Oxidative stress due to the imbalance in the production and detoxification of reactive oxygen species in antioxidant defence system of the body, as well as subsequent chronic inflammation, is believed to be associated with age-related eye diseases. Prevention of chronic degenerative diseases such as age-related macular degeneration (AMD) and primary open-angle glaucoma are of particular interest. In the last decade, tremendous success has been achieved in the treatment of age-related retinal pathology. However, these treatments are expensive and require frequent monitoring and, in some cases, injections, which place a huge burden on both the healthcare system and patients. Consequently, considerable interest remains in preventing or slowing the progression of these diseases. Epidemiological studies have shown that diet is a modifiable risk factor for AMD, and nutritional modification with food antioxidant supplements is a particularly attractive method of prevention because of its potential benefits and relatively low cost. A large number of experimental studies, including clinical studies in animals and humans, have provided supporting evidence that antioxidant food additives inhibit the oxidation of macromolecules, as well as an inflammatory response that occurs in the pathogenesis of involutional retinal pathology, which ultimately inhibits its development and progression. This review discusses the role of antioxidant dietary supplements in the prevention of age-related retinal pathology.

Choroidal melanoma is the most common and life-threatening intraocular malignant neoplasm affecting the eye choroid in about 90 % of cases. The incidence varies from 0.7 to 1.1 per 100,000 of the population. This category of malignant neoplasms is highly aggressive in terms of local distribution, the occurrence of loco-regional and distant metastases. According to various authors, the frequency of metastasis reaches up to 50 %, the risks of metastatic disease depend on the size of the tumor, the duration of observation, clinical and pathomorphological characteristics of the choroidal melanoma and genetic factors. This article provides a detailed literature review on the developmental aspects and growth dynamics of choroidal melanoma from the point of view of neoangiogenesis and the phenomenon of vasculogenic mimicry, and the possibilities of instrumental diagnostics for determining the malignant vasculature of a tumor. The relevance of studying this issue is determined by the peculiarities of the origin of choroidal melanoma, which can occur both de novo and due to malignant transformation from nevus cells and the critical point for it is a tumor thickness of more than 2 mm, at in which the the process of neoangiogenesis starts. This review details the role of various methods of instrumental diagnostics, such as doppler ultrasound imaging to determine the presence or absence of blood flow in the tumor and its blood flow characteristics, angiography using contrasts: fluorescein and indocyanine green angiography, and optical coherent tomography—angiography to identify the malignant vasculature and evaluation of tumor angioarchitectonics. It has been shown that in the diagnosis of especially small choroid melanomas, which are of significant diagnostic complexity, a multimodal approach using the above research methods is important. There is no doubt that these instrumental technologies aimed to identify the malignant vasculature of choroidal melanoma play a large role not only in diagnosis, but also are of considerable practical interest in planning treatment, in assessing its effectiveness, and also in predicting the risks of metastatic process development.

Eye injury is one of the actual problems in modern ophthalmology. Penetrating wounds of the cornea are the most significant among all eye injuries. New data on the course of inflammation in corneal injury will allow us to predict the course of the post-traumatic period and improve treatment outcomes. The corneal immune privilege is a unique system of protecting one’s own tissues from damage caused by systemic immunity reactions, which is realized through several mechanisms. Modern research shows that healing from corneal injury is a complex cascade of cellular reactions, the understanding of which is still far from consummation. It was described the regenerative potential of cell populations of the cornea when it was damaged. Contravention of barrier properties in injuries of the cornea deprives the organ of vision of immune privilege. This violation initiates the launch of the messenger pools of angiogenesis, remodeling and inflammation. Besides studying the interaction of cellular messengers in cornea trauma and inflammation, researchers pay great attention to cellular reactions. Recruitment of immune cells during corneal injury is mediated by pro-inflammatory cytokines released during damage from epithelial cells and keratocytes.

