Purpose: To evaluate the clinical results of transepithelial corneal collagen crosslinking (CXL) compared with the standard CXL in patients with keratoconus.

Patients and methods. There were 94 patients (119 eyes) with I‑III stage keratoconus (according to the Amsler classification) under observation since 2011 to 2013. The first group included 43 patients
(56 eyes) among them 11 patients (11 eyes) with an initially thin cornea (380‑430 microns) underwent transepithelial CXL. 51 patients (63 eyes) in the second group — the standard CXL. Saturation of the cornea with a photosensitizer during transepithelial CXL was performed via electrophoresis using the «Potok-1» device, in the amperage of 1 mA for 10 minutes. CXL was performed with the use of «UFalink» device and «Dextralink» photosensitizer.

Results. Pseudo haze of corneal stroma was diagnosed on biomicroscopy after both methods of CXL. In the 1st group in 38 % of cases (30 eyes) it disappeared in 2‑4 weeks after the CXL, in the 2nd group in 100 % of cases (63 eyes) it resolved in 3‑4 months, on average, after the treatment. According to optical coherence tomography (OCT) in two weeks after transepithelial CXL there was a demarcation line in 27 eyes (48.2 %) after 1 month — in 15 (26.7 %), at a later stage — has not been determined. After a standard CXL demarcation line was determined during the first two weeks in all patients (100 %) and persisted until 12 months in 2 eyes (3.5 %). Indicator of cornea’s refractive power in 2 years after transepithelial CXL decreased by 1.5 D (p> 0.05) compared to baseline values after standard CXL decreased by 1.8 D (p>0.05). Uncorrected visual acuity after transepithelial CXL increased from 0,31±0,01 to 0,45± 0,05 (p<0.05) in 2 years, after the standard CXL — from 0,27±0,03 to 0.3±0,05 (r≥0,05). Corrected visual acuity (CVA) in both groups tended to increase over the two-year followup. The obtained comparable results showed that the use of transepithelial and standard methods of CXL in patients with keratoconus prevents disease progression in 73.2 % and 77.7 % respectively what confirms the possibility of its equal usage in clinical practice.

Conclusion. Transepithelial CXL with photosensitizer saturation by electrophoresis does not require de-epithelization, it’s well-tolerated and does not cause pain. This technique is equa the standard CXL procedure. It improves optometric data and stabilizes the disease process.

Structural biomechanical properties of the ocular corneoscleral shell largely determine its anatomic and optical parameters and its supporting and protective function. Therefore, changes related to age restructuring processes may affect the state of the cornea and the sclera, which should be taken into account in diagnosing eye diseases, especially age-related. According to actual literary data, age-related changes of the corneoscleral shell affecting its biomechanical properties involve all connective tissue components of the extracellular matrix: fibrous proteins (collagen and elastin) and intermediate substance components (proteoglycans and glycosaminoglycans). Aged patients have a larger diameter of elastic fiber fibrils in the external part of the sclera and a lower density of fibrils in the center as compared to young patients, which is an evidence of elastin damage at the molecular level and fibril degeneration. Age-related changes of proteoglycans are primarily
manifested in hydration loss, which leads to an increase in corneal and sclera density and regional thinning of tissues. Agerelated changes of collagen are less expressed than those of elastin and proteoglycans. Yet, the distance between collagen fibrils in the cornea becomes smaller with age; they are subject to destruction, and small spaces devoid of collagen tend to appear in the posterior stroma. The most pronounced age-related degenerative changes of collagen in the deeper layers of the corneal stroma occur in the limb, which accumulates more cross striated collagen fibrils. Recent years of research have shown that the formation of cross-linked chemical bonds, i.e. intra- and intermolecular cross links of collagen is the most important structural factor. It is this particular process that is responsible for structural stability of the corneal and scleral tissue, which tends to change with age or due to certain eye diseases, such as keratoconus or progressive myopia. Obviously, we need clinical technologies that allow an adequate estimation of the biomechanical state of the fibrous shell of the eye.

Currently, the most scientifically based local risk and progressive factors are elevated levels of intraocular pressure and its instability during the day, caused by local hydromechanical disturbances. However, the other factors affecting the circadian changes of intraocular pressure levels are still evaluated. It was found that light is one of the most important factors affecting the intensity of the cyclical fluctuations of various biological processes, including, and fluctuations of intraocular pressure. At the same time, glaucoma can lead to a variety of sleep disorders, due to a mismatch between cycles «sleep-wake». One if this reason is the death of retinal ganglion cells and their axons. Such damage indirectly lead to a decrease in production of the pigment melanopsin, which is located in the retina. It is not involved in the visual process, but ensures the implementation of circadian rhythms «sleep-wake» and mediated suppression of epiphyseal melatonin. Most likely, melatonin plays a protective role in the occurrence and progression of glaucoma, protecting retinal cells against free radicals and has a direct impact on the intraocular pressure level. Several studies have shown that the circadian change in intraocular pressure levels, and in particular, its substantial reduction, is influenced by melatonin. In this regard, glaucoma is a disease in which the death of retinal cells, including producing melanopsin, a unique opportunity to study violations of cyclic rhythms. Melatonin acts on such established risk factors and progression of glaucoma as hypertension and diabetes. There are published results of the use of melatonin agonists in the experiment and clinical practice. So, in addition to local and systemic hypotensive action, normalizes sleep patients. Data about the melatonin’s effects on the direct and indirect reduction of intraocular pressure, neuroprotective effects and reducing symptoms of depression can be used in the complex treatment of patients with glaucoma in future.

