The  article  describes  modern approaches  for  controlling  wound  healing  after  fistulizing  glaucoma   surgery.  The  review  recounts international experience of steroidal and nonsteroidal anti-inflammatory drug 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 activit y through  its angiogenic effect and also has  a supposed direct  effect on fibroblast activit y; proinflammatory placental  growth factor (PIGF), that  increases  bleb area size and  its survival time,  and  decreases postoperative  angiogenesis, inflammation  and  fibrosis  intensit y.  The last  part  of the article gives a brief report on less  widespread and researched methods of wound healing regulation, such  as  suppressing the activit y of matrix metalloproteinases and amniotic membrane application.

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  safet y  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 predictabilit y and efficiency of the  method  of correction of residual  refractive error.

Uveitis is a heterogeneous group  of inflammatory  diseases of the  choroid  and  adjacent structures. The pathophysiology of uveitis may be different. The treatment approach of infectious and non-infectious uveitis or masquerade syndrome is also different, but the correction of immune  disorders of any uveitis should play a leading role.  Infectious etiology requires the  pathogen eradication with adequate antimicrobial therapy. Therapy of noninfectious  uveitis based on the suppression of the local immune response. Depending on the activit y of the inflammatory process it may require  system or topical anti-inflammatory and/or immunosuppressive treatment with corticosteroids or immunomodulatory therapeutic agents. The main groups  of drugs are presented with the immunosuppressive alkylating agents,  corticosteroids, antimetabolites, T-cell inhibitors  and  biological modulators of the  immune  response. They can reduce the amount  and intensit y of recurrence, the number of complications, decrease  the dose  of corticosteroids or even replace them  in the  case of the  development of side effects and resistance. An alternative uveitis treatment is extracorporal efferent-quantum hemocorrection methods. The most  commonly used  is plasmapheresis based on the removal of plasma  with dissolved mediators of inflammation,  immune complexes, antibodies, exoand endotoxins.  Treatment should  be  pathogenetically oriented  and  localized to  the  affected tissue in order  to  maximize the  ratio  of efficacy / side effect. Often, however, this can’t be achieved.  So the  search continues to develop new therapies for use  in uveitis that  aim  to  suppress inflammatory  activit y,  prevent  accumulation of damage, and  preserve  visual function  for  patients with the minimum possible  side effects.

Cataract is one of the  most  common  diseases, especially in the  elderly. Despite  the  fact that  the  share of elderly people  in economically developed countries is higher than  in developing countries, the incidence  of cataract in people over 50 years  in Western countries is 15% and it is about  40%  in developing countries. The reasons are  unbalanced nutrition,  lack of specialized ophthalmic  care  at the initial stages of the disease, the impact of adverse environmental conditions,  etc.  Surgical treatment is the only curative method. However, there are  not always enough indications for this treatment on the one hand, and it is not always possible due to patient’s unfavorable physical status, on the other  hand.  The supportive anti-cataract therapy  should be provided with the dynamic follow-up in such  cases. The pharmaceutical industry offers anti-cataract drugs  with a different composition  and properties, they are  based on the  mechanisms of the  onset  and development of the  disease. “Oxidative stress” is one  of the  main factors, which can  be the  cause of both  nuclear  and  cortical  cataracts. There  are scattering zones in the mature nucleus  of the lens, an increase in extracellular  spaces between corrugated membrane protein-like deposits in case of cataract. It is generally believed that  the  basis  of these deposits are  denatured, initially water-soluble  proteins, which turn  into opaque  substances due to the action of quinoids products formed through  the disturbed metabolism of aromatic aminoacids (tryptophan, tyrosine,  etc.).  Based  on this theory, an anti-cataract substance — pirenoxine was developed.  It inhibits the action of quinoids and prevents the formation of the len’s opacities  and the cataracts progression.