Vascular pathology of the vision organ is one of the leading causes of irreversible vision loss. Ocular ischemic syndrome is a serious condition that requires special attention to prevent adverse effects and outcomes. Today, this syndrome mainly occurs in the form of ischemic optic neuropathy and chronic ischemic retinopathy, which are based on damage caused by impaired perfusion in the pool of the ophthalmic artery. According to the data presented in foreign and domestic literature, there is an correlation between the ocular ischemic syndrome and the pathology of the cardiovascular system. Often, this pathology is accompanied by such diseases as: coronary heart disease, atherosclerosis, arterial hypertension, and diabetes mellitus. A number of studies have shown that an important risk factor for the development of vascular eye’s pathology is the combination of coronary heart disease with elevated total blood cholesterol and atherosclerosis in combination with arterial hypertension. Also, there are data indicating the association of the risk of ischemic opticopathy with the presence of cardiovascular diseases in patients, and vice versa, previously transferred opticopathy can be considered as predictors of cardiovascular pathology. Thus, prevention and treatment of this pathology is an interdisciplinary problem. The classical approach in the treatment of ocular ischemic syndrome today remains conservative therapy, which aims to reduce local ischemia and the effects of hypoxia. However, conservative treatment does not eliminate the main reason for the development of this condition; therefore, the search continues for new, more effective methods of preventing and treating this pathology. In recent years, data on high clinical efficacy in the treatment and prevention of ocular ischemic syndrome manifestations have appeared in the literature after surgery to restore the main blood flow at the level of the brachiocephalic arteries. A variety of cardiovascular diseases and various levels of its damage determine the approach to the treatment of this pathology. This literature review is devoted to the analysis of the causes of ocular ischemic syndrome, depending on the level of localization of the lesion of the cardiovascular system.

Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up.
Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months).
Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %).
Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.

Purpose. To rationale experimentally the use of an excimer laser for forming an ultrathin transplant for posterior lamellar keratoplasty.
Materials and methods. Atomic force microscopy was used for examination of 10 samples. Control group was 5 corneal flaps obtained by mechanical microkeratome (Moria SLK-2, France). Main group — 5 corneal flaps, obtained by microkeratome and underwent photoablation by “Microscan 500” (Optosystems, Troick, RF) excimer laser at 50 um depth. For quantification of endothelial loss 10 donor corneas (5 pairs) with viable endothelium, preserved in Borzenok—Moroz media, were used. Two groups were formed: main — 5 ultrathin transplants obtained by consistent application of microkeratome and excimer laser, control (from the paired eyes of same donors) — ultrathin transplants prepared by two cuts of microkeratome. Detection of live and dead endothelial cells (EC) was provided by Calcein Violet 450 and Propidium Iodide “vital” fluorescent dyes. Nonparametric Mann—Whitney test was used for statistical analysis. Coefficient of reliability (p < 0.05) was considered to be significant.
Results. RMS (roughnessmean square) of the transplant, prepared by excimer laser was — 24.17 ± 12.4 um, and RMS of the transplant prepared by microkeratome — 22.3 ± 18.3 um. Statistical analysis did not reveal significant differences in RMS values in the mentioned groups (p > 0.05). EC death in excimer laser group was 10.35 ± 5.84 %. EC death in microkeratome group — 8.06 ± 1.31 %. No statistically reliable difference of EC death was revealed in the 2 groups (p > 0.05).
Conclusions. The investigation has showed identical RMS values in the examined groups, representing high optical qualities of the transplant prepared by excimer laser. EC loss was also comparable in 2 groups. The received results indicate considerable potential of excimer laser transplants for posterior lamellar keratoplasty.

Purpose. Evaluation of the visual and refractive results of additional correction using LASIK and PRK methods in patients with residual refractive error after previous cataract surgery.
Patients and methods. The prospective open study included 57 patients (79 eyes) who previously underwent cataract phacoemulsification (n = 37) or refractive lensectomy (n = 42) with various IOL models implantation (2012–2017). The average age of patients was 50.8 ± 13.9 (19–79) years. Operations LASIK (91.1 %) and PRK (8.9 %) were carried out according to standard methods. In 6 cases, femtosecond laser supported by laser correction. The target refraction ranged from –0.25 to 0.25 D in most (97.5 %) cases. The follow-up period ranged from 6 to 9 months.
Results. The patients were divided into groups according to the type of residual refractive error (Group 1 — myopia, group II — emmetropia and group III — hyperopia). Statistically significant differences were determined for the species of previously implanted IOLs — in group II, the frequency of monofocal IOLs was significantly higher (p < 0.05). In group II, the values of the cylindrical component of refraction were significantly higher compared with groups I and III (p < 0.05). In group I, a significant (p < 0.05) decrease in the spherical component of refraction from –1.36 ± 0.92 to –0.2 ± 0.8 D was observed. In patients of group II, there was a slight increase in the spherical component of refraction from 0 ± 0.20 to 0.25 ± 0.29 D (p > 0.05). In group III, a significant (p < 0.05) decrease was observed in the spherical component of refraction from 1.27 ± 0.69 to 0.43 ± 0.49 D. When analyzing the cylindrical component of refraction in group I, its decline was noted from –0.69 ± 0.5 to –0.38 ± 0.46 D (p > 0.05). In group II, the largest decrease in the cylindrical component was observed from –1.6 ± 1.0 to 0.03 ± 1.10 Dptr (p < 0.01). In all the studied groups, a statistically significant (p < 0.05) increase in UCFVA was revealed in the postoperative period. Indicators K1 and K2 did not significantly change.
Conclusion. The high efficiency of the correction using the LASIK, PRK and femtoLASIK methods on pseudophakic eyes with the achievement of the target refraction in most of the studied cases was shown. This method can be used as an alternative to spectacle and contact correction in patients with residual refractive error after cataract phacoemulsification and refractive lensectomy with IOL implantation.

