The purpose is to analyze the stages of ophthalmological healthcare system’s evolution in premature children on the basis of Kaluga branch of FGAU «MNTK “Eye Microsurgery” named after acad. S.N. Fedorov».

Methods. In 2003, on the basis of Kaluga branch of MNTK “Eye Microsurgery” the system of ophthalmological care for premature children had been created. The specialists of children’s ophthalmologic department of the branch had started regular field screening examinations of premature infants from risk group of ROP in neonatal care unit in 4 regions of the Central Federal district. In parallel, new diagnostic methods and technologies of laser and surgical treatment of active PH stages had been actively developed and introduced.

Results. From 2003 to 2018 approaches for detection, diagnostics and treatment of ROP had been evolved substantially. At the initial stage, there were no uniform data about the optimal timing for early detection of active stages ROP, and quantitative markers of ROP progression were not determined. The effective management and treatment algorithms for the patients with active ROP had not been implemented yet. To the date vast experience had accumulated: more than 15 thousand infants with ROP risk had been screened, more than 750 on-site examinations in the neonatal care units and perinatal centers had been performed. High-tech methods of diagnostics, laser and surgical treatment of ROP had been developed and are actively used now. Multicenter clinical studies evaluating the possibilities of anti-VEGF therapy for active ROP have being performed. Over 3000 laser and more than 1.300 surgical operations for different stages of ROP had been performed.

Conclusion. Many-years experience of ophthalmological healthcare system in premature children functioning have demonstrated its consistency and effectiveness. The system includes interrelated stages, providing continuity between the perinatal centers and specialized ophthalmic institution, with complying the common approaches to early screening and diagnostic monitoring, including through telemedicine, as well as technologies of laser and surgical treatment of ROP. 

Purpose. Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).

Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.

Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.

Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP. 

The purpose is to determine the features of different stages of active retinopathy prematurely according to fluorescent angiography data.

Patients and methods. In 2011–2017, 271 angiographic studies were performed in 207 premature infants born at 25– 33 weeks of gestation with 710–1980 grams weight at birth, with different stages of active ROP in age of live 3–12 weeks (30– 39 weeks of post-conceptual age). A voluntary informed consent to perform the examination was received from the legal representatives of all patients. FAG was performed using retinal pediatric digital video system «RetCam-3» with built-in angiographic unit under mask anesthesia, in the presence of anesthesiologist-resuscitator, under the monitor control of the respiratory and cardiovascular systems of the child.

Results. Unfavorable types of active ROP are characterized by the specific manifestations that are not defined by the standard ophthalmologic methods: early flat neovascularization, the presence of small tortuous peripheral vessels with signs of leakage, reperfusion areas with an apparent lack of capillaries and shunts. This opens up the opportunities for early detection of stages of the disease requiring therapeutic measures. The aggressive posterior ROP is distinguished by a variety of angiographic patterns, the most important feature is the massive loss of the retinal capillary bed in the vascularized retina. FAG data about latent neovascularization and ischemic zones of the retina represent the particular value in the prediction of active ROP course.

Conclusion. The obtained results could allow to make the most differentiated approach to the management of children with active ROP, timely and effectively predict the course of the disease and to performed adequate treatment based on objective indications. 

The purpose: to analyze anthropometric and diagnostic parameters in children with aggressive posterior ROP at the manifestation stage on its basis to build a predictive model, which allows to determine the indications for laser or surgical treatment.

Patients and methods. The study included 111 children (190 eyes) with aggressive posterior ROP at the manifestation stage. 67 children (134 eyes) underwent transpupillary retinal laser photocoagulation (LPC) in the period from 2008 to 2013. In 46 children (82 eyes) the disease regression was archived (group 1), in 31 children (52 eyes) the progression continued (group 2), so at the second stage early lens-sparing vitrectomy was performed (2–4 weeks after LPC). In 34 children (56 eyes) primary lens-sparing vitrectomy was performed in the period from 2013 to 2017 (group 3). Anthropometric and diagnostic data for all patients were subjected to statistical analysis for building a predictive model.

Results. The predictive model was based on logistic regression that determines the probability of separation of children with aggressive posterior ROP to the manifestation stage on treatment methods: transpupillary LPC or primary vitrectomy. The following parameters were selected: the diameter of the central arteries and tortuosity index (TI). All groups were joined into a single array to create the model, which allowed to differentiate the patients according to the treatment types based on the input data processing. It was obtained the equation of the logistic regression: Z = exp(55,2726 – 0,1584X – 35,3911Y) / (1 + exp(55,2726 – 0,1584X – 35,3911Y)), where Z has the value from 0 to 1.0; X value is the diameter of the central artery of the patient; Y — the value of the TI arteries of the patient. If Z < 0.5, then the patient has indications for surgical treatment, if Z > 0.5 — for laser treatment.

Conclusion. The predictive model was obtained that with a probability of 96% allows to determine objectively the optimal treatment method for children with aggressive posterior ROP at the manifestation stage of the disease: transpupillary LPC or primary vitrectomy. This will increase the effectiveness of treatment of the severe and prognostically unfavourable forms of ROP. This model can be a “working” tool for ophthalmologists involved in the treatment of ROP, its introduction into the clinical practice is advisable. 

Refractive errors are remaining one of the most important problems in pediatric ophthalmology. At present, there are changes in organization approaches of prophylactic medical examinations in children. It causes the necessary of comprehensive clinical and economic assessment of their effectiveness.

Purpose: to develop the recommendations for improvement of ophthalmological care for children with refractive errors. For diagnostics we used visometry, determination the vision characteristics, determination of chromosensitivity, biomicroscopy, definition of refraction of manifest and cycloplegic, determination of volume and accommodation reserves, ophthalmoscopy, electrophysiological study (EFI), optical coherence tomography (OCT), fundusography.

Methods. A retrospective analysis of typical practice of treatment patients with amblyopia and strabismus was organized. Data was processed with mathematical methods and descriptive statistics. Modeling, Budget impact and burden of diseases analyses were used for clinicoeconomical evaluation.

Results. 636 patients aged from 5 to 7 years old were included. Depending on the age of the diagnosis of ametropia, three groups were identified. Group I (318 patients): the diagnosis was detected up to 1 year, group II (190 patients) — at the age from 1 to 3 years, Group III: (127 patients) from 3 to 7 years. A direct correlation between the age of ametropia diagnostics and frequency such complications as amblyopia, disturbance of binocular vision and strabismus development of strabismus was established. According to the results of clinical and economic analysis, uncorrected refractive errors in children are characterized by a high level of economic and social burden of disease (the older the age of ametropia diagnosis caused increase of direct medical and non-medical costs). With regard to non-medical costs, we established that a reduction the frequency of courses in vision office and operational treatment results in a reduction in payments to parents on temporary incapacity sheets.

Conclusion: the optimal age for diagnostics of refractive errors in up to 1year from both clinical and economic perspective. 

Objective: analysis of remote clinical functional results of femtolaser-assisted laser in situ keratomileusis (FS-LASIK) in children with hyperopia and anisometropic amblyopia.

Patients and methods: 30 children aged 5–13 (7.9 ± 2.3) years were in the study. FS-LASIK refined technology surgery was rendered to all children under general anesthesia at amblyopic eye, previously they had no success of conservative treatment. Mean spherical equivalent of refraction (SE) of amblyopic eye was +5,08 ± 1.64 D in conditions of cycloplegia. Mean SE anisometropia was 3,42 ± 1.92 D, difference in refraction between eyes was statistically significant (pmu = p < 0,001) in all patients. There was 43.3% of severe amblyopia, 56.7% cases of moderate amblyopia. General period of control was 5 years.

Results: In 5 years after FS-LASIK SE of operated eye was +1.02 ± 0.28 D, predictability of refractive effect within ±0.5 D was 47%, ±1.0 D was 77% of cases. All patients gained 1–5 lines, UDVA was 0,5 and higher in 61% of cases. There were 6.7% of cases with moderate amblyopia, mild –80%, and amblyopia absence –13.3 % of cases. SE anisometropia decreased 2,37 ± 1.17 and was 0,18 ± 1.05 D, difference between operated and fellow eye was minor, but statistically significant (pmu = p < 0,05). Trend to myopisation of fellow eye was revealed.

Conclusion: remote clinical functional results of FS-LASIK in correction of hyperopic anisometropia in children show safety and efficacy of interference. Refractive surgery in children should be considered not as an independent method of treatment, but in complex with conservative methods of amblyopia treatment. 

