The article describes modern approaches to controlling wound healing after fistulizing glaucoma surgery. It provides a classification of refractory glaucoma degrees and summarizes risk factors for excessive scarring. Author describes various applications of widely administered in clinical practice antimetabolites (5 fluorouracil, mitomycin C) in patients with different degrees of excessive wound healing risk. The review also recounts international experience of steroidal and nonsteroidal anti-inflammatory drug use and their efficacy research study results. Much attention is given to new strategies of wound healing regulation after fistulizing glaucoma surgery, aimed at enhancing its results. The article describes characteristics and modes of action of medicinal agents effecting the cytoskeleton, such as Rho-kinase inhibitors and taxane anticancer agents. A detailed account of modes of effecting wound healing through regulating the process growth factors, proteinases and cytokines is also given. Possible strategies include antifibrotic cytokine interferon-α application and inhibiting the following agents: transforming growth factor β; connective tissue growth factor (CTGF), that controls extracellular matrix components production and cicatrical tissue formation; vascular endothelial growth factor (VEGF), that indirectly influences fibrotic activity through its angiogenic effect and also has a supposed direct effect on fibroblast activity; proinflammatory placental growth factor (PIGF), that increases bleb area size and its survival time, and decreases postoperative angiogenesis, inflammation and fibrosis intensity. The last part of the article gives a brief report on less widespread and researched methods of wound healing regulation, such as suppressing the activity of matrix metalloproteinases and amniotic membrane application.

Acute bacterial postoperative endophthalmitis (AE) is a destructive intraocular infection with a tendency to an increase of morbidity and prevalence. This phenomenon is contributed by worldwide increase of surgical activity together with an increase of life expectancy. Nowadays AE prevalence in the best ophthalmic clinics of the world varies from 0.039% to 0.59%. Modern approaches to complex treatment of acute bacterial postoperative endophthalmitis are described in details in EVS 1995 and ESCRS 2013 investigations where the two main standards — “gold” and “silver” — are reflected. “Gold standard” includes 3-port vitrectomy with bacterial seeding of anterior chamber and vitreous cavity content and intravitreal antibiotics injection at the final step of operation within 1 hour after diagnosing acute endophthalmitis. Use of “silver standard” is acceptable in absence of vitreoretinal operation room and trained surgeon, that is, in case if full vitreoretinal surgery is impossible. In such cases surgical intervention is limited by taking vitreous cavity and anterior chamber content for bacterial seeding with intravitreal antibiotics injection at the final step of operation. Nowadays surgeons have the task not only to suppress infection and preserve the eye as an organ, but also to preserve maximal possible visual functions. The review deals with the questions of antibiotics choice with sufficient antibacterial spectrum and minimal toxicity. Questions of modern antibiotics pharmacokinetics and influencing factors such as molecular mass of the antibiotic, the extent of vitreous liquefaction, solubility coefficient of the antibiotic, the extent of eyeball inflammation, status of iris-lens diaphragm and vitreous cavity (phakic, aphakic, pseudophakic, avitreal eye, silicone tamponade), density of antibiotic solution are being discussed. Features and advantages of vitreal surgery are considered. Choice of vitreous body substitutes which are capable to improve anatomic results of treatment is analyzed. Thus, search for most effective treatment algorithm for acute bacterial endophthalmitis is still going on.

The review presents an analysis of the literature data on the methods of surgical correction of residual refractive error after cataract phacoemulsification. Keratorefractive and intraocular approaches are considered in details. A comparison of the efficacy and safety of different groups of methods on the example of comparative studies is given. Historically earlier keratorefractive methods (laser vision correction with LASIK and PRK techniques on intact eyes, LASIK after implantation of multifocal IOLs and arcuate keratotomy after phaco) are indicated for the correction of astigmatic refractive error and a small spherical refractive error. Intraocular methods, including the replacement of the IOL and “piggyback” IOLs implantation are used to correct a large spherical refractive error. The introduction of new technology, the implantation of light-adjustable IOLs, will expand the existing evidence and provide greater predictability and efficiency of the method of correction of residual refractive error.