Purpose. To evaluate the quality of the surface of an ultra-thin donor transplant prepared from the endothelial surface of the cornea using a femtosecond laser and to demonstrate the preliminary clinical results.
Patients and Methods. 4 eyes were operated: 3 with Fuch`s endothelial dystrophy and 1 with pseudophakic bullous keratopathy. All patients were treated with DSEK with an ultrathin graft prepared by Alcon Wavelight FS 200 femtosecond laser (Germany). Before and after surgery UCVA, BSCVA, astigmatism, ECD were measured. EC death, graft thickness and CCT were evaluated at 12 months` observation. Atomic force microscopy was used for examination of 10 samples. Control group was 5 corneal flaps obtained by mechanical microkeratome (Moria SLK-2, France). Main group — 5 corneal flaps, obtained by femtosecond laser. Nonparametric Mann-Whitney test was used for statistical analysis. Coefficient of reliability p < 0.05 was considered to be significant.
Results. RMS value of femto-laser group samples was 18.6 ± 7.8 um. RMS of microkeratome group samples was 22.3 ± 18.3 um. Statistical analysis did not reveal significant differences between the values of the studied parameter in these groups (p > 0.05). Transparent engraftment was observed in all cases, no corneal edema was identified. BSCVA ranged from 0.2 to 0.6, which was associated with the presence of concomitant pathology. Astigmatism was 1.35 ± 1.0 D. ECD = 1526 ± 434 cells/mm2. EC loss = 48.0 ± 12.8 %. Graft thickness in the central zone was 78.0 ± 18.1 µm. Center-Edge Index — 0.84 ± 0.12. CCT = 600 ± 31 um. No postoperative complications were found.
Conclusion. The developed settings allowed to obtain high-quality ultra-thin graft with a sufficiently uniform surface without a risk of perforation. Preliminary clinical results showed the method potential for restoration of corneal transparency. ECD loss corresponded to the one achievable by DSAEK.

The purpose: to study to evaluate the effect of ortokeratology lenses (OK-lenses) on the state of the ocular surface, depending on the duration of their wearing by adolescents with myopia.
Patients and methods. Under control were 212 patients with myopia aged 12 to 16 years, who used OK-lenses “Paragon CRT100” (USA) for a long time (3–5 years). Examination, in addition to standard ophthalmological methods, included evaluation of complaints using the OSDI questionnaire/scale, Schirmer, Norn tests and biomicroscopy with staining of the cornea with fluorescein before and during wearing OK-lenses. Patients with keratopathy additionally underwent scanning confocal microscopy of the cornea using ConfoSkan-4 (Nidek, Japan); bacteriological examination of scraping from the cornea.
Results. Clinical and functional signs of dry eye syndrome (SDE) in patients before and after prolonged use of OK therapy are not diagnosed. In 12 (5.6 %) teenagers with non-standard values of corneal curvature, signs of late epitheliopathy were revealed against the background of the absence of complaints. Patients were divided into 2 subgroups depending on the choice of antimicrobial eye drops in addition to keratoprotectors. The results of treatment in both subgroups were the same, but the use of fluoroquinolones was accompanied by an adverse development of SDE.
Conclusion. In general, long-term OK therapy of myopia in adolescents is safe. The compulsory condition is an adequate prescription and observance of the wearing and lens care rules. It does not have a significant adverse effect on the clinical and functional state of the ocular surface, including the cornea. The frequency of late epitheliopathies with long-term (3–5 years) wearing OK lenses is 5.6 %, and the severity of the manifestation is characterized mainly by a mild degree. Patients with extreme corneal curvature are in a high-risk group for the development of late corneal complications during the use of OK therapy. If late epitheliopathies are detected while wearing OK lenses, it is necessary to cancel their use and to prevent the development of infectious keratitis, in addition to keratoprotectors, you can add the modern antimicrobial drug with antiseptic effect, for example, Vitabact, as the original, without a preservative, approved medicine for use in children. The use of fluoroquinolone drugs with virtually aseptic inflammation of the cornea is unjustified.

