of amblyopia and associated conditions. The control group was composed of subjects of the same age range without eye pathologies. The retinal photosensitivity and fixation parameters were studied using an MP-3 Nidek microperimeter (Japan). Chorioretinal parameters were evaluated using an RS-3000 Advance 2 spectral optical coherence tomograph (Nidek, Japan).Results. Retinal photosensitivity was lower in the groups with nystagmus and relative amblyopia in congenital myopia compared with the control group. The indices of density and stability of fixation were the lowest in nystagmus and dysbinocular amblyopia. In all groups with nystagmus, a smoother profile of the foveal region was revealed as compared to the control group. The grossest violations of the differentiation of the central fossa were found in nystagmus in combination with congenital myopia. In nystagmus, refractive and dysbinocular amblyopia, a significant correlation was found between the indicators of BCVA and the density of fixation. In the groups associated with congenital myopia, a relationship was found between BCVA, refraction, and foveal photosensitivity.Conclusion. With nystagmus, violations of both fixation and photosensitivity are revealed. With relative amblyopia due to congenital myopia, the fixation is normal while photosensitivity is impaired. With dysbinocular and refractive amblyopia, the photosensitivity of the retina remains within the normal range, and the fixation parameters are slightly reduced.

Purpose: to study the correlation between the acoustic and morphometric parameters of the optic nerve (ON) and anthropometric data in healthy young people.Material and methods. The research involved 24 healthy volunteers (48 eyes), including 9 men and 15 women, the average age was 25.0 ± 1.9 years. Anthropometry included measurements of height, weight, and body mass index (BMI). Ultrasound examination of the retrobulbar part of the ON included measurement of the thickness of the ON with and without sheath, echodensitometry of the ON, and ocular biometry. Using optical coherence tomography, we measured the intraocular part of the ON, including the registration of Bruch's membrane opening and ovality index.Results. The average ON thickness with the sheath was 4.6 ± 0.3 mm, and without sheath, 2.6 ± 0.2 mm. In men, ON with the sheath was thicker than in women (p = 0.001). The acoustic density of the parenchyma of the orbital part of ON was 101.2 ± 11.4 r.u. in women, the mean acoustic density of the ON was significantly higher than that in men. Correlation analysis revealed a statistically significant correlation between the height and the thickness of the ON with the sheath (r = 0.480). The strongest reliable correlation was established between the index of the ON thickness and body weight (r = 0.712) and BMI (r = 0.509) (p < 0.05). No statistically significant correlation was found between the morphometric parameters of the optic disc, anthropometry data and acoustic parameters of the ON.Conclusion. Studying the acoustic and morphometric characteristics of the intraocular and intraorbital parts of the ON in healthy young people, which included anthropometric data and gender characteristics, will contribute to the development more accurate diagnostic criteria of ON state evaluations.