Review describes the theme of rhegmatogenous retinal dеtаchment associated with choroidal separation. It is rare, but quite severe eye pathology. In most cases it has a very poor prognosis. Most authors consider the retinal detachment as a primary pathogenetic part, which decompensates the production of aqueous humor by increasing the absorptive surface of the retinal pigment epithelium. Dilatation of choroidal arterioles occurs in hypotension, it leads to extravasation of protein-rich fluid in the choroidal and the suprachoroidal space. This helps to further swelling and separation of the ciliary body and the choroid with reduced production of aqueous humor and progressive hypotension. There is a high risk of developing “retino-choroidal” separation in patients with macular rupture due to localization of retinal separation and rupture rear hyaloid membrane. The protein level in aqueous humor can be increased to 70 times. It may be a result of reflux of suprachoroidal proteins through uveoscleral route and / or venous proteins through the trabecular network. In addition, the diffusion of proteins from the posterior camera and vitreous cavity is possible. This creates favorable conditions for cell proliferation that can lead to postoperative proliferative vitreoretinopathy. Typically patients have a pronounced signs of inflammation, pain, and “red eye”, which is accompanied with vision decrement. Rhegmatogenous retinal reparationcan be associated with such clinical symptoms as severe panuveit, deepening of the anterior camera and the inflammatory response in the moisture, concentric wrinkles and sagging back of the iris, posterior synechia, iridofakodenez, blurred vitreous detachment of the ciliary body, hypotension, and choroidal and retinal detachment in addition. Debatableness of etiopathogenesis and a clinical picture, which is similar to other eye diseases create significant difficulties in early diagnosis and proper treatment of this pathology. Correct early diagnosis of “retino-choroidal dеtаchment” is complicated by several factors: sluggish pupil dilation, exacerbated by the presence of posterior synechiaes, clouding environments with the presence of cellular elements, choroidal dеtаchment, masking the retinal tears. Rhegmatogenous retino–choridal dеtаchment should be differentiated from a number of pathologies. The most obvious sign of “retinyl choroidal” dеtаchment is severe generalized inflammation leading to an erroneous diagnosis of uveitis. A particular problem is the differentiation with syndrome of uveal effusion, choroidal melanoma. Retino-choroidal dеtаchment is a rare pathology that requires timely and correct diagnosis of pathogenically based treatment.

The goal is to identify objective indications for early primary vitreous surgery in infants with aggressive posterior ROP and to develop a methodology. Patients and methods. The study included 20 preterm infants (40 eyes) with aggressive posterior ROP at the stage of formation exudative-tractional retinal detachment, which were divided into two groups. The main group consisted of 10 infants (20 eyes) with severe manifestations of aggressive posterior ROP. The control group included 10 premature infants (20 eyes) with aggressive posterior ROP, who underwent transpupillary laser coagulation of the retina (LC). In all cases (20 eyes) 5-8 days after LC was recorded the progression of the disease. Based on data from a complex ophthalmic examination, given the progression of the disease after LC in the control group and baseline severe aggressive posterior ROP in the main group with the control with identical clinical picture, patients in both groups was made early vitreous surgery: in the main group — after ophthalmological examination and control after 8-16 days after LC. Results. In the main group after 6 months in 15 eyes (75%) formed the correct vitreomacular interface, in 5 cases (25%) were diagnosed with the smoothness of the foveolar pits by sealing the internal limiting membrane with no signs of retinal edema. In the control group after 6 months in 6 eyes (30%) formed the right macular interface in 11 (55%) — was defined by flatness or lack foveolar pit with no signs of retinal edema. On 3 eyes (15%) in the 2nd zone remained a local retinal detachment. Conclusion. Primary vitrectomy performed according to the developed indications, allows to optimize the treatment of patients with aggressive posterior ROP in cases of inefficiency of the LC. It is an alternative and pathogenetically substantiated technology, which efficiency is not inferior to the traditional approach, including LС followed by vitreous surgery.

Purpose: efficacy and safety assessment of hypotensive drugs in patients with combined pathology — primary open angle glaucoma (POAG) and diabetic retinopathy (DR).

Methods: Patients with POAG 1, 2, 3 stages comorbid with DR and diabetic macular edema (DME) were alocated into three groups based on the stage of glaucoma and hypotensive therapies. POAG 1 –group treated with selective beta-blockers, POAG 2 — the combination of prostaglandin analogues with selective beta-blockers. In POAG 3 — group used the combination of three IOP-lowering drugs include prostaglandin analogues, selective beta-blockers, and carbonic anhydrase inhibitors. Therapy of DR, DME included three intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors. Visual function, eye hydrodynamics and morphometry of retina and optic disc were evaluated in dynamics.

Results: glaucoma monitoring showed no significant increase in intraocular pressure, positive dynamics of tonography during ranibizumab theraphy with use of hypotensive drugs. Combined therapy in patients with POAG 1, 2 improve the visual acuity and perimetric indices MD, PSD testing by Humphrey Field Analyser, reduce edema in the macula and the optic nerve head according OCT.

