There are numerous criteria of glaucoma surgery efficacy. Among them, IOP level is of special importance. The development of tolerant and target IOP concepts as well as IOP tolerability issue are reviewed below. Individual normal IOP values and their role in glaucoma surgery evaluation are described. The gradation of glaucoma surgery effect and target IOP level depending on optic nerve damage degree as well as statistical principles of scientific data presentation are discussed. Current controversies forced World Glaucoma Association (WGA) to develop Guidelines on Design & Reporting Glaucoma Trials (2009) which are now recommended for modern studies. The assessment of appropriate IOP reduction is the keystone of this paper. In addition, the results of the above-mentioned studies were analyzed and own recommendations were developed. Two approaches to evaluate glaucoma surgery efficacy are proposed, i.e., by true IOP (P0) and by IOP decrease from baseline (in %). In the last three decades, novel micro-invasive techniques that prolong glaucoma surgery effect were developed. Among them are suture removal (which can be cut or pulled out), laser suture lysis, Nd:YAG laser goniopuncture following non-penetrating surgery, filtering bleb and sub-scleral space needling revision in the early and late postoperative period. These procedures significantly increased hypotensive effect in the late post-op period (up to 96.7 %). Repeated surgery rate and medical therapy need were the primary surgical outcome while complete and partial success rates were the secondary outcome. Baseline IOP was defined as an IOP level on maximum medical therapy pre-operatively. Medical therapy is an important efficacy criterion as well. The number of drugs used (prostaglandin analogues, beta blockers etc.) should be specified. When interpreting surgical outcomes, statistical methods must be considered. The required minimum is Kaplan-Meier survival analysis, scatter diagram, and box diagram.

Summary: eye injuries are one of the leading causes of blindness and low vision at any age. The article provides an overview of the literature on the frequency, reasons and epidemiology of eye injuries in children. The results of the survey showed that boys aged 5‑7 years old are most susceptible to trauma of the eye and its appendages at home or on the street with no adult supervision. High level of injuries and monocular blindness due to them requires intensive study of this problem with the development and implementation of effective preventive measures.

Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae). It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women) aged 16‑63 (129 eyes) were observed and treated over the last five years. 124 patients were diagnosed with acute keratoconus and 2 patients were diagnosed with pellucid marginal degeneration. Acute kereatoconus patients
represented a special and compromised cohort with systemic allergic diseases (neurodermatitis and various atopic disorders, n = 48), Down’s syndrome (n = 16) or mental disorders (n = 19). In many of these patients who vigorously rubbed their eyes, keratectasia progressed more rapidly. In 7 cases, acute keratoconus developed during pregnancy. 3 cases of recurrent keratoconus were reported — in a woman with Down’s syndrome (recurrence in 3 years), in a man with severe neurodermatitis (recurrence in 5 years), and in a man with anamnestic acute keratoconus (recurrence in 20 years). 3 patients experienced bilateral acute keratoconus. Acute keratoconus can be subdivided by the area of corneal edema into three categories, i.e., partial (6 mm or less, 52 eyes), subtotal (7‑10 mm, 56 eyes), and total (more than 10 mm, 21 eyes). Corneal edema ultimately disappeared, however, acute keratoconus resulted in a deep local scarring through the corneal layers. Slit lamp exam revealed Descemet’s membrane ruptures (so-called fish mouth). 73 eyes were referred to refractive penetrating keratoplasty (PKP). Corneal perforation was unusual even in severe corneal thinning (4 cases). In one case, descemetocele with a high risk of perforation was observed. 4 eyes required subtotal PKP. In one case, linear perforation was closed with interrupted sutures. Postoperative period following PKP was often complicated. Medical therapy which included topical steroids (eye drops and injections) in combination with antibiotics and drugs that promote corneal healing (Corneregel, Hylo-PARIN, VitA-POS) for 2‑3 months provided more rapid symptom relief and visual rehabilitation. There are many conflicting approaches to manage keratoconus. However, our long-term experience argues for PKP after complete symptoms relief excepting corneal perforation.

Purpose: The pathogenesis of keratoconjunctivitis sicca in patients with thyroid eye disease is presented. The influence of therapy by a HYLO-PARIN® on a condition of a tear film in patients with various forms of thyroid eye disease is assessed.

Methods: 34 eyes (17 patients) with thyroid eye disease were investigated. Dry eye evaluations included Shirmer and Jhones testing, tear film break-up time, corneal fluorescein staining. Patients were treated with HYLOPARIN ® (Ursapharm, Germany).

Results: Study showed that HYLO-PARIN® resulted in marked improvement as assessed by subjective complaints, Schirmer’s test, tear film break-up test.

Conclusion: HYLO-PARIN® provided relief from the signs
and symptoms of dry eye syndrome at patients with various forms of thyroid eye disease.