Cytokines play an integral role in pathogenesis of age-related macular degeneration (AMD). Of particular interest are the late stages of this disease, which causes progressive visual impairment. Therapy-induced effects of post-treatment cytokine concentrations also need to be studied, both at long and short observation terms. These studies are of vital importance if the atrophy occurs during antiangiogenic therapy. Our purpose was to study an array of 45 cytokines, in blood serum (BS) and lacrimal liquid (LL) of the patients with wet and atrophic AMD.The study included 70 people (85 eyes) with stage 3-4 AMD according to AREDS. Depending on the form of AMD, 3 groups were discerned: I group (n = 24) included the patients with “geographic atrophy”; II group (n = 22), consisted of the patients with macular atrophy treated with antiangiogenic therapy of wet AMD; III group (n = 24), comprised the patients with a wet AMD who did not previously receive the treatment. Control group consisted of healthy volunteers (n = 25). All the groups were comparable for age and gender. The patients underwent a comprehensive ophthalmological examination to make a diagnosis. A multiplex study of the local (in the BS) and systemic (in the LL) cytokine status was carried out on a MAGPIX device (platform хMAP, Luminex Corporation, USA) in the Luminexx PONENT 3.1 software, using Procarta Plex kits (eBioscience, Austria). We determined 45 cytokines causing various biological effects, i.e., IL-1á, IL-1â, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-9, IL-10, IL-12p70, IL-13, IL-15, IL-17A, IL-18, IL-21, IL-22, IL-23, IL-27, IL-31, IFNá, IFNã, IL-8/CXCL8, IP-10/CXCL10, SDF-1á/CXCL12, MCP-1/CCL2, MIP-1á/CCL3, MIP-1â/ CCL4, RANTES/CCL5, Eotaxin/CCL11, TNFá, TNFâ, GM-CSF, VEGF-A, VEGF-D, FGF-2, EGF, PDGF-BB, HGF, SCF, GRO-á, NGF-â, BDNF, LIF, PIGF-1.Screening of a wide range of cytokines showing various biological effects was carried out in BS and LL of patients with atrophic and wet forms of AMD. It has been shown that the late stages of the disease are associated with local and systemic changes of pro / anti-inflammatory mediators (IL-1â, IL-1ra, IL-18, LIF), chemoattractant cytokines (IL-8/CXCL8, IP-10/CXCL10, MCP-1/CCL2, MIP-1á/CCL3, MIP-1â/ CCL4, RANTES/CCL5, Eotaxin/CCL11), hematopoietic regulators (IL-7), and growth factors with known angiogenic activity (EGF, HGF, PDGF-BB, VEGF-A). Altered concentrations of numerous chemokines, e.g., IP-10/CXCL10, SDF-1á/CXCL12, MIP-1á/CCL3, MIP-1â/CCL4, RANTES/CCL5 and Eotaxin/CCL11 (p < 0.05) in BS of the patients with atrophic and wet AMD may be of interest for the search of biomarkers associated with various clinical phenotypes of the disease and may be also helpful for development of new therapeutic strategies.

Purpose: to evaluate hypoxic changes in the limbus area conjunctiva of patients with primary open-angle glaucoma (POAG) treated with prolonged instillations of prostaglandin (PG) analogs. Material and methods. A spectrofluorimetric study of the limbus zone was carried out in 202 patients aged 56–87 years with POAG in the developed and advanced stages, divided into 2 groups. Group 1 consisted of patients aged 69.4 ± 10.3 years who received beta-blockers (BB) and carbonic anhydrase inhibitors (ICA) for 5–10 months; of these, 39 (30.2 %) had a developed stage of POAG and 90 (69.7 %) had advanced POAG. Group 2, aged 72.3 ± 9.4, received PG analogs, in addition to BB and ICA, for 5–10 months. In this group, 21 (28.7 %) patients had developed POAG and 52 (71.23 %) had advanced POAG. Results. The patients who received PG instillations showed a significantly higher ratio of fluorescence intensity in the wavelength range of 410/520 nm NADH/FAD (0.352 ± 0.043) than those receiving no such therapy (0.319 ± 0.047), which can be interpreted as a hypoxic state of the limbus area. Conclusion. Spectrofluorimetric testing of POAG patients taking PG analogs can be useful for detecting ischemia in the limbus area, because this category of patients are very likely to form cicatricial changes in the area of the filtration cushion in the early postoperative period after antiglaucomatous interventions.

The atrophic form of late age-related macular degeneration (AMD) is a common cause of severe vision loss. Recently, a new classification system has been proposed, which identifies two types of atrophy in the late stage of AMD that require a more detailed study: (1) drusenassociated geographic atrophy (GA), which is the final stage of progression of dry AMD, and (2) macular atrophy (MA), which occurs in wet AMD, including the period of AMD treatment with angiogenesis inhibitors. Purpose: an integrated analysis of clinical and morphometric signs of atrophic AMD forms. Material and methods. 48 people (61eyes) aged 48–84 with GA (group 1) and MA (group 2) and a control group, recruited from age-matching 25 healthy volunteers (35 eyes), underwent standard ophthalmological examinations, fundus autofluorescence (FAF) with lesion area measurement, fundus photography, optical coherence tomography (OCT) in the standard mode and Enhanced Depth Imagine Mode, Multicolor, and OCT angiography. Results. The comparative analysis of two atrophic AMD forms showed that in GA eyes, foci of atrophy capturing the fovea were significantly more common, while, contrariwise in MA eyes atrophic foci not capturing the fovea were more frequent (p < 0.05). Photoreceptor tubulation was diagnosed mainly in eyes with GA (p < 0.05). The morphometric analysis showed a significant decrease in the subfoveal thickness of the choroid in the groups with GA and MA as compared to the control (p < 0.05), whilst no significant differences between two groups were noted. The assessment of the frequency of occurrence of types of fundus AF patterns in groups 1 and 2 followed by a comparative analysis, showed the presence of all types of patterns in GA patients, including the heterogeneous and the bordering pattern (p < 0.05). In the MA group, diffuse and focal types of patterns were revealed, while the frequency of the diffuse pattern turned out to be significantly more frequent (p < 0.05). Conclusion. The integrated analysis revealed the main semiological signs and morphometric parameters, their features and prevalence in GA and MA, which may have diagnostic and prognostic importance for the management and treatment of patients with AMD.

