Crosslinking is a formation of chemical bonds between large molecules. It makes material stronger. Corneal crosslinking with riboflavin and ultraviolet A (UVA) has been successfully used in keratectasia treatment since 2003. There are some presuppositions of the scleral crosslinking successful using in the progressive myopia, characterized by thinning and mechanical strength decrease of the sclera, as well as in corneal ectasia. Experimental investigations showed an increase in the mechanical strength of the sclera after crosslinking with riboflavin and UVA in vitro. At the same time there were no changes in the thickness of the sclera. Achieved biomechanical effect was constant over a time with interval during up to 8 months in rabbits in vivo. Scleral structure changes after crosslinking were studied with light, electron and atomic force microscopy. Dense collagen bundle at the same time with fibers diameter increase was observed. The spatial pattern of fibrils within crosslinked scleral tissue was tangled and running in different directions. Some authors found such side effects of the procedure as damage of the retina and cornea on the irradiation side because of the high irradiance and thinning of the sclera as a result of dehydration. The optimal duration of riboflavin instillation (20 minutes) and irradiation with 3 mW/cm² (40 minutes) were determined in the experiments. It was shown in vivo, that crosslinking of the sclera with riboflavin and UVA prevented the growth of the rabbit eyes in occlusion-induced myopia. There are several data about successful clinical using of the scleral crosslinking. However, only 6 patients (12 eyes) were observed, procedure parameters are not clear, follow-up period was only 6 months. Thus, now there are many unsolved questions about efficacy and safety of the scleral crosslinking with riboflavin and UVA. Experimental results encourage for a new method of the progressive myopia treatment will be created.

Post-operative wound healing is one of the key-factors, defining success of filtrating surgery in late post-operative period. Wound healing is a physiological response directed at tissue structure reconstruction and function restoration, performed by several interacting cellular pathways. Surgical trauma leads to plasma proteins penetration to the filtration zone, as well as coagulation pathway and complement activation. The process of wound healing can be divided into three interconnected stages: inflammation, proliferation and scar remodeling. Inflammation is a protective response to tissue damage, that helps preserve its structure and cellular functions. It is characterized by neutrophil and monocyte arrival at the wound site. Neutrophils phagocytose the wound infecting bacteria and clean the wound site. Macrofages aid wound cleansing, participate in phagocytosis and produce a range of factors, necessary for new tissue formation. Proliferation stage consists of reepithelization and granulation tissue formation, which is accompanied by growth factors release. The growth factors stimulate the extracellular matrix formation and fibroblast proliferation. The last stage of the wound healing process is characterized by extracellular matrix remodeling with wound debridement achieved by a simultaneous synthesis and destruction of certain matrix components, cell differentiation, maturation and apoptosis. Apoptosis disturbance prolongs the fibroblast cell life and promotes excessive scarring. Three growth factors are thought to play a pivotal role in tissue healing and scarring transforming growth factor β, connective tissue growth factor and vascular endothelial growth factor. The article contains a review of their isoforms, role in wound healing and the possibility of their inhibition to alter the process. Matrix metalloproteinases are a protein family that can digest extracellular matrix components. Due to their influence on the tenon’s capsule fibroblasts, they supposedly play a key role in bleb contraction. Metalloproteinases selective inhibition after glaucoma filtration surgery can serve as a preventive measure against postoperative bleb constriction, which in turn enhances the likelihood of postoperative success.