The prevalence off allergic diseases has  been  significantly increased among  adults  and children during last 30-40 years. International study has  shown  that  the  frequency  of atopy  in developed  countries, including Russia,   is higher  than  in developing.  Often atopic dermatitis, started in infancy, can develop into an “allergic march”  — food allergy, followed by the formation of allergic rhinitis, allergic conjunctivitis and  other  allergic diseases. The problem  of prophylaxis and  treatment of allergic pathology  becomes actual  for these reasons. An opinion according some  preventive  measures has  changed in recent. It was  noted  that  in families  with many children, where  children  were  often  sick  with respiratory infections,  the  incidence  of allergic  diseases was  lower  than  among  rarely sick children.  It is explained by the  “hygienic theory” — insufficient “training” of the  Th1 response in rarely sick children.  Allergic diseases, which are  based on IgE-mediated inflammation,  have a common  pathogenetic nature and,  consequently, general  principles of therapy, in which, as  is well known,  antihistamines take  a significant  place.  This is cased by the  mandatory involvement of histamine  in the mechanism of development of the main symptoms of allergic diseases. Current  capabilities  of local ophthalmologic  antiallergic therapy includes medicines  with multiple action mechanisms, such as mast cell stabilizers, antihistamines, combined  agents, steroids and nonsteroidal anti-inflammatory effects. The latest generation antihistamine drug — olopatadine hydrochloride  0.2% is a new form of the molecule of olopatadine, which is intended  to increase the duration  of the action.  The article considers the main modern directions in prevention  and treatment of allergic diseases, including allergic eye diseases, which are  a manifestation of the underlying disease and have a common  pathogenetic nature to all atopic diseases, based on the IgE-mediated inflammation reaction.

Introduction. Strabismus is the  deviation  of one  eye from  a  common  fixation point, associated  with impaired  of binocular  vision. The eye’s position in horizontal and vertical directions looking straight determines the t ype of strabismus. Despite  numerous reports of surgical  interventions on the  vertical action  muscles, there is no a differentiated approach to the  treatment of patients with this pathology. The search for the optimal methods and principles of surgical  treatment of vertical strabismus caused by hyperfunction  of the inferior oblique muscle, testifies to the relevance of developing new approaches to eliminate hypertropia  depending  on its severit y.

The purpose — to  develop  a  method  of dosing  the  degree of anterior transposition of the  inferior  oblique muscle  in the  surgical treatment of vertical  strabismus caused by hyperfunction  of the  inferior oblique muscle  depending  on severit y,  and  to  evaluate  its clinical efficacy.

Patients And Methods. In the  period  from January 2013 to October  2015 60 children  (96  eyes) aged  from 3 to 17 years  with a vertical strabismus caused by hyperfunction  of the inferior oblique muscle  were  followed-up. All patients underwent a complete pre  — and postoperative examinations. All patients received  surgical  treatment — weakening  of the inferior oblique muscle through  its anterior dosed  transposition.

Results. There  were  no intraoperative complications and  specific complications t ypical for weakening  surgeries on the  inferior oblique muscle. Overcorrection  wasn’t  registered neither  in the  case of surgical  treatment of large vertical angles  of strabismus, no small vertical deviations.  Restriction of mobilit y of the eyeballs wasn’t recorded throughout the observation period  in any patient. Residual  hyperfunction  of the  inferior oblique muscle  was  in 3 patients (5%). It did not exceed  the value of the  vertical,  with the  fusion and  did not  require  additional surgical  treatment.

Conclusion. The technology  will significantly improve  the  efficiency and  safet y  of treatment, reduce the  risk  of complications and  the  duration  of surgery and  anesthesia, the number of surgical treatment stages, to create optimal conditions  for the rehabilitation  of visual functions  in children.

Purpose: To study the role of corneal  microtrauma in the development of complications, leading to bacterial ulcers. Performed clinical assessment, conservative therapy, and surgical  interventions for 236 patients with the  complication  of microtrauma, mainly related to  the  prolonged  presence of foreign bodies  in the  cornea (86.1% they  had  a  metallic  nature). Methods included  ophthalmologic investigations  and  laboratory  procedures, which revealed  the  presence of bacterial corneal  ulcer  in 97 cases (41.1%), recurrent erosion  — 62  cases (26.3%), traumatic keratitis — 25 cases (10.6%) and  deep  cornea’s infiltrate  — 52  cases  (22.0%). The development of complications was  due to the  later  removal  of FB (in some  cases more  than  1 month  after  the  trauma), incomplete removal of foreign bodies,  non-compliance  with aseptic and antiseptic rules  during in the removal of FB’s without follow up of patients. Streptococcus,  staphylococcus, pneumococcus, and  isolated  cases of Pseudomonas aeruginosa and  Escherichia  coli were  mainly diagnosed. Conservative therapy  included specific, pathogenetic, symptomatic and antiallergic medications. Nitric oxide (NO) in the gas stream was used  to accelerate the reparative processes, weakening  of the inflammatory exudation and cellular proliferation.  Surgical interventions  were  performed for  preserving  of eyes,  prophylactic  and  therapeutic purposes in the  form  autoconjunctiveal  plast y, deep  lamellar  and  penetrating keratoplast y  (preserved  and  fresh  corneas) and  amniotic  membrane transplantation. According  to the results of treatment of 236 patients with the corneal  erosion  completed with elimination of inflammatory reaction, restoration of corneal  transparency; 52 patients with corneal  infiltrate -development  of opacities  in the stromal cornea layers;  patients with keratitis –formation of corneal  leucoma  and 52%  — keratoplast y were  performed. In cases of corneal  ulcer process ended  with the formation of a  rough  leucoma  in 30 patients (30.9%), surgical  interventions  with a  partial  improvement of visual function  were  observed  in 62 patients (63.9%), the removal of the eye were  done in 5 patients (5.2%).

