Post-keratoplasty glaucoma (PKG) remains one of the leading causes of blindness due to the loss of optic nerve fibers and irreversible graft opacification. PKG is a challenge due to diagnostic and therapeutic difficulties and recalcitrant course. This paper reviews main pre-operative PKG risk factors such as pre-existing glaucoma, corneal disorders for which keratoplasty is performed, and lens status. Intraoperative errors that caused by ocular hypertension (tight suturing, larger trephine sizes, long bites of individual sutures, increased peripheral corneal thickness and graft-host disparity) are evaluated. Peripheral anterior synechiae, steroid use, and tonometry errors after deep anterior lamellar keraplasty are amongst post-operative causes of PKG. Partial transparency optical media, high post-operative astigmatism and graft edema make standard tonometry unreliable. Various tonometers and measurement reliability after keratoplasty are discussed. Currently, multiple treatment options including medications, laser and filtering surgery, glaucoma drainage devices and cyclodestructive procedures are available. In most cases of PKG, medications are initially prescribed. Evolution of approaches to PKG treatment as well as current therapy schedules, their advantages and ophthalmic complications are discussed. In cases non-responsive to medications, laser trabeculoplasty is performed. If laser procedures cannot be performed of their hypotensive effect is insufficient, glaucoma surgery is advised. A number of specialists prefer trabeculectomy with intra- or post-operative cytostatic adjunct. Glaucoma surgery with various drainage device implantation prevails. Ineffective surgery can be enhanced with transscleral laser cyclophotocoagulation.

Cataract surgery after radial keratotomy (RK) represents many challenges as many patients who had RK are now developing visually significant cataracts. Currently, cataract surgery is not only the exchange of opaque lens but a refractive procedure as well. Despite a huge armamentarium of diagnostic methods, intraocular lens (IOL) power calculations in these patients can be inaccurate and are associated with residual refractive errors for many reasons (overestimation of the corneal power by keratometry and corneal topography, errors in the assessment of effective lens position, inadequate selection of power calculation formulas). Methods based on refractive history which consider refraction and K values before corneal refractive surgery and its refractive result before cataract development as well as methods based on corneal topography are the most accurate methods to neutralize keratometry errors. Methods of «true» refraction estimation using correction coefficients which were calculated based on regression analysis of IOL implantation results after corneal refractive surgery are of significant importance as well. Patients with prior RK who undergo cataract surgery often require intraocular correction of astigmatism. The techniques include positioning and modifications of tunnel incision, anterior dosed keratotomy, excimer laser surgery, and toric IOL implantation. Finally, phaco technique should be carefully selected in patients with prior RK. Intraoperative dehiscence of RK incisions is the key challenge. 1.8‑2.2‑mm corneal incision placed between keratotomy incisions prevents this complication. In numerous keratotomy incisions, scleral tunnel is recommended.

Purpose. Development of a new method of autokeratoplasty using of femtosecond laser in patients with advanced keratoconus and evaluation of early results of treatment.

Patients and methods. 17 patients with advanced stable keratokonus were included in the study (15 men, 2 women) mean age 33±8.4 years old. Stage III of keratokonus was diagnosed in 3 eyes, stage IV was revealed in 14 eyes. Minimal corneal thickness was 381±33.82 μм, keratometric indices Ks 60.1±5.7 D, Kf 54.8±5.8 D, cylinder 9.1±3.8 D. Femtolaser-assisted refractive autokeratoplasty (FRAK) was performed with the use of «IntraLase 60 kHz». The idea of our method consists in performing of 2‑step resection of corneal stroma using femtosecond laser. Firstly, circular corneal cut should be made at an angle to the surface is fulfilled on distance 1.5‑2.0 mm from the limbus to a depth of up to 90 % of stroma thickness. Secondy, a second circular corneal cut — perpendicular to the surface, on distance from 150 to 300 mm from the first one, is performed so that the cuts intersected at a predict depth and the circular corneal flap with wedge-shaped profile was formed. After flap removal corneal wound is suturing with the single buried sutures 10‑0.

Results. Operation and early post-op period were uneventful. Mean
UCVA significantly improved from 0.07±0.03 to 0.26±0.13 to 3 months after surgery. Between 3 to 6 months after surgery, we observed the increasing of visual functions (like UCVA and BCVA). The improvement of BCVA was observed in 94.1 %, and in 76.5 % of cases the increase was more than 3 lines. The cylindrical component decreased from 9.1±3.8 to 5.4±2.5 D.

