The ophthalmologist often raises the issues about using of various vitamins, trace elements and other nutrients for the prevention and treatment of the different ocular diseases at their practice. The significance of this problem is caused by the importance of the vision for the socialization of modern person, as well as the high intensity of the visual analyzer using both in the process of performing professional occupation and in the usual indoor/outdoor activities. The issues of the supplemental support in pediatric ophthalmology are especially important, as today formation of the visual organ in children develops under increased visual stress. For the total population, including children, of the industrialized countries the most typical form of vitamin deficiency is subnormal vitamin supply, which occurs among almost healthy children of different ages. The supplemental support issues should be considered in relation to certain types of ocular pathology in children. The most common problem today among children is myopia with projected high increase of this refraction anomaly magnitude in the future. The oxidative stress is the main pathogenesis factor of many degenerative diseases development, including myopia. It is considered as the oxidative stress is realized due to both endogenous processes and various external factors impact, including ultraviolet radiation. Not only vitamins with antioxidant properties (A, C, E), but the trace elements (zinc and copper), bioflavonoids (anthocyanoides) and xanthophilic pigments (lutein, zeaxanthin) are necessary to stabilize myopia and to prevent the development of degenerative diseases in adulthood. These substances are involved in the most important physiological and biosynthetic processes in the sclera, retina and other eye structures and render an influence on its microvessels and hemodynamics in general. All these substances are not synthesized in the human body, and in order to maintain metabolism and homeostasis the sufficient alimentary intake should be provided beginning with early age. The complex drugs, which include multipotential and synergistic active substances, are of particular interest.

This paper presents clinical and pharmacological drug interactions for the treatment of patients with glaucoma combined with concurrent cardiovascular pathology, risks of side effects, and adverse drug reactions. The article discusses the multifactor nature of glaucoma, age factors, and the direction of local and systemic pathogenetic treatment, principles of the personified approach, and its feasibility. It is shown that an essential element of this approach can be a system of questionnaires for glaucoma patients with chronic diseases, the principal place in which is occupied by a questionnaire filled out by the patient himself. Digital processing of individual data and assessments provided by patients allows us to implement the tasks of a personalized approach to the treatment. Analysis of the pharmacological effects of the available and used arsenal of medicinal products allows you to generalize the array of data obtained, to form model algorithms for deciding by an ophthalmologist on the choice of medications. In scheme optimizing of the prescribed medications, it is important to cross-inform between specialists of different profiles (ophthalmologists, therapists, neurologists, cardiologists, endocrinologists, rheumatologists, etc.), create an algorithm for entering the medications of choice and their rational combinations, which reduces the risk of polypragmasia. Possible causes of progression of glaucoma optic neuropathy (GON) against the background of age-related systemic diseases (using the example of the cardiovascular system’s pathology) are considered. Ways of influencing the pathogenetic links of the glaucomatous process are proposed from the standpoint of an optimal combination of medications. Analysis of literature on the problem of structural and functional disorders in GON’s development shows that it is promising to expand our understanding of the fundamental processes underlying these changes, search for clinically significant combinations of contemporary markers of changes in structure and function, and, accordingly, treatment approaches. The possibilities of neuroprotection of glaucoma optical neuropathy, as well as modern methods of electrophysiological research in the monitoring assessment of its effectiveness and the differential diagnosis, approaches to enhance the effectiveness of medications treatment with combined medications are analyzed in the article.

Visual impairment in elderly people is a serious problem that significantly affects the quality of life of millions people around the world. The magnitude of this problem is becoming increasingly apparent as the population ages and the number of older people increases. Age-related macular degeneration (AMD) is the third leading cause of blindness worldwide and the main cause of vision loss in people over 60 years. It is expected that AMD will affect about 288 million people by 2040. AMD is a multifactorial disease with a progressive course. The arised dystrophic changes in the retina cannot be reversed by any of the known treatment methods. A lot of research and effort has already been invested in identifying various biomarkers for predicting the incidence rate, identifying people at risk, finding out the pathogenetic mechanisms of this disease, and finding effective methods of treatment and prevention.

Aging is the basis of pathological changes that occur during AMD. Aging biomarkers are measurable vital signs that qualitatively and quantitatively change with the age of the body. DNA methylation is a molecular mechanism that is a potential biomarker of aging. Sirtuins indirectly participate in this process, regulating the activity of the DNMT1 enzyme. The article discusses current knowledge of the mechanisms underlying the action of sirtuins (Sirtuins / SIRT), with an emphasis on SIRT1. Analysis of the pathophysiological action of sirtuins can affect the prevention and treatment of pathological eye changes associated with AMD. The article provides literature sources containing the results of studies of the effect of SIRT1 as a marker of aging in body tissues. SIRT1 is an attractive candidate for developing therapeutic strategies preventing early eye aging, in particular, age-associated diseases such as AMD The impact on the genetic mechanisms of this disease is a promising direction in treatment.