Purpose: to study the clinical and laboratory changes after phacoemulsification of the cataract in patients with diabetic retinopathy and essential hypertension as the comorbidity.
Patients and methods: 130 patients were divided into 3 groups. Visometry, tonometry, refractometers, perimetry, biomicroscopy and direct ophthalmoscopy, optical coherence tomography, autofluorescence, ultrasound biomicroscopy were conducted. The samples of tear fluid and serum were collected. The clinical and laboratory parameters of homeostasis (endothelial factors, cytokines (IL-6, TGF-β, VEGF, PEDF)), adhesion molecules (sICAM, sVCAM) have been evaluated.

Results: Stability of pro-and angiogenic balance has been defined after the phacoemulsification in patients with diabetic retinopathy without essential hypertension. Opposite changes proangiogenic potential has been observed in the group of patients with diabetic retinopathy and hypertension after phacoemulsification. Insignificant changes of immunobiochemical indicators were identified in patients, receiving Angiotensin-converting enzyme (ACE) inhibitors in postoperative period. It allows to predict a favorable course of disease. The changes in the balance of the evaluated parameters inpatients, receiving other medicines, were characterized with the increase of proangiogenic and endothelial dysfunction. It was a predictor of vascular changes. All identified laboratory patterns were confirmed by the parallel dynamic prospective ophthalmic studies that demonstrated a higher incidence of vascular disorders after phacoemulsification in patients with diabetic retinopathy and hypertension who were not taking ACE inhibitors. Accordingly, in patients treated with ACE inhibitors for the normalization of vascular hypertension, clinically stable course of disease has been noted.

Conclusion: The assessment of changes in vascular factors after phacoemulsification and the impact of antihypertensive drugs on the balance of laboratory parameters in patients with diabetic retinopathy and hypertensive disease allowed to establish a beneficial effect of ACE inhibitors on the stability of the angiogenic potential. It can be assumed that the basis of the picture described pharmacological properties of ACE inhibitors is a positive influence on the stabilization of the angiogenic potential and reduce endothelial dysfunction.

Purpose. Evaluation of efficacy and safety of a new nonsteroidal anti-inflammatory drug (NSAID) Broxinac (bromfenac 0.09 %).

Patients and methods.The study included 79 patients with different mainly inflammatory eye pathology. 

All of them have got the instillation of Broxinac 1 per day. The duration of treatment ranged from 1 to 4 weeks.

Results. No corneal complications and allergic reactions during the treatment were observed. Patients did not note any significant discomfort during instillation of Broxinac eye drops. In all cases fast relief of pain was noted. We registered not only quick decrease of exudative reaction in the anterior chamber, but also decrease of inflammation in posterior segment of the eye (fibrinous reaction in vitreous by uveitis).

Conclusion. Broxinac (bromfenac 0.09 %) is new effective and safe ophthalmic NSAID. Broxinac is very convenient eye drops with instillation only once per day. It should be used widely by different inflammation of anterior and posterior segment of the eye and also in the postoperative management.

Introduction. The main criterion for evaluating the efficiency of oncology service at the population level should be survival of cancer patients under strict control of all stages of conducted research from the collection of primary medical documentation to careful monitoring the state of health of follow-up patients. In the previous article («Russian ophthalmology» № 2, 2012) we have followed survival dynamics in patients with malignant tumors of the eye (C69) and C69.3 for the period from 1994 to 2008 in comparison with the European average data (programs Eurocare-3 and Eurocare-4).

Purpose. To continue the study of the dynamics of the observed and relative survival in patients with malignant tumors of the eye and its adnexa (C69) at the population level taking into account the peculiarities of this process in respect to tumors of choroid (S64.3). Material and methods. Since the formation of Cancer Registry’s database, from 1994 to 2012 there were registered 750 cases for the entire column C69, including 395 cases of malignant tumors of the choroid. The paper presents a detailed histological structure of malignant tumors per C69 and C 69.3. Survival rates were estimated for all histological codes. Estimations were carried out according to classical methods of data analysis at the population-based level.

Results. The findings suggest certain stabilization of efficiency of specialized care to patients with malignant eye tumors. This same applies to the structure of histological tumor types.

Conclusions. This study confirms constant positive dynamics of survival in patients with malignant tumors of the eye and its adnexa.

Disturbances of refraction are one of the most urgent problems of pediatric ophthalmology. Late and incomplete correction of refractive errors leads to the development of amblyopia, disturbances of binocular vision, the appearance of strabismus. Such complications reduce the quality of life, drastically limit the choice of professional child. Pediatric Ophthalmology always face a choice: many drugs and technologies are not approved for use in pediatric patients, practitioners are forced to use their «off-label», but such situations require great care and strict medical indications. For example, refractive surgery has worked well in adults, but its use remains controversial in children for security reasons and unpredictable effects. Several authors have described the use of laser refractive surgery in children under the age of 18 years, but there are no results of a multicenter, controlled study evaluating the safety, efficacy, and especially long-term results. In all the studies, the calculation was performed on adult nomograms ablation, while not proved how they are accurate for children. Long-term results and data on the endothelial cell density, corneal curvature changes in catamnesis are presented no longer than two years. Despite the fact that currently there is insufficient information about the results of remote application keratorefractive laser surgery in children, and there are no indication system and contraindications, modern achievements in medicine should be used in pediatric patients, and our successful track record proves it clearly. Undoubtedly, the positive experience of the laser surgery use in a child with clouding of the cornea in the outcome of herpetic keratitis, which provided a positive result: high visual acuity, binocular vision and lack of infection relapses for 2 years, requires study, evidence multicenter studies, and possibly expansion of indications for refractive laser surgery.