Degenerative-dystrophic retinal diseases, particularly age-related macular degeneration (AMD), are now considered to be the lead cause of blindness and low vision in developed countries, with a steadily increasing trend. Recent publications provide evidence for the involvement of inflammatory mechanisms in TMD development and progression unveiled due to advances in innate and adaptive immunity research. However, the immunopathogenesis of atrophic AMD form, “geographic atrophy” (GA) remains largely unstudied. Objective: to investigate local mRNA expression of inflammatory cytokines IL-1β, IL-18, CCL2/MCP-1 in a model of RPE atrophy induced after subretinal injection of 0.9% sodium chloride solution in experimental rabbits. The investigation was carried out in tissue complex retina-RPE-choroid (TC) samples isolated from eyes of 23 albino New Zealand rabbits after modeling RPE atrophy by subretinal injection of 0.9% sodium chloride solution and 5 healthy rabbits lacking eye lesions. Animals in the experimental group (one week before surgical intervention, in the early period, and in the period of sustained RPE atrophy formation) and controls were subjected to optical coherence tomography (OCT) and ocular fundus autofluorescence (FAF). Evaluation of proinflammatory cytokine gene expression levels in TC was performed by RT-PCR. Results. Subretinal injection of 0.01 ml of 0.9% sodium chloride solution induced experimental RPE atrophy development in rabbits vs. control that was associated with multidirectional changes of IL-1β, IL-18, MCP-1/CCL2 gene mRNA expression. Three types of response in the TC, formed during development of atrophic changes and determined by the value of local cytokine gene expression were characterized: 1) hypo/ no response – decreased/no expression; 2) normal response – moderate increase; 3) hyper response – overexpression. 69.6% of animals with persistent atrophy had a moderate to hypertrophic increase in locally expressed mRNA MCP-1/CCL2, whereas 30% cases had significantly increased IL-1β mRNA expression – factors damaging the blood-retinal barrier and contributing to posterior segment immune privilege. It should be taken into account while developing new strategies for treatment of ophthalmic pathology, in particular the currently actively studied and tested options for RPE stem cell transplantation into subretinal space. The data obtained may be useful to investigate various types of RPE atrophy and develop new strategies of ophthalmopathology treatment in preclinical studies.

Testing patients with primary geographic atrophy (GA) requires a multimodal approach and identification of functional biomarkers characterizing retinal structural remodeling.Purpose: to identify the changes in the functional activity of the retinal cone system, which may serve as biomarkers of primary GA in non-exudative age-related macular degeneration (AMD).Material and methods. We tested 22 patients (30 eyes) aged 45–83 (ave. 72.1 ± 10.8 years) with non-exudative AMD and 18 age matched controls (60.2 ± 7.6 years) all of which underwent standard ophthalmological examinations, optical coherence tomography, autofluorescence study, and fundus photography. Standard photopic ERGs, photopic flicker ERGs to stimuli with frequencies of 8.3, 10, 12, and 24 Hz, multifocal ERG (mfERG), and electrooculogram (EOG) were recorded.Results. Electroretinographic signs for GA of retinal pigment epithelium and choriocapillary layer atrophy were described. The results confirm early impairment of the activity of cones in GA and weakening of the functional interaction of M ller cells with the cone bipolar cells. The delayed P1 peak latency of mfERG indicates a decrease in the entire central retina function in non-exudative AMD. A selective reduction in the fovea's mfERG magnitude can serve as a biomarker of primary GA. The spread of the P1 anomaly to adjacent rings may indicate a possible risk of disease progression. A decrease in the dark trough on the EOG and an increase in the Arden ratio can serve as a biomarker of primary GA.Conclusion. We determined electrophysiological signs which can serve as markers of early retinal dysfunction in eyes with primary GA and non-exudative AMD.