Purpose. To perform the comparative efficacy assessment of complex treatment for average degree anisometropic amblyopia in children using red, green laser speckles and their combination.

Patients and methods. 216 children aged 5–9 years old with anisohypermetropia and anisometropic amblyopia of average degree were followed up. Cycloplegic refraction of sighting eye was from +1.5 to +3.0 D, of the amblyopic one — from +3.5 to +8.5 D. All patients underwent the basic treatment course using magnetostimulation and computer programs. Depending on the applied laser the children were divided into three groups: patients of group I underwent the basic course of pleoptics using laser in the red wavelength range, in patients of group II the basic course was supplemented with laser stimulation in the green wavelength range, group III — along with the basic treatment the alternate stimulation by red and green speckles was used, control group IV — received only basic course without any laser stimulation. The best corrected visual acuity before and after the treatment was estimated.

Results. Before treatment there were no any significant differences between groups according to age, refraction and best corrected visual acuity. As a result of treatment we received the reliable increase in visual acuity in all groups. The minimum increase was noted in patients who received the basic course of treatment, 15% increase was noted in patients stimulated with green speckle, in patients who underwent red speckle stimulation visual acuity increased by 27%, the maximum increase in visual acuity was achieved in patients who received the combined stimulation by red and green speckles.

Conclusion. The paper has proved the high efficacy of combined application of red and green speckles in pleoptic treatment in comparison with their separate usage and traditional basic course. 

Purpose: to study the frequency and structure of undifferentiated connective tissue dysplasia (UCTD) in school-age children with myopia, their relationship to choroidal thickness and course of myopia.

Patients and methods. The object of study was 120 children (240 eyes) aged 11–13 years with school axial myopia (axial length (AL) from 24.5 to 26.0 mm). Special ophthalmological examination included optical coherent tomography of macular zone (“RTVue 100” Optovue, USA) and “Cross Line” scan for measuring choroidal thickness in foveal area and 1000 μm from it in nasal and temporal regions.

Results. According to studies, the phenotypic signs of UCTD were diagnosed in 56 children (46.7%) with school myopia, the largest group included phenotypic signs of locomotor syndrome; 14 children (25%) had a weak degree of UCTD, 34 children (60.7%) — moderate degree and 8 children (14.3%) — pronounced degree. Comparative characteristic of changes in choroidal thickness detected a high degree of interrelation between the severity of clinical manifestations of UCTD and the level of decrease in blood-flow in the choroid. In children of the main group with signs of UCTD, the annual growth of AL exceeded the same parameters in children of the control group by more than 2.5 times (p < 0.05); due of accumulation of phenotypic signs of UCTD, a more noticeable tendency to decrease of choroidal thickness and the increase of AL was observed (p < 0.05). The statistical analysis confirmed the presence of significant negative correlation between the decrease in average thickness index in segment of the macular map and the degree of increase of AL (p < 0.05).

Conclusions. According to results of diagnostic screening, in 46.7% children with school myopia, we detected phenotypic signs of UCTD. The method of optical coherence tomography showed that with increasing severity of UCTD, indexes of choroidal thickness in the macular zone are significant decreased. In the catamnesis (duration 1 year), it was found that in children with myopia with moderate and pronounced degrees of UCTD, increase of AL is associated with degree of thinning choroidal thickness, which indicates violations of biomechanical status of sclera. 

Objective: to determine optimal method of progressive myopia optical correction in children and adolescents.

Patients and methods. Conducted 5-year prospective clinical and instrumental examination of 494 children with myopia using orthokeratology lenses, soft contact lenses and glasses. 61 children (the average age 11.7 ± 2.36 years) with myopia –2.87 ± 1.1 D and astigmatism –0.58 ± 0.27 D used orthokeratological lens. 92 children (the average age 12.8 ± 1.51 years) with myopia –3.66 ± 1.07 D, astigmatism –0.53 ± 0.18 D wore soft contact lens. 79 children (the average age 11.52 ± 1.78 years) with myopia –1.59 ± 1.08 D, astigmatism –0.71 ± 0.54 D used glasses with monofocal lenses, with full correction. The control group consisted of 249 children (the average age 9.1 ± 1.14 years) with initial emmetropia. Determination of refraction, subjective and objective determination of accommodation, and axial length of the eye (“IOL-master”) was conducted in children.

Results. The maximum progression of myopia was observed in younger children (8–9 years). Correction of myopia with orthokeratology lenses (OKLs) was accompanied by the lowest dynamics of changes in axial length (axial elongation 0,44 ± 0,32 mm) compared to the correction with soft contact lenses (SCLs) (axial elongation 0,73 ± 0,36 mm), spectacle correction (axial elongation 1,39 ± 0,47 mm) and the control group (axial elongation 0,6 ± 0,41 mm). In all children with myopia, at the beginning of the study, there were reduced values reserve of relative accommodation and an objective accommodative response. Correction of myopia with OKLs (p = 0,0002) and SCLs (p = 0,036) provides the normalization of subjective and objective reserve indication of relative accommodation in both age group in comparison of spectacles correction.

Conclusion. Correction with orthokeratology lens in children with progressive myopia contributes to the minimum growth length of the eye. Correction of myopia OKLs and MKL improves of subjective and objective indicators of relative accommodation reserve. 

The first histological and clinical description of the optic nerve drusens was given in the 19th century. Then authors considered drusens as congenital pathologies, and a study of 1999 showed that drusen is not the primary pathology, but the dysplasia of the optic nerve disk and its circulation predisposes to the formation of drusen. Central vision in patients with drusens of the optic nerve disc is reduced rarely, and their diagnosis is reduced to ascertaining of the fact of having drusen without taking into account the structural and functional changes in the visual system.

Purpose of the work: to identify the pattern of changes in visual functions in children and adolescents with druses of the optic nerve disk, the development and addition of classification criteria.

Patients and methods. 45 children with drusens were examined, a comprehensive analysis of the visual system included a standard ophthalmological examination, a comprehensive study of visual system with ultrasound scanning, OCT and OCTA, standard automated and pulsarperimetry.

Based on the results of the cluster analysis, a graph of the distribution of patients into three groups (control group and two clinical groups) was constructed, and the structural and functional state of the visual system was analyzed. Drusens in children in the second group we marked as “peripheral”, and in the third — “central”. The carried out researches have shown, that the revealed disturbances are more expressed in the third clinical group. All this determines the need to complement the clinical classification of drusens and their separation depending on the location relative to the vessels of the optic nerve disk to the central and peripheral. The compression effect of drusen is accompanied with changes in the volume of the optic nerve disc, a violation of retinal hemodynamics, damage to the neuroglia and ganglion cells, which allows treating this pathology as a progressive neuroopticopathy, and the revealed dependence of changes on the localization of druses requires supplementing the existing classification. 

Purpose: to evaluate the safety and clinical efficacy of the Femto-LASIK refractive surgery performed under local (topical) anesthesia in children and adolescents with anisometropic and refractive amblyopia against a background of mixed astigmatism, medium and high hypermetropia with hypermetropic astigmatism.

Patients and methods: 28 children (28 eyes) aged from 7 to 16 years (av. age — 13.6 ± 2.1 years old) were operated under local anesthesia by the FemtoLASIK method. The degree of anisometropy was from 3.25 to 5.21 (average — 4.27 ± 0.53 D). Uncorrected visual acuity averaged 0.21 ± 0.07, corrected one — 0.41 ± 0.1. Psychological history of patients and readiness for operative treatment of the disease were found out during the diagnostic examination. Based on the Spielberger-Khanin technique, the level of personal and reactive anxiety was determined, allowing identifying patients for surgical intervention under topical anesthesia. The surgeon assessed the comfort of the operation. During the first postoperative examination, the developed questionnaire was used to assess the comfort level of the patient during surgical treatment.

Results. During the surgical intervention and in the postoperative period there were no complications. The behavior of all patients during the operation can be considered adequate. The duration of the operation slightly exceeded the duration of FemtoLASIC in adults. Uncorrected visual acuity in the first day after the operation averaged 0.39 ± 0.08, in 6 months — 0.61 ± 0.1, which is 80% higher than the baseline indices. After 6 months, the equivalent of anisometropia was 0.69 ± 0.12 D, that is, the refraction of the operated eye approached the value of the paired eye. In 60.8% of patients, the sensations during the operation corresponded to the level of “comfortable”. The surgeon’s assessment of the conditions for performing operations as ‘satisfactory” was noted in 92.9%.