Conclusions. FRAK is a new method for the treatment of stable advanced keratoconus, which helps to improve optical capacity of cornea, allows to save the patient’s own cornea, improves both UCVA and BCVA. Non-penetrating nature of the operation helps to minimize the complications. Femtosecond laser for corneal stroma resection provides high accuracy and predictability. Further research is needed to determine long-term outcomes.

Purpose: is to evaluate the effectiveness of YAG laser posterior lens capsule dissection in patients with secondary cataract with concurrent intraocular pathology.

Patients and methods: retro- and prospective analysis of the results of the YAG — laser treatment of secondary cataract in the 196 eyes, including the intraocular concomitant pathology (myopia, glaucoma, age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa operated retinal detachment, chronic uveitis in remission, peripheral chorioretinal degeneration). Effectiveness of treatment was evaluated by checking visual acuity and dynamics of complaints as aberration, glare, distortion in the central field of view without proper disease of the macula. Complex preoperative studies included: refractometry, visometry with correction, perimetry, tonometry, biomicroscopy, ophthalmoscopy, ultrasound examination of the eyeball (if necessary). The examination results should demonstrate convincing evidence that posterior capsular opacification is the main reason for the decrease of visual acuity.

Results:, Visual acuity, at average increased from 0.4‑0.6 to 0.8‑1.0 in 50 cases after dissection, Visual acuity improved to 2‑3 lines in 66‑4–5, 24‑6‑7 lines in 74 cases. Visual acuity remains the same, but contrast sensitivity was increased in 6 cases. The IOL location after disruption was evaluated by β-scanning and biomicroscopy. In case of the initial correct IOL position in all 195 (100 %) cases, there were no dislocation in the postoperative period. Complications that can be identified were single microcraters on the IOL surface in cases of its full contact with the posterior capsule. These injuries did not affect the visual functions.

Conclusion: YAG -Laser dissection of secondary cataract is effective, less traumatic, and the optimal treatment of secondary cataract, including patients with concomitant intraocular pathology, and helps to avoid over diagnosis of visual field check among patients with open-angle glaucoma.

Purpose: To develop an uniform method of the treatment for patients with progressive keratoconus (stage 1‑2) and cataract.

Patients and methods: 4 patients (5 eyes) with cataract and progressive keratoconus stage 1‑2 were enrolled in the study. Mean age was 42 years. In all patients, standard ophthalmic examination as well corneal topography, anterior segment optical coherence tomography, biometry, and IOL power calculations using IOLMaster were performed. Mean uncorrected visual acuity (UCVA) was 0.1 while mean best-corrected visual acuity (BCVA) was 0.4. Surgical technique included two steps. The first step was the creation of corneal tunnels with femtosecond laser with subsequent phaco and monofocal aspheric IOL implantation. The second step (1‑2 weeks later) was the implantation of intrastromal ring segments based on corneal topography and corneal crosslinking.

Results: After the first step, all patients had myopic refraction (from –1.0 D to –2.5 D). Cylindrical component was almost unchanged. After the second step, the patients reported the vision improvement, mainly due to UCVA. Both spherical (myopic) and cylindrical components decreased, mainly due to the steep meridian. After the treatment, optical power of the cornea decreased, mainly due to the steep meridian. UCVA was 0.6 or more in 60 % of cases, final BCVA was 0.8‑1.0 in 80 % of cases. Neither intraoperative nor postoperative (follow-up was 2 years) complications were observed.

Conclusions: Combined phaco and prior creation of corneal tunnels with subsequent intrastromal ring segment implantation and crosslinking in patients with cataract and progressive keratoconus stage 1‑2 is safe, provides good predictable outcome and significantly reduces rehabilitation period.

Purpose. To suggest a safe and effective way to improve the rotational stability of the position of toric the intraocular lenses in the capsular bag.

Patients and methods.86 patients (97 eyes) with corneal astigmatism undergoing cataract surgery and Acrysof Toric (Alcon, USA) intraocular lens implantation. In 42 patients (47 eyes), the intraocular lens (IOL) were implanted in accordance with the proposed invention.

Results. Average rotation angle IOL implanted by traditional technology was 2,2±2,0 degrees during 12 months. In patients with IOL implanted by the proposed method, the average angle of rotation of the IOL in all operated eyes was significantly lower and amounted to 0,8±1,2 degrees (p <0,05). Сonclusion. The proposed method of fixing the toric IOL provides for prevention the IOL rotation and decentration relative to the eye optical axis, take steps to prevent phimosis anterior lens capsule, maintaining high visual function for a long time, and as there is no need for repeated surgery.