With this article, the Journal is commemorating the 200th anniversary of Hermann von Helmholtz, the genius scientist of the 19th century. The article outlines the main facts of his biography, and discusses the major areas of his activity in a variety of branches of science, testifying the versatility of his talent. Special attention is given to Helmholtz’ contribution into the development of ophthalmology. The importance of his collaboration with prominent researchers of his time, including those descending from Russia, is emphasized.

Inherited retinal dystrophies (IRD) is an extensive group of genetically heterogeneous diseases with significant clinical polymorphism. With the development of gene therapy, a new era in the treatment of hereditary human diseases has opened. To date, clinical studies of a number of gene medications are performed the world over, including those intended for the treatment of hereditary eye diseases (Leber congenital amaurosis (LCA), retinitis pigmentosa, achromatopsia, Stargardt's disease, choroideremia, etc.). The varieties of two former conditions, specifically LCA type 2 and retinitis pigmentosa (RP) type 20 with biallelic mutations in the RPE65 gene belong to IRD. Epidemiological studies indicate the rarity of these diseases, which explains why IRD caused by biallelic mutations in the RPE65 gene are included into the list of rare (orphan) diseases of the Russian Ministry of Health. For these IRDs, a gene replacement therapy has been developed: voretigen neparvovek, which must only be applied once. Currently, the Medical Genetic Research Center and Helmholtz National Medical Research Center of Eye Diseases have identified a group of patients who meet the criteria for genetic therapy. In 2021, а specialized gene therapy center has been established at the Helmholtz Research Center, which was certified by the Ministry of Health. A group of leading experts in the field of inherited retinal diseases and medical genetics developed and approved at professional workshops a number of measures that promote the introduction into clinical practice of the voretigen neparvovek as a gene replacement therapy for the treatment of RPE65-related IRD in the Russian Federation.

Age-related macular degeneration (AMD) and central serous chorioretinopathy (CSC) are diseases targeting the posterior segment of the eye that often lead to lowered visual functions. Pathogenesis of such disorders largely remains unclear. Among the risk factors of developing chronic inflammation, various microorganisms are considered, particularly Cytomegalovirus (CMV ). The study was aimed at analyzing the humoral response to individual viral proteins during chronic and reactivated CMV infection in AMD and CSC patients. Materials and methods. 104 CMV-seropositive patients were enrolled in the study including 75 AMD and 29 CSC subjects. IgM- and IgG-antibodies specific to CMV late viral antigens as well as IgG antibodies against the main non-structural immediate early (IE) antigen were evaluated by ELISA. IgG antibodies to individual CMV phosphoproteins such as the main non-structural immediate early protein (IE), the DNA-binding phosphoprotein pp52, and the tegument phosphoproteins (pp150, pp65, and pp28) were assessed by using Line-Immunoassay: recombinant antigens containing immunodominant protein fragments derived from viral antigens (p52, p150, p65, p28) were used. Positive (bands 2+) and strongly positive (bands 3+) data were only used for analysis. Results. It was shown that in both groups patients with chronic CMV infection had comparable rate of detected antibodies specific to individual antigens. The level of seropositivity to CMV р150 and р65 was significantly higher than that to CMV р52 and р28 (p < 0.05). Patients with AMD compared to patients with CSС had significantly higher moderate positive response (2+) to all the antigens examined. Upon reactivation of chronic CMV infection in AMD patients, the level of seropositivity to all antigens was increased, the number of cases with an intensely positive response to individual antigens was elevated, but patients with moderate positive response still prevailed. However, reactivation of chronic CMV infection was observed only in 6 CSС patients, allowing to perform no comparative analysis between these two groups. Conclusion. The main difference between CMV-chronically infected patients with AMD and CSC was not found at the level of seropositivity to individual CMV recombinant antigens, but rather in magnitude of antibody production so that AMD patients in comparison to CSC patients displayed moderate antibody production (bands 2+). A marked difference was related to the level of antibodies against CMV p150: AMD patients showed moderate antibody response (bands 2+), whereas CSC subjects dominated with strong positive response (bands 3+) (p < 0.05). It seems that moderate antibody production to recombinant CMV antigens examined in AMD patients occurs due to a weak expression of such viral antigens during chronic infection, resulting in long-term maintenance of antigenic stimulation leading to prolonged inflammation.