Purpose: to analyze the effectiveness of Ex-Press drainage device implantation  for refractory glaucoma  of different origin for 3 years.

Patients and methods: The study  consisted of 82 patients (86  eyes)  with refractory  glaucoma  aged  26–86 years  (67.37±0.53). Pre-operative  IOP level averaged 37.8±1.04  mm  Hg.  Ex-Press  drainage device  implantation  was  rated according to  the  following criteria: IOP, time course of visual functions,  the need  for additional drug therapy  and reoperation, the presence of intraoperative and postoperative complications. Examination of the  patients was carried out from 1 to 8 days after  the  surgery and within 1, 3, 6, 12, 24 and 36 months.

Results: According to our research results relative hypotensive effect equaled  74.4% (64/86) within a year after the  surgery; 67.4% (58/86) — within 2 years;  65.1% (56/86) — after  3 years  of follow-up period.  The maximum decrease in IOP by 61.6% was observed immediately after  the  surgery. There  was no effect of surgical  treatment within3 years  in 34.9% (30/86). Complications  were  observed  in 23.2% (20/86) of cases: choroidal  detachment — 12.8% (11/86),  hyphema  — 3.5% (3/86), eruption  and  dislocation  — 3.5% (3 / 86), delayed  expulsive hemorrhage — 2.3% (2/86), cyst of filtering bleb — 1.2% (1/86).

Conclusion. Fistulizing operations with implantation  of Ex-Press drainage device for refractory glaucoma  provide normalization  of IOP in 65.1% of cases (including 15.1% on the background of additional drug therapy)  at follow-up period up to 3 years.

The aim was to determine different possibilities and the operating principle of modern optical coherent tomographs OCT RETINASCAN-3000 and  DRI OCT TRITON in automatic layer-by-layer segmentation of the  retina  and  perioretinal  structures. 

Methods. The study involved 31 patients (31  eyes) with no retinal pathology in the  macular area. Of these, there were  13 men,  18 women.  The average age  of the  patients was  55.8±3.65  years. Each patient  was  followed by a layered  automatic structuring of the  central  retina  with the help of RetinaScan-3000 (Nidek Technologies)  (1st  group,  n = 31)  and DRI OCT Triton (Topcon Japan) (2nd group,  n = 31)  of the right eye only. The OST device RetinaScan-3000 used  the  mode  macula  multi cross 6 mm,  the  DRI OCT Triton used  the  5 line cross 6 mm mode.

Results: The difference in the automatic layer-by-layer segmentation between the optical coherent tomographs DRI OCT TRITON and OCT RETINASCAN-3000 is, first of all, in the unequal coverage of the retina  layers and the preand subretinal space and the number of automatically layered zones.  For example,  OCT RETINASCAN-3000 (SD-OCT) suggests the separation of the transverse optical  section  of the  structures of the  posterior segment of the  eyeball into 5 structural zones  when,  as  DRI OCT TRITON in (SSOCT), further  clearly  isolates  the  preretinal structures  and  the  choroid,  delineating  the  border of the  sclero-choroidal Articulation. The DRI OCT Triton device in the  SS-OCT system allowed for a more  complete differentiation from the  position of layered  delimitation of the  retina  covering  6 retinal  zones  to obtain  digital values  for  coverage of 5 layers  on RetinaScan-3000 (SD OCT).

Conclutions: The DRI OCT Triton device with SS-OCT technology has  more  possibilities for topical diagnostics of the  posterior eyeball structures in the autonomous mode  relative to the Retinascan-3000 with SD-OCT technology.

Purpose — to develop a multidirectional  model  for detecting hidden  corneal  lesions  in patients after  chemical  and  thermal first or second degree burns  with predominant lesion of eyelid or cornea and  the  timely  emergency help with irrigation  systems.