Conclusion: the use of ranibizumab in patients with association of primary open-angle glaucoma and DR, DME is effective and safe then the correct selection of hypotensive drugs. 

Purpose — to determine the effect of fistulizing operations with Glautex drainage and Ahmed valve implantation in the cases with neovascular glaucoma within 3 years.

Patients and methods. We observed 44 patients (44 eyes) with secondary neovascular glaucoma on the background of post-thrombotic and proliferative diabetic retinopathy. Patient age averaged 60,84±1,29 years. Males — 19, females — 25. The patients were divided into two groups depending on the used drainages and drainage devices. In Group I the standard sinus trabeculectomy with Glautex drainage was performed in 23 patients. The II group included 21 patients who were implanted Ahmed valve.

Results. According to the results of our research the relative hypotensive effect was in groups I and II, respectively, 52.2% (12/23) and 79.4% (17/21) 1 year after surgery; 43.5% (10/23) and 71.4% (15/21) — 2 years after surgery; 39.1% (9/23) and 66.7% (14/21) — after 3 years of follow up. The maximum decrease in IOP was observed immediately after surgery in the analyzed groups, 66.8% and 64.5%, respectively. There was no surgical treatment effect for 3 years in Group I in 60.8% (14/23), in group II — 33.3% (7/21) of the cases.

Conclusion. The analysis of clinical and functional results of surgical treatment of patients with neovascular glaucoma in terms of 3 years follow up showed that the most lasting preservation of visual function and the hypotensive effect was achieved after implantation of the Ahmed valve — in 66.7% of the cases. In the cases of sinus trabeculectomy with Glautex drainage — in 39.1% of the cases. The incidence of postoperative complications in both groups was comparable: as hyphema, hypotension, and the eruption of implants developed after sinus trabeculectomy with Glautex drainage in 26.1%, 21.7% and 4.3%, respectively, after Ahmed valve implantation in 23 8%, 19.1% and 9.6% of the cases.

The most common representative of primary tumors is a cavernous hemangioma of the orbit, which can lead to the disorder of functions of an eye and a cosmetic defect. The literature has repeatedly described the clinical picture of patients with cavernous hemangioma, their CT semiotics, hemangiomasintercourse with orbital structures. However, there is no data about the effect of the tumor on the state of the orbital fat.

The purpose — to study structural features of cavernous hemangiomaand toundertake a study of state of the orbital fat, depending on the size of tumors.

Patients and methods. We studied 36 patients with cavernous hemangioma of the orbit. CT scans were performed according to standard procedures to give axial and frontal slices. Volumetric soft tissues of the orbit indicators obtained after the construction of three-dimensional models. Originally built a three-dimensional reconstruction of the osseous orbit outside the orbit's part of the eye, and then — a muscular channel and soft tissue reconstruction unit (extraocular muscles, the optic nerve, lacrimal gland and eyes). We calculate the orbit of the eye and orbital fat. The volume of the orbital part of the eye obtained by subtracting the volume of the volume of its eyes outside the orbit’s part. The amount of fiber internal surgical space obtained by subtracting from the muscular channel volume of extraocular muscles and optic nerve. Control in all cases was a healthy contralateral orbit.

Results and discussion. It was found that an increase in the volume of tumors occurssubatrophy of orbital fat. In patients with smallhemangiomas the amount of orbital fat is reduced by about 0.5 cm3, in patients with an average hemangiomasthe amount of orbital fat is retracted more than 1 cm3. The most prominent orbital fat atrophy in theorbitlocalization of large cavernous hemangiomas (on 2,88±0.09 cm3).

Conclusions. An increase in the size of cavernous hemangioma leading to its structural changes, and the development of orbital fatsubatrophy. 

Objective. The objective of the study is to evaluate in vitro the cytotoxic effect of different moisture eye drops (containing or without preservatives) on the epithelial cells of the conjunctiva and the cornea.

Materials and methods. The objects of the study are moisture eye drops: Hylabak®, Thealoz®, Sistane Ultra®, Kationorm®, Oftolik®, Artelak® Balance, Optiv®. As test systems there were used the transformed cells of normal eye tissues: constant conjunctiva transformed cell lines (Chang Conjunctiva, Clone 1-5c-4) and the human cornea (HCEC). The cytotoxicity of the “artificial tears” was assessed by the viability of cells, cultured in substratum containing the solutions of the objects at concentrations 1, 5 and 10%. Cell viability was assessed by their morphology and metabolic activity.