Eye inflammation can be caused by different factors — allergies, infection, trauma (including surgery). It can have severe complications, last even after elimination the reason and cause the visual impairment as an outcome. Two main classes of anti-inflammatory agents (corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs)) are used for the prevention and relief of the inflammatory process. Along with the fact that corticosteroids are the «gold standard» treatment of inflammation in ophthalmology, they have a number of serious side effects such as increasing of intraocular pressure and the risk of developing glaucoma, cataracts, activation of bacterial, viral infection and herpes. The positive effects of NSAIDs in comparison with corticosteroids are stable intraocular pressure (IOP), analgesic effect and reduce the risk of secondary infection. The three classes of NSADs are currently used in ophthalmology. They are phenylacetic acid (diclofenac and bromfenac nepafenak), indole acetic acid (indomethacin) and geteroariluksunoy acid (ketorolac). The last synthesized NSAIDs for ophthalmology are amfenac and bromfenac. Bromfenac is effective for the relief of the inflammatory symptoms of and fully complies with the requirements for the ideal anti-inflammatory drugs such as good a penetration ability, creating a sufficient concentration inside the eye, the activity of cyclooxygenase, inhibiting the progress of macular edema, a good analgesic effect, minimal toxicity, comfort of use patients. Bromfenac is the only nonsteroidal antiinflammatory drugs, which is applied once a day and has a pronounced anti-inflammatory action.

Purpose. To develop a surgical treatment for large idiopathic macular holes using a new technique of internal limiting membrane fragment formation to close the macular hole.

Material and methods. We observed 19 patients, from 56 to 71 years old (average age was 63,8±5,3 years old) with idiopathic macular holes (IMH) stage III according to J. Gass classification. Standard ophthalmologic examination and spectral optical coherence tomography and microperimetry were performed in all cases. The follow-up was before treatment and 2 weeks, 1 and 3 months after surgery. A new technique of internal limiting membrane (ILM) fragment formation reminds the process of removal petals from a flower and is performed in several steps, including step-by-step separation of local areas ILM around MH preserving foveolar fragments and one ILM fragment, which is then partially separated towards MH, stopping at a distance of 0,1‑0,2 mm from the edge of the MH, inverted and covered on MH, closing it.

Results. Surgical interventions were made in full volume without complications in all cases. During follow-up visual acuity increased from 0.1‑0.4 to 0.3‑0.7 (mean 0,39±0,15). An improvement of the retina anatomical condition in foveal zone was observed in all cases: complete closure of MH was achieved in 8 patients, and partial closure of MH was achieved in 11 patient. Fixation point offset on 153‑369 mm toward the center of the fovea and fixation stabilization, and disappearance of absolute scotoma in the fovea center was observed in all patients.

Conclusion. The developed technique is perspective in the treatment of large idiopathic macular holes. Further investigations are necessary.

Purpose: to study the advantages and the efficiency of improvement of the surgical detoxification in patients with inflammatory and vascular eye diseases.

Patients and Methods. Examination included visometry with maximum correction, optical coherence tomography (OCT), ophthalmoscopy, fluorescein angiography (FAG), B-scan.

Results. The study was performed in 53 eyes of 53 patients (age from 45 to 60 years). There were 21 men, 32 women. 19 observed patients (19 eyes) had a partial or subtotal hemophthalmus. 34 patients (34 eyes) were observed for chronic recurrent uveitis. A significant decrease of blood in the vitreous was showed after treatment in 19 patients with hemophthalmus according to B-scan. Complete resorption of hemophthalmus and improvement in visual acuity (average: 0.71±0.15) was noted in 76,6%. In 14 from 34 people with chronic recurrent uveitis macular edema occurred. 3 months after surgical treatment retinal thickness in macular area decreased to an average of 256.3±9.2 mm. At the same time, there was an increase in visual acuity to an average of 0.65±0.05. Among 15 patients (15 eyes) with inflammatory exudation in the vitreous body against recurrent chronic uveitis there was a complete relief of symptoms of inflammation in 7‑10 days after surgical treatment in 78.4% of patients. In the remaining 26.6% the inflammatory exudates resorption in the vitreous occurred by 12‑15 day after the operation.

Conclusion. The proposed method of ophthalmodetoxification is a promising method of treatment of chronic recurrent uveitis and vascular eye diseases. Terms of recovery of patients with inflammatory and vascular eye diseases were reduced by 30% and visual acuity achieved at discharge exceeded 3.2 times the original level.