With multimodal visualization of the chorioretinal complex structures using modern research methods, it was possible to isolatea mixed, or combined, phenotype of the late stage of age-related macular degeneration (AMD). Early detection of this AMD form is of vital importance not only for accurate diagnosis, but for choosing optimal management tactics for patients. The paper presents two clinical cases with different variants of the development of the mixed phenotype of the late AMD stage. In one case, the long-lasting “geographic atrophy” (GA) was complicated by the development of choroidal neovascularization, while in the other case GA appeared during the treatment of wetAMD.

Intravitreal injection (IVI) is a drug delivery method, widely used in modern ophthalmology. To increase the awareness of patients receiving treatment in the healthcare system of the Russian Federation, the Expert Council on Retinal and Optic Nerve Diseases of the Association of Ophthalmologists, an All-Russian Public Organization in 2020 proposed a leaflet “Intravitreal injections (information for patients)”.Purpose: to conduct a clinical assessment of the leaflet by multicenter anonymous surveying of patients.Material and methods. Patients who had experienced IVI treatment were asked to read the leaflet for 20 minutes and then answer 12 questions of the specially designed questionnaire. 93 patients were interviewed in clinics in Moscow, St. Petersburg, Yekaterinburg and Novosibirsk: of these, 57 (61.3%), the average age of all patients was 63.9 years, the most common diagnosis was neovascular age-related macular degeneration (52 cases, 55.9%), the experience of previous treatment ranged from 1 to 104 months.Results. The leaflet had a positive response from the patients (91.4% of the questionnaires received “excellent” and “good” ratings), 90.3% patients reported that the information contained was fully or largely consistent with their experience of IVI treatment. The overwhelming majority of respondents (88.2%) did not experience any difficulties in reading the leaflet. At the same time, the patients revealed insufficient awareness on issues related to the treatment. Also, the patients showed insufficient awareness of issues concerning their health: only 20 (21.5%) respondents could answer all five questions of the questionnaire about the understanding of the relevant information, and 31 patients (33.3%) could answer four questions. This fact emphasizes the importance of information support for the patient.Conclusion. The clinical assessment of the leaflet “Intravitreal injections (information for patients)”, which contains brief information about what the procedure is, contraindications, preparation details, symptoms of the postoperative period that require urgent assistance, allows us to recommend the leaflet for use in the clinical healthcare practice of the Russian Federation.

The widespread introduction of intravitreal drug injections into clinical practice has highlighted a number of issues to be solved, including the risk of serious complications, the treatment burden on patients and the patient’s insufficient adherence to treatment, as well as a significant effect on the healthcare cost and effort. One of the ways to resolve the issues is to increase the patients’ awareness concerning the therapy they are about to receive, which contributes to the patients’ understanding of the details of treatment and enables them to make correct decisions. The best option of presenting such information to the patient is to provide them with a written document. The Expert Council on Retinal and Optic Nerve Diseases of the All-Russian Association of Ophthalmologists has developed, approved and tested an information brochure for patients who receive intravitreal injections. It offers brief information on what the procedure is, contraindications, details of preparation, and symptoms, both common ones and those requiring emergency assistance. The paper outlines the results of the study and presents a layout of an information leaflet for patients recommended for use in the Russian Federation.

