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

Despite the fact that the eye represents a challenge for biomechanical research due to its size, over the last two decades, much data on ocular biomechanics were accumulated. Scleral and lamina cribrosa biomechanics contribute to our understanding of myopia and open-angle glaucoma; iris and trabecular meshwork biomechanics to that of angle-closure glaucoma; vitreous biomechanics to that of retinal detachment and ocular drug delivery; corneal biomechanics to that of keratoconus; and lens capsule biomechanics to that of cataract. This paper offers a general overview of recent advances in corneal, scleral, crystalline lens, and lamina cribrosa biomechanics and summarizes the results of experimental and clinical studies. Ocular biomechanics abnormalities affect etiology of many eye diseases. Ocular biomechanics plays an important role in the development of novel diagnostic methods, therapeutic and surgical procedures. Corneal biomechanics impacts etiology and pathogenesis of keratoconus as well as tonometry accuracy and explains corneal refractive surgery effect. Scleral biomechanics is associated with IOP and progressive myopia. Accommodative apparatus (ciliary body and crystalline lens) is an important anatomic physiological structure. Recent studies uncovered the causes of agerelated loss of accommodation as a result of lens involution. Optic nerve head abnormalities due to IOP fluctuations are the key factor of glaucomatous neuropathy. They are directly associated with ocular biomechanics as well.

Electrophysiological tests may be used to detect early glaucomatous changes and glaucoma progression risk and to monitor treatment efficacy. Most important pathogenic aspects of glaucomatous process, pathogenesis and multifactorial nature of glaucomatous optic neuropathy are described. Major triggers of glaucomatous optic neuropathy are mechanical and vascular. Principles of neuroprotective therapy, neuroprotective drugs, and mechanisms of action of direct and indirect neuroprotective agents are presented. IOPcc is a basis for neuroprotective therapy selection and its efficacy monitoring. Amongst neuroprotective drugs, NMDA agonists, antioxidants, peptides, and calcium channel blockers are of special importance. Structural damage and functional deficiency (e.g., visual field loss) in glaucoma and the most informative and accurate methods of their detection are characterized. Confocal laser microscopy, optical coherence tomography, and scanning laser polarimetry are compared. These techniques are used to study optic nerve head and retinal nerve fiber layer. They are proposed as diagnostic and monitoring tools for glaucoma, glaucoma suspicion, and ocular hypertension. The most sensitive and specific electrophysiological tests for glaucomatous optic neuropathy are pattern electroretinography, multfocal electroretinography, and multifocal visually evoked potentials. 

Rhegmatogenous retinal detachment (RRD) is a severe ocular disorder which requires prompt treatment to prevent low vision and blindness. It is also a significant socio-economic problem as 84% of RDD patients are able-bodied. RRD grading systems (including current Machemer grading system), risk factors, and pathogenesis are reviewed. The role of proliferative vitreoretinopathy in RDD pathogenesis and recurrence is described. Macula involvement determines RDD outcome. Optical coherence tomography (OCT) provides the study of retina anatomy and the analysis of parameters that affect post-op best corrected visual acuity, i.e., defects of the junction between inner segments and outer segments (IS/OS), the integrity of external (ELM) and internal limiting membrane (ILM), outer nuclear layer thickness (ONLT) etc. Fluorescent angiography allows to understand the reasons for low vision in anatomically successful RDD surgery. Scleral buckling, balloon buckling, pneumatic retinopexy, vitrectomy, cryopexy, and laser coagulation are important tools in surgical armamentarium. In recent years, vitrectomy is growing in popularity for RDD treatment. Criteria for procedure selection and surgical success rate in phakic and pseudophakic eyes are discussed. The outcomes of vitrectomy with air/gas and silicone oil tamponade are compared. Bimanual vitrectomy benefits are discussed. 

Retinal vein occlusion (RVO) is one of the leading causes of permanent vision loss. In adults, central retinal vein occlusion (CRVO) occurs in 1.8% while branch retinal vein occlusion (BRVO) occurs in 0.2%. Treatment strategy and disease prognosis are determined by RVO type (ischemic/non-ischemic). Despite numerous studies and many current CRVO and BRVO treatment approaches, the management of these patients is still being debated. Intravitreal injections of steroids (triamcinolone acetate, dexamethasone) and vascular endothelial growth factor (VEGF) inhibitors (bevacizumab, ranibizumab) were shown to be fairly effective. However, it is unclear whether anti-VEGF agents are reasonable in ischemic RVOs. Laser photocoagulation remains the only effective treatment of optic nerve head and/or retinal neovascularization. Laser photocoagulation is also indicated for the treatment of macular edema. Both threshold and sub-threshold photocoagulation may be performed. Photocoagulation performed with argon (514 nm), krypton (647 nm), or diode (810 nm) laser for macular edema provides similar results (no significant differences). The treatment may be complex and include medication therapy and/or surgery. Medication therapy includes anti-aggregant agents and antioxidants, i.e., emoxypine which may be used in acute RVO as well as in post-thrombotic retinopathy. 