Purpose is the optimization of surgical methods in patients with isolated orbital wall fractures.

Patients and methods: for patients with isolated orbital wall fractures were used extraoral (n = 46) and infraaxillary (n = 66) surgical approaches. Abolition of defects and deformations using infraaxillary approach was made with a combined endoprosthesis which was developed in the Department of Oral and Maxillofacial Surgery in Novokuznetsk State Institute of Postgradu ate Medicine. The construction is a combination of L-shaped titanium mini-sheet and silicone slab.

Results: during the observation the patients who underwent extraoral approaches (n = 46) we have diagnosed following complications: limit of the eyeball movement, diplopy (in case of using metal implants made of porous titanium nickelide and meshed titanium) — 3 (6,5 %) patients; — long-term lymphostas after surgery when using transconjunctive and subciliary approaches — 12 (26,1 %) patients; — ectropion when using infraorbital approach — 2 (4,3 %) patients; — moving of silicone implant with staying by infraorbital rim combined with enophthalmos as a late complication — 3 (6,5 %) patients. In group with infraaxillary approach (n = 66) there were no complications in early postoperative period. Late complications in 2‑6 months in the way of miniplate cutting were found in 5 (7,6 %) cases (in the area of inferior eyelid fold in the scar location), in 1 (1,5 %) cases — enophthalmos within 3 mm. While cutting the miniplate the implants were removed; then there were no any complications.

Conclutions: in this study was determined infraaxillary approach was determined the effective method for reconstruction of orbital wall fractures as it removes post-traumatic enophthalmos, limitation of eyebulb movement, diplopy, eversion and lymphostasis of the lower eyelid. The use of infraaxillary approach allows to avoid all these comlications and to reach best clinical and functional results of patients treatment.

Purpose: to study the vascular platelet hemostasis parameters in primary open-angle glaucoma (POAG).

Patients and methods: ophthalmic examination, plasma level of spontaneous and induced platelet aggregation and von Willebrand factor (vWF) were performed in 67 patients with high pressure glaucoma (HPG), 41 patients had normal tension glaucoma (NTG) and 38 were in control group. Period of study was 36 months. The statistical analysis included standard methods of variation statistics. The threshold P value for statistical significance was 0.05.

Results: platelet aggregation was increased in glaucoma (adrenalin-induced aggregation in HPG was 63,34 %±20,42 %, р = 0,043, in NTG 62,35 %±11,53 %, р = 0,047, in comparison with control group — 49,71 %±15,96 %; ristocetin-induced aggregation in HPG was 79,45 %±28,63 %, р = 0,015, in NTG 68,98 %±12,42 %, р = 0,022, and in control group 53,56 %±8,80 % accordingly); the mean level of vWF was increased in HPG (113,25 %±24,31 %, р = 0,009) and NTG (106,85 %±21,02 %, р = 0,012) in comparison
with control group (93,86 %±17,13 %). Patients with normal level of vWF did not have a progression of glaucoma optical neuropathy. Patients with normalized level of vWF under treatment had significant improvement of MD in 6 months (from –4,916±5,121 to –4,103±4,658, р = 0,037) and were stable in the further follow up period. Patients with increased level of vWF had deterioration of MD in 36 months (from –4,616dB±8,426 dB to –5,974dB±8,852 dB, р = 0,042), increase of cup / disk ratio (from 0,59±0,21 to 0,66±0,24, р = 0,041) and thinning of average RNFL according to HRT and OCT (from 0,21±0,09 μm to 0,17±0,08 μm, р = 0,04; from 74,37±15,34 μm to 69,44±15,12 μm, р = 0,04).

Conclusion. The obtained results indicate the importance of the vascular platelet hemostasis in POAG pathogenesis and the perspectives of its correction in glaucoma treatment.

Purpose: To determine the correlation between global and sectoral topographic parameters (TP) of the optic nerve head (ONH) and the standard automated perimetry common indices, to assessment of the diagnostic accuracy of the ONH TPs in primary open-angle glaucoma (POAG) discrimination; to establish a combined staging system of glaucomatous structural damage based on global and sectoral TPs of ONH obtained by Heidelberg Retina Tomograph (HRT) II.

Patientsand methods: 257 eyes of 176 patients (mean age 64±11), 69 (79 eyes) men and 107 (178 eyes) women were examined. They were separated in four groups: a control group of healthy volunteers and three groups of POAG patients with different severity of their visual field changes according to the Hodapp-Parrish-Anderson classification. Comprehensive ophthalmic examination, standard automated perimetry (SITA standard 30‑2) and examination with HRT II (3.1.2) were performed.

