Recurrent corneal erosion (RCE) syndrome is characterized by episodes of recurrent spontaneous epithelial defects. Main clinical symptoms (pain, redness, photophobia, lacrimation) occurred at night. Corneal lesions revealed by slit lamp exam vary depending on the presence of corneal epithelium raise, epithelial microcysts or epithelial erosions, stromal infiltrates and opacities. Microtraumas, anterior corneal dystrophies, and herpesvirus give rise to RCE. Other causes or factors which increase the risk of RCE syndrome include meibomian gland dysfunction, keratoconjunctivitis sicca, diabetes, and post-LASIK conditions. Basal membrane abnormalities and instability of epithelial adhesion to stroma play a key role in RCE pathogenesis. Ultrastructural changes in RCE include abnormalities of basal epithelial cells and epithelial basal membrane, absence or deficiency of semi-desmosomes, loss of anchor fibrils. Increase in matrix metalloproteinases and collagenases which contribute to basal membrane destruction results in recurrent erosions and further development of abnormal basal membrane. The goals of RCE therapy are to reduce pain (in acute stage), to stimulate re-epithelization, and to restore «adhesion complex» of basal membrane. In most cases, RCE responds to simple conservative treatment that includes lubricants, healing agents, and eye patches. RCEs that are resistant to simple treatment, require complex approach. Non-invasive methods include long-term contact lens use, instillations of autologous serum (eye drops), injections of botulinum toxin (induces ptosis), antiviral agent use or oral intake of metalloproteinase inhibitors. Cell membrane stabilizers, i.e., antioxidants, should be included into treatment approaches as well. Antioxidant effect of Emoxipine promotes tissue reparation due to the prevention of cell membrane lipid peroxidation as well as due to its anti-hypoxic, angioprotective, and antiplatelet effects. If conservative therapy is ineffective, surgical procedures (Bowman’s membrane polishing with diamond drill, anterior stromal puncture, excimer laser phototherapeutic keratectomy) are required. RCE therapy decision making should consider disease severity, the presence of concurrent pathology, medical experience and surgical instrument availability if needed. 

Aim. To assess preliminary clinical functional outcomes of phakic intraocular lens pIOL-3 implantation in high myopia.

Patients and methods. pIOL-3 was implanted in 6 patients (10 eyes) aged 27‑63 with high myopia and no concomitant pathologies. Follow-up period varied from 1 to 12 months. IOL is made of hydrophilic material Contamac CI26 with water content of 26% and refraction index of 1.46. pIOL design (holes in the haptic portions) provides its matching to ciliary sulcus size (0.5 mmless than linear size of the sulcus). Preoperative and postoperative examination included visual acuity measurement, biomicroscopy, ophthalmoscopy, visual field test, tonometry, endothelial microscopy, and ultrasound biomicroscopy. Simplicity of surgical technique, adaptability of haptics, and postoperative course were evaluated.

Results. Early postoperative period was uncomplicated. Uncorrected (UCVA) and best-corrected visual acuity (BCVA) improved in the first hours after the surgery. No visual acuity worsening (as compared with preoperative BCVA) was observed. Surgical procedure did not affected IOP even despite the absence of basal iridotomy. Maximum endothelial cell loss was less than 5%. No IOL forward «vaulting» was observed.

Conclusions. pIOL implantation in high myopia patients is safe and provides maximum visual acuity in the first postoperative hours. Owing to its design this IOL can be implanted into ciliary sulcus (which size is0.5 mmless than IOL diameter) without forward «vaulting». 

Aim. To analyze the efficacy of novel biodegradable Nasopore® nasal dressing for bleeding prevention in postoperative period after endonasal endoscopic dacryocystorhinostomy.

Patients and methods. Two cohorts of patients who underwent endonasal endoscopic dacryocystorhinostomy were analyzed. In these patients, the area of rhinostoma was plugged with biodegradable Nasopore® or non-biodegradable Merocel® nasal dressing to prevent bleeding. 37 women and 9 men (mean age 56 years) underwent the surgery which was performed under anesthetic using standard technology and endoscopic instruments. Nasopore® and Merocel® were used in 20 and 26 cases, respectively. Re-bleeding rate and the presence of post-operative discomfort were assessed. Specifics of nasal mucosa regeneration, formation of granulations, synechiae, and membranes in the area of nasolacrimal anastamosis were noted.