Results. The most sensitive to the investigated eye drops is considered to be the test system based on human corneal cells. Four of the seven investigated eye drops (Artelak® Balance, Optiv®, Kationorm®, Oftolik®) at a concentration of 10% (by volume) of the substratum showed a high degree of toxicity for cornea cells. Eyedrops Sistane Ultra® had moderate toxic effect on the cells of the cornea and conjunctiva at concentration 5 and 10% (by volume). Hylabak® and Thealoz® in this concentrations did not have any cytotoxic effect on the cells of all test system and showed the best results in the research. The most toxic of all cell types were eye drops Oftolik® and Artelak® balance.

Conclusion. A direct relationship between the concentration of drug in culture medium and cell cytotoxicity was investigated. Eye drops Hylabak® and Thealoz®, that do not contain in its composition a preservative, had no cytotoxic effect on the cells of both test systems at all concentrations used. The lowest toxic effect of the test had eye drop Sistane Ultra® containing “soft” preservative Poliquad®. Among the “artificial tears”, the greatest toxic effect on all cell types at all concentrations used, was observed in eye drops Oftolik (BAK 0.01%) and balance Artelak® (containing “soft” preservative Oxide). Studies have shown the possibility of using in vitro cell systems for the comparative evaluation of the cytotoxic effect of mousture eye drops. 

Purpose: Optimization of approaches to the treatment of early stages diabetic retinopathy based on modern diagnosis and monitoring of patients with type 2 diabetes.

Patients and methods: It was examined 90 patients (180 eyes) with type 2 diabetes with DR: women (74.4%) and men (25.6%), age 63,7±2,3 years. All groups matched by sex and age: Group 1 — control (healthy individuals without diabetes); Group 2 — Patients with DR0 (30 patients, 60 eyes) with type 2 diabetes without DR; 3 group — patients with DR I without DMO with type 2 diabetes (30 patients, 60 eyes). Patients 2 and 3 groups was treated with conservative treatment angioprotectors drug-Doxi-Hem® registered in Russia. The drug was administered in a dose of 500 mg three times a day for six months. Monitor patients for six months of receiving Doxi-Hem® preparation consisted of monthly conventional ophthalmic examination, including further analysis of BCVA (BCVA), light sensitivity of the macula (SM) as a result of fundusmikroperimetrii MAIA, central retinal thickness (PZT) based on the results of the optical coherence tomography (OCT). We take into account the compensation of diabetes on the level of glycated hemoglobin (HbA1C) blood.

Results: When monitoring patients with type 2 diabetes to optimize the treatment of established efficacy and safety of drug therapy Doxi-Hem® in the prevention and treatment of pre-clinical and early manifestations of DR (DR0, DR1), which is confirmed by reliable positive dynamics of visual functions (BCVA, p <0.05, before treatment 0,8±0,02, after treatment increased to 0,92±0,02), morphological reduction in retinal thickness (PZT, p <0.05; before treatment 272,3±5,8 mm, after treatment 241.5±15.8 um), increased sensitivity of the macula (CM, p <0.05, before treatment 22.2±1.5 dB, after treatment 27.0±3.2 dB). Required control the severity of type 2 diabetes on the target level of blood glycosylated hemoglobin (HbA1C).

Conclusion: Optimization approaches to HIV prevention, treatment of pre-clinical and early manifestations of DR (DR0, DR1) with the use of drug therapy angioprotector Doxi-Hem® based on modern diagnosis and monitoring of patients with type 2 diabetes for a long time will allow to stabilize and maintain clinical and morphological condition of the retina. Modern diagnostics, including the definition of the ophthalmological examination: visual acuity, central retinal thickness, macular light sensitivity as well as the definition and stabilization of important biochemical indicator of blood glycated hemoglobin (HbA1C) will not prevent the development of more severe stages of DR. In patients with type 2 diabetes without signs of diabetic retinopathy (DR0), while maintaining high visual acuity and normal retinal thickness showed a significant and meaningful reduction in the light sensitivity of the retina of the macula, which allows to start treatment with redox Doxi-Hem® at the preclinical stage (DR0).

Purpose. Experimental-clinical substantiation of the effectiveness of subtenon injection of anti-VEGF drug on the viscous media with the purpose of strengthening and prolong of therapeutic effect in the treatment of wet form of age-related macular degeneration (AMD).