The review analyzes the capabilities of modern technologies of structural neuroimaging of the retina, standard perimetry, and studies of ocular blood flow in the early diagnosis and management of glaucoma. The relevance of the search for those structural and functional changes that are primary in the development of glaucomatous optical neuropathy (GON) and the diagnostic method that has the greatest clinical significance is discussed. Progress in understanding the pathogenesis of glaucoma and the expansion of scientific understanding of key risk factors for the development and progression of the disease, including genetic factors, can be crucially important to substantiate new strategies for preclinical diagnosis and the development of radically new approaches to personalized and preventive glaucoma therapy. However, the search for what arises most early with in primary open-angle glaucoma — changes in structure or function — will not have clinical relevance unless you take into account the capabilities of specific methods of structural and functional neuroimaging that represent information at various levels of organization of the visual system. The search for a single primary factor in the pathogenesis of GON can lead to an erroneous exaggeration of the close relationship between the variables being studied, which in reality either does not exist as a causal relationship or is significantly less than what is supposed — the phenomenon called “illusory correlation”. The reliable diagnosis of early changes that occur before the clinical manifestation of glaucoma is most likely to be based on a combination of structural, functional, and hemodynamic indicators, aimed not only to increase the sensitivity of diagnosis in detecting the earliest events in the development of GON, but rather to dramatically improve the understanding and quality of interpretation of those markers that we own.

Modern corneal refractive surgery provides high efficiency, safety, predictability and stability of the different ametropia kinds correction’s clinically-functional results. However, in overwhelming percentage of cases, having spent some time after surgery patients complain about discomfort, eyes dryness, burning, feel gritty, redness, blurred and vision instability. Complaints mentioned above are caused by the appearance of transitory dry eye syndrome. Main etiology and pathogenesis factors of this disease are presented in this review. The results of dry eye syndrome classical diagnosis methods have been analyzed, as well as modern techniques, characterized by high specificity and sensitivity, which allow to increase the dry eye’s diagnostics accuracy. The study of the dry syndrome after corneal refractive surgery is devoted to a huge number of works of domestic and foreign authors. However, at present time there is no unique algorithm for assessing the damage of the ocular surface before and after corneal refractive surgery, which would include a set of high-precision and specific techniques for quickly and reliably evaluate the severity of dry eye syndrome, allowing to develop preventive measures and pathogenetically oriented treatment and, thereby, accelerate rehabilitation of patients after surgery. Research continuation is needed in this direction.

Purpose: to develop an effective and safe method of cyclotorsion compensation, to improve the clinical and functional results of the of myopic astigmatism correction with SMILE surgery.

Patients and methods: Two equivalent groups of 30 people (30 eyes) were formed with cyclotorsion from ±5 degrees («Standard» and «Verion»). The correction for cyclotorsion was carried out only in the «Verion» group. Before the laser-refraction surgery, all eyes were examined using «Verion» image guided system (Alcon, USA) to determine cyclotorsion. In the «Verion» group, the obtained cyclotorsion data was used to aligement the astigmatism axis by Introducing into the «Visumax» femtolaser system. Further, the operation was carried out according to the standard protocol. At 3 months after SMILE surgery, all patients were examined by a UDVA, CDVA, objective refraction. Furthermore, efficiency and safety, as well as vector analysis of corneal astigmatism according to Alpins were calculated indices at 3 months after surgery.

Results: The mean and standard deviation of cyclotorsion of the «Standard» and «Verion» groups was 6.16 ± 1.31 D and 6.30 ± 1.36 degrees, respectively (p > 0.05). The increasement of 1 or more UDVA lines was noted at 20 % and 7 %, respectively after 3 months in the «Standard» and «Verion» groups. The safety index (postoperative UDVA / preoperative UDVA) in both groups was not statistically significantly different (p > 0.05). The predictability of the spherical equivalent within ±0.5 D relative to the target refraction (emmetropia) in the «Standard» and «Verion» groups was 70 % and 100 %, respectively. The predictability of the cylindrical component of refraction within ±0.5 D relative to the target refraction (emmetropia) was 40 % and 90 % for the «Standard» and «Verion» groups, respectively (p < 0.05). Difference vector was 1.01 ± 0.59 D in the group «Standard» and 0.64 ± 0.33 D in the «Verion» group (p < 0.05). Correction index was 0.80 ± 0.43 in the «Standard» group and 0.99 ± 0.04 in the «Verion» group (p < 0.05).

Conclusions: Сyclotorsion compensation using the «Verion» image guided system is a safe method. It improves the efficiency and predictability of correction myopic astigmatism in patient undergoing to SMILE surgery. This method recommended for patients with cyclotorsion from ±5 degrees and myopic astigmatism from –0.75 D. 

The method of phacovitrectomy can be used for surgical treatment of patients with cataract and asteroid hyalosis. However, there is still a topical question in the choice of surgical treatment taking into account the completeness of the posterior hyaloid membrane (PHM) detachment.

Patients and methods: the study involved 24 patients (24 eyes) with cataract and asteroid hyalosis. The average age of patients was 72.9 years, out of the total number of men — 11, women — 13. Pre-and postoperative diagnosis of all patients included standard methods of investigation, as well as optical coherence tomography performed on the Cirrus HD-OCT 400, Carl Zeiss, Germany. Pre-and postoperative subjective satisfaction was assessed using a validated visual Function Qusetionnaire 14 ophthalmological questionnaire. Patients were divided into 3 groups. In the first group of patients, cataract phacoemulsification with posterior chamber lens implantation and total three-port vitrectomy through a flat part of the ciliary body were performed. In the second patients’ group, cataract phacoemulsification with posterior chamber lens implantation and subtotal vitrectomy through posterior capsulorexis were performed. In the third group of patients, cataract phacoemulsification with posterior chamber lens implantation was performed. All operations were performed with the help of ophthalmic systems Infinity Vision System (Alcon, USA) and Constellation Vision System (Alcon, USA).