Conclusion. The use of topical anesthesia in refractive surgery in children with an initially low level of anxiety is an effective, safe and predictable method of anesthesia, allowing to conduct surgery in comfortable conditions for both the patient and the surgeon, with a high functional result. 

The purpose is to analyze the results of complex treatment of chronic uveitis in juvenile idiopathic arthritis.

Patients and methods. The study included 26 children (46 eyes) with uveitis associated with JIA aged from 5 to 16 years. All children underwent a comprehensive ophthalmological examination. The patients were divided into 3 groups. The first group included children with anterior uveitis (18 eyes), 3 eyes had iridocyclitis without changing of optical media transparency; precipitates on the endothelium in combination with the rear adhesions and complicated cataract were revealed in 15 eyes. The second group included children with middle and posterior uveitis (12 eyes), where effusion into the vitreous in combination with retinal edema in macular area were shown. The third group included children with panuveitis (16 eyes), where ribbon-like corneal dystrophy in combination with the rear adhesions, complicated cataract, and pericardial effusion of varying severity in the vitreous body traction syndrome, macular edema were revealed. Treatment tactics in each group depended on the characteristics of the pathological process.

Results. In the first group, visual acuity in the postoperative period was 0.5–0.8. In the second group, after the conservative drug anti-inflammatory treatment, the pathological process subsided and visual acuity increased up to 0.6–0.8 in 4 eyes. In 3 eyes with a pronounced traction component on the periphery and the presence of vitreomacular traction syndrome, where vitrectomy was performed, visual acuity was 0.3–0.5. After intravitreal “Ozurdex” implantation (5 eyes), diffuse macular edema decreased and visual acuity increased up to 0.7–0.8. In the third group, in cases of intense opacity of the vitreous body due to exudative effusion, a 3-port 25–27G vitrectomy with silicone oil tamponade was performed. Visual acuity after the surgery varied from 0.2 to 0.5.

Conclusion. High functional results in children with uveitis associated with JIA were achieved due to modern methods of preoperative diagnosis, advanced surgical techniques, as well as proper management of the patients in the postoperative period. 

Purpose: To analyze the effectiveness of Fresnel prism in the complex treatment of friendly strabismus.

Patients and methods. The main group consisted of 428 patients with strabismus, who were assigned Fresnel prisms in combination with pleoptoorthoptic and surgical treatment. Indication for the appointment of Fresnel prism with a friendly strabismus was: angle of strabismus to 25 degrees, postoperative residual angles. The age of the patients ranged from 4 to 60 years. We evaluated the visual acuity without correction and with correction, refraction, character of vision, ability to bifoveal fusion evaluated with synoptophore. The results were compared with a control group treated without Fresnel prisms.

Results. During initial selection of Fresnel prisms, doubling was revealed in 73% cases. With the constant wearing of glasses with Fresnel prisms, in which the state of orthotropy is achieved, in most patients doubling was cupped in the period from 2 weeks to 3 months. During the first month, doubling stopped in 72% of patients, and the minimum periods for arresting double vision were noted in preschool children. The absence of doubling served was an indication for surgical correction of strabismus. After the surgery, a good cosmetic effect was achieved in 392 persons (97%), and the state of orthotropy was in 330 of people (81.7%). Doubling after the operation was not observed, there was no relapse of strabismus. Comparative analysis of the main and control groups showed that in the main group of patients the use of prisms combined with pleoptoorthoptic and surgical treatment made it possible to restore binocular vision in 32.9% of cases.

Conclusion. The use of Fresnel prism in the complex treatment of friendly strabismus in children allows to obtain not only a good cosmetic effect, but also to develop binocular vision in 32.9% of cases. The use of Fresnel prisms in the preoperative period in adults allows avoiding postoperative double vision, thereby reducing the risk of recurrence of strabismus because of the development of mechanisms for the formation of a single binocular image. 

The purpose to evaluate the effectiveness of dosing procedures for the degree of anterior transposition of the lower oblique muscle in the surgical treatment of its secondary hyperfunction of varying severity using modern methods of ophthalmological examination.

Patients and methods. Between January 2013 and June 2017, 31 children (31 eyes) aged 3 to 17 years with vertical strabismus due to unilateral insufficiency of the superior oblique muscle were monitored. Depending on the magnitude of the vertical deviation in the adduction on the paretic eye measured in degrees by the Hirschberg method in the head rotation position, all patients were divided into two groups: group 1 — 12 children (12 eyes) (no more than 7° according to Hirschberg); group 2 — 19 patients (19 eyes) (more than 7° according to Hirschberg). Surgical treatment of hypertrophy was performed in all patients in both groups. Weakened the lower oblique muscle by its dosed front transposition. The degree of anterior transposition of the lower oblique muscle depended on the magnitude of the angle of vertical deviation.

Results. The surgical intervention on the lower oblique muscle was performed in all patients in full. Hypertrophy in the primary position of the gaze in group 1 was completely eliminated in 11 eyes (91.7%), in group 2 — in 17 eyes (89.5%). The residual vertical angle, equal to 3 ° according to Hirschberg, in group 1 was detected in 1 eye (8.3%), in group 2 — in the 2 eyes (10.5%). Hypertrophy in adduction in group 1 was completely eliminated in 10 eyes (83.3%), in group 2 — in 17 eyes (89.5%). The residual vertical angle of 3° in Hirschberg’s group 1 was detected in 2 eyes (16.7%), in group 2 — in 2 eyes (10.5%).

The conclusion. Application of the technology of dosed front transposition of the lower oblique muscle in the surgical treatment of its secondary hyperfunction will significantly improve the effectiveness and safety of treatment and reduce the risk of complications, shorten the duration of surgery and anesthesia in child. The developed method of dosing the degree of anterior transposition allows to perform this operation monolaterally, without fear of developing secondary hyperfunction of the lower oblique muscle in the pair eye. 

The purpose: to determine the features of different stages of active retinopathy prematurely according to fluorescent angiography data.

Patients and methods. In 2011–2017, 271 angiographic studies were performed in 207 premature infants born at 25–33 weeks of gestation with 710–1980 grams weight at birth, with different stages of active ROP in age of live 3–12 weeks (30-39 weeks of post-conceptual age). A voluntary informed consent to perform the examination was received from the legal representatives of all patients. FAG was performed using retinal pediatric digital video system “RetCam-3” with built-in angiographic unit under mask anesthesia, in the presence of anesthesiologist-resuscitator, under the monitor control of the respiratory and cardiovascular systems of the child.

Results. Unfavorable types of active ROP are characterized by the specific manifestations that are not defined by the standard ophthalmologic methods: early flat neovascularization, the presence of small tortuous peripheral vessels with signs of leakage, reperfusion areas with an apparent lack of capillaries and shunts. This opens up the opportunities for early detection of stages of the disease requiring therapeutic measures. The aggressive posterior ROP is distinguished by a variety of angiographic patterns, the most important feature is the massive loss of the retinal capillary bed in the vascularized retina. FAG data about latent neovascularization and ischemic zones of the retina represent the particular value in the prediction of active ROP course.

Conclusion. The obtained results could allow to make the most differentiated approach to the management of children with active ROP, timely and effectively predict the course of the disease and to performed adequate treatment based on objective indications. 

Purpose: Comparison of refractive results calculation of IOL optical power calculated with the IV-generation formula in patients after a previously performed radial keratotomy and to determine the relationship of these results to modern standards of error calculation of the IOL optical power in cases of age-related cataract surgery.

Patients and methods. The study group consisted of patients after radial keratotomy caused by myopia and myopic astigmatism. Retrospectively data of 47 cases were analyzed (42 patients), 13 women and 29 men. The average age — 58.9 years (range 44 to 64 years). Patients were operated on the basis of the Ekaterinburg center of IRTC “Eye microsurgery” phacoemulsification through incisions not intersecting radial scars of the cornea. The calculation of the IOL optical power was performed according to IV generation formula: II Holladay (Iol consultant HicSoap Pro) and Olsen (PhacoOptics,) built-in software Scheimpflug camera Oculus Pentacam. The formula was chosen with calculation that it covers the whole spectrum range of optical cornea and front-back axle of all patients in this sample. Refractive outcome was taken into account in one month or more after surgery.