Diagnosis of deep optic disc drusen (OND) in children is difficult because they are not visualized ophthalmoscopically and often mimic a picture of stagnation, identifying the wrong tactics diagnostic and therapeutic actions.

Materials and Methods: Children who ophthalmoscopically revealed prominence and blurring of the optic disk with a comprehensive survey includes an ultrasonic scanning of the eyeball and orbit, optical coherence tomography (OCT) and retinal optic disc, computer perimetry, electroretinography (ERG) and the registration of visual evoked potentials (VEP).

Results and discussion: Optic disc drusen is diagnosed by ultrasound scan that leds to prominence disk. No changes perineural space allowed excluding stagnation and avoiding the need for complex and invasive methods. OCT allows locating drusen, and assessing the degree of prominence disc and peripapillary retinal condition. The degree of functional disorders of the optic disc and retina, correlated with the volume and topography of the drusen. Drop of electrophysiological parameters (neuroglial index and amplitude oscillatory potentials) and increased light sensitivity of the retina of depression (from the expansion of the «blind spot» to a generalized depression with lots of scotomas) depend on the volume, the depth of druses and their proximity to the vascular bundles, characterizing the degree of compression glial tissue of the optic disc and hemodynamic disturbances.

Conclusions: The proposed algorithm of examination of patients with optic disc drusen can not only establish the fact of presence of drusen, but also to determine their exact location, assess the severity of morphological and functional changes, determining the prognosis of the disease.

Purpose is analysis of development ocular ischemic syndrome after antiglaucomes operation. Patients and methods.

The materials: data of 14 patients after antiglaucomes operation. The age of patients ranged from 58 to 73 years, 5 females and 9 males. Ocular ischemic syndrome (OIS) was diagnosed in all patients at different times after surgery. This diagnosis is based on clinical manifestations of the syndrome and sharp disturbance of hemodynamic parameters in the main vessels of the eye and the brachiocephalic trunk. Hemodynamic parameters were evaluated with a multifunctional ultrasonic instrument («VOLUSON 730 PROGE») by contact transpalpebral method in 3‑D mode.

Results. 14 patients had OIS at different times after antiglaucomes surgery. In all cases, the surgery was without complications. In 3 patients OIS was set at 10‑12 days after surgery, at 7 — after 20‑22 days, at 4 patients — after 1 month. Computed perimetry noted concentric narrowing of the boundaries at 6, sectoral loss in 4 patients, MD, on average –11,43±0,892 (p <0,05), PSD on average 10,25±0,843 (p <0.05). Hemodynamically significant asymmetry of blood flow: internal carotid artery — in 9 patients, common carotid artery — in 7, external carotid artery — in 5 patients according to data of Doppler ultrasound.

Conclusion. Hemodynamically significant changes in the main vessels of the brachiocephalic trunk and the body trigger the development of ocular ischemic syndrome in these patients after antiglaucomes surgery. Considering the above, comprehensive examination of patients, including Doppler main vessels brachiocephalic trunk and eyes should be conducted before penetrating operations cause changes in perfusion pressure of the optic nerve.It helps to diagnose and provide therapy OIS.

Purpose. To study the influence of the new cosmecevtic — cream «Demazol» on the dynamics of clinical and laboratory parameters (akarogramms) with Demodex blepharitis.

Patients and methods. There were 56 patients with Demodex blepharitis with symptoms of blepharitis or blepharoconjunctivitis in the study. In all cases, the clinical diagnoses were confirmed by laboratory investigations of epilated lashes. The akarogramms indicated the number of adult mite larvae and eggs of parasites separately for each eye. The cream was applied topically on the eyelids 2 times a day following our instructions, and before this, we provided pretreatment alcohol eucalyptus or sage tincture. The course of treatment was 1.5 months. Alongside this, we conducted drug correction of the status of the tear film via artificial tears eyedrops and therapy of blepharitis or blepharoconjunctivitis withantibiotics, steroids or non-steroidal anti-inflammatory drugs. A controlled laboratory testing for the presence of the mite Demodex folliculorum was undertaken after the course of treatment with cream. Evaluation of the efficacy of the cream was undertaken in accordance with the age of patients (up to 70 groups of patients 70 years and older), and the amount of mites.