Results: in the first day after the operation, all patients noted improvement in visual acuity and quality of life, but more significant improvement was noted in patients of the first and second groups.

Conclusion: analysis of the results of surgical treatment, questionnaire survey, preoperative diagnosis allowed to develop an algorithm for choosing the method of surgical treatment in patients with cataract and asteroid hyalosis, taking into account the state of PHM. 

Macular holes are the most often pathology leading to reduced vision among persons after 60 years. The macular hole is the acquired disease which is a defect of a foveola part of retina on all thickness from an internal limiting membrane to an external segment of a photoreceptor layer. The standard method of treatment is surgery method: a microinvasive vitrectomy with membrane peeling in macular area. There is a number of the techniques increasing efficiency of operative intervention. Even in case of successful surgical intervention macular holes are not always closed.

The purpose: development and assessment of morphological parameters of the central retina with a new surgical method of closing earlier operated macula hole using a free flap.

Material and methods. 40 patients (40 eyes, 28 women and 12 men) had participated in this study. All patients were operated about macular hole with negative anatomic result. By technology which were used earlier, patients were divided into 3 studied groups (with PRP mass using, with introverted flap using, with mechanical matching of edges of a hole). The main method of research was the optical coherent tomography. All patients were operated by an original technique. It’s purpose was a closing of earlier operated rigid macular hole using a free flap.

Results. The defect of a photoreceptor component was closed with an additional expansion of earlier created macular rexis in patients of the 1st and 3rd groups at reoperation. The earlier created flap of an internal limiting membrane was used in patients of the 2nd group. In the analysis of dependence of change of visual acuity from morphological parameters of a macular hole after primary surgical treatment the inverse correlation relation from diameter of a macular hole on small and big radiuses is revealed. The highest visual acuity after a reoperation was reached at patients of the second group.

Conclusions. It is necessary to consider the technique which was used earlier, diameter of a macular hole on small and big radiuses, postoperative edema in a parafovea zone for planning the surgical treatment and a forecast of functional results. 

Neuroleukemia is a severe complication of hemoblastosises characterized by infiltration of blast cells of the meninges, the substance of the brain, cranial and peripheral nerves.

The purpose. To analyze the clinical manifestations of leukemia with optic nerve damage in leukemia and malignant lymphomas.

Patients and Methods. From January 2016 to January 2020, one center-based non-randomized prospective study was conducted on patients with leukemia and non-Hodgkin’s lymphomas who were treated in the hematology department of MONIKI and made complaints about reduced vision. 26 patients were examined, 4 of them were diagnosed neuroleukosis with leukemic infiltration of the optic nerves: three women aged 41, 44, 46 years and a man aged 50 years.

Results. All patients had one common ophthalmological symptom — decreased visual acuity. Complaints of reduced vision in one patient appeared at the onset of the disease, in other patients-during a relapse. The picture of the eye’s fundus in all patients was identical: the optic disk had blurred borders, and elevated above the retina. In the first days, the vascular funnel was viewed, then closed by infiltration. A dense white infiltrate of the peripapillary retina spread over the entire macular area. The retinal veins were sharply dilated of uneven caliber. Along the course of the vessels, there were a large number of different sizes and shapes of hemorrhages. Various types of neuroleukemia with lesion of the optic nerve were described: a combination of focal lesions of the brain and the optic nerve, isolated damage to the optic nerve with blast cytosis in the cerebrospinal fluid (CSF), isolated damage to the intraocular part of the optic nerve without changing the cerebrospinal fluid. In three patients the diagnosis of neuroleukemia exhibited on the basis of changes according to magnetic resonance imaging (MRI) and/or the number of blast cells in punctate liquorologic research. In the fourth patient, in the absence of changes in the liquor and MRI, the diagnosis of leukemic infiltration of the optic nerve was confirmed by data from a cytological examination of a punctate from the peripapillary retina. After the beginning of antitumor treatment, the significant improvement visual acuity and decrease in leukemic infiltrate of the optic disc and retina of the affected eye was noted in all patients.

Discussion. Damage of the optic nerve can develop both at the onset of the disease, and relapses of leukemia or aggressive non-Hodgkin’s lymphomas. Leukemic infiltration evolves in all parts of the optic nerve, but more often affects its intraocular portion. The damage to the intraocular part is characterized by the presence of a dense infiltrate both in the area of the papilla and the peripapillary retina.

Conclusion. Leukemic infiltration of the optic nerve is manifested by a significant decrease in visual acuity. Careful attention to complaints of reduced vision in patients with leukemia can help to recognize the development of the disease’s debut or its progression. Timely antitumor treatment leads to an improvement in visual acuity and, consequently, an improvement in the quality of life of patients. 

Purpose: to determine the features of myopic choroidal neovascularization (mCNV) using optical coherent tomography-angiography (OCTA) in patients with complicated myopia during anti-VEGF therapy.

Patients and methods. A prospective study of 25 people (40 eyes) with complicated myopia was carried out, which consisted in a comparative analysis of the qualitative and quantitative OCTA characteristics of 29 eyes with myopic CNV and 11 paired intact eyes. OCTA was used in the Angio Retina and Angio Analytics modes based on automatic software. The phenotypic features of CNV before treatment, during anti-VEGF therapy (Ranibizumab) and at the end of the observation period were taken into account.