Results. Refractive error in case of calculation with formula Holladay II ±0.50 diopter was in 74% cases; ±1.00 diopter — in 92%, the average refractive error in calculation with the IOL optical power was 0.5 ± 1,2 diopters. Refractive error in the calculation with the Olsen formula was ±0.50 diopters in 75%; ±1.00 diopter — in 90% cases, the average refractive error of calculation the IOL optical power was 0.4 ± 1.3 diopters.

Сonclusions. Refractive results of calculating the optical power IOL in cases after radial keratotomy using the formula IV generation (Olsen — Phaco Optics and Holladay II — HicSoap Pro), provide achievement of modern standards of error in the calculation of IOLs.

Actuality. Complicated cataract surgery in high myopia is accompanied by the high risk of intra- and postoperative complications caused by this background disease. The presence of lens opalescence influences the results of many functional diagnostic tests. Diagnostic and prognostic research of the modern methods of investigation such as spectral optical coherence tomography, ultrasound biomicroscopy and B-scanning is urgent in patients with high myopia and cataract. The true prognosis of visual functions in these patients will allow solving the problem of cataract phacoemulsification expediency, decreasing the risks of complications.

Purpose. To determine prognostic criteria of complicated cataract phacoemulsification outcome in high myopia.

Patients and methods. 62 patients (101 eyes) with arising or immature cataract and high myopia were examined. All patients underwent ultrasound biomicroscopy of retinal periphery, ultrasound B-scanning of vitreous body and spectral optical coherence tomography of macular zone preoperatively, in the first postoperative days, in a month, in 6–8 months. We performed the correlation analysis of the initial morphological parameters and postoperative visual acuity. To solve the problem of the favorable outcome prognostication (achieving a certain level of visual acuity by the definite term after surgery) the method of binary logistic regression was used.

Results and conclusion. The performed mathematical analysis showed the correlation between the postoperative visual acuity and the initial morphological parameters in a myopic eye: the value of ocular anterior posterior axis, the height of the posterior vitreous detachment, posterior staphyloma, the retinoschisis length in the superior outer segment, epiretinal membrane height, pigmented epithelium destruction and discharge, increased choroidal reflectivity, subfoveal choroidal thickness. We built the mathematical models that allowed predicting with high accuracy the probability of achieving a certain level of postoperative visual acuity following cataract phacoemulsification in high myopia. 

Purpose — to study the relations between the posterior capsule (PC) and intraocular lens (IOL) after cataract surgery in pseudoexfoliation syndrome (PEX).

Patients and methods. We examined 46 eyes of 37 patients with PEX who underwent a standard and uncomplicated phacoemulsification. The age of patients was 60–94 years. Postoperative period ranged from 1 day to 10 years. An optical coherence tomography (OCT) (RTVue XR Avanti, “Optovue”) was used to image the IOL-PC space in early and late postoperative period.

Results. In the first days full contact PC-IOL was not observed in any case. The maximum of space PC-IOL was noted on the first day postoperatively. Posterior capsule had a wavy or folded profile on the scans. In the next two weeks we observed a decrease of the distances between posterior capsule and IOL. After 1 month we noted the formation of capsular bend around optic edge, the full adhesion of posterior capsule to IOL was not detected. In the late postoperative period the fibroplastic and proliferative capsular changes with secondary discontact PC-IOL was noted. Primary inadhesion of a posterior capsule to IOL was recorded in half of the cases.

и. High resolution OCT was suitable for quantitative analysis of IOL-PC space. Involution changes in structures of anterior segment in the eyes with PEX had a role in closure of the IOL-PC space. Complete adhesion of posterior capsule to IOL was not observed in the majority of eyes with PEX. 

In recent years, the incidence of vitreoretinal pathology has increased both in elderly and young patients. Such types of vitreoretinal pathology as macular holes, epiretinal membranes and vitreous opacities of various genesis require surgical intervention (vitrectomy) that may lead to cataract in the early postoperative period. Moreover, in elderly patients vitreoretinal diseases and cataract frequently accompany each other. From this, the necessity arises to perform phacovitrectomy. This procedure takes more time and is more technically complicated however, it is well tolerated by patients. There are several benefits of phacovitrectomy when complex ocular pathology, e.g., optimized visualization of the posterior segment, decreased amount of total surgical procedures, faster visual rehabilitation, and reduced risks and costs associated with a second surgery. However, some complications may still occur. The most common complications are posterior capsule opacification, increased postoperative inflammation, early postoperative IOP rising, and refractive errors. Numerous studies have described a mismatch between the expected postoperative refraction according to preoperative calculations and the actually achieved refraction. Most studies report about a negative refractive error. Various explanations have been suggested, including the biometry for measuring the axial length, changes in the effective lens position, IOL type, the formula used to calculate IOL power, the use of gas tamponade, and the type of macular pathology.

Purpose: to compare two types of phacoemulsification parameters (combination ultrasound and torsional US with IP) with estimating the number of postoperative complications caused by intraoperative trauma of corneal endothelial cells.

Patients and methods. 72 patients underwent phacoemulsification with IOL implantation. Patients were randomly divided into two groups (main n = 33 and control n = 39). During the aspiration of lens fragments in the main group the combination ultrasound was used, while torsional US with IP was used in the control group. Endothelial cell counting and other examinations were performed 1 day, 1 week and 6 months after the surgery.

Results. CDVA in the explored groups 1 week after the surgery was similar: the main group — 0.813 ± 0.228, the control group — 0.765 ± 0.250, There was also no statistically significant difference in the thickness of the cornea between the groups: the main group — 533.48 ± 12.41, the control group — 536.44 ± 10.92. At the same time, a statistically significant difference was found in the density of endothelial cells: the main group: 1871.30 ± 187.41 (after 1 week), 1865 ± 178.9 (after 6 months); control group: 1809.63 ± 225.43 (after 1 week), 1791 ± 230.82 (after 6 months). The percentage of cell loss was, respectively, lower in the main group at all times of observation: 3.90% (after 1 day), 4.54% (after 1 week), 4.9% (after 6 months). In the control group: 7.71% (after 1 day), 9.25% (after 1 week), 10.4% (after 6 months).

Conclusions. Data obtained in this study has showed the advantages of combination ultrasound in comparison with torsional US with IP, when performing aspiration of dense lenses. Due to lower consumption of ultrasound energy and higher aspiration rate of the fragments, combination ultrasound can reduce the loss of corneal endothelial cells and decrease the number and severity of postoperative complications associated with it. 

Purpose: to study the structure of the swelling lens, the dependence of its anatomical parameters on the nucleus sizes and density, patients’ age.

Patients and methods. 52 patients with intumescent mature cataract were examined. All patients underwent phacoemulsification with a two-stage continuous circular capsulorhexis. After the 2–2.5 mm capsulorhexis had been created, the liquid lenticular masses were removed from the anterior and posterior lens compartment with the aspiration/irrigation system. Visually we determined the size of the nucleus, its color and density according to Buratto’s classification.

Results. When performing this work 4 types of the swelling lens structure were revealed. Type I — a small emerging white nucleus with large amount of liquid lenticular masses in the anterior and posterior lens compartment, II degree of density according to Buratto’s classification. The mean age was 49.09 ± 3.19 years old. The related ophthalmic diseases accounted for 36.4%. Type II — a large white nucleus with the presence of liquefied lenticular masses in the anterior and posterior lens compartment. III degree of density according to Buratto’s classification. The mean age was 71.00 ± 1.92 years old. Associated diseases — 84.6%. Type III — a large brown nucleus with the presence of liquefied lenticular masses in the anterior and posterior lens compartment. IV degree of density according to Buratto’s classification. The mean age was 75.84 ± 1.46 years old. Associated diseases — 100%. Type IV — a small, very dense, brown nucleus with liquid lenticular masses. V degree of density according to Buratto’s classification. The mean age was 77.33 ± 2.49 years old. Associated diseases — 100%.

Conclusion. 4 types of lens structure in intumescent cataract were described depending on the nucleus size, density, the amount of the lenticular masses. By means of UBM method, it was shown that intumescent cataract is accompanied with the alterations of the ocular anterior segment parameters, which depend on the type of lens structure. It was revealed that the types of swelling lens structure are directly connected to the patients’ age: mean age of patients with type I — 49.09 ± 3.19 years old, with type II — 71.00 ± 1.92, with type III — 75.84 ± 1.46, with type IV — 77.33 ± 2.49 years old. 