Purpose: To evaluate the effectiveness of a new modification of the vacuum-perimeter test (VPT) by V.V. Volkov in the early diagnosis of glaucoma in comparison with the results of the original test and its known modification — vacuum-compression automated test (VCAT) in an open comparative clinical research.
Patients and Methods. The study involved 26 patients (47 eyes) (average age 52.9 ± 8.5 years) with suspected open-angle glaucoma (OAG). Patients were divided into three groups: 1-st — 19 eyes with preglaucoma, 2-nd — 18 eyes with the early stage of OAG, 3-rd — 10 eyes of five patients with unconfirmed glaucoma. The control group (4-th) included 20 eyes of 10 healthy people (average age 56.4 ± 4.4 years). Along with the standard ophthalmological examination, all patients underwent perimetry on Humphrey Visual Field Analyzer II 745i (Germany-USA), our modification of Frequency Doubling Technology (FDT) perimetry, evaluation of the optic nerve head (ONH) on Heidelberg Retina Tomograph (HRT 3, Germany) and three stress tests: VPT, VCAT and our modification — vacuum-contrast-frequency test (VCFT). VCFT was created on the base of FDT perimetry with the aim of increasing the sensitivity of the original test (VPT) for detection of preglaucoma through the use of non-standard stimulus and increasing the number of investigated points of central visual field.
 Results. According to the National classification (1975) the diagnosis of preglaucoma was determined on the basis of a positive result of at least one of three stress tests, taking into account the risk factors for the development of glaucoma in patients. The early stage of OAG was established on the base of International standards for structural and functional assessment of the ONH (2003). The specificity of all three compared stress tests was 100 %, which confirmed their negative results in all patients (10 eyes) from the 3-rd group. However, the sensitivity of VCFT (75 %) was significantly higher than VPT (21.05 %) and VCAT (21.05 %), which is due, we believe, to the specific nature of VCFT stimulus.
Conclusion. According to the obtained data, the developed new modification of VPT — VCFT on the specificity of the results was not worse, and the sensitivity was better than the original VPT and VCAT in the diagnosis of preglaucoma. VCFT is quickly performed and comfortable for patients.

The literature review presents the results of a static perimetry for the study of the visual field in patients with compression in the chiasm-sellar region on the Humphrey Visual Field Analyzer (HFA) and Octopus. These models of perimeters are recognized as the “gold standard” and are most widely used in the global ophthalmic practice. The analysis of research results using traditional and function-specific perimetry with selective stimulation of the magnocellular and koniocellular (frequency-doubling technology perimetry, FDT; short-wavelength automated perimetry, SWAP) visual pathways was performed. The literature data analysis allows us to conclude that the static perimetry for the study of the visual field in patients with chiasmatic compression is carried out quite widely and is informative. But despite this, there are no generally accepted recommendations on the use of certain testing strategies and programs for the diagnosis and further dynamic observation of changes in the visual field in patients with this pathology. In this regard, it is advisable to conduct further studies that will allow the formation of standard perimetric protocols for diagnosing and monitoring visual field defects in patients with compression in the chiasm-sellar region based on a comparative analysis of the diagnostic informativity of various strategies and programs.