Results. The average follow-up period is 26.12 (12.36; 35.02) months. Two mCNV phenotypes were established: glomerular (44.83 %) and flat (55.17 %) as regularized (18.75 %) and tangled (81.25 %) vascular network patterns. Hypointensive peripheral halo during the entire period of the neovascular complex activity was visualized regardless of the phenotype. Significant differences in the flat phenotype were revealed: neuroepithelial detachment (87.50 %) was more common, the Select Area and Flow Area of the neovascular complex was significantly greater both before treatment and at the end of the observation period, the mCNV course of continued growth after injection of anti-VEGF did not occur, recurrence rate is much higher. The area and perimeter of the foveal avascular zone (FAZ) in the eyes with mCNV increased significantly by the end of the observation. The acirculatory index (AI) was determined to be significantly higher, and the Retinal capillary flow density in the fovea region 300 μm wide around the FAZ (FD) was lower in the eyes with mCNV compared to the control group. The nonactive neovascular complex were characterized by depletion of the vascular network with a predominance of intervascular space, vessels in the form of a residual skeleton, blindly end, dim, small capillaries and end loops are missing. Halo with nonactive CNV is not found.

Conclusion. OCTA identifies the features of the course of myopic CNV depending on the phenotype, allows to evaluate the effectiveness of anti-VEGF therapy and the degree of progression of degenerative changes in the macular region. 

Purpose. To study the correlation between pregnancy, complicated by preeclampsia and gestational hypertension (GH), and formation of retinal vascular and optic nerve disorders in the late postpartum period.

Patients and methods. 231 women with different previous pregnancy variants of pathology. Exclusion criteria — presence of systemic endocrine, autoimmune, rheumatic pathology before pregnancy; bad habits. Four groups were formed. 1st main group: pregnancy with GH. 2nd main group: pregnancy with preeclampsia. 1st comparison group: pregnancy on the background of pre-existing hypertension, without proteinuria. 2nd comparison group: edema and/or proteinuria during pregnancy, without hypertension. The control group — physiological process of pregnancy. Period of ophthalmological examination after pregnancy is 6–12 years.

Results. Development of various vascular and ischemic disorders of posterior eye segment occurred in 70 women (30.3 %). The periods of their formation after previous pregnancy varied from 3 to 11 years. Their frequency in the 1st and 2nd main groups was statistically significantly higher. The most common were retinal vein occlusion and post-thrombotic retinopathy. The negative outcomes of transferred GH and preeclampsia are no eliminated with delivery and can manifest next years and even decades after it.

Conclusion. Нigh risk factors for development of vascular and ischemic disorders of posterior eye segment are transferred preeclampsia, especially with its early onset (20–24 weeks), or premature birth (26–28 weeks); pregnancy, complicated by GH. The risk of developing this eye pathology is highest in women aged 38–40 years and over. 

Purpose: To evaluate the possibility of registration of the photopic negative response (PhNR) without pupil dilatation in healthy individuals to determine the dysfunction of neurons of the inner retina.

Methods: 12 healthy persons (23 eyes) aged 24 to 40 years were examined. Refraction anomalies did not exceed 0.5 diopters. A PhNR was evaluated in photopic ERGs recorded on a blue background with red flashes of four intensities (0.375, 0.75, 1.5, 3.0 cd·s/m2) using the RETIport/scan21 (Roland Consult). First, ERG was recorded with the natural pupil (3.5 ± 0.2 mm). Then, the recording was repeated after drug mydriasis (average pupil size 8.7 ± 0.1 mm).

Results. In eyes with natural pupil width, in comparison with drug mydriasis, PhNR amplitudes in responses to weakest stimuli (0.375 cd·s/m2) were significantly reduced. The effect of pupil size on the PhNR amplitude from a baseline was virtually absent in responses to higher strength flashes. This phenomenon can be associated with an irregular distribution of light over the retina with small pupil size, the effect of which is maximal in responses to weak flashes. For the maximal brightness stimuli (3.0 cd·s/m2), differences were found between groups of non-dilated and dilated pupils in the amplitudes of the b-wave and PhNR from the b-peak, which may reflect a decrease in the number of stimulated photoreceptors during ganzfeld stimulation when the pupil is not dilated.

Conclusion. The effect of pupil size on the parameters of the PhNR was most significant in the ERG with minimal flash strength and it decreases in responses to flashes of higher brightness. If it is necessary to record the ERG without drug mydriasis, especially in screening studies, it is recommended to limit the protocol to estimate the PhNR from a baseline in responses to maximal flashes, and use the relative parameter — the amplitude ratio of PhNR/b. Keywords: photopic negative response, electroretinography, pupil width

Purpose: to study the features of eye hydrodynamics in patients with thyroid dysfunctions.

Patients and methods. The material for this study was the results of a survey of 43 patients (86 eyes) with thyroid dysfunctions: 23 people (46 eyes) with primary untreated hypothyroidism (PGT) and 20 people (40 eyes) with primary untreated thyrotoxicosis (PTT). There weren’t ophthalmic hypertension and glaucoma There weren’t signs of ophthalmic hypertension and glaucoma in the patients included in this study at the stage of primary ophthalmologic diagnostics.