Purpose: to optimize the technique of hypermature Morganian cataract phacoemulsification.

Patients and methods. 18 patients (18 eyes) with hypermature Morganian cataract were examined. Group I included 8 patients who underwent surgical intervention according to the improved technology using the iridocapsular retractors. Group II included the retrospective results of phacoemulsification with IOL implantation performed according to a standard technique in 10 patients. The optimizing surgical technique in patients of group I consisted in the consecutive usage of four iridocapsular retractors: when creating a capsulorhexis — to stabilize the capsular bag during the circular rupture of the anterior capsule; during the nucleus phacoemulsification — to stabilize the complex: capsular bag, nucleus, capsular ring — in the sagittal plane and additional (together with the capsular ring) support of the capsular bag fornices.

Results. No complications were noted in patients of group I. In patients of group II there were two ruptures of the posterior capsule (20%), two cases of re-implantation of a capsular ring because of the stop of its edge into the fold of the capsular bag fornix, one rupture of the anterior capsulorhexis border without its transition to the posterior capsule. In group I there were no any complications in the postoperative period. In group II we noted two corneal oedemata, Descemet membrane folds, which were jugulated by the conservative treatment on the 4–5th days postoperatively.

Conclusion. The optimizing technique of hypermature Morganian cataract phacoemulsification with the use of four iridocapsular retractors and capsular ring allowed reducing the number of intraoperative complications in comparison with the standard technique and making the surgical intervention more effective and safe. 

Purpose: to carry out an advanced combined technology, including femtosecond astigmatic keratotomy and topographically-oriented photorefractive keratectomy in order to correct corneal astmigmatism in patients with a thin cornea. Presentation and evaluation of the results of this observation.

Patients and methods. There are data of 19 patients (30 eyes) with complex myopic astigmatism combined with a thin cornea who received the operation of femtosecond astigmatic keratotomy (the first stage of an improved combined technology). Mean values before surgery: sph –4.1 ± 2.1 (from –0.3 to –7.8) D, cyl –4.9 ± 1.4 (–3.0 to –7.3) D, UDVA 0.1 ± 0.05 (from 0.01 to 0.2) of the rows of table, CDVA 0.6 ± 0.1 (from 0.4 to 0.9) of the rows of table, Kmax 46.70 ± 1.1 (from 44.50 to 48.50), Kmin 42.8 ± 1.3 (from 40.00 to 44.00), the thickness of the cornea is 470.0 ± 12.7 (from 4470 to 495.0) μm. The second stage: topographically oriented photorefractive keratectomy was performed to the same patients with the aim of correcting residual ametropy. Mean values before surgery: sph –5.3 ± 2.0 (from –1.8 to –8.8) D, cyl –1.6 ± 0.8 (from –0.5 to –3.0) D, UDVA 0.3 ± 0.1 (from 0.1 to 0.6) rows of the table, CDVA 0.7 ± 0.1 (from 0.5 to 0.9) rows of the table, Kmax 46.70 ± 1.1 (from 44.50 to 48.50), Kmin 42.8 ± 1.3 (from 40.00 to 44.00), the thickness of the cornea 464.3 ± 8.3 (from 460.0 to 485.0). All patients from the study received a diagnostic examination by standard and special methods based on the S. Fyodorov Eye Microsurgery State Institution, a screening of the keratoconus on the scanning topograph Pentacam HR “Oculus Optikgerate GmbH”, Germany was carried out. The first stage of the advanced combined technology was used the LenSx Laser (“Alcon”, USA), the second stage — WaveLight EX-500 (“Alcon”, USA), was used.

Results. After the completion of two stages of improved combined technology the following results were obtained: reduction of the sph with –4.1 ± 2.1 (from –7.8 to –0.3) to –0.4 ± 0.3 (from –1.0 to 0.0), cyl with –4.9 ± 1.4 (from –7.3 to –3.0) to –0.1 ± 0.1 (from –0.5 to 0.0), Kmax from 44.70 ± 1.1 (from 44.50 to 48.50) to 37.8 ± 1.6 (from 36.00 to 43.00), Kmin 42.80 ± 1.3 (from 40.00 to 44.00) to 37.00 ± 1.3 (from 36.00 to 40.00), CDVA growth with 0.6 ± 0.l (from 0.4 to 0.9) to 0.8 ± 0.1 (from 0.5 to 1.0), UDVA from 0.1 ± 0.05 (from 0.01 to 0.2) to 0.7 ± 0.1 (from 0.4 to 0.9).

Conclusion. The improved combining technology, including femtosecond astigmatic keratotomy and topographically — oriented photorefractive keratectomy is effective and safety technology, allowing to correct of corneal astigmatism in patients with a thin cornea. 

Refractive surgery is a dynamically developing field of ophthalmic surgery, which requires studying new approaches for determining indications and contraindications for refractive surgery.

Purpose. To investigate the possibility of expanding indications for refractive surgery in conditions related to contraindications on the example of four clinical cases.

Material and methods. The study included 4 clinical cases of photorefractive operations in patients with relative contraindications who underwent refractive surgery (Femto-Lasik, photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK)).

Results and discussion. Follow-up period of patients after Femto-Lasik, PRK and PTK was 1 year. During this period, stabilization of such parameters as intraocular pressure (IOP), progression of diabetic retinopathy, visual acuity was detected on all operated eyes. There were no postoperative complications. In the first clinical example, to avoid flap injury pneumotonometry was performed 72 hours after the surgery. IOP indices differed from preoperative ones and were 15 mm Hg because of the flap cut and the removal of part of the corneal tissue as a result of laser ablation. In the second clinical example, BCVA OU was 1.0 throughout the whole follow-up period. In the third clinical example recurrence of retinal detachment and any formations of new zones of peripheral vitreochorioretinal were not observed. BCVA improved up to 0.9–1.0. In the fourth clinical example, 3 months later, the patient complained for “misting” in the right eye. On examination, subepithelial fibroplasia of the 1st degree was revealed. After the course of treatment, the transparency of the cornea was restored. The data of the diagnostic examination after the surgery at the period of 1 month, 3 months did not differ and corresponded to preoperative ones. Diagnostic examination data 1 year after the operation: visual acuity: OD — 1.0; OS — 0.4 sph + 1.0Dcyl + 1.5Dax 45 = 0.8.

Conclusion. The presented clinical examples allow us to reconsider the list of relative contraindications for performing refractive operations for compensated diabetes mellitus, glaucoma, retinal detachment, corneal opacities, as it can be performed safely and effectively with good refractive results. 

Purpose: to evaluate the relationship between the functional state of the accommodative eye apparatus according to the data of accomodography and the increase of the ophthalmotonus in patients with myopia.

Patients and methods. There were 74 patients with myopia (148 eyes) from 6 to 17 years old. The mean age of the examined subjects was 12.7 ± 0.32 years. Low myopia was detected in 37 persons (73 eyes), medium myopia — in 23 persons (46 eyes) and high myopia — in 15 persons (29 eyes). Progressive myopia was detected in 110 eyes (74.3%), stationary — 38 eyes (25.7%). Constantly redundant tension of accommodation (CRTA) was found in patients on 134 eyes (90.5%).

Results. In 53% patients with progressive myopia (58 eyes) the cornea-compensated intraocular pressure (P0CC) was within the limits of the upper individual norm — from 18 to 21 mm Hg or higher. In progressive myopia with combination of accommodation weakness, CRTA and an increase of IOP up to the range of upper norm limits occurs in 4.8 times more often than with stationary myopia (t = 4.7, p < 0.05).

Сonclusions. It is necessary to measure intraocular pressure in patients with myopia taking into account the biomechanical properties of the sclera in case of accomodation arrors in the form of a combination of accommodation weakness and CRTA. The combination of accommodation weakness, CRTA and elevated IOP (upper-range) indicates the progression of myopia. 

Purpose: tо study the histomorphological state of the cornea with the help of confocal microscopy in patients with myopia in the period of adaptation to orthokeratological contact lenses (OCL).

Patients and methods. The study of the histomorphological status of the cornea was performed in the central optical, middle peripheral and perilimbal zones using confocal microscopy (ConfoScan-4) in 72 patients (144 eyes) with low myopia (38 people, 76 eyes) and middle myopia (34 persons, 68 eyes) after the appointment of OCL within 1 to 12 months.