Currently, ultrasound biomicroscopy (UBM) is the only diagnostic method that uses a 50‑100 MHz transducer with a depth of penetration of 4 mm. This provides greater sensitivity and resolution.

Aim. To visualize meibomian glands and to evaluate their morphological and functional status using UBM.

Methods. UBM was performed in 14 patients aged 29‑81 with obvious meibomian gland dysfunction (MGD) and healthy meibomian glands. 6 patients had no biomicroscopic signs of blepharitis while 8 patients had biomicroscopic signs of blepharitis, blepharoconjunctivitis, and MGD.

Results. UBM provides detailed information on meibomian glands and eyelid margins and their pathological conditions, i.e., eyelid margin thickening due to inflammation, meibomian gland orifice obstruction, increase in distance between meibomian glands due to their atrophy, and cartilaginous tissue destruction. UBM findings may depend on patient age as well as on disease stage and severity. When re-positioning UBM transducer, bullous conjunctiva and subconjunctival cysts can be visualized. This provides differential diagnosis between opaque cysts and tumors.

Conclusion. UBM combined with standard exams increases information value, reliability, and accuracy of the diagnostics of anterior segment disorders and facilitates the development of targeted therapeutic approaches. Further studies on diagnostic value of conjunctiva and eyelids UBM are required.

Common pathogenic aspects of age-related macular degeneration (AMD) and primary open-angle glaucoma (POAG), i.e., the role of free radicals inducing oxidative damage of the retina and optic nerve, are discussed. Factors that activate free radical reactions as well as multilevel antioxidant protection system are reviewed. Data derived from studies on current antioxidants that are used to treat and prevent dry AMD and glaucomatous optic nerve damage are compared. Neuroprotection for glaucoma will be considered soon as a basis for its treatment. B vitamins are generally included into therapeutic algorithms for glaucomatous optic neuropathy. While being metabolic therapeutics, they stimulate adaptive compensatory mechanisms and reduce the severity of various pathological processes, e.g., hypoxia, lipid peroxidation etc. Neurotrophic, antioxidant, and regenerative effects of B vitamins as wells as their involvement in metabolism, myelin
synthesis and other processes are of special importance for ophthalmologists. Currently, several vitamin and mineral supplements that differ in composition, dosage, and schedule are approved in Russia. SuperOptic, a biologically active
additive, contains more free lutein (10 mg) and zeaxanthin (500 μg) as well as potent antioxidants (vitamin E and vitamin C), microelements (zinc and copper), and balanced vitamin B complex. These components play an important role in ocular health. SuperOptic can be recommended for the prevention and treatment of AMD and glaucomatous optic nerve damage.

Aim: To analyze ocular fundus photos and visual field test findings in vibration disease patients depending on highfrequency
exposition.

Methods: 62 vibration disease patients aged 40‑65 (55.69±0.7 years on average) were examined. The patients were divided into 2 groups depending on vibration exposition: group 1 (local exposition) included 30 patients (49.2 %), group 2 (combined exposition) included 32 patients (50.8 %). Healthy persons not exposed to vibration were controls. Non-mydriatic ophthalmoscopy was performed using fundus camera Topcon TRC-NW300. Threshold visual field test which covers central 30 degrees of field was performed as well.

Results: In vibration disease patients, enlarged optic nerve excavation, violation of the ISNT rule, peripapillary atrophy, optic disc hemorrhages, and blurred disc margins were detected. Enlarged optic nerve head was observed in combined vibration exposition group while medium-sized optic nerve head was observed in local exposition group. Retinal dystrophy and hemorrhages were found
in the central area regardless of vibration exposition. The analysis of visual field test indices demonstrated that MD was significantly lower while PSD, SF, and GPSD were significantly higher in vibration disease patients as compared with controls. However, no significant difference was revealed between local and combined vibration exposition. Visual field test exam showed foveal light sensitivity reduction by 1‑22 dB. In combined vibration exposition group, decrease in retinal sensitivity within the central 5 degrees was greater than in local vibration exposition group.

Conclusion: Vibration disease patients with over 20 year-experience have signs of optic nerve damage (neuropathy). Chronic exposition to vibration provokes optic nerve atrophy and central retinal degeneration.

Background: Optimal placement of dacryostoma and minimally invasive non-traumatic bypass surgery that creates an anastomosis between the lacrimal sac and the nasal cavity are important to prevent the recurrence of nasolacrimal duct obstruction. Aim: To develop a simplified technique of bypass creation. Methods: In addition to optic rhinoendoscopy, virtual endoscopy of lacrimal sac and nasal cavity was performed (n = 15). Virtual endoscopy is based on 3 D computer data processing with subsequent reconstruction of nasal cavity and lacrimal sac visualization. This provides 4 D movement effect mimicking optic endoscopy. Nasal mucosal flap was created using radio-wave Jawad tip, lacrimal sac flap was created through the canal using improved radio-wave tip. Flaps were fixed with Tissucol® bioglue. The whole surgery was performed under the control of video endoscope (Storz).