Results. Correlation analysis revealed a causal relationship between the ratio of T4 / TSH hormones, on the one hand, and indicators of secretion of aqueous humor per unit of time and ease of outflow, on the other hand. In the group of patients with hypothyroidism, a weak linear inverse correlation was found between the ratio of free thyroxine and thyroid stimulating hormone and the minute volume of aqueous humor: according to the regression model, an increase in the ratio of T4 / TSH hormones by 1 was accompanied by a decrease in the minute volume of aqueous humor by 3 units. In patients with thyrotoxicosis, a statistically significant inverse linear correlation was found between the ratio of the T4 / TSH hormones and the coefficient of ease of outflow. According to the regression model, with an increase in the ratio of hormones T4 / TSH by 1, the coefficient of lightness of outflow decreases by 5 units. The presence of thyroid receptors in the cytoplasm and nuclei of the endothelium cells of the trabecular apparatus, the nuclei of fibroblasts forming the stroma of the trabeculae, as well as in the nuclei of the pigment and non-pigment epithelium of the processes of the ciliary body substantiates the molecular basis of the causal connection of thyroid dysfunctions with hydrodynamic disorders The conducted studies confirm the modern concept that the control of regulation of the tissue and organ homeostasis is carried out by the coordinated interaction of 3 systems: nervous, endocrine, and immune. Regression modeling clearly shows a pronounced causal relationship between thyroid dysfunctions and hydrodynamic processes in the eye.

Conclusion. The results of clinical studies demonstrate the fact of controlling regulation by hydrodynamic processes at the eye level by the endocrine system, explain the possible mechanism on a morphological basis, and reveal the potential of a new therapeutic strategy. 

Purpose. The study of color deficiencies prevalence in young people, students of higher educational university.

Materials and methods. The study was carried for the half year — fall semester. A total of 1,609 students were examined, aged 17–21. There were 1191 boys and 418 girls. The survey was conducted to determine the health groups in physical training and in various sports sections. An ophthalmologic examination determined refractive disorders and other ocular pathology, which is important for determining health groups. Rabkin polychromatic tables and Neitz color vision test (Neitz Lab (UW Medicine) were used for determining of color deficiencies. The obtained results of these tests were compared in terms of the time spent on the test, the results of the test effectiveness, the determination of dissimulation, and the assessment of the shift in the color spectrum in individuals with impaired color perception.

Results. A total of refractive disorders were detected in 856 students (53.2 %). The high degree of myopia was in 40. Disorders of color deficient were noted in 101 students (8.48 %) of 1191 male subjects when using the Neitz color test. Dichromatic eye changes were observed from 2.1 % students: protanopia and deiteranopia were in 0.67 % and 1.43 %. Most of all there were violations with the perception of shades of light brown and light green colors. A third of healthy students noted the impossibility of distinguishing light brown from light gray. This is regardless of the state of refraction. Simultaneous violations of the perception of shades of red, green, yellow and blue were observed in one subject, it was associated with congenital cataracts. In four young people, acquired eye diseases caused. In two girls, violations of the perception of a pastel shade of light green were noted, with one girl (0.24 %) having a violation in two eyes, and was presumably due to a gene anomaly. The second girl had one eye and was associated with partial atrophy of the optic nerve after the optic neuritis.

Conclusions. Neitz color test expands the diagnostic possibilities, since in its design it has pastel shades of light green and light brown colors on a gray background, reduces the likelihood of dissimulation, reduces the time of the survey. Neitz color test allows to expand the possibilities for more accurate and differential diagnosis dichromatic and anormal trichromatic subjects and acquired color vision defects. 

Optical-reflex treatment of patients with myopia and computer visual syndrome with a concomitant asthenic form of accommodation asthenopia seems relevant and not fully developed. The basic provisions that determine the tactics of treatment are monocular exposure in order to increase the absolute accommodation rate and staging (outpatient room, home conditions) of training. Measures aimed at improving the effectiveness of optical reflex treatment at home include the development of alternative instrumentation with reasonable (in accordance with the clinical and physiological characteristics of the functioning of the ciliary muscle of the eye) optical, amplitude and temporal parameters of the training process.

The research is devoted to one of the most urgent problems of modern ophthalmology — the search for new approaches to creating effective methods of functional treatment of refractive amblyopia using computer technologies.

The purpose of the work is to evaluate the effectiveness of computer technology with consistent use of alternating and non-alternating modes of presentation of stereostimulars in the functional treatment of refractive amblyopia in children.

Patients and methods. 105 patients with refractive amblyopia at the age of 7 to 17 (on average 11.45 ± 0.3) years were observed. Refraction was hypermetropic in 31 (29.5 %) children, myopic in 62 (59 %) and mixed astigmatism was detected in 12 (11.5 %) children. The visual acuity of the best-seeing eye was on average 0.76 ± 0.01, that of the worse-seeing eye was 0.68 ± 0.02, and that of the binocular eye was 0.77 ± 0.01. In the study on synoptophore, all children had normal correspondence of the retina with the fusion reserves, which were significantly reduced. The character of vision was binocular in all children, but the presence of stereo vision on the Fly test was detected in 96 (91.4 %) children, and on the Lang test only in 73 (69.5 %) children. Functional treatment was performed using computer programs with sequential use of modes of alternating and non-alternating presentation of stereo stimuli with certain characteristics.

Results. As a result of the course of treatment, the number of children with stereo vision increased from 96 (91.4 %) to 105 (100 %) on the Fly test and from 73 (69.52 %) to 97 (92.4 %) on the Lang test. In addition, there was a significant increase in visual acuity (on average, up to 0.96 ± 0.01 for the best-seeing eye, up to 0.9 ± 0.01 for the worse-seeing eye, and up to 0.97 ± 0.01 binocularly). There was also an increase in positive fusion reserves by 1.5 times and negative reserves by 1.3 times.