Results: The TPs rim area (r = 0.469, r = –0.384) and rim volume (r = 0.431, r = –0.363) were most strongly correlated with the visual field changes expressed by the common indices — MD and PSD. The ONH TPs with highest diagnostic value were: cup shape measure (AUROC = 0.778), vertical cup / disc ratio (AUROC = 0.721), rim / disc area ratio (AUROC = 0.714), rim area (AUROC = 0.711) and rim volume (AUROC = 0.706). The staging system of glaucomatous structural damage based on global and sectoral TPs of ONH obtained by HRT II was established. It consists of four different stages: early, developed, advanced and terminal. Each of them is characterized by the interval of the chosen TP values.

Conclusion: The changes of TPs rim area and rim volume determine the highest level of visual field changes in POAG. Cup shape measure is the most important TP in early glaucoma diagnostics. The proposed combined glaucoma staging system presents both the degree and the localization of the ONH defects together with some disease progression risk factors. The presence of standardized criteria allows its use in glaucoma progression follow-up.

Purpose: Conducting complex (clinical, hemodynamic, subjective) evaluate the effectiveness of vitrectomy in patients with expressed destructive changes in the vitreous (CT).

Patients and methods. We observed 74 patients (86 eyes, mean age 63.4 years) with severe destructive changes CT manifested almost constant presence of «flying flies» in front of his eyes. Subtotal vitrectomy was performed by standard methods using instruments 25-30G with intraoperative use of a standard balanced salt solution (Balansed Salt Solution, BSS), further enriched with the introduction of an antioxidant (glutathione) in all patients in the main group.

Results. Vitrectomy in patients with acute ST destructive changes
associated with significantly positive parametres of microcirculation (by 24,7 % –30,7 %, p <0,05) and subjective status (at 12,7 %, p <0,05), the progress after the surgery performance was not significantly different from that of the control group. There was a trend (p> 0,05) of increasing the maximum correctable visual acuity and the degree of lens opacity after surgery. The results of the the postoperative survey have shown that 92 % of patients were completely satisfied with the outcomes of operations (6 % — not satisfied, 2 % — had difficulties with answer). Subjectively, significant improvement in vision after surgery indicated in 62 % patients, eyesight was better — 26 %, unchanged — 10 %; blurred vision — 2 %. Our results regarding the dynamics of microcirculation suggest that surgical removal of the CT in expressed destructive changes lead to the normalization of the eyeball microvasculare perfusion. It is accompanied with the restoration of the natural balance between the arteriolar influx and venular outflow, as well as between the active and passive components of the regulatory microhemodynamics. These changes are responsible for the improvement of metabolic processes in the tissues of the eyeball, contributing to maintain a constant temperature and transparency of the CT, which generally provides the necessary prevention of postoperative complications in the retina.

Observational study of patients after excimerlaser vision correction by LASEK method.

Purpose: to estimate efficacy HILOZAR-COMOD® solution in patients after excimerlaser vision correction.

Patients and methods: We examined 80 eyes (40 patients) after excimer laser correction by LASIK method. All patients were divided in 2 groups. The patients from the first group were treated with by standard drug’s scheme, included deprotein izing the dialysate from the blood of healthy dairy calves (Solkoseryl® eye gel). HILOZAR-COMOD ® was prescribed as cornea protector in the 2 group of patients.

Results: In the first group complete cornea epitalization by biomicroscopy in 70 % eyes after 48 hours of excimerlaser vision correction was found. Minimal unepitalization areas were diagnosed in 30 % (12 eyes). In the second group complete cornea epitalization was found in 82,5 % eyes (33 eyes) in the same term after excimerlaser correction. Cornea epitelium defects in optical area were diagnosed in the17,5 % eyes. The difference between number of patients with cornea epitelium defects first and second groups was 12,5 %. 97,5 % patients (39 eyes) of second group (HILOZAR-COMOD ®) had complete cornea epitelization after 72 hours of excimer laser correction. In the same term unepitelization areas were found in 3 eyes (7,5 %) in patients of first group. It was to 5 % more than in the first group, where dexpantenol and hyaluronic acid was used (complete cornea epitalization in first group was found in 37 eyes).

Conclusions: The combined medicine included dexpantenol and hyaluronic acid decreases intensity of the dry eye symptoms, stimulate quick and full cornea healing and decrease the risk of postoperative complications risk.