Aim. Retrospective analysis of clinical profile, etiology, and treatment strategies of childhood glaucoma. 

Materials and methods. Medical reports of childhood glaucoma patients from January 2002 to December 2013 were analyzed. The ratio of various disease types and treatment pattern were studied. 143 patients (210 eyes) aged 4.8±0.4 years (on average) were enrolled. 59.4% (85) were boys, and 40.6% (58) were girls. 81 patients (56.6%) had bilateral disease. 

Results. Primary congenital glaucoma was the most common type of childhood glaucoma (60.8%). In 70.1% of cases, the disease was bilateral. The second most common type was uveal glaucoma (9.8%), the third most common type was primary juvenile glaucoma (6.3%), the fourth most common type was traumatic glaucoma (5.6%). In general, trabeculotomy, trabeculectomy, and combined trabeculotomy-trabeculectomy (with or without subconjunctival Ologen implantation) was performed for primary congenital glaucoma. 

Conclusions. According to Zarifa Aliyeva National Eye Center reports, primary congenital glaucoma, uveal glaucoma, and primary juvenile glaucoma are the most common types of childhood glaucoma in Azerbaijan. When comparing with literature data, primary congenital glaucoma pattern is similar to western countries. 

Aim. To study diagnostic capabilities of OCT parameters (ganglion cell complex/GCC and retinal nerve fiber layer/RNFL) and their ability to discriminate between normal and ocular hypertension (OH), preperimetric glaucoma (PPG), and early, moderate, and advanced perimetric glaucoma (PG) eyes. 

Material and methods. 353 eyes enrolled in the study were divided into six groups: OH (32 eyes), PPG (46 eyes), early PG (104 eyes), moderate PG (54 eyes), advanced PG (60 eyes), and healthy individuals (57 eyes). Complete eye examination including standard automated perimetry and OCT was performed. Avg. GCC, Inf. GCC, Sup. GCC, GLV, FLV, and Avg., Sup. and Inf. RNFL (ONH map) were measured. ROC curves were constructed. Sensitivity and specificity of each parameter, positive (PLR) and negative likelihood ratio (NLR) were analyzed. 

Results. In OH group, sensitivity and specificity of all parameters were above 66% (> 98% for FLV and GLV). In PPG group, sensitivity and specificity were above 82% (>91% for GLV, Avg. GCC Avg. RNFL and Sup. RNFL). In OH group, GLV and Inf. GCC were the most accurate diagnostic parameters (0.795 and 0.790, respectively). In PPG group, GLV was the most accurate diagnostic parameter (0.981). In early PG group, maximum sensitivity and specificity were found for Inf. GCC (91%). In moderate PG group, maximum sensitivity and specificity were found for the Avg. GCC (98%). In early and moderate PG groups, GLV was the most accurate diagnostic parameter (0.971 and 0.999, respectively). In advanced PG group, sensitivity and specificity of all parameters were about 100%. In advanced PG groups, Avg. RNFL and Inf. RNFL were the most accurate diagnostic parameters (1.0). 

Conclusions. In PPG and PG groups, high sensitivity and specificity of GCC map and RNFL map parameters as well as their very high diagnostic accuracy (more than 0.90) was demonstrated. In OH group, the diagnostic accuracy of these parameters was lower (0.66). GCC map and RNFL map parameters are characterized by high and comparable diagnostic abilities irrespective of glaucoma damage severity. ОСТ is a valuable diagnostic method of early glaucomatous changes detection in OH and PPG. Diagnostic capabilities of the parameters improve as disease severity increases. 

Aim. To analyze the efficacy of modified non-penetrating deep sclerectomy. 

Materials and methods. POAG patients enrolled in the study were divided into 2 groups: study group included 29 patients who were referred for modified non-penetrating deep sclerectomy, control group included 33 patients who were referred for standard non-penetrating deep sclerectomy. IOP level was 31.9±3.2 mm Hg in the study group and 31.5±3.3 mm Hg in the control group. Modification of non-penetrating deep sclerectomy consists in the separation of fornix-based Ushaped scleral flap, Schlemm’s canal opening, scleral tunnel creation and its dilation with polyamide 5/0 suture. 