Conclusion. Visual training with computer programs that provide the consistent use of modes of alternating and non-alternating presentation of stereo stimuli with certain characteristics is an effective way of functional treatment of refractive amblyopia in children, allowing to increase monocular and binocular visual acuity, improve the performance of fusion reserves and improve the state of stereo vision. 

The work is devoted to one of the most actual problems of current strabismology — the development of effective ways to study binocular vision.

The purpose — to study the effectiveness of the developed modification of the Bagolini test in the diagnostics of binocular disorders.

Patients and methods. 240 patients with non-paralytic strabismus aged from 6 to 17 (on average 10.8 ± 0.24) years were observed. There were 190 patients with converging strabismus and 50 patients with diverging strabismus. The control group consisted of 180 children aged also from 6 to 17 (on average 10.9 ± 0.3) years without ophthalmopathology. All children were examined for the character of vision using a Worth-test, the classic Bagolini test (CTB), and the developed modified Bagolini test (MTB). If the patient has a strabismus angle, the study was performed in two variants: without prismatic deviation compensation (under the subjective angle of strabismus — SU) and under full prismatic compensation (under the objective angle of strabismus — OU). For qualitative assessment of binocular vision with MTB, static presentation of the test image was used, for quantitative assessment — alternating (alternate presentation of details corresponding to the right and left eyes).

Results. The qualitative evaluation data obtained with the help of MTB made it possible to differentiate patients with non-permanent regional functional scotoma of suppression (FSP) and patients with stable bifoveal fusion among children with binocular vision by color test, and to distinguish patients with regional stable FSP and total FSP among children with monocular vision by color test. In the study under SU, the sensitivity of the method was 97.8 % and specificity 96.2 %, under OU — 96.6 % and 92.7 %, correspondingly. Using quantitative evaluation, it was found that the minimum duration of monocular phases required to eliminate functional inhibition in children with total FSP is twice as long as in children with regional FSP (z = 6,303, df 52, p < 0.001 according to the Mann — Whitney criterion).

Conclusion. Thus, the modified Bagolini test developed by us is an effective way of qualitative and quantitative assessment of the state of binocular vision. The method has a high sensitivity and specificity, combines the capabilities of anaglyphic and phase haploscopy, and can be used for a personalized approach to the selection of conditions and modes of functional correction of binocular disorders, as well as for monitoring binocular vision during treatment. 

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. The paper is devoted to the study of the feasibility of using hypercorrection in the functional treatment of children with non-paralytic strabismus.

The purpose of this work is evaluation of the effectiveness of hypercorrection in the diagnosis and functional treatment of children with non-paralytic strabismus. Patients and methods. We observed 166 school-age children with friendly strabismus: 140 children with esotropia (134 children with hypermetropic refraction and 6 children with myopic refraction) and 26 children with exotropia (17 children with myopic refraction and 9 children with hypermetropic refraction). The control group of children included 151 school-age children with ametropia without strabismus: 110 children with hypermetropia and 41 children with myopia. Optimal optical correction, accommodation and visual acuity were studied under monocular observation conditions and then under bifixation control using a binarimeter at different distances from the eyes (0.5, 1, and 5 m).

Results. In children with esotropia and hypermetropic refraction, the most favorable conditions for the formation of a binocular visual image (BVI) were created using hypercorrection (average values from 2.4 ± 0.06 to 2.8 ± 0.06 D for different distances from the eyes). Children with exotropia and myopic refraction also needed hypercorrection to form BVI (Me = 2.5 [Q1 = 2.0; Q3 = 3.0] D at all distances from the eyes). At the same time, a strong positive correlation was found between the deviation value and the hypercorrection value necessary for the formation of BVI in children with both esotropia and exotropua (r = 0.85, p < 0.001 and r = 0.8, p < 0.001, respectively). In children with “inappropriate” refraction (myopic with esotropia and hypermetropic — with exotropia), BVI was easier to occur and better maintained under hypocorrection by an average of 1.75 ± 0.06 d. In the control group of children, the maximum visual acuity under the control of BVI was observed with the strength of correcting lenses 0.5 D less compared to monocular conditions of the study.

Conclusion. The effectiveness of using hypercorrection in children with non-paralytic strabismus and “appropriate” refraction for the formation of BVI on a binarimeter is shown. In this case, the value of hypercorrection has a direct dependence on the value of deviation, which is consistent with the principles of accommodation-convergent synkinesia. In children with non-paralytic strabismus and “inappropriate” refraction, more favorable conditions for the formation of BVI are created when using hypocorrection. The result of functional treatment on a binarimeter with an individual selection of optimal optics for performing exercises is an improvement of accommodation, binocular and stereo vision, an increase of fusion reserves and visual acuity. 

Purpose: to study the features of the anatomical and topographic relationships of the eye’s anterior segment structures in children with stage 5 ROP in the cicatricial period with the method of ultrasound biomicroscopy and optical coherent tomography of the anterior segment and to evaluate the possibility of using the data to optimize the surgical treatment of ROP.