Results: The analysis of virtual endoscopy protocols with visible projection of lacrimal sac on nasal cavity lateral wall enabled to select an optimal place for dacryostoma depending on the size and the placement of lacrimal sac. The use of curved radio-wave Jawad tip made possible to create mucosal periosteal flap in all patients. Transcanalicular radio-wave formation of the flap from lacrimal sac wall was easier and safer than endonasal one. Glue flap fixation was technologically easier than suturing.

Conclusion: Radio-wave endoscopic nasal mucosal flap creation, radio-wave transcanalicular lacrimal sac flap creation, and flap gluing are a simple and safe method of anastomosis formation in endoscopic dacryocystorhinoscopy.

Aim: To analyze visual morbidity attributable to primary glaucoma, its eight-year dynamics, and gender differences in Siberian industrial town inhabitants.

Methods: Medical records (out-patient and in-patient departments) from the database of the sectional information analysis center of Novokuznetsk Health Administration over an eight-year period (2004-2011) were studied. Individual patients diagnosed with primary glaucoma in 2004‑2011 were reviewed only.

Results: Standardized primary glaucoma morbidity rate in men and women aged over 40 years was 3.5±0.3 ‰ and 2.6±0.26 ‰, respectively. Men were diagnosed with primary glaucoma earlier than women. In male residents aged over 70 years, primary glaucoma was found more often than in female residents. Male glaucoma patients required in-patient treatment more often than female patients. Primary glaucoma was diagnosed in men and women at 66.1±11.6 and 67.0±10.9 years (on average), respectively (U = 2.27, p = 0.023). 441 of 5424 patients (8.1 %) diagnosed with glaucoma in 2004‑2011 subsequently died. The average age at death was 69.0±7.2 years, the median (25 %; 75 %) was 71 years (66 years; 75 years). Patients who were diagnosed with primary glaucoma survived for 2.6±1.8 years. The median (25 %; 75 %) was 2 years (1 year; 4 years). The distribution of the variable that characterized the difference between the age at death and the age of diagnosis making was abnormal (D = 0.151, p<0.001). Half of glaucoma patients died in the first two years after glaucoma has been diagnosed. Less than 20 % of patients (16 % men, 18 % women) survived for ≥4 years after primary glaucoma diagnosis has been made. Conclusion: The analysis of morbidity and mortality rates as well as disability due to impaired vision is of great importance to health official and practitioners. Stably low glaucoma morbidity rate in Siberian industrial town inhabitants indicates a great lack of glaucoma specialists and forces to develop optimal organizational arrangements as well as observational and treatment approaches to glaucoma care.

Aim: To study the efficacy of functional (physiotherapeutic) stimulation of an eye in visually intensive work patients with the initial symptoms of presbyopia.

Methods: 104 visually intensive work patients before and after complex physiotherapy (low-energy laser radiation, magnitotherapy, stimulation of accommodation) were examined.

Results: Physiotherapy improved near vision (by 0.16 RU on average) and subjective psychophysiological status (by 11.8 %) and reduced eye strain (by 2.1 times). Additionally, objective accommodography indices improved, brightness sensitivity thresholds decreased by 16.5 %, and psychological status improved by 18.2 %. These positive effects of physiotherapeutic stimulation enabled to delay eyeglasses prescription for 6 months in 76 % of patients and for 9 months in 42 % of patients.

Conclusion: Functional (physiotherapeutic) stimulation provides effective correction of initial presbyopia in visually intensive work persons.

To compare dry eye symptoms after LASIK with mechanical keratome-created flaps and femtosecond laser keratome-created flaps as well as to analyze the efficacy of Systane® Ultra Monodose used to prevent and to treat transient dry eye after excimer laser surgery. Methods: 98 patients (194 eyes) with myopia and compound myopic astigmatism who underwent excimer laser surgery were included in the study. In group 1 patients with pre-op dry eye, femtosecond laser-assisted LASIK was performed, Systane® Ultra Monodose was prescribed postoperatively. In group 2 patients with pre-op dry eye, LASIK was performed using mechanical microkeratome, Systane® Ultra Monodose was prescribed postoperatively. In group 3 patients without pre-op dry eye, LASIK was performed using mechanical microkeratome, standard anti-inflammatory therapy without any lubricant eye drops was prescribed. Patients were followed up for 60 days. Results: It was demonstrated that excimer laser surgery provokes transient dry eye in all patients, therefore, artificial tears are required for 2 months and more after the surgery. Post-operative lubricant eye drops use improves tear film stability, tear production, tear osmolarity, and objective signs of dry eye. Femtosecond laser decreases clinical and functional symptoms of transient dry eye as compared with mechanical microkeratome and provides more rapid visual recovery. Conclusion: Systane® Ultra Monodose has both high efficiency and good tolerability. It can be recommended for the prevention and treatment of dry eye following excimer laser surgery.