Results. Efficacy of nasal dressing was assessed in the first week after the surgery. In group 1 (Nasopore®), no nasal bleeding was observed and no re-tamponade was required. In group 2 (Merocel®), nasal bleeding occurred in 10 cases (38.4%) after nasal dressing removal, and re-tamponade was performed in 8 patients (30.8%). Main disadvantage of Merocel® is the «sawing» effect due to the pore texture of its surface. This property resulted in the bleeding after nasal dressing removal. None of group 1 patients complained of severe discomfort while 19% of group 2 patients experienced significant discomfort.

Conclusions. Biodegradable Nasopore® nasal dressing use in endonasal endoscopic dacryocystorhinostomy prevents recurrent post-operative nasal bleedings, decreases patient discomfort, provides better anatomical and functional outcomes and improves quality of life and medical social rehabilitation. 

Aim. To assess prognostic value of neuron-specific enolase (NSE) in blood serum and tear fluid in optic neuritis (ON).

Patients and methods. ON patients as well as healthy persons were examined. Group I included 27 patients (27 eyes) with acute ON. Group II included 23 patients (23 eyes) with ON and continuing optic nerve atrophy. Group III (controls) included 10 healthy persons (20 eyes). NSE levels in tear fluid and blood serum were measured using electrochemical luminescence immune analyzer Cobas-e-411.

Results. In group I, NSE levels in tear fluid and blood serum averaged 0.81±0.15 and 13.67±1.44 ng/mL, respectively. In group II, NSE level in tear fluid was 24.86±3.84 ng/mL (on average) while its blood serum level was within normal limits. In controls, NSE levels in tear fluid and blood serum were within normal limits (15.7±0.2 and 16.8±0.12 ng/mL, respectively).

Conclusions. In group I, NSE level in tear fluid was 19‑fold less than normal (р < 0.05). It appears to be due to the activation of hypoxia and anaerobic glycolysis in neurons. In group II, NSE level in tear fluid was 1.43‑fold higher than normal (р < 0.05). This may be due to neuronal degeneration and progressive death with NSE release from damaged neurons into the cellular matrix. 

Aim. To assess reliability, efficacy, and stability of corneal collagen crosslinking (CXL) results for stage I‑II keratoconus.

Patients and methods. 2‑year (2012-2014) results of CXL were analyzed. CXL was performed on 20 eyes of 15 patients (13 men and 2 women, mean age 31 years). Stage 1 keratoconus was diagnosed in 13 eyes, stage 2 keratoconus was diagnosed in 2 eyes. Primary stage 1‑2 keratoconus was diagnosed in 17 eyes, keratoconus after corneal refractive surgery (LASIK, radial keratotomy) was diagnosed in 3 eyes. Preoperative and postoperative examination included uncorrected (UCVA) and best-corrected (BCVA) visual acuity measurement, pachymetry, corneal topography (total astigmatism measurement), and biomicroscopy. Follow-up period varied from 1 to 24 months.

Results. All patients reported on vision improvement. Preoperatively, mean UCVA and BCVA were 0.4 and 0.64, respectively. Postoperatively, mean UCVA and BCVA were 0.49 and 0.66, respectively. Preoperatively and postoperatively, total astigmatism was 2.1 D and 2.0 D, respectively, while mean central corneal thickness was 454 μm and 447 μm, respectively.

Conclusions. Corneal collagen crosslinking for stage 1‑2 keratoconus provides mild UCVA and BCVA improvement, decrease in total astigmatism and central corneal thickness. CXL provides stable results of treatment of primary stage 1‑2 keratoconus and keratoconus after corneal refractive surgery. 

Aim. To analyze visual acuity, clinical refraction, and defocusing tolerance after the implantation of monofocal IOL with rotational asymmetric optic (Lentis Mplus 313 MF) compared with Acrysof ReSTOR SN6AD1.

Materials and methods. Phacoemulsification was performed in a total of 194 patients (288 eyes), i.e., 144 patients (188 eyes) with cataract and 50 patients (100 eyes) with presbyopia and high ametropia. The patients were divided into two groups. Study group included 132 patients (194 eyes) implanted with Lentis Mplus while control group included 62 patients (94 eyes) implanted with Acrysof ReSTOR. Uncorrected distance (5 m), intermediate (50‑70 cm), and near (20‑40 cm) visual acuity under photopic (85 cd/m2) and mesopic (8 cd/m2) conditions were measured, objective and subjective refractometry were performed, and defocusing tolerance was evaluated.