Patients and methods. For the period 2015–2018 in the Kaluga branch of the Fyodorov Eye Microsurgery, 68 children (118 eyes) with 5 cicatricial ROP stages were examined and treated. Gestational age at birth varied from 24 to 31 weeks, body weight at birth — from 630 to 1600 grams. Age at the time of the survey ranged from 5 to 15 months. All children underwent the complex diagnostic examination, which included biometrics, tonometry, ultrasound ophthalmoscanning in B-mode, as well as UBM and OCT of the anterior segment of the eyeball. The extent of fixation of retrolental opacities to the posterior lens capsule, the presence of cystic cavities and retinal folds at the periphery, traction detachment of the ciliary body were determined. OCT of the eye anterior segment was performed in the presence of iridocorneal contact in order to clarify its length. As a result, a comprehensive detailed assessment made it possible to clarify or reject the characteristics identified by UBM, as well as determine the phasing and develop an individual plan of the operation in each case.

Conclusion. The use of complex diagnostic examinations, including UBM and OCT of the eye anterior segment in patients with 5 cicatricial PH stages, allows to optimize the tactics of surgical treatment in the advanced stages of the disease. 

The paper considers the problems of the early glaucoma diagnosis before the development of the marked glaucomatous optic neuropathy. Special attention is paid to the methods of computer perimetry, which are important in diagnosing the presence or progression of glaucoma.

Purpose. To create the computer program “perimetric calculator” that performs mutual recalculation of perimeter data of HFA and HEP without additional perimetric studies, as well as calculation of diagnostic information content of perimeter parameters with different “cut-off points” of HFA and HEP parameters.

Patients and methods. 56 patients (85 eyes), including 16 men and 40 women aged 55 to 84 years (mean age 64.9 ± 6.4 years). All patients were divided into 2 groups: group I — 23 healthy subjects (40 eyes) without any signs of glaucoma; group II — 33 patients (45 eyes) diagnosed with the initial stage of primary open-angle glaucoma.

Results and discussion. The study revealed the comparability of the standard automated perimetry (HFA) results and Heidelberg edge perimetry (HEP), determined the most informative diagnostic criterion (MD/HEP). According to the obtained results, a computer program was created, it included two modules: the first — diagnostic information content of perimeter parameters with different “cut-off points”, the second-mutual recalculation of HFA and HEP parameters.

Conclusions. This computer program allows calculating the main indices of diagnostic information content of the perimeter parameters (sensitivity and specificity) at different “cut-off points”, gives the results of calculating the values of sensitivity, specificity and accuracy for at least 150 threshold values, allows performing mutual recalculation of the parameters of the standard automated perimeter (HFA) and Heidelberg perimeter (HEP). 

Purpose: To study the features of small choroidal melanoma and choroidal nevi angioarchitectonics using the optical coherence tomography angiography (OCTA).

Patients and methods. We examined 128 patients with small choroidal neoplasms: 41 — with small choroidal melanoma (group 1), 42 — with suspicious nevi (group 2) and 45 — with benign nevi (group 3). All patients underwent general ophthalmic examinations and special instrumental diagnostic methods (ultrasound examination (US), fluorescence angiography (FA), spectral optical coherence tomography (SOCT), OCTA).

Results. OCTA in all patients with small choroidal melanoma showed neovascular network under retinal pigment epithelium. We found a looped, cranked-twisted, heterogeneous vascular network with uneven clearance and with numerous bends and weaves, located under the vessels of retina. The limiting avascular zone corresponding to the tumor slope was determined in 19 (46.3 %) of 41 cases. There was a rim of dilated hyperreflective choriocapillaries on the periphery of the tumor. We identified hyperreflective homogeneous enlarged choriocapillaries in the focus area with a brighter glow than the surrounding choriocapillaries in 39 (92.9 %) of 42 patients with suspicious choroidal nevus. We detected an avascular zone with surrounding extended hyperreflective choriocapillaries in the center of the nevus in 3 (7.1 %) of 42 cases. We diagnosed homogeneous isoreflective choriocapillaries similar in brightness to the surrounding vessels in all 45 patients with benign nevi.

Conclusions. Thus, the complex of clinical and instrumental methods, including OCTA, makes it possible to establish the diagnosis of malignant tumor of the choroid in early stages. At the same time, OCTA: 1) allows to visualize of the tumor vessels in the choroidal layer in 100 % of cases of in small choroidal melanoma; 2) makes it possible to distinguish the newly formed tumor vessels from the choriocapillaries in case of small choroidal melanoma; 3) provides an opportunity to establish the correct diagnosis and provide timely assistance to patients with benign and malignant choroidal tumors. 

Intravitreal use of vital dyes in combination with the action of endoillumination can induce a cyto- and phototoxic effect on posterior eye segment structures. The search for a staining agent with a maximum safety profile to retinal structures, intensively and selectively coloring vitreous body and vitreoretinal interface structure, remains relevant.

Objective: to determine comparative viability of NIH / 3T3 mouse fibroblast cell culture with traditional agents for chromovitrectomy and “Vitreocontrast” suspension with and without endovitreal illumination.

Materials and methods. NIH / 3T3 mouse fibroblast cultures contacted with agents for chromovitrectomy (MembraneBlue® Dual, Triamcinolone acetonide, “Vitreocontrast” suspension) and the corresponding controls in a volume of 50 μl / well. The test plate was irradiated with a Photon II illuminator (Synergetics, USA), working distance of 5 mm. The control tablet with the introduced preparations was not exposed to light. Next, the cells were washed and incubated, after which the morphology and lysis of the cells, as well as the number of proliferating relatively negative control of fibroblasts, were evaluated using the vital dye PrestoBlue Cell Viability Reagent. Negative control was the complete growth medium for the cultivation of mouse fibroblasts of the NIH / 3T3 line. The results of the cytotoxic reaction of a culture of mouse fibroblasts of the NIH / 3T3 line were interpreted using the table “The degree of cell response”.