Purpose of the study is to determine the reliability of OCT angiography in the diagnosis of type 1 choroidal neovascularization (CNV) in wet age-related macular degeneration depending on the height of pigment epithelium detachment (PED).Material and methods. The study included 82 patients (114 eyes) with confirmed type 1 CNV, who were examined using spectral OCT and OCTA. The patients were divided into two groups depending on PED height: group 1 consisted of 69 eyes with PED height less than 300 μm, while group 2 (45 eyes) had PED height of more than 300 μm. A separate comparative analysis of the visualization of pathological vessels was made in a group of untreated patients (56 eyes) and a group of patients (58 eyes) treated with angiogenesis inhibitors.Results. In group 1 with a PED height less than 300 μm (167.0 ± 60.4 μm) OCTA detected blood flow along abnormal vessels in 100 % of cases. In group 2 with a PED height above 300 μm (484.7 ± 131.9 μm) CNV vessels were visualized in 24.4 % of eyes. The PED height of patients after intravitreal injections of angiogenesis inhibitors (IVI IA) ranged from 38 to 683 μm (221 ± 133 μm). According to OCTA visualization of type 1 CNV vasculature was noted in 55 eyes (94.8 %). In patients who received no antiangiogenic therapy, with a PED height 59 - 800 μm (238 ± 149 μm) CNV was visualized in 41 % of cases (23 eyes).Conclusion. OCTA showed high reliability in the diagnosis of type 1 CNV with low PED. This method was significantly less informative when the height of the neovascular PED exceeded 300 μm, with the exception of PED after IVI IA.

The novel coronavirus infection (COVID-19) caused by SARS-CоV-2 virus, may lead to ocular diseases besides affecting the respiratory system. Cororonavirus infection may be transmitted not only through the respiratory system but also through the conjunctiva. The review article summarizes the data on the origin and variants of coronaviruses that infect humans, as well as on SARS-CоV-2 structures. Literature data on prospects of molecular diagnostics of the disease, coronavirus type detection methods, clinical sample types and duration of the disease before it is diagnosed are discussed. The data on the relationship between the coronavirus infection and conjunctivitis are given. Molecular tests of the tear and conjunctival swabs were used to diagnose the coronavirus infection independently of whether symptoms of ocular disorders were present. The real-time reverse-transcription of RNA polymerase chain reaction (PCR) was the most informative method for diagnosis of SARS-CоV-2 in the early stage of COVID-19 (until the 9th day). The presence of SARS-CоV-2 in the tear fluid and conjunctival swabs indicates the need for safety measures to prevent virus transmission through the ocular surface, including protective goggles to be worn by healthcare workers. Since side effects in the eye may appear, COVID-19 patients with visual impairment who received etiotropic or pathogenetic treatment are advised to consult an ophthalmologist.

Diabetic retinopathy (DR) is becoming more and more widespread disease. Investigation of local changes of metabolic pathways in the eye improves our knowledge about diabetic retinopathy pathogenesis and provide perspective for the development of new pathogenetically based and individually focused therapy of this disease.Purpose of the study was to determine the concentrations of angiotensin II (AII), angiotensin-converting enzyme (ACE) and matrix metalloprotease-9 (MMP-9) in tears and serum of patients with diabetic retinopathy, estimate their significance for the evaluation of diabetic retinopathy severity and choice of treatment.Patients and methods. Tear and serum samples from 31 patients with diabetic retinopathy were analysed. Control group consisted of healthy volunteers of the same sex and age. Concentrations of angiotensin II, angiotensin-converting enzyme and matrix metalloprotease-9 were measured using the ELISA kits.Results: in controls angiotensin II concentration was 9.8 ± 5.5 pg/ml, in tears — 11.8 ± 6.6 pg/ml, angiotensin-converting enzyme concentration in serum was 82.6 ± 10.9 ng/ml, in tears it was 40 times lower: 2.5 ± 0.5 ng/ml, matrix metalloprotease-9 concentration in serum was 186.3 ± 8.9 ng/ml while in tears it was 100 times lower: 2.0 ± 0.9 ng/ml. In tears of patients with diabetic retinopathy levels of all 3 substances were significantly higher than in controls. Concentration of angiotensin II was 8 times higher, angiotensin-converting enzyme concentration 5 times higher and matrix metalloprotease-9 level 3 times higher. In serum angiotensin II concentration was increased 9 times, angiotensin-converting enzyme — 2 times. No difference in serum matrix metalloprotease-9 levels was observed. Thus diabetic retinopathy cause a significant activation of local and systemic rennin-angiotensin system. Local changes are more marked than systemic. Estimation of angiotensin II, angiotensin-converting enzyme and matrix metalloprotease-9 concentrations in tears can serve as an objective test for the diabetic retinopathy diagnostic and a pathogenetic rationale for the development of a new method of therapy — topical use of angiotensin-converting enzyme inhibitors.