The role of the vitreous body and vitreomacular interface (VMI) is key in many processes including proliferative diabetic retinopathy (PDR). In PDR patients, the VMI changes can significantly influence the emergence and progression of the disease. There are multiple factors at work in the VMI including taut posterior cortical layers, vitreoschisis, posterior vitreous detachment (PVD), and vitreous adhesions. But there is no general consensus about their role in proliferative complications. Further understanding the VMI relationship in a case of PDR is warranted in order to design better treatments, to arrest and possibly even reverse progression of PDR.  Today there is no imaging techniques to determine normal vitreous and VMI interactions in different PDR stages intraoperatively.
Purpose: to analyze intraoperative vitreous and vitreoretinal interface features during chromovitrectomy in patients with A-C stages of PDR.
Patients and methods. Seventy-four diabetic patients (74 eyes) were included. We performed standard 25 Gauge pars plana vitrectomy using Vitreocontrast for vitreous and vitreoretinal interface (VRI) visualization. Intravitreal “Vitreocontrast” suspension is the most favored agent of those studied and it is increasingly used as an adjunct during surgery to delaminate fine tissue planes and pockets of formed vitreous and VRI structures that may not be visible with routine operative illumination systems, or using modern vital dyes.
Results. “Vitreocontrast” suspension allows to visualize posterior cortex changes during different stages of PDR. We investigated vitreous and VRI anatomy, topography and structure and determined safety of retrociliary and equatorial cisterns walls in 97 % in stage A of PDR, 95 % in stage B and in 82 % of stage C. In 3–5–18 % cases, correspondently, we determined disorganization of some vitreous cisterns. In 94 % cases of PDR A and 96 % cases of PDR B we visualized preretinal vitreous layer in a central macular zone, within the boundaries of vascular arcades. It has specific topography and strong adhesion to the internal retinal membrane. It’s the first time when this new vitreous cortex layer was revealed. The presence of this layer is the result of a strong vitreomacular adhesion that causes the posterior vitreous cortex split as it attempts to detach from the inner retinal surface. Such outermost layer remains attached to the macula and can induce further proliferation process. On a stage B of PDR this area correspond with multiple vitreoschisis, on a stage C of PDR — with fibrovascular membrane. The complete PVD was revealed in 61 cases.
Conclusion. In this article we analyze the results of surgical treatment in 74 patients with A-C stages of proliferative diabetic retinopathy. Newer imaging technique with new dye — suspension “Vitreocontrast” allows to detect sensitive relationships of vitreous and VRI in each stage of the disease. The role of vitreous body in this process gives us a reason to consider it as an important object for further research. Moreover, the understanding of their relations in different stages of PDR enables to develop optimal surgical approach on each stage of PDR.

Purpose: study of the effect of dosed pneumatic vasocompression (DPVС) as part of complex therapy on functional indicators in patients with primary open-angle glaucoma (POAG) depending on the characteristics of the individual profibrinolytic response of the vascular wall.
Patients and methods. An additional analysis of data that was obtained earlier in 20 patients of the main group with stage II POAG was performed. Patients of this group, along with conservative drug therapy at the inpatient stage, underwent a course of DPVС, including 4 sessions of pneumocompression of the upper extremities (see previously submitted to print work — Non-pharmacological enhancement of fibrinolysis in the treatment of primary open-angle glaucoma. Part 2). According to the results of assessing the severity of the profibrinolytic response to pneumocompression, patients were conditionally divided into two groups: 1st group — with a high response to a single external mechanical effect, documented by an increase (∆) of t-PA / PAI 1 ≥1.00 (Me 1.57; 95 % CI 1.12–3.83); 10 patients, and the 2nd group — with a low response with ∆t-PA / PAI 1 <1.00 (Me 0.30; 95 % CI 0.20–0.37); also 10 patients. In the both groups, a comparative analysis of the hemostasis and fibrinolysis system indicators, as well as the functional parameters of the organ of vision, hydrodynamics and retinal sensitivity, was carried out.
Results. It was revealed that in patients with a high response after external mechanical exposure there is an increase in t-PA level after 1 hour 1.88 times and after 24 hours 2.08 times from baseline (median). In contrast, in patients with low response, there was only a tendency for this indicator to increase after 1 hour (1.43 times, median) and return to baseline after 24 hours, which was not statistically significant. In patients with a high response to pneumocompression after the end of the course of complex therapy, the best results were observed, reflecting the indicators of hydrodynamics and photosensitivity of the retina. Conclusion. When selecting patients with POAG that require vasocompression, it is advisable, at the treatment course beginning, to evaluate the individual reaction of the wall of the blood vessels of the upper limb by changing the ratio of t-PA / PAI-1 before and 1 hour after the session. It is proposed to include DPVС in the composition of complex drug therapy for POAG in those cases when the ∆ ratio indicator t-PA / PAI-1 is equal to or more than 1.0.