Results. Postoperatively, uncorrected distance and near visual acuity was high while intermediate visual acuity was moderately low. Lentis Mplus patients had better near and intermediate visual acuity under mesopic conditions as compared with Acrysof ReSTOR patients. Emmetropia (target refraction) was achieved in 90.2% of study group patients and in 87.2% of control group patients. In patients implanted with Lentis Mplus, refraction was measured by subjective method. Optimal A-constant for Lentis Mplus and Acrysof ReSTOR was 118.0 and 118.6, respectively. Under defocusing, Lentis Mplus patients had better visual acuity than Acrysof ReSTOR patients. This indirectly confirms better intermediate vision.

Conclusions. Lentis Mplus provides better vision at various distances that does not almost depend on light levels and induces minimal dysphotopsia. 

Aim. To analyze long-term outcomes and efficacy of retinal degeneration treatment with Retinalamin.

Patients and methods. Group I included 20 patients (40 eyes) with pigmentary retinal dystrophy (15 patients, 30 eyes) and retinal abiotrophy (5 patients, 10 eyes) who received treatment with Retinalamin for 5‑7 years. Group II included 11 patients (22 eyes) with pigmentary retinal dystrophy (9 patients, 18 eyes) and retinal abiotrophy (2 patients, 4 eyes) who received treatment with Retinalamin for 23‑25 years. Group III (controls) included 15 patients (30 eyes) with pigmentary retinal dystrophy (11 patients, 22 eyes) and retinal abiotrophy (4 patients, 8 eyes) who received traditional treatment (vasodilators, angioprotectors, antisclerotic agents, vitamins) for 25 years. Standard ophthalmological examination, i.e., visual acuity measurement, visual field test, refractometry, biomicroscopy, ophthalmoscopy, was performed.

Results. First course of treatment with Retinalamin improved vision in 58.1 % of retinal degeneration patients. Visual fields improved in 64.5 % of cases. Repeated treatment courses (1‑2 times a year) for 23‑25 years preserved residual vision in 55.6 % of patients and object vision in 11.1 % of cases. In retinal abiotrophy patients, residual vision preserved in 100 % of cases.

Conclusions. In retinal degenerations, Retinalamin improves vision and visual fields and decreases total area of absolute scotomas even after the first treatment course as well as preserves vision in prolonged use.

 

Aim. To study the effects of Cationorm for the prevention of ophthalmic complications in intensive care unit (ICU) patients and to compare the efficacy of ocular surface lubricants used in ICU. Patients and methods. 50 ICU patients (100 eyes) with bilateral lagophthalmos (2 mm or more) were enrolled in the study. Study group and control group each included 25 patients (50 eyes) who were on deep sedation and ventilator. Before and after the treatment, general examination, biomicroscopy, tonometry, ophthalmoscopy, Schirmer’s test and Norn’s test (with fluorescein) were performed. Results. Cationorm significantly improves tear film stability without any corneal epithelial defects (100 % of patients). In 7 controls (14 eyes, 28 %), initial signs of corneal xerosis and exposure keratitis were revealed. Conclusions. ICU patients are at high risk of complications due to hypodynamia and reduced innervation of the eye and its appendages. Bilateral lagophthalmos develops in 16.67 % of ICU patients who are on deep sedation and ventilator (up to 3 days). In the abscence of preventive therapy, lagophthalmos results in complications, i.e., keratitis and, occasionally, corneal ulceration and perforation. ICU patients require ophthalmological examination and tear substitutes. Regular instillations of Cationorm minimize ophthalmic complications due to intensive therapy. Cationorm restores tear firm architectonics and may be considered as a first-line choice for such disorders. 