Results. Three weeks after surgery, moderate hypotension was observed in both groups (15.7±1.56 mm Hg in the study group and 16.9±1.9 in the control group). Three months after surgery, IOP level was 17.47±1.24 mm Hg in the study group and 18.74±1.37 in the control group. Ten months after surgery, IOP level in the study group was significantly lower than in the control group (19.14±1.27 mm Hg and 21.31±1.42 mm Hg, respectively, р<0.05). 

Conclusions. The proposed surgical technique provides stable and long-term hypotensive effect and prevents excessive scarring in filtering area. Suture inserted into the scleral tunnel dilates it and provides continuous aqueous humor outflow. 

Aim. To assess the correlation between eyelid and facial demodicosis and to develop an optimal anti-parasitic treatment schedule for posterior blepharitis associated with eyelid demodicosis. 

Materials and methods. 100 patients with posterior blepharitis associated with eyelid demodicosis were enrolled in the study. The patients were divided into 2 groups depending on Demodex count. Demodex count less than 4 mites was considered normal while Demodex count more than 4 mites was considered pathological. 60 patients with Demodex count more than 4 mites were subdivided into 2 groups. Study group patients (n = 30) received anti-parasitic therapy with preceding anti-inflammatory treatment, eyelid hygiene and massage. Control group patients (n = 30) received antiparasitic therapy only. Patients with verified facial demodicosis received dermatological treatment as well. In all patients, integral indices of subjective discomfort and objective signs of posterior blepharitis were measured, Schirmer’s and Norn’s tests were performed, functional state of meibomian glands was evaluated (compressive test). 

Results. Eyelid demodicosis was associated with facial demodicosis in 48% of patients. In 10%, Demodex count was less than 4 mites. In 38%, Demodex count was more than 4 mites. Skin lesions were revealed in 1% of patients with Demodex count less than 4 mites and in 20% of patients with Demodex count more than 4 mites. Anti-parasitic therapy with preceding anti-inflammatory treatment, eyelid hygiene and massage improved functional state of meibomian glands and objective signs of posterior meibomian blepharitis. In 1.5 months after the treatment, Demodex was absent in 80% of study group patients and 56.6% of controls. 

Conclusion. Stepwise treatment of posterior blepharitis associated with eyelid demodicosis (anti-inflammatory and anti-parasitic therapy, eyelid hygiene) is effective and provides prolonged remission. 

Exhaustion of anti-oxidative potential and oxidative stress are considered as trigger mechanisms of cataract development. Products of free radical oxidation are accumulated in lens. Decrease in water solubility of proteins results in the sorption of uncharged proteins on cellular membranes. This affects regular lenticular membrane folding. Light scattering on folded membranes of lenticular fibers is considered as a primary cause of lens opacities in cataract. Most problems occur in complicated cataract surgery as its development is associated with background diseases, ocular pathology, and external factor exposure. 

Aim. To increase the efficacy of cataract treatment in metabolic syndrome patients. 

Materials and methods. 115 cataract patients (230 eyes) were examined. All patients have undergone detailed clinical and complex eye examination and were divided into 2 groups depending on cataract genesis. In group 1 (age-related cataracts), somatic disorders were diagnosed in 4.5% of cases, in group 2 (complicated cataracts), somatic disorders were diagnosed in 100% of cases. Tear and blood tests were performed. Tear level of active peroxiredoxin 6 (PRDX6) and/or its breakdown fragments in fluid and blood level of metabolic syndrome markers were studied. 

Results. The expression of oxidative stress protective enzymes in tear fluid was investigated. Comparative assessment of tear antioxidant enzyme activity under oxidative stress in therapeutic and surgical procedures (phaco and ECCE) was performed. Post-operatively, PRDX6 increase was revealed in age-related cataract patients. This is confirmed by the absence of phaco complications. In complicated cataract, PRDX6 level was 6 times lower than in age-related cataract patients. 

Conclusions. Dynamic analysis of laboratory tests in complicated cataract patients confirmed or disproved the presence of general metabolic disorders and oxidative stress development. Tear proteomic profile and blood metabolic disorder parameters served as a basis for selective choice of topical and systemic antioxidant agents to prevent and stabilize lens opacities. 