Aim: To reveal ultrastructural changes of chorioretinal complex and their possible reversibility under sub-threshold laser exposure at wavelengths of 0.81 and 0.532 μm in 1, 8 and 30 days. Methods: Experimental study was performed on 16 chinchilla rabbits (32 eyes) using laser at wavelengths of 0.532 and 0.81 μm in CW, micropulse, and transpupillary thermotherapy modes. Transmission electron microscope EM-10C (Opton, Oberkochen, Germany) was used to perform ultrastructural study of retina following laser exposure. Results: In a day after sub-threshold laser exposure, ultrastructural changes were mainly detected in retinal pigment epithelium (RPE), choriocapillaries, and photoreceptors. In 8 days, intracellular regeneration of RPE and partial restoration of choriocapillary blood flow and RPE macrophages were observed. In 30 days, RPE morphology, the number and the structure of photoreceptor outer segments were re-established. Mitochondria of photoreceptor inner segments regenerated as well. Conclusion: Ultrastructural changes of chorioretinal complex following sub-threshold laser radiation were reversible. Intracellular regeneration provided almost complete recovery of chorioretinal complex structure by day 30.

Conjunctivitis is one of the main forms of ocular infections and occurs from 40.4 to 70.3 % of the total number of patients with inflammatory eye diseases. The purpose of this study was to assess the treatment effectiveness of chronic conjunctivitis various fluorochinolones. Results: There were examined 36 children (72 eyes) with chronic blepharocon-junctivitis. The disease duration was 3 months or more. To clarify the etiology blepharoconjunctivitis all patients was taken from the conjunctival cavity material for planting on the microflora. The sensitivity of microflora to antibiotics used in the form of eye dosage forms, determined by discodiffution method. In addition, bacterial conjunctivitis character was confirmed by cytology material scrapings from the conjunctiva. In children with chronic blepharoconjunctivitis content in crops conjunctival cavity often detected Staphylococcus aureus (61,2 %, n = 22). In 11 cases determined by mixed infection (30.65 %), then there is an association with Staphylococcus aureus or Staphylococcus epidermidis with streptococcus. In 2 children has been detected Staphylococcus epidermidis (5,5 %). Sowing proved sterile only one child (2.7 %). All patients were divided into 3 groups. In each group of children received instillation one from fluoroquinolones, which was marked by the minimum resistance of Staphylococcus aureus. The first group consisted of 14 children (28 eyes) who were buried ofloxacin 0.3 %, the second — 10 patients (20 eyes) treated with 0.3 % ciprofloxacin, and a third — 12 patients (24 eyes) who received the drug instillation Signitsef (SENTISS). Conclusion: the treatment of chronic bacterial conjunctivitis instill drops containing a solution of antibacterial drugs of the fluoroquinolones, has high clinical efficacy. The dynamics of the main clinical signs of chronic blepharoconjunctivitis was more pronounced on the background of 0.5 % levofloxacin (Signitsef, SENTISS).

Clinical case of high thin-wall cystic limited filtering bleb needling revision in the early post-op period after trabeculectomy with sinusotomy accompanied by toxic keratopathy is presented. Optical coherence tomography (OCT) demonstrated that filtering bleb height was 2700 μm and bleb wall thickness was 70 μm. Bleb needling revision with its lateralwall dissection and subconjunctival injection of dexamethasone, fluorouracil, and ranibizumab near to the bleb site was performed. In 1.5 hours after the procedure, bleb height decreased to 550 μm (by 5 times) while bleb wall thickness increased up to 100 μm. Topical antibacterial, steroid, and non-steroid anti-inflammatory therapy was recommended. The next day IOP level reduced from 11 mm Hg to 4.5 mm Hg. It was accompanied by choroidal effusion that was managed conservatively with cycloplegic agents (drops and injections) for 3 days. On day 6, central corneal edema affecting all layers, Descemet’s membrane folds, and ocular hypertension were revealed. Metabolic therapy resolved corneal edema within 3 days. Re-needling bleb revision decreased IOP level to 6.2 mm Hg. This resulted in transient Descemet’s membrane folds. This paper describes filtering bleb needling revision with its lateral wall dissection and anti-inflammatory, cytostatic, and anti-VEGF agents use to prolong glaucoma filtering surgery effect in excessive scarring. The procedure was accompanied by toxic corneal endothelium decompensation with corneal edema and Descemet’s membrane folds treated with active metabolic therapy.