Purpose. To evaluate changes of anatomical and functional parameters of the eye in children with initial emmetropia and to assess their impact on the occurrence of myopia.
Patients and methods. 189 children: 85 boys (44.97 %) and 104 girls (55.03 %) aged 7–11 years (mean 8.5 ± 1.01 years) with emmetropia were examined. Ophthalmic examination consisted of refractometry, keratometry with registration of the radius of corneal curvature (CR) on the RC-5000 autorefractometer (Tomey), visual acuity testing with and without correction, positive relative accommodation (PRA), optical biometry with axial length (AL) measurement were performed with a IOL-master biometer (Carl Zeiss).
Results. 87 schoolchildren (56 girls (64.4 %) and 31 boys (35.6 %)) of the 189 healthy children had myopia (p = 0.017) by the end of 5-year observation period. Myopia was more prevalent in girls (53.8 %) than boys (36.5 %). There was a statistically significant difference in the values of the ratio of the axial length to the CR in children with stable emmetropia and developing myopia: 2.9 ± 0.06 and 2.95 ± 0.07 (p < 0.001). PRA at the beginning of the study was lower in children with subsequent myopia in comparison with children with stable emmetropia (3.76 ± 0.72 diopters and 4.1 ± 0.7 diopters, p = 0.002). Change of AL was 0.58 ± 0.39 mm in healthy young children (7–8 years old) and 0.44 ± 0.29 mm — the oldest (9–10 years old) (p = 0.021). Increase of AL in case of myopia was 1.55 ± 0.67 mm in children of the younger age group and 1.13 ± 0.32 mm in the older one (p = 0.011).
Conclusion. Higher ratio of the axial length to the radius of curvature of the anterior corneal surface was noted in children with developing myopia compared with stable emmetropia. Decline in positive relative accommodation before clinical manifestation of myopia was revealed. A greater increase of axial length was noted in children of 7–8 years of age compared with children of 9–10 years of age in groups with stable emmetropia and with developing myopia.

The purpose of our study was to substantiate and evaluate the effectiveness of the conservative method of treating keratoconus in the early stages of the development of the disease.
Patients and methods. The study of the effectiveness of the proposed method for the conservative treatment of keratoconus was performed on clinical material obtained by monitoring 39 patients (75 eyes) with a diagnosis of keratoconus stage I–III for at least 10 years. Every 4–6 months, all patients underwent an ophthalmological examination — visometry, autorefractometry, keratometry, keratotopography, pachymetry, biomicroscopy. Along with the study of the ophthalmic status of the patients, cardiointervalography was performed before starting conservative treatment. The assessment of vegetative homeostasis was performed using the Mustang-Diagnost device of the Technika company (Russia).
Results. All patients observed by us were matched with corneal or corneoscleral gas-permeable contact lenses of various models and manufacturers. According to cardiointervalography, in 97 % of our patients vegetative dysfunction was determined, while in 85 % and all examined, a significant predominance of sympatheticotonic neurotrophic regulatory processes was determined. At the first stage of the conservative treatment of keratoconus pharmacological agents were selected. They potentiate cholinergic neurotrophic regulatory effects and activate aerobic processes in the tissues of the eyeball. The next step was the potentiation of sympathicotonic (ergotropic) neurotrophic regulatory processes. Treatment was carried out during the entire observation period, alternating complexes of preparations for 60 days. An increase in diopter strength along the steep meridian was noted in patients with keratoconus of all stages. In the group of patients with stage I keratoconus in 4 eyes out of 16, in patients with stage II disease in 7 eyes out of 35, in stage III patients in 7 eyes out of 24. Opposite, a study of the KISA % index in all observed patients showed a decrease in the coefficient values. Conclusions. The combination of therapeutic factors into tonic (trophotropic, anabolic) and phase (ergotropic, catabolic) regulatory blocks, taking into account their mutual neurodynamic synergism and in accordance with the phase nature of biorhythmogenesis of reparative processes, makes it possible to prevent the progression of keratoconus. The use of the treatment complex developed by us, which includes therapeutic treatment and correction with rigid gas-permeable contact lenses, corrects metabolic disorders and stabilizes collagen synthesis, which makes it possible to lay off the surgical treatment of patients with keratoconus.