Material and methods. The experimental part of the work was carried out on 10 rabbits (20 eyes). The main group of rabbits (10 eyes) were injected into the back subtenon space 0,5 ml of a 10% solution of fluorescein on the viscous mediа, which was used as a 2% solution of hydroxypropylmethylcellulose; a control (10 eyes) — without the viscous medium. After enucleation and isolation of ocular tissues in the posterior pole was performed water extraction of the dye determined the intensity of fluorescence after 3, 7, 10, 14 and 16 days after injection. In the clinical part of the work included 32 patients (34 eyes) with the wet form of AMD, to be administered anti-VEGF drug at a dose of 12,5 mg (0,5 ml) into the back subtenon space аt the same viscous media. The efficacy and safety were evaluated for 6 months.

Results. As a result of the experimental study found that the length of stay in the back subtenon space of fluorescein solution of rabbit’s eye, introduced in the viscous medium to 2 times longer than without it. In a clinical study of stabilization was observed in 52,9 % of cases, improved visual function in 35,3 % of cases. Deterioration in visual functions noted in 11,8 % of cases. It was also noted improvement in photo-stress test. According OCT showed a decrease in central retinal thickness 2 times by reducing the size and volume of lesions by 30%, a significant decrease transsudativ processes in the retina in all patients, indicating that suppression of choroidal neovascularization.

Conclusion: Subtenon injections of anti-VEGF drug is safe and has a positive effect in wet AMD, and its application to a viscous media has a prolonged action or property interest in any material or method mentioned. 

HIV infection — is a socially significant problem for many countries, as the infected die in an average of 10-11 years due to the immunodeficiency virus. Up to 20% of patients with AIDS lose their sight because of cytomegalovirus retinitis (CMV retinitis), which occurs in 70% of HIV-infected people. In some patients with HIV infection blindness occurs because of acute retinal necrosis of CMV etiology. The algorithm of CMV retinitis treatment in HIV-infected patients is described in modern manuals (ganciclovir, valganciclovir, foscarnet and others on the background of antiretroviral therapy), but the tactics of treatment of retinal separation in these patients is not clearly defined. It may be “wait and see”, providing conservative treatment with antiviral drugs, and the active tactics — vitreoretinal surgery. In this article the authors present their personal clinical observations of three HIV-infected patients with CMV retinitis at the age of 8 to 36 years with a detailed analysis of the clinical data and the results of the laboratory tests. In particular, the authors give their own results of intravitreal introduction of ganciclovir in patients with CMV retinitis. Given the poor prognosis for the life of these patients, the authors put a deontological question of justification of active treatment of retinal separation in AIDS patients with CMV retinitis.

Purpose: To evaluate safety, precision and stability of refractive results after phacoemulsification with implantation of NanOptica (Russia) IOL like a method for high myopia correction.

Patients and methods. 4 eyes of 2 patients aged 34 and 81 y.o. with high myopia: sph -6.5D — sph -12.0D (mean -9.12Д±2.39) were operated by phacoemulsification with hydrophylic IOL “Aquamarine” NanOptica (Russia) implantation. In first case operation was performed in young female, for correction of myopia with clear lens, the target was about -2.0 D. The second patient was treated for mature cataract by the same method. Study included evaluation UCVA, UCVA, Autorefractometry, IOP measurement, IOL master, ultrasound biometry, slit lamp examination, fundus examination, keratotopography, Cirrus OCT of posterior segment. Pre op mean UCVA (Decimal) 0.0475 (0.04–0.05 ), mean ВCVA 0.73 (0.4–1.0). Biometry (А method) from 26.82 mm to 28.49 mm, average 27.48 mm ±0.72. For IOL calculation we used SRK/T formula. The standard phacoemulsification was performed. Incision 2.4 mm. Injector Comfort C, RET, (Korea) was used for IOL delivery into the eye. There were no difficulty with IOL positioning in cartridge, injection in the eye and centration. Follow up period was 4 months. Study was performed at International Center for Ophthalmology in Moscow, Russia.

Results: Early postoperative period was without any complications. Post op mean UCVA (Decimal) was 0.66±0.27 (0.4–0.9), mean ВCVA — 0.95±0.05 (0.9–1.0). Target refraction corresponded to predetermined values: sph -1.75D–0.0 D (average -0.81). 34 years old patient had signs of posterior capsule fibrosis I st. after 3 months after operation. It didn’t affect at the visual acuity.

Conclusion: First successful results of IOL “Aquamarine” Naooptica (Russia) implantation were reached. Refractive target have been achieved. Aquamarine can be recommend for correction in patients of different age with high myopia patients. Future follow-up study is required.