Results. The maximum significant increase in the degree of epithelial changes in the central optical zone of the cornea was recorded after 7 days of the application of OCL and an increase of nerve fibers activation, the number of activated keratocytes — after 1 month. There were noted the degree of changes in the epithelium, the number of activated keratocytes after 1 month and the degree of activation of nerve fibers after 3 months in the middle peripheral zone of the cornea. At a period of 12 months of the using of OCL in the central optical zone and middle peripheral zone of the cornea the index of the degree of changes in the epithelium, nerve fibers, and the number of activated keratocytes was stabilized. In the perilimbal zone of the cornea the histomorphological parameters did not differ from the initial data at the observation periods, except for innervation. The densities of keratocytes in various layers of the stroma, endothelial cells did not change statistically throughout the study.

Conclusions. The results of the histomorphological indices made it possible to single out a “stressful” period of adaptation lasting 1 month, a transitional period of 1 to 3 months and a stable adaptation period, the formation of which was noted after 12 months of the application of OKL. Stable densities of keratocytes in various layers of the corneal stroma, endothelial cells during the entire period of observation indicated a fairly good tolerability of OCL. 

Purpose: to evaluate the effectiveness, safety, and predictability of the wavefront-guided FemtoLASIK using the Platoscan computer program and data from the KR-1W aberrometer, in comparison with the conventional algorithm FemtoLASIK in patients with low to moderate myopia.

Patients and methods. There were 62 eyes of 62 patients with low to moderate myopia who had undergone FemtoLASIK procedure using an excimer laser ‘Microscan Visum” (Russia) and a femtosecond laser Femto LDV Z6 (Switzerland) in the study. In the “Wavefront” group which included 31 eyes with a mean spherical equivalent (SE) -=3,32 ± 1,23 D (M ± SD) was performed a wavefront-guided Femtosecond LASIK using aberrometer KR-1W (Japan) and a program for calculating the operation’s parameters “Platoscan” (Russia). “Standard” group included 31 eyes with an average SE –3.51 ± 1.21 D (M ± SD), who received the conventional FemtoLASIK. The “Wavefront” and “Standard” groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central thickness of the cornea, sphere, cylinder, SE) (p > 0.05). All patients underwent complete ophthalmological examination before refractive laser surgery, and also patients were examined on the 1st day and 1 month after FemtoLASIK.

Results. One month postoperatively, in the “Wavefront” group the UDVA 1.0 or better (20/20 or better by Snellen) was achieved in 93.5%, in the “Standard” group — in 96,8% (p > 0.05). There wasn’t observed a loss of the CDVA lines in both groups. In the “Wavefront” group, gain of one or more lines of the CDVA was in 38.7%, in the “Standard” group — in 12.9% (p = 0.04, Fisher’s exact test). In the “Wavefront” group the predictability of targeted refraction within ±0.5 D was in 93.5%, within ±1.0 D — in 100%, in the “Standard” group — in 90,3 and 100%, respectively (p > 0.05). The efficiency index in the “Wavefront” group was 1.00 (1.00; 1.20) (Me (Q25; Q75)), in the “Standard” group — 1.00 (1.00; 1,00) (Me (Q25; Q75)) (p > 0.05). The safety index in the “Wavefront” group was 1.00 (1.00; 1.20) (Me (Q25; Q75)), in the “Standard” group — 1.00 (1.00; 1,00) (Me (Q25; Q75)) (p > 0.05).

Conclusions. The FemtoLASIK procedure, performed according to the conventional and wavefront-guided algorithms using the “Platoscan” computer program and data from the KR-1W aberrometer, is an effective, safe and predictable method for correcting low to moderate myopia, there is no statistically significant difference between two algorithms (p > 0.05). 

Purpose: to identify risk factors for the development of asthenopic syndrome (AS) in patients with moderate to high myopia after keratorefractive surgery (KRS).

Materials and methods. 122 patients (244 eyes) with medium and high myopia underwent a standard pre-operative examination of patients before KRS. The special methods of examinations were the study of reserves of relative accommodation (RRA) and the volume of absolute accommodation (VAA), and the accomodomography; the vision characteristics was determined on a four-point color test by E.B. Belostotsky, S.Y. Friedman at distances of 5.00 and 0.33 m, fusional reserves — with synoptophor. Patients survey was held with CISS questionnaire to detect the presence of AS.

Results: There were no complications after KRS in all cases. Uncorrected visual acuity was the same or higher than maximal corrected before surgery in 1 week after KRS. Patents were divided into 2 groups according to results of CISS survey: 88% — without AS, 12% — with signs of AS. Retrospective analysis of pre-operative data of the patients with AS has shown that a combination of an absence of binocular vision with a pronounced decrease in fusion reserves, reserves of relative accommodation and volume of absolute accommodation is prognostically unfavorable factors in patients with myopia.

Conclusion: All patients with moderate and high myopia have the refractive errors, there is no binocular vision in 12.3% patients. More significant errors of accommodation and binocular function were registered in patients with postoperative AS vs. patients without AS. Low fusion reserves and absence of binocular vision don’t allow to adopt for KRS results. This group of patients should be separated for pre-operative functional preparation. 

Purpose: to identify risk factors for the development of asthenopic syndrome (AS) in patients with moderate to high myopia after keratorefractive surgery (KRS).

Materials and methods. 122 patients (244 eyes) with medium and high myopia underwent a standard pre-operative examination of patients before KRS. The special methods of examinations were the study of reserves of relative accommodation (RRA) and the volume of absolute accommodation (VAA), and the accomodomography; the vision characteristics was determined on a four-point color test by E.B. Belostotsky, S.Y. Friedman. at distances of 5.00 and 0.33 m, fusional reserves — with synoptophor. Patients survey was held with CISS questionnaire to detect the presence of AS.

Results: There were no complications after KRS in all cases. Uncorrected visual acuity was the same or higher than maximal corrected before surgery in 1 week after KRS. Patents were divided into 2 groups according to results of CISS survey: 88% — without AS, 12% — with signs of AS. Retrospective analysis of pre-operative data of the patients with AS has shown that a combination of an absence of binocular vision with a pronounced decrease in fusion reserves, reserves of relative accommodation and volume of absolute accommodation is prognostically unfavorable factors in patients with myopia.

Conclusion: All patients with moderate and high myopia have the refractive errors, there is no binocular vision in 12.3% patients. More significant errors of accommodation and binocular function were registered in patients with postoperative AS vs. patients without AS. Low fusion reserves and absence of binocular vision don’t allow to adopt for KRS results. This group of patients should be separated for pre-operative functional preparation. 

Purpose: based on the results of an experimental study in vivo, to determine the optimal type of fibrillar structured drainages for glaucoma surgery.

Material and methods. An experimental morphological study was performed on 32 rabbits of the chinchilla breed, which were divided into 4 groups of 8 animals each. The rabbits were implanted with fibrillar structured drains from polyurethane, polyethylene terephthalate, polyamide, polylactide. In the postoperative period, a postoperative inflammatory reaction was assessed. After removing the animals from the experiment, the eyes were subjected to morphological examination.

Results. In rabbits with drainage from polyurethane, a mild congested hyperemia was noted in visual evaluation compared with the pair eye during the entire follow-up period. The eye reaction to the operation was regarded as a 1st degree. In more distant terms, there was a proliferation of subconjunctival tissue in the projection of the operation zone. In histological examination, the implant was represented by thin fibrous structures throughout the volume of drainage, a uniform distribution of macrophages, lymphocytes, among the fibers. In rabbits with drainage from polyethylene terephthalate, the reaction of the eyeball to the implantation of the polymeric material corresponded to the 0 degree. When a histological study was carried out along the periphery of the drainage, a thin capsule was formed. In rabbits with drainage from polyamide, the reaction of the eyeball corresponded to 1 degree. Histological examination showed that the fibrous structure of drainage was practically not determined, an abundance of cellular elements was observed throughout the drainage: macrophages and multinucleate giants predominated, fibroblasts, fibroblasts, lymphocytes, and newly formed connective tissue fibers between the drainage fibers were present. When analyzing the results obtained during the implantation of the matrix from the polylactide, the reaction of the eyeball corresponded to the 0 degree. Histological examination showed the preservation of fibrous structure of drainage, a moderate accumulation of macrophages was determined between the fibers, single giants, single lymphocytes were present.