The authors study the problem of inertia in the medical practice of ophthalmology, which implies the absence of any modification of the treatment in the presence of objective necessity or clinical indications. The treatment of multifactorial diseases, including primary glaucoma is particularly critical. An anonymous survey of 147 ophthalmologists from different regions of Western Siberia — Altai Territory, Kemerovo Region and the Republic of Khakassia, has been conducted. Most of the surveyed doctors believed that their treatment was successful in 40‑80 % of patients. According to literature data, ithe target value of IOP level is achieved in practice in under half of the patients receiving regular therapy. Another reason of medical inertia was the fear of polypragmasy. Almost 54 % of doctors said they are afraid to prescribe several medications, which limits their desire to intensify therapy. The results of our study suggest that the cost of glaucoma treatment, i.e. the fear to prescribe an expensive treatment for patients does not significantly determine the doctors’activity. Doctors often exaggerate the fear of patients for the treatment, believing that a particular medical drug
will not be taken by the patient, without trying to figure out the patient’s intention. The economic barrier has become an essential factor for our doctors, as 35 % ophthalmologists believe that 300‑500 Rubles for the therapy per month is expencive for a patient. Over 30 % respondents discussed with the patient the prescribed treatment with cost about 700‑900 Rubles. This could potentially lead to the fact, that the second and third medical drugs would be less likely prescribed due to the increased cost of treatment. Thus, we have set up the structure of the causes of medical inertia — a psychological unwillingness to achieve target values of IOP, overestimation of the therapy success. Less important reasons were the lack of doctor’s awareness and the economic barrier forthe decision making.

The main goal of this study is to identify the role of compliance in the prevention of complications while wearing soft contact lenses (SCL). 2257 patients in the «Center of vision correction contact» were examined. The age of patients was from12 till 46 years. 58 % female, 42 % male. 47.5 % patients were using daily disposable lenses, 52.5 % — lenses of planned replacement: 23.4 % — 2 weeks, 25.1 % — 1 month, 4 % — 3 months. All patients were using SCL for at least 1 year. The benefits of contact lens are compared with the glasses by different authors. However, any contact lens are a foreign body for the eye, which requires special care, and in case of non-compliance with the doctor’s recommendations may cause the complications. This study has shown that compliance among patients using contact lenses is below 50 %. The main reason for noncompliance of patients is the lack of time and attention to the health of patients. For achievement of compliance and prevention of complications of contact lens is recommended to regularly take the following necessary measures: patient education, explaining to him the need for each stage of lens care, which increases motivation. At the same time, the learning process can be demonstrated to have complications arise in the case of disturbances. Optimization of individual therapeutic program, which is the correct selection of contact lenses and care products tailored to the individual needs of the patient, his lifestyle and personal finance. However, the risk of complications depends not only on the doctor or the manufacturer, but to a greater extent on the patient. In other words, compliance — a necessary condition for ensuring the effectiveness of contact lens and avoiding the occurrence of complications.

The purpose — to evaluate the effectiveness of the posterior sclerectomy with the corneal trepan in a uveal effusion syndrome.

Patients and methods. Patient 1. The man, 61 years, complained about a blindness of the right eye and the progressing decrease in vision of the left eye. According to data of examinations the diagnosis was: uveal effusion syndrome, detachment of the choroid, exudative retinal detachment, the complicated cataract of both eyes. Patient 2. The man, 62 years, with complaints to low vision of the right eye and a blindness of the left-hand eye. Diagnosis: uveal effusion syndrome, detachment of the choroid, exudative retinal detachment, the initial complicated cataract of the right eye. Subatrophy operated retinal detachment, complicated cataract, silicone into the vitreal cavity of the left eye. Both patients underwent trepanation posterior sclera.

Results. The patient 1noted significant improvement of vision in both eyes at the last examination. Мisual acuity with correction was OD — 0,2, OS — 0.3. Intraocular pressure was normal, improvement of electrical sensitivity and lability was diagnosed. On ultrasound examination of the retina belonged, moderate swelling of the choroid remained. Patient 2. Visual acuity was 0,1 + 3,0 D at the time of the last inspection. According to the ultrasonic B-scan of the right eye retinal detachment decreased to 3,8 mm, moderate swelling of the choroid remained. The OСT has showed detachment of the neuroepithelium in the macula to 60 μm. In ultrasonic biomicroscopy circular, ciliochoroidal detachment to 0,15 mm was diagnised.

Conclusion. Described clinical cases confirmed the almost complete recovery of patients with the uveal effusion syndrome. Sclerectomy with the use of corneal trepan is a technically simple procedure and helps to define the path of the outflow suprachoroidal fluid subtenon space.