Serotonin plays an important role in maintaining homeostasis due to a broad spectrum of receptors localized in nearly every part of the body, i.e., central nervous system, vegetative ganglia, cardiac and lung reflexogenic zone, smooth muscles, internal organs and microcirculatory bloodstream, ocular tissues and optic tract. Serotonin levels can be altered by serotonin receptor blockade. Dusopharm (naftidrofuryl), a drug with complex mechanism of action, inhibits 5-HT2 receptors. Selective inhibiting of 5-HT2 receptors of vascular endothelial and smooth muscle cells decreases vasoconstrictor effects of serotonin that releases from atherosclerosisand hypoxia-damaged vascular endothelium and prevents thrombocyte aggregation. In addition, naftidrofuryl is the antagonist of vasoconstrictor action of endothelin-1 expressed by vascular endothelium. Experiments with isolated rabbit smooth myocytes demonstrate that naftidrofuryl prevents endothelin-1 binding with endothelial serotonin receptors and smooth myocyte contraction. Naftidrofuryl improves blood flow owing to its effect on blood rheological properties (increases erythrocyte deformability and decreases their aggregation). This paper reviews the studies of Dusopharm in patients with intermittent claudication, post-insult conditions, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, and central retinal vein and its branches occlusion. These data allow to include Dusopharm in the complex therapy of central retinal vein and its branches occlusion, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, peripheral retinal degeneration, and retinal detachment to improve and stabilize visual functions and microcirculation. 

Currently, several eye nutritional supplements and food additives with bilberry extract are approved in Russia. Bilberry effects directly depend on anthocyanidin content. Hence, the expertise of nutritional supplements and food additives with bilberry extract is required to determine their qualitative and quantitative composition. 

Aim. To determine qualitative and quantitative content of bilberry anthocyanidin pigments in food additives. 

Materials and methods. Anthocyanidins from five samples were extracted with distilled water per anthocyanidin content. The samples were obtained by the dilution of a pill or capsule in 50 mL of water. Extraction was performed under continuous mixing on hot shaker. 1 mL aliquots were taken from the solutions, centrifuged for 10 min at 14,000 rpm, and filtered through syringe filters. Total level (i.e., quantitative and qualitative content) of bilberry anthocyanidin pigments in five samples was evaluated using UV spectroscopy. Experiment was performed twice for each sample. Qualitative content of anthocyanidin pigments was evaluated using reversed-phase HPLC. 

Results. All examined samples contain anthocyanidin pigments from bilberry extracts but no other natural sources. Their quantity which was measured by pH differential spectrophotometry varies greatly (from 0.168% to 8.30%) and may significantly differ from that of declared by manufacturer. This is due to phytogenic raw material and difficulties in standardization of active component content. 

Conclusions. The data obtained optimize dosing of food additives with bilberry extract by clinicians and patients considering individual tolerance, needs, and disease severity. 

Aim. To describe eye injuries in intensive care unit (ICU) patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.

Materials and methods. Study group included 50 patients (54 eyes) with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry), cranial CT and MRT, and bacteriological study of conjunctival smears. 

Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. 

Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

is case report describes Descemet’s membrane tear occurred during phaco. Early post-op corneal edema involved optical zone. 1-month treatment was ineffective, and the patient was referred to endothelial keratoplasty. Considering that corneal endothelium is able to cover local Descemet’s membrane defects if endothelial cell density is initially high, we decided to postpone endothelial keratoplasty and to observe the patient. Topical medications included osmotic, antiinflammatory, and hypotensive agents. 2 months after phaco, corneal edema began to reduce. 4 months after phaco, the cornea was almost transparent. Endothelial cell density in the central zone (where Descemet’s membrane was absent) was 1002 cells/mm2. The cornea remained transparent for 2-year observation. In a year after phaco, visual acuity was 20/32. Post-op bullous keratopathy treatment provided good therapeutic and optical outcome. Complete resolution of corneal edema due to Descemet’s membrane tear that persisted for 4 months after complicated cataract surgery demonstrates the possibility to recover structural integrity and functions of corneal endothelium even in large Descemet’s membrane tears. In corneal edema due to mechanical injury, endothelial keratoplasty should be performed at least 3 or 4 months after the injury since endotheliocyte function recovery is possible if endothelial cell density is initially high. 

Retinal disorders are the second leading cause of blindness and low vision in children. Early diagnosis and accurate interpretation of optic fundus abnormalities and novel diagnostic tools improve outcomes and prevent irreversible complications. Recently, the occurrence of atypical optic fundus pathology in children has increased. This requires correct differential diagnosis using modern non-invasive methods. Erythema nodosum (EN) is a rare condition that affects preschool children. This condition is characterized by acute or chronic deep dermal hypodermal skin vasculitis. Infectious diseases are considered as one of EN causes. EN is also associated with fungal diseases, inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), hormone imbalance, sarcoidosis, rheumatoid arthritis, tuberculosis, medications.
However, EN may occur as an isolated condition as well. Literature data on ocular manifestations of erythema nodosum are limited (episcleritis, pigment epitheliopathy). Acute bilateral neurochorioretinitis with serous MZ neuroepithelium detachment in a 5-year girl is of interest for clinicians, pediatricians, and ophthalmologists.