The conclusion. Fibrillar structured drains based on polylactide due to a stable highly porous structure, high biocompatibility and biodegradability create favorable conditions for transport of aqueous humor and formation of outflow pathways. 

Purpose: To analyze the results of operation in patients with glaucoma depending on its stage, terms of follow-up and detection.

Patients and methods. 102 patients (204 eyes) operated on at IRTC “Eye Microsurgery” Tambov branch within October-November 2017 were examined. Mean age was 69.6 ± 9.5 years old. There were 58 male and 44 female. Patients’ eyes were divided into 4 groups: eyes with absolute glaucoma (33), III stage of glaucoma (71), I–II stage of glaucoma (54) and healthy eyes (46). The age of glaucoma patients in all groups was almost identical: age 60-69 years old (47.7%) and 70–79 (31.3%) prevailed.

Results. The mean follow-up period was 2.2 years (from 1 week to 11 years), the average number of examinations per patient in a year was 5. Before the first surgery 16% of the eyes with absolute glaucoma were detected, 40% — with III stage glaucoma, 26.5% — I–II stage glaucoma, the rest 17.5% were healthy (paired) eyes. Within the total follow-up 211 antiglaucomatous and 36 cataract surgeries were performed. The marked visual improvement was not noted after antiglaucomatous surgeries. In 5 patients without any glaucoma symptoms but followed up during 5-10 years without interruption absolute glaucoma was revealed. Among the above mentioned patients 3 had a rather high level of tolerant pressure (17 mm Hg) and high true IOP (25 mm Hg), other 2 — low tolerant pressure (12–14 mm Hg) and normal true IOP (19–20 mm Hg).

Conclusion. If glaucoma is diagnosed based on the examinations and patient received treatment, he/she should be under the supervision of an experienced ophthalmologist who determine and change treatment in time, including early surgery. 

Selective laser trabeculoplasty is a widely spread method of primary open-angle glaucoma treatment. Confirmation of SLT treatment efficacy is associated with economic feasibility and is used for reducing costs for patients.

The purpose of this study was comparative analysis of the cost value for patients with POAG, following SLT and having medical treatment without surgery, as well as determining the dynamics of the cost of treatment for patients at all its stages. An analysis of 250 medical charts of POAG patients, who underwent SLT (treatment group) and 50 medical charts of patients with POAG, who were treated conservatively (control group) was carried out, IOP before the surgery was from 20 to 30mm Hg. Selective laser trabeculoplasty was performed using Quantel Medical Optimis with Solutis device according to the standard technology. During the whole treatment course IOP every patient was examined 5 times: 1 day after SLT, 1 month, 3 months, 6 months and 1 year after the surgery (treatment group patients) and at primary visit, 1 month, 3 months, 6 months and 1 year later (patients of the control group). Linear method and cluster analysis were used as mathematical methods; data processing was performed using software STATISTICA 10. The obtained results allow to compare the costs for patients received SLT and treated without surgery, as well as the dynamics of the patient costs at every stage of the treatment, that can be concerned for the further clinical and economical correction of the whole treatment course for POAG patients. 

The contrast agents in vitreoretinal surgery are necessary to ensure the visualization of translucent and ultra-thin membranes and vitreoretinal interface (VRI) structures, but the ideal staining agent has not been found yet.

Purpose. To investigate and compare staining properties of two vital dyes for vitreous body (VB) and vitreoretinal interface visualization: “Kenalog-40” and “Vitreocontrast”.

Patients and methods. The study was performed on 20 cadaveric eyes. After eyeball dissection with the original technology, we carried out posterior vitreous cortex separation and comparative staining of retinal fragments on the side of VB and corresponding section of the VB by “Kenalog-40” and “Vitreokontrast”. Vitreo-retinal interface samples underwent morphological analysis.

Results. In contrast to «Kenalog-40», «Vitreocontrast» enables the visualization of thin layer of VB on retina surface after splitting of cortical layers during posterior vitreous detachment induction. Upon that, the adherent particles of the “Vitreocontrast” suspension remained on the corresponding splitted fragment of the VB. After staining with “Kenalog-40”, the VB surface remained smooth, shiny, with no visible changes. The results of histological examination of the obtained retinal and VB samples confirmed the presence of VB layer on the retina surface at the site of vitreoshisis formation during the induction of posterior vitreous detachment.

Conclutions. Received data confirm the possibility of vitreoshisis formation during posterior vitreous body detachment, and demonstrate the advantages of the staining properties of the “Vitreokontrast” suspension for visualization of fine structures of vitreoretinal interface. 

Purpose: to study the effectiveness of the posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes on the basis of the retrospective analysis of the retina changes, identified by OCT, and functional outcomes of surgical treatment.

Patients and Methods. A retrospective analysis of outcomes of posterior microinvasive vitrectomy was performed in 30 patients operated about non-full thickness macular holes. The following features were assessed: maximum diameter of the non-full thickness macular holes, the diameter at the base of the hole, the minimum thickness of the retina before and after operation, the maximum thickness of the retina before and after surgery. In addition, the configuration of the hole edges before surgery, the presence of intraretinal cysts before and after surgery, the integrity of the ellipsoid zone of the photoreceptors before and after the operation and the restoration of fovea centralis as a result of surgical treatment were assessed.

Results. As a result of surgical treatment the closure of non-full thickness macular holes was reached in all cases. The most corrected visual acuity in the postoperative period was ranged from 0.1 to 1.0 (0,66 ± 0,04). The visual acuity improved in 20 cases (64.5%), remained at the same level in 8 cases (25.8%) and decreased in 3 cases (9.6%, in 1 case due to the development of cataracts). The results of correlation analysis has allowed to establish correlation between the initial BCVA and the maximum retinal thickness (R = –0.4), and residual retinal thickness in the area of the hole (R = –0.3). The increase in visual acuity after surgical treatment significantly affected the recovery of the ellipsoid zone of the photoreceptors (RD = 0.833), regression of the retinal thickness (R = 0.42). In addition, the initial diameter of non-full thickness macular holes, both external and at the base, also had an impact on the increase in BCVA (R = –0.3 and R = –0.25, respectively).

Conclusion. Posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes is a highly effective method of treatment, as evidenced by the closure of the defect and improvement or stabilization of the most corrected visual acuity 90.4% cases. On the basis of the retrospective analysis it is found that the most significant increase in the most corrected visual acuity was increased in patients with low visual acuity. The recovery of the ellipsoid zone of photoreceptors, regression of the retinal thickness and the diameter of non-full thickness macular holes, both external and at the base mostly influences nn the recovery of the most corrected visual acuity. 

Purpose: to develop an algorithm for testing patients with optic nerve atrophy due to MS using microperimetry with the different functional disorders.

Patients and Methods. There were 20 patients (40 eyes) with the correct diagnosis of MS at the age of 33 ± 1.88 years in the study. The BCVA was from 0.1 to 1.0. Microperimetry was done on MP-1 (Nidek technologies, Vigonza, Italy) with the definition of mean sensitivity, stability and type of fixation. We chose the parameters of microperimetry: the research program, the size of the stimulus, the fixation mark and the test mode.

Results. The best program for diagnosing central visual field defects was the program macula 12° 10 dB, for paracentral visual field defects – retina 40° 20 dB. The testing was conducted by using a standard stimulus Goldmann III, mark and survey mode is selected individually, according at the various types of functional disorders. The visual acuity was from 0.1 to 0.4 in 11 eyes with optic nerve atrophy. There were revealed absolute or relative defects of the central field of vision and the decreasing of mean sensitivity to 8.21 ± 2.3 dB, unstable central fixation — 71.18 ± 10, 3%. In 29 eyes with optic nerve atrophy and visual acuity 0.5–1.0 have been identified relative small central visual field defects and paracentral visual field defects in the inferior side with a decrease in sensitivity to 15,32 ± 0,84 dB in the area of 6° from the fixing point, stable central fixation 88,96 ± 2,9%.

Conclusion. The authors developed an algorithm for testing patients with optic nerve atrophy due to MS. Using the algorithm identified the central and paracentral visual field defects with the decrease in the mean sensitivity. 