Purpose — to analyze the effectiveness of artificial tear drops HYLOPARIN-COMOD® in the complex medical support of the FemtoLASIK operation based on monitoring of clinical, functional and morphometric indicators of the eye surface’s condition.
Patients and methods. The study included 25 patients (50 eyes) who underwent a keratorefractive surgery (Femto-LASIK) and were prescribed instillations of artificial tear drops HILOPARIN-COMOD®. To analyze the effectiveness of artificial tear drops HYLOPARIN-COMOD® in the complex medical support of the Femto-LASIK operation based on monitoring of clinical, functional and morphometric indicators of the eye surface’s condition: UCVA, BCVA, Schirmer’s II test, tear break-up time (Norn’s test), OCT pachymetry of the cornea and corneal flap. The treatment effectiveness was evaluated at 1 day, 1 week, 1 and 3 months after the surgery.
Results. As a result of the treatment, the following refractive data were obtained: UCVA increased from 0.09 ± 0.02 to 0.94 ± 0.07 on the first day after surgery and to 0.96 ± 0.04 and 0.99 ± 0.07 to 1 and 3 months of follow-up, BCVA respectively, from 0.97 ± 0.04 to 0.94 ± 0.07, 0.97 ± 0.07 and 0.99 ± 0.07 after surgery. A faster restoration of the cornea and corneal valve was revealed, as evidenced by a decrease in their thickness already in the 1st week after surgery in comparison with the control group, where were more pronounced changes occur only by the 1st and 3rd month of observation (p ≤ 0.05). There was a significant increase in the basal secretion of the lacrimal gland (Schirmer’s II test) from 10.16 ± 1.33 to 11.66 ± 1.13 and 12.88 ± 0.96 µm by 1 and 3 months after surgical treatment, respectively (p ≤ 0.05). The Norn’s test increased from 10.89 ± 1.94 to 12.78 ± 1.59 and 13.83 ± 0.5 s to 1 and 3 months of treatment, respectively (p ≤ 0.05).
Conclusion. The effectiveness of the HILOPARIN-COMOD® use in the correction of the dry eye syndrome after keratorefractive operations has been proven. The obtained results clearly demonstrate that the HILOPARIN-COMOD® preparation enhances not only the stability of the tear film, but also the restoration of the OCT morphometric parameters of the thickness of the cornea and corneal flap.

Purpose. To evaluate the prevalence, clinical and pathogenetic variants and statistically significant risk factors of dry eye (DE) in patients before cataract surgery.
Patients and Methods. 600 age-related and complicated cataract patients (70.6 ± 7.8 years old; 269 men, 331 women) were examined. Visometry and biomicroscopy with photographic recording of the lens state and assessment of its opacities according to the LOCS III classification were used to cataract revealing. OSDI testing, lipid interferential test, TBUT, Shirmer-1, -2 tests, visual and OCT meniscometry, evaluation of epitheliopaty and microerosion (with vital staining), compression Norn test in Korb modification, visual and OCT LIPCOF assessment, lid viper epitheliopathy evaluation, anterior segment of the eye photoregistration with computer morphometry were performed to assess the ocular surface condition. The structure of the DE risk factors, was studied both in DE patients and non-DE subjects with calculation of the Pearson xi-square test. To estimate the strength of the connection between the etiological condition and the DE, the normalized value of the Pearson coefficient (C´) was used.
Results. The dry eye prevalence was 53.2 % (of them, 25.5 % was mild, 27.7 % — moderate, by Brzhesky). Subclinical DE prevalence was 27 %. Clinical and pathogenetic variants of mild DE included: isolated lipid deficiency (71.9 %), lipid-mucin deficiency (28.1 %). In patients with moderate DE were identified: aqueous-lipid-mucin deficiency (54.8 %), aqueous-lipid deficiency (37.95 %), isolated aqueous deficiency (7.2 %). The most significant systemic-organ DE risk factors were: diabetes mellitus (C´ = 0.302; in 18.8 % DE patients), female sex (C´ = 0.240; in 62.1 % de patients), allergy (С´ = 0.233; in 23.2 % DE patients). Local risk factors most significantly associated with DE were: meibomian glands dysfunction (С´ = 0.58; in 77.7 % DE patients), chronic blepharitis (С´ = 0.233; in 23.2 % DE patients), pterygium (С´ = 0.276; in 13.2 % DE patients), allergic conjunctivitis (С´ = 0.21; in 21.3 % DE patients). Among the exogenous risk factors, the most significant were: the use of medication affecting tear production or tear film stability (С´ = 0.485; in 89.03 % DE patients), preservative eye drops instillation (С´ = 0.2975; in 56.1 % DE patients).
Conclusion. In our opinion, data on the high DE prevalence in cataract patients (53.2 %) should be taken into account when planning cataract surgery, since perioperative correction of the ocular surface condition can increase the surgical treatment efficiency, predictability and safety. The data on the structure of significant risk factors and clinical and pathogenetic DE variants in cataract patients can be the basis for the development of measures to ensure timely DE detection and implementation of reasonable therapy. The risk factor most significantly associated with DE in cataract patients was the meibomian gland dysfunction (MGD) (Pearson xi-square test = 88.542, p < 0.001, С´ = 0.58; “relatively strong” strength). Considering the modifiability of this risk factor (MGD), as well as its high prevalence (77.7 %), it can be considered that eye lids hygiene may be a reasonable therapy in most DE and cataract patients before phacoemulsification.