Aim. To analyze the efficacy of modified pupillary massage technique using cycloplegic agent Appamide Plus in the treatment of anterior uveitis. Patients and methods. 45 patients (25 men and 20 women) aged 21‑69 with endogenous uveitis (51 eyes) were enrolled in the study. Etiology of uveitis was identified in 57.7 % of cases: herpes simplex virus (22.2 %); systemic disorders — rheumatoid arthritis, Reiter syndrome, Bechterew’s disease, psoriasis (17.7 %); local infection — purulent periodontitis or sinusitis (11 %). Patients were divided into two groups. Group I received basic therapy in combination with traditional pupillary massage. Group II received basic therapy in combination with modified pupillary massage using Appamide Plus (muscarinic receptor antagonist and alpha adrenergic agonist) and plasma exchange with cell mass ozonation. Results. Inflammation of the uveal tract was prevented in all patients. In group I (traditional pupil massage), posterior synechiae persisted in 26 % of cases. In group II (pupil massage using Appamide Plus), anterior chamber humor was transparent, posterior synechiae were broken, normal pupillary response was re-established. Additionally, inflammatory exudate in the anterior chamber and endothelial precipitates resolved by 3.3 days earlier than in group I (р < 0.05). Visual outcomes were also better in Appamide Plus group. T cell-mediated immunity study revealed initial CD3+ cell and T cell subpopulation deficiency. Relative and absolute references of T cells and their subpopulations tended to decrease even when uveitis signs reduced. Conclusions. T cell-mediated immunity depression is probably due to pharmacotherapy. Appamide Plus eye drops are highly effective for therapeutic mydriasis and pupillary massage in the course of anterior uveitis treatment to prevent synechiae formation in enlarged or small pupil.

Aim. To study immune and antioxidant status of diabetic cataract patients and to assess the efficacy of preoperative preparation for diabetic cataract surgery to prevent intra- and postoperative complications and the efficacy of cataract treatment in metabolic syndrome patients. Patients and methods. 136 cataract patients (272 eyes) were examined (mean age 62±3.2 years). Among these patients, women predominated (n = 74). Control group included 25 healthy volunteers (10 men and 15 women) aged 32‑56 (mean age 44.3±2.4 years) without ocular diseases (50 eyes). Two patient groups were examined. Group 1 included 78 patients (mean age 54±1.5) younger than 60 (52.5 %) with similar lens morphological changes and metabolic disorders who were diagnosed with complicated (diabetic) cataract. Group 2 included 58 patients with age-related cataract. Tear, anterior chamber (AC) humor, and blood tests were performed. Immune status, lipid peroxidation parameters in tear fluid and blood, active peroxiredoxin 6 (PRDX6) and / or its breakdown fragments in tear fluid and AC humor were studied. 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. Expression of protective enzymes against oxidative stress in tear fluid was studied. Activity of tear antioxidant enzymes under oxidative stress conditions in therapy and after cataract surgery was evaluated. Results. Postoperatively, increase in PRDX6 level was revealed in age-related cataract patients. The absence of phaco complications confirms these findings. In complicated (diabetic) cataracts, PRDX6 level was 6‑times less than in age-related cataracts. Conclusions. Prophylaxis of inflammatory complications in age-related cataract patients can be performed using the following schedule: 0.5 % levofloxacin 4 times daily, bromfenac once daily. 

Increased load on the visual analyzer of an operator, increase in everyday visual performance, universal introduction of information displaying on cathode-ray tubes result in temporary and stable visual disturbances. Accommodative refractive apparatus of an eye is one of the key points of application of visually intensive labor. Work associated with permanent eyestrain overloads oculomotor and accommodative apparatus thus provoking myopic shift, increase in dynamic refraction, exophoric or esophoric shift of initial visual equilibrium. Accommodation disorders are accompanied by changes in ciliary muscle blood supply, abnormalities of vegetative segment regulation, parasympathetic brain vascular dystonia due to the decreased tonus of sympathetic nervous system. Evaluation of certain kind of activity in terms of ergonomics includes examination of visual status and visual working capacity, development of visual professiograms and vision standards for certain professions, justification of methods and tools of visual work optimization. Visual disturbances in operators developing in the course of visually intensive occupational work should be considered from the viewpoint of traditional accommodation and refraction disorders as well as functional manifestations of general fatigue or thoracic cervical spine dysfunction. Symptoms of accommodative asthenopia can be regarded as a functional manifestation of general fatigue syndrome or functional neurosis. Development of multidisciplinary approach to the correction of accommodation refraction disorders in visually intensive labor persons is of scientific urgency and practical reasonability. There is a long-felt need in additional attraction of different specialists who use in their work physical factors for accommodative asthenopia correction. Development of multidisciplinary approach to accommodation refraction disorder correction in visually intensive labor persons is based on syndromic pathogenic treatment approach. Specific visual stimulation as well as tonic and psychorelaxation methods which provide correction of psychoemotional state and thoracic cervical spine dysfunction are the most actual tools. Cranial osteopathic therapy which uses specialized systems based on biological feedback principle are of special importance. These methods provide cervical muscle training and audio-visual stimulation as well. 