Results. The cosmetic cream «Demazol» had eliminated all forms of the mite Demodex — adults, larvae and eggs of parasites after 45 days of application. The number of mites after the course was significantly reduced: 5.7 times (by the number of adults); 3.7 times (the number of larvae) and 12 times (the number of parasite eggs). Reduction the number of ticks was noted in general by 95% of patients; full or substantial reduction by 62.5%, proving the specific efficacy of «Demazol.» The clinical effect of varying degrees (excluding akarogramm) was noted in 49 of 56 patients (87.5%). The percentage of patients with a moderate pronounced effect from the cream was 78.6%. The combination of a pronounced positive clinical effect with full 100% elimination of mites is recorded at 2/3 of all patients (60.7%). The efficacy of the cream «Demazol» according to clinical symptoms and laboratory parameters (akarogramm) is reduced in patients of an advanced age (over 70 years) and in patients with a high level of initial contamination of ticks or mites, from 5 to 15 on 1 eye. Overall, skin tolerance to the cream was good. Irritation after applying the cream was observed in 5 patients.

The study was hold on the basis of LLC «Eye Microsurgery» in Astrakhan.

Purpose: clinical evaluation the influence of Systane Balance (Alcon) the condition of the «ocular surface comfort» at patients with phaco.

Materials and methods. 60 patients took part in the study. 30 men and 30 women aged from 68 to 80 years. After the first survey the patients were divided into two groups by means of random choice (15 men and 15 women in each group). Three days before the surgery Both groups of patients received antibiotics (Vigamox (Alcon) and NSAIDs (Nevanac, Alcon) according to the standard scheme for preoperative preparation (during 3 days before operation). These drugs were also recommended in the postoperative period. Systane Balance (1 drop 2‑3 times a day) was prescribed for the first group in 2 weeks before phaco. The second group didn’t get any artificial tears. Systane Balance had been chosen as an artificial tears as its composition is very close to the natural tear film, compensates the deficiency of the lipid layer that is broken when meibomean gland dysfunction (MGD) thus it prevents from increasing tear film osmolarity and its rupture.

Results: In 60% (36 people) SSG was due to dysfunction of the meibomian glands, and 40% (24 people) had a different genesis (endocrine pathology, receiving β-blockers for local and systemic effects, long-term use of drugs containing the preservative benzalkonium chloride, menopause). One week after phacoemulsification all patients of group 1, treated with the drug Sisteyn Balance dramatically decreased the severity of complaints of dry eye, foreign body sensation, burning, lacrimation, blurred vision in comparison with the group without artificial tears One month after surgery, these complaints were even less pronounced. At the same time, subjective complaints in patients of the second group observed significantly more frequently than before surgery.

Conclusions. The patients who belong to the senior age group have MGD much more frequently (up to 60%). We received the optimization of the postoperative course, the improvement the quality of life of such patients and prevention from complications is possible in case of Dry Eye treatment, that is associated with MGD, with the help of Systane Balance.

The article presents data on the incidence of malignant tumors of the eye and its adnexa in Russia (according to the state reporting) and St. Petersburg (in accordance with the Population-based Cancer Registry (PCR)). There is reflected information included in the new X volume of the monograph of the International Agency for Research on Cancer «Cancer in five continents,» where only data for St. Petersburg were presented from Russia. During the period since the publication of our first article («Ophthalmology» 2012 №3) the Ministry of Health of Russian Federation has taken into account our proposal and included information on registered cases of primary malignant tumors of the eye and its adnexa (C69) in the state reporting (f. №7). Data on the frequency of new cases of malignant tumors are summarized in Russia by the staff of the P.A. Herzen Moscow Research Oncological Institute. Published data are for 2011‑2013.

Purpose. To present the latest data on the incidence of malignant tumors of the eye and adnexa.