Conjunctival lymphomas are predominantly extranodal B-cell non-Hodgkin’s lymphomas (NHL), most of them are MALT-lymphomas originating from the mucosa-associated lymphoid tissue. Manifestations of the conjunctival NHL are very diverse, and often imitate the appearance of other ocular diseases, which makes their clinical diagnosis difficult and significantly lengthens the time from the first visit to the ophthalmologist until the diagnosis is verified. The article presents the case histories of two young patients who were treated for a long time at the place of residence as acute chlamydial conjunctivitis (in one case — 3, in the other — almost 5 months). A comprehensive laboratory study to detect specific blood antibodies, DNA of the pathogen in conjunctival scrapings and the cytological picture of the conjunctiva did not confirm the chlamydial etiology of the process. A pronounced lymphoid reaction mainly due to small lymphoid cells was found in both patients in scrapings from the conjunctiva of the eyelid, which was the basis for referring patients for consultation to oncologist. Histological examination of conjunctival biopsy specimens also revealed proliferation of lymphoid tissue: patients with suspected MALT lymphoma were referred to onco-hematologists. A PCR analysis of the biopsy material revealed HHV-8 DNA in one patient and Epstein-Barr (EBV) DNA in another, although no pathogen genomes were detected in the conjunctiva scrapings. Immunohistochemical analysis in one patient confirmed the conjunctival MALT-lymphoma, in another one diagnosed hyperplasia of the conjunctival mucous-associated lymphoid tissue, caused by prolonged antigenic stimulation (EBV DNA was detected in the biopsy). The follicular appearance of the lymphocyte hyperplasia in conjunctiva may imitate the clinical picture of infectious diseases. For differential diagnosis of chlamydial conjunctivitis and MALTlymphoma, especially in young patients with refractory follicular conjunctivitis, it is advisable to include a set of serological, molecular biology and cytological methods.

Introduction. Reduced corneal transparency leads to dissipation of energy of the femtosecond laser (FSL), which may complicate the formation of the intrastromal incision and limits the use of FSL in eyes with corneal opacities and scars. The purpose of this work is to demonstrate the possibility of successful ReLEx SMILE in a patient with superficial corneal opacity located in the paracentral zone.
Case report. Patient R., 29 years old, complained of decreased vision in both eyes since childhood. Visual acuity OD = 0.1 sph –2.75D = 1.0; OS = 0.1 sph –3.50 D cyl –0.75D ax 165° = 1.0. Biomicroscopy of the right eye visualized a superficial semi-transparent corneal opacity of 5 x 3 mm located at 5.30–6 hours at a distance of 1.3 mm from the optical center. According to the anterior segment optical coherence tomography (AS-OCT) the depth of the opacity was 73–78 microns and was limited by the Bowman’s membrane. ReLEx SMILE for myopia correction was performed on both eyes with 6.7 mm lenticule diameter at a depth of 120 µm, which covered the opacity area by 1.1 mm. The surgery was standard and uncomplicated. Seven days postoperatively the patient did not complain. Uncorrected visual acuity (UCVA) was 1.0 for both eyes (and binocularly it was 1.2). According to the AS-OCT data, a hyperreflective line of the interface zone was visualized on the right eye at the depth of 141–147 µm; the opacified superficial corneal layers were detected in the lower paracental zone over the interface line. In one month after the surgery the visual acuity did not change: UCVA = 1.0 in both eyes (binocularly 1.2).
Conclusion. ReLEx SMILE technology can be considered as one of the options for myopia correction in patients with superficial corneal opacity located in the paracental zone. More observations are required to evaluate the effectiveness of this technology on corneas with paracentral opacities different in sizes and located at different depths.