Purpose: to evaluate the effect of inadequately performed laser coagulation (LC) of peripheral vitreochorioretinal dystrophies (PVCRD) on the microcirculation of the macular region in patients with myopia. Material and methods. The state of the microvascular bed was investigated by OCT angiography (OCT-A), Angio Retina mode, scanning area 6 x 6 mm. The density of the surface vascular plexus was evaluated using a 9-quadrant protocol and an ETDRS grid. The parameters of the foveolar avascular zone (FAS) were determined. OCT-A of the retina was performed in 18 patients with PVCRD who had signs of inadequate retinal LC, such as hypercoagulation, an excessive number of coagulates with minimal changes in the retina, or massive LC in normal fundus eyes documented in their case histories. The research results were compared with the data of OCT-A obtained in 10 patients with myopia without signs of PVCRD (controls 1) and in 75 healthy individuals (controls 2). Results. In all patients with myopia (in the main group and controls 1), blood flow density indices were, respectively, 10–20 and 2–14 % lower than those in controls 2. The maximal decrease in blood flow density was found in the foveal zone in cases of hyper LC (p < 0.05). Also, in the eyes with excessive LC a significant expansion of the FAS and thinning of the retina were revealed. Conclusion. The results of the OCT-A study point to a negative effect of hyper LC of the PVCRD on the state of the microvasculature of the retina in the central zone. The obtained data correlate with our results of electrophysiological studies presented in the first part of this paper [ROJ, 2020; 13 (2): 45–52], which indicate functional changes in the fovea zone after inadequate laser coagulation in the peripheral areas of the retina.

Purpose: to compare the effectiveness of corneal ulcer treatment by antibiotic therapy and local ultraviolet crosslinking in a clinical and morphological experimental study using the new Crosscor device. Material and methods. The study was performed on 15 rabbits (30 eyes) with a model of corneal ulceration caused by Staphylococcus aureus. Rabbits were divided into 3 groups of 5 specimens each (10 eyes). Group 1 received local ultraviolet A range (UVA) crosslinking (CL) of the cornea using the Crosscor device (3 procedures lasting 5, 6 and 6 minutes each were given with intervals of three days). In group 2, CL was combined with antibacterial treatment (AB): instillations of tobramycin 0.3 % and ofloxacin ointment 3 mg / g were given 4 times a day for 14 days. In the control group, only AB treatment was given. The dynamics of inflammation, the intensity of turbidity and the size of the corneal ulcer were evaluated using biomicroscopy, fluorescein test, photoregistration of the anterior part of the eye, and according to a point system. Morphological changes in the cornea were determined using light microscopy (Leica with a DFC 420C digital camera). Results. In group 1 (CL) complete healing of the ulcer defect was noted on the 9th day of observation; in group 2 (CL + AB), the diameter of the corneal ulcer was reduced to 1.6 ± 0.5 mm, in the control group (AB) it was reduced to 1.9 ± 0.3 mm (p < 0.05). The total score of inflammatory changes on day 9 in the 1st group was 0.8 ± 1.3, in the 2nd group, 3.6 ± 0.8, and in the control group, 3.7 ± 0.4 (p < 0.05). On day 9, in all cases of the 1st group, a slight clouding of the cornea was formed (0–-1 point); in the 2nd group and in the control group in 90 % of cases a rough clouding of the cornea with vascularization was formed (3 points). Morphological examination of the eyes showed that only in the 1st group avascular scars with an ordered arrangement of fibrous tissue fibrils were formed. Conclusion. The data obtained indicate a significantly higher efficiency of corneal ulcer treatment by local UVA crosslinking using Crosscor as compared with antibiotic therapy.