Material and methods. There were used statistical materials of the International Agency for Research on Cancer, the statistical materials of the P.A. Herzen Moscow Research Oncological Institute, data of the Population-based Cancer Registry of St. Petersburg. The standard methods of estimation of analytical rates were used as well.

Results. Taking into account that at a national level (F. №35) there is no possibility of estimating of analytical rates such as the level of morphological verification, the distribution of patients according to the stage of disease, the possibility of analysis by administrative territories of malignant tumors of the eye and adnexa by age and sex groups, these estimations can be carried out only on the basis of the territorial registries.

Conclusions. Data on mortality from malignant tumors of the eye still remain inaccessible to researchers as far as the State Statistics Committee considers them as other group. The determine characteristics of mortality from malignant tumors of the eye can be obtained only from cancer registries database.

The aim of the study was to develop a methodology for assessing the quality of life in patients with different types of vitreoretinal pathology. The first stage is detection of target group, collection data of diseases, choosing the key features and principles of valuation developed questionnaire. The detailed list of questions, determination the type of questionnaire, method of data collection, as well as developing (if necessary) scaling system (indexation) of answers is made on the second stage. The preliminary version of questionnaire on the base on 2 first stage. At the final stage of development assess the reliability, validity and sensitivity of the method of construction with the possibility of some modification of both the questionnaire and psychometric evaluation of the parameters of the test should be accessed. We conducted a broad survey of 28 experts-ophthalmologists (mean age 42.4 years), with extensive experience as a general clinical practice (average work experience is 20.4 years), and immediate surgical operation in the field of medical and surgical treatment of patients with various types of vitreoretinal pathology. The list of suggested questions for patients (total 37 questions), and the time of occurrence of the symptom criteria for psychometric scale responses was presented to the every expert. The choice of psychometric rating scale is (along with the definition of specific issues) the basic methodological position of developing the questionnaire. The most appropriate time scaling with the month period. Therefore the answers were presented in the the form of «permanent», «once a day», «every week», «every month», «absent». From a practical point of view it is extremely important to the The consideration of a quantitative estimation of the responses is extremely important from the practical point of view.

Acanthamoeba keratitis (AK) — corneal inflammation caused by protozoa — Acanthamoeba. The disease is related mainly with wearing of contact lens, pathogen — Acanthamoeba penetrates under the contact lenses. The cases of AK after Lasik are described. Corneal epithelium microtrauma and contact with sources of environmental pollution are the risk factors of the invasion of Acanthamoeba into the cornea.

Acanthamoebas affect soil, stagnant reservoirs, swimming pools, drain pipes, tap water, etc. Diagnosis can be confirmed only when cysts are detected in cornea material, plate count, smear, and the containers where such material is stored. Long life cycle including cyst stage helps keratitis relapsing course last for months. It is not always possible to detect cysts. Assessment of etiology presents certain difficulties.

Such aspects as history taking, monitoring the clinical course of disease, confocal microscopy that enables to reveal acanthamoebas in vivo help to determine a diagnosis.

Disease is characterized by a long chronic course with the development descemetocele and cornea perforation. The sequence of remissions and exacerbations of inflammation, apparently, occurs due to peculiarities of Acanthamoeba life cycle. Acanthamoeba keratitis is difficult to treat, it’s resistant to antibiotics. Untimely diagnosed disease and delayed initiation of treatment in patients with AK promote corneal perforation and inflammatory process in deep eye structures what often leads to eye enucleation.

Severe pain is typical for AK in onset of disease. It is caused by emergence of subepithelial infiltrates and defects along the nerve fibers located in the most sensitive surface layer of the cornea. Conservative treatment is conducted with the use of antiseptics. The most effective one against cysts is 0.02% chlorhexidine which is prepared ex. temporae.

The article presents the peculiarities of clinical course of Acanthamoeba keratitis, clinical cases of the disease and the results of penetrating keratoplasty as the main method of treatment of severe AK.

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