The value of dry eye for general public health increases due to its high occurence in elderly persons and aging population. Non-specific questionnaires are adopted for dry eye. Additionally, 36‑item Medical Outcomes Study-Short Form (MOS-SF-36) and benefit evaluation method were developed. Methods. Information analysis and mathematical methods and public health technology evaluation methods (i.e., modelling, analysis of disease burden, and budget impact analysis) were applied to economic aspect study. Decision tree model based on these finding was developed and applied to cost estimating of blepharoconjunctival and exogenous dry eye treatment in computer vision syndrome. Two scenarios of patient management were considered, i.e., typical management and management using therapeutic eyelid hygiene. Similar model was developed for early postoperative period after LASIK. Short-run analysis (1 year) was performed, direct medical costs were considered. This analysis implies the calculation of overall cost (economic burden) of the disease. Official data on adult population size in 2014 and the occurrence of the disease were used to assess prevalence. Budget impact analysis evaluates the difference in total economic effects due to comparison technology use in money terms. Sensitivity analysis assesses the stability of simulation results. Medical treatment cost was considered the most valuable parameter. Results and conclusions. Direct medical costs of typical management and management using therapeutic eyelid hygiene in demodicosis, computer vision syndrome, and after LASIK were 14,623 RUB and 9,200 RUB (savings of 37 %), 17,630 RUB and 9,200 RUB (savings of 47 %), 4,425.5 RUB and 3,004 RUB (savings of 32 %), respectively. Analysis of economic burden with respect to disease occurrence and typical management costs demonstrated that in 2015 this parameter was estimated as 576,198,416,556 RUB. In terms of direct medical costs, therapeutic eyelid hygiene saves 44 % (on average).

Aim. To analyze the impact of early ametropia detection on clinical and economic treatment aspects. Patients and methods. Retrospectively, quality of ophthalmological care in 60 children aged 6-8 with ametropia and strabismus was analyzed. All children were divided into three groups depending on age, refractive error and year at which treatment was initiated. In group 1 (30 children), refractive error and strabismus were diagnosed at the first year of life. In group 2 (18 children), refractive error and strabismus were diagnosed at the age of 1-3 years. In group 3 (12 children), glasses were prescribed at the age of 3-7 years. Retrospective analysis of primary medical records of enrolled patients was performed. All diagnostic and treatment methods that were applied as well as treatment results performed at the age of 6-8 were considered. The study of economic aspects considered the rates of ophthalmological examinations and pleoptic and orthoptic treatment courses as well as need in surgery. Direct medical costs were calculated for mediumterm prospects (3-5 years). Results. Early detection of refractive errors prevents amblyopia, binocular vision impairment, and strabismus. Uncorrected refractive errors in children are characterized by high economic and social burden (i.e., the higher is the age at which refractive error was revealed, the higher treatment costs are). Ametropia diagnosis in children requires special skills, hence, dilated eye exam must be performed by pediatric ophthalmologist but not by an orthoptist. Early diagnosis of refractive errors and strabismus provides accurate glass correction and timely therapy thus reducing treatment costs. Conclusions. In terms of clinical and economic efficacy, optimal age of refractive error detection is less than 1 year. Increase in diagnostic costs is compensated by good clinical outcomes and decrease in costs of managing complications and non-medical costs associated with reduced quality of life of patients and their families. 

Aim. To describe clinical manifestations of rare eyelid tumor (epithelioma Malherbe) and to improve differential diagnosis of benign eyelid tumors in children. Patients and methods. We observed 8 children aged 3,5‑8 years (sex ratio was 1:1). In all cases, examination, palpation, surgical excision of the tumor with histological examination were performed. Results. Trichilemmoma, or pilomatricoma, was suggested from clinical manifestations. Epithelioma Malherbe was diagnosed by histology only. Microscopically, the tumor is surrounded by a capsule which includes two cell types. Peripheral basophilic cells are small cells with poor cytoplasm, indistinct borders, and deeply basophilic nucleus. Central shadow cells have a distinct border and a central unstained area. Islands of small basaloid epithelial cells with squamous cell focuses and cornification are embedded in the stroma. Epithelial lesions are often necrotized. Epithelial mass is surrounded by granulations with giant cells. Osseous trabeculae are often adjacent to necrotic lesions. Further follow-up revealed no complications or recurrences. Conclusions. Our observations and literature data suggest that epithelioma Malherbe is occured in 1.3 % of benign eyelid tumors in childern. Tumor growth is slow and non-invasive.