Purpose: to compare informativity and accordance of indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCT-A) data in visualization of neovascularization associated with chronic central serous chorioretinopathy. Patients and

Methods. Twenty one eye of 21 patients (aged 51.0 ± 8.4 years old) with chronic central serous chorioretinopathy (CSR) and assumed choroidal neovascularisation (CNV) with «double layer» sign on optical coherence tomography scans were enrolled in this study. ICGA on Spectralis HRA+OCT, (Heidelberg Engeneering, Germany) and OCT-A on RTVue XR Avanti (Optovue, USA) were performed to evaluate CNV. The assessment of obtained pictures was examined by two experts.

Results. Both diagnostic methods have shown similar results. CNV has been revealed in 11 of 21 eyes by ICGA imaging while OCT-A confirmed neovascularization in 13 eyes — with no statistical difference between methods (p = 0.74, χ2). CNV has not been diagnosed in 10 cases by ICGA and in 8 cases by OCT-A (p = 0.69). However, the consistency of the two methods in CNV evaluation while pairwise comparison of angiography data has been confirmed only in 8 eyes. The absence of CNV has been confirmed in 6 eyes — mostly in patients with CSR recurrence. One third of patients (7 of 21 eyes) have not shown consistence of two methods. The OCT-A visualization of CNV could be poor because of subretinal deposits and pigment-related signal blocking. In cases of diffuse retinal pigment epithelium atrophy the neovascular network cannot been seen on ICGA images while well visualized on OCT-A.

Conclusion. The informativity of ICGA and OCT-A in visualization of neovascularization associated with chronic central serous chorioretinopathy is similar. For the best data interpretation the condition of neurosensory retina and pigment retinal epitheluium should be taken into account. OCT-A is more preferable in cases of diffuse epitheliopathy, while the neovascularization activity and leakage points is better seen on ICGA. 

Introduction. To summarize our fifteen-years clinical experience of using Botox in strabismology and determine the indications for the most effective use of chemodenervation in the complex treatment of oculomotor system pathology.

Patients and methods. To carry out chemodenervation of extraocular muscles, Botox was used. The optimal dose of Botox for intramuscular injection ranged from 1.25 to 5.0 units. The choice of dosage depends on the patient’s age, the type oculomotor system pathology, the level of muscular dysfunction and the purpose of the treatment. The treatment was performed in 376 patients with various disorders of oculomotor system. At the time of treatment, the patients’ ages ranged from 12 to 78 years. Injection of Botox into the extraocular muscles in all cases was the primary method of treatment.

Results. In general, the state of relative functional recovery was achieved in 71.81% of cases (in 270 patients). The best results were obtained in treatment of decompensated heterophories, acute heterotrophies, atypical heterotrophies and primary hyperfunction of the inferior oblique muscles (in 100% of cases). In these conditions, the binocular vision was preserved in patients, and the imbalance of the oculomotor system did not show any sign of incomitance. However, patients with paralysis and paresis of the cranial nerves chemodenervation allowed creating conditions for a more complete restoration of muscular functions, to avoid the occurrence of a secondary imbalance in the oculomotor system. In 70.3% cases (185 patients), subsequent surgical treatment was not required. Reliable functional results of treatment allowed creating the optimal algorithm for chemodenervation.

Discussion. Chemodenervation of extraocular muscles is an effective independent and additional method of complex treatment of oculomotor system pathology and expands opportunities in patients’ rehabilitation. To achieve maximum functional results, it is necessary to select patients correctly for this procedure, taking into account its appropriateness and advantages over alternative methods of treatment, selection of optimal dosages of Botox. 

Purpose: analysis of clinical cases of different course of diabetic retinopathy in pregnancy.

Patients and methods. The article presents 5 clinical cases of different course of diabetic retinopathy in pregnancy: absence of manifestation, stable course and progression to macular edema and aggressive proliferation.

Results. The reasons for progression of diabetic retinopathy during pregnancy were analyzed. The most important were the compensation of diabetes mellitus in preconception period and throughout pregnancy, the severity of retinopathy, and the presence of concomitant pathology. It is emphasized that timely detection of progression signs of retinopathy and laser coagulation during pregnancy makes it possible to stabilize the course of disease and improve visual prognosis. Thus, the monitoring of pregnant women with diabetes mellitus requires an individual approach and careful dynamic observation during pregnancy and in postpartum period. Timely laser coagulation in progression of retinopathy can contribute to preservation of visual functions.

Conclusions. Clinical course of diabetic retinopathy in pregnancy is variable: no manifestation, stabilization, progression. Progression of diabetic retinopathy during pregnancy is determined by many factors, in particular, the compensation of diabetes mellitus in preconception period and throughout pregnancy, the severity and stabilization of retinopathy as results of treatment in preconception period, the presence of concomitant pathology. Timely detection of signs of diabetic retinopathy progression and its treatment, particularly laser coagulation of the retina, during pregnancy allows stabilizing the course of disease. There may be an aggressive course of diabetic retinopathy with progression in postpartum period, in connection with which, active monitoring of patients with retinopathy after childbirth is required. 

Purpose: to study noninvasive diagnostic options for polypoidal choroidal vasculopathy (PCV) — a subtype of neovascular agerelated macular degeneration — by monitoring clinical progression, defining optical coherence tomography (OCT) findings specific for PCV and evaluating diagnostic utility of OCT angiography.

Patients and methods. The study included 254 patients (292 eyes) with neovascular age-related macular degeneration. All patients underwent complex eye examination: visual acuity test, slit lamp biomicroscopy, ophthalmoscopy with 60 and 78D fundus lenses, fundoscopy with color filters, spectral-domain OCT, OCT angiography and biometry. Fluorescein angiography was performed in 66 cases. Indocyanine green angiography was employed in 16 patients with PCV. All statistical analyses were performed with IBM SPSS Statistics 19 software package.

Results. In 14 of 16 patients (87.5%) indocyanine green angiography revealed round hyperfluorescent lesions which corresponded to ophthalmoscopy findings — subretinal reddish orange nodules localized primarily in the parafovea. In 11 cases (68.8%) the nodules were associated with hemorrhage and in 14 cases (87.5%) — with hard yellowish exudates. Comparative analysis of retinal anatomy allowed for defining typical OCT signs of PCV that distinguish the clinical entity from type 1 and 2 choroidal neovascular membranes: neurosensory retinal detachment in the parafovea (80.0%, p < 0.001) and hard exudates (71.9%, p < 0.001). OCT findings characteristic of PCV are dome-shaped pigment epithelium detachment (100%), bubble sign (94.74%), notch sign (68.4%) and double layer sign (92.9%).

Conclusion. Noninvasive diagnosis of polypoidal choroidal vasculopathy should encompass clinical signs, fundoscopy findings, OCT-based morphometry and OCT angiography criteria. OCT angiography has high diagnostic value and enables detection of branching vascular network and polypoidal formations. 

Demodicosis is one of most spread dermatosis. Blepharitis of Demodectic etiology occupy from 39 to 88% among all inflammatory diseases of the eyelids. The disease is widespread, 89% of patients are parasite carriers, despite the fact that most of them do not feel any manifestations of this pathology. The effect of predisposing factors such as chronic diseases of the gastrointestinal tract and liver, endocrine pathology, undernutrition, unhealthy habits etc. promote the development of Demodicosis. According to some authors, the mite of Demodex genus is a potentially pathogenic saprophyte microorganism, showing its pathogenic activity under certain conditions. According to Russian studies, infection with Demodex is up to 92%, but it is not always Demodicosis, the manifestations of it depend not only on the number of individuals, but also on the state of immunodefence. In recent years, cases of mite detection in humans have increased. Perhaps, this is facilitated by the environmental problem associated with environmental pollution, including air pollution, and the growth of chronic diseases, especially digestive diseases, endocrine diseases — diabetes mellitus. The reason for this, as a rule, is an unhealthy way of life and nutrition. Despite the variety of drugs with specific and symptomatic effect, the treatment of eye Demodicosis is ineffective. This is caused by the duration of therapy, noncompliance of treatment and hygiene standards, the prescription of symptomatic drugs that do not have acaricidal action, the lack of chronic diseases treatment, and the need for comprehensive treatment of eye Demodicosis by an ophthalmologist and facial skin — by a dermatologist. The lack of knowledge of etiopathogenesis and the insufficient effectiveness of Demodex therapy methods contribute to its chronically recurrent course with impairment of the severity of clinical manifestations and are a significant psychotraumatic factor for patients that leads to the development of psychoasthenic state and neuroses and indicates the medico-social significance of the problem of this Dermatosis.