Patients and  methods. 110  patients with thermal and  chemical  eye  burns  were  examined.  All  patients underwent a  detailed  clinical and comprehensive ophthalmological  examination. According  to  results they  were  divided into groups, depending  on  the  cause of the first and  second degree burn.  Group 1:  the  patients with thermal eye burn  (n = 45);  Group 2:  the  patients with chemical  eye burn (n = 41). Group 3:  the  patients after  an induced  chemical  burn  (alcohol deepithelization  with an 18%  alcohol solution in LASEK) (n = 27). Group 4:  healthy people  (n=25).  We  used  computer corneotopography, topography  of the  cornea and  analysis of anterior eye chamber, counting  the  number of endothelial  cells,  optical coherence tomography of the  anterior segment, confocal  microscopy, all tests were determined before  and after  treatment with irrigation systems.

Results. In cases of the I or II degrees chemical  burn with a predominant lesion of the cornea — irrigation system is for emergency treatment — a neutral  pH buffer solution is 4.9% phosphate salts, possessing amphoteric properties, neutralizing acids  and bases. In cases of the I or II degrees thermal burns  with predominant damage to the  eyelids and  conjunctiva — an irrigation system is sterile sodium  chloride solution 0.9 %.

Conclusions. The model of diagnostics and  treatment provides  high functional outcomes results in the  thermal and  chemical  burns  with predominant lesion of the eyelid or cornea with accurate timely diagnostics of the cornea and use  of optimal irrigation solutions  for emergency and targeted therapy.

“Balanced” bone  decompression of the  orbit was  performed in a patient  with endocrine ophthalmopathy, CAS3, OD=30 mm,  OS=31 mm with the use of minimally invasive transconjunctival approaches and frameless neuronavigation. At the first stage the preoperative computed  tomography  of  the  orbits   was  imported   into  the  navigation  software,  and  then   marked  the  area of  the  proposed resection of the  orbit  walls. Further, in the  operating room,  the  patient  was  registered in the  navigation system. To perform  bone decompression of the orbit and lipectomy, we used  preseptal, transcaruncular and lateral retrocanthal approaches. These approaches are  transconjunctival and  do not  leave postoperative scars. Upon completion  of the  orbitotomy, its accuracy and  dimensions were determined by the intraoperative pointer of the neuronavigation system.

Results. The postoperative period was uneventful. In the early postoperative period there was a regression of exophthalmus OD=26 mm,  OS=27  mm,  closure  of the  eye gap,  but retraction of the eyelids remained. When examined 3 months after the operation, the exophthalmic regression was OD=23 mm, OS=24 mm, retraction of the  eyelids — 1 mm,  with lead — finishing to the  lateral  adhesion. When  examined  after  6 months — the  position of the  eyeballs in orbit: ОD=21 mm,  ОS=22  mm,  retraction of the  eyelids is not present, there is no violation of oculomotorics, complications were not recorded. A satisfactory result  was  obtained.

Conclusion. Minimally invasive transorbital approaches allow the  transconjunctival acces to all orbital walls to perform  decompression of the  orbit and lipectomy without cutaneous incisions,  to achieve good cosmetic and functional results. And the intraoperative use  of the neuronavigation system ensures  the bone decompression of the orbit in full. The technique is promising  and requires further  randomized  studies.

Objective  — analysis  of survival  rate   among   the  patients with uveal  melanoma eyeball  removal  in Perm   Region.  patients  and methods. Retrospective  analysis  of medical  documentation of 108 patients treated in ophthalmologic  departments in the  cit y  of Perm  has  been  carried out.  Patients have  undergone the  surgery for uveal melanoma eyeball enucleation (2005–2014).

Results. Analytic period  involved 108 uveal melanoma eyeball removal  in 108 patients aged  17–89 (61,61,6 years  in average). There  were 61 (56,5%) women and 47 (43,5%) men.  Practical blindness  was identified in 63,8% eyes,  and in remaining  eyes it was detected in 0,005–1,0 cases. Melanoma  was localized in choroid in 79,6%; ciliary body — 10,2%; iris — 4,6%; and ciliary body and iris — 5,6%. Histology revealed  mixed cell form  in 68,5% cases; sarcomatoid form  — 28,7%; epithelioid cell form  — 2,8%. The outcome was determined in 99 (91,7%) patients. Follow-up period  was  from 6 months to 10 years  after  enucleation. Among those  27 (27,3%) patients died within the analytic period.  Five-year survival rate  was observed in 79,8% patients with average lifespan 3,4 yrs. Cause  of death  was established in 19 (70,4%) individuals. Association  with oncologic diseases was determined in 6 (31,6%), and non-oncologic in 13 (68,4%) subjects.

Conclusion. At the place of residence life-long observation by ophthalmologist and oncologist  is essential for these patients. Outpatient  physicians should have oncologic alertness while working with patients of any age for early diagnosis  of eye neoplasm.