Results. Studies have shown that exposure to a source of endovitual illumination does not affect the cytotoxic effect of TA suspension and MembraneBlue® Dual dye. The TA suspension, both after light source and without it, has a moderate cytotoxic effect, and MembraneBlue® Dual has no cytotoxic effect on the culture of mouse fibroblasts of the NIH / 3T3 strain. Without light, “Vitreocontrast” suspension does not have cytotoxic effect on mouse fibroblasts culture NIH / 3T3 line. Light irradiation for 1 h increases the cytotoxicity of “Vitreocontrast” suspension to the level of unsharp cytotoxicity allowed by ISO Standard 10993-5-2011.

Conclusion. The safety profile of MembraneBlue® Dual and “Vitreocontrast” suspension allows them to be recommended for use in endovitreal surgery. The cyto- and phototoxicity demonstrated in the experiment with TA suspension can reduce the functional outcomes of retinal surgery. 

The purpose: to evaluate the effectiveness of the Delfanto® in the complex therapy of patients with dry eye syndrome of various etiologies and severity of the clinical course.

Patients and methods. 114 patients (228 eyes) with dry eye syndrome of various etiologies were examined: 72 patients with chronic meibomian blepharitis and dysfunction of the meibomian glands (xerosis due to increased evaporation of the tear film), 33 women with perimenopause (a mixed form of xerosis with a predominant decrease in the production of components of the tear film) and 9 persons with Syegren syndrome (xerosis due to a pronounced decrease in tear production). All patients received individually selected tear replacement therapy over the past weeks and the drug was not replaced throughout the study. At the same time, patients with mild and moderate clinical course of SSG for 30 days received Delfanto® at a dosage of 60 mg, and with severe course — 120 mg per day.

Results. All patients on the background of complex therapy showed a significant decrease in the severity of subjective manifestations of the dry eye syndrome, an increase in the of the tear film stability and indicators of tear production. At the same time, the dynamics of changes in these parameters of the course of the xerotic process increased as the therapy continued, reaching a maximum by the 30th day. The maximum effect of Delfanto® in the complex therapy of patients with dry eye syndrome was observed in patients with chronic meibomian blepharitis. Moreover, patients with a mild clinical course of cornealconjunctival xerosis were the most susceptible to the therapy.

Conclusion. The effectiveness of the complex therapy for patients with dry eye syndrome can be significantly increased by prescribing Delfanto® in a daily dose of 60 mg for mild and moderate xerosis and 120 mg — for severe disease. Delfante® can be recommended for widespread clinical use in complex treatment of patients with various clinical and pathogenetic forms of dry eye syndrome. 

Purpose: to assess effect of eye drops instillation on the refractive power of the cornea and potential intraocular lens (IOL) power calculation errors appearing related within.

Patients and methods. There were 478 patients divided in 3 groups: 1st — patients without glaucoma and topical treatment (n = 325); 2nd — individuals with primary open angle glaucoma (POAG) on treatment (n = 122); 3rd — patients with POAG and previous trabeculectomy (TE) without using eye drops (n = 31). For each patient keratometry was performed by IOL-Master 500. Mean preoperative keratometry and corneal astigmatism were compared within IOL calculation error received by Barrett Universal II formula 1 month after phacoemulsification (PE).

Results. Mean keratometry was significantly (p < 0.001) less (0.6 D) at the 1st group (44.00 ± 1.96 D) versus 2nd group (44.6 ± 1.76 D). Cancellation of topical eye drops due to TE leads to insignificant decline of corneal curvature (from 44.6 ± 1.76 D to 44.1 ± 1.59 D). There was no any difference in corneal astigmatism level between study groups (0.92 ± 2.23 D, 0.8 ± 0.59 D and 0.86 ± 0.50 D for groups respectively) as like as no distinction in IOL calculation error in these groups (–0.08 ± 0.57 D, –0.06 ± 0.6 D and 0.003 ± 0.61 D). However, men have more flatter cornea (43.6 ± 1.98 D) than women (44.4 ± 1.80 D) (p < 0.001). Mean keratometry at the age group 60–74 years was less (43.7 ± 2.3 D) than at 75–90 years (44.4 ± 1.54) (p = 0.002).

Conclusion. Patients with coexistent cataract and glaucoma on treatment require special attention in IOL calculation. To avoid keratometric errors it is recommended to prescribe lubricants and change hypotensive eye drops to preservative-free analogs to form a stable tear film. 

Malignant tumors of the eye and its adnexa (C69) relates to rare tumors. Until 2011, this group of tumors was not included to the official cancer report in Russia.

Purpose: to investigate the incidence of malignant tumors of eye and its adnexa (C69) in the population of St. Petersburg, to consider the dynamics of a complex of analytical indicators. Standard methods of statistical analysis, state reporting materials and data from the St. Petersburg Population Cancer Register were used. Malignant tumors of the eye and its adnexa (С69) were started to be officially registered only from 2011 onwards, however not in full as only Form 7 that allows to calculate morbidity was filled in. Other information could be obtained from the databases of the Population Cancer Registers (PRR), organized in the country in the late 90’s. Each year, more than 1,000 thousand (e.g.1977–2017 year) cases of malignant tumors of eye and its adnexa (С69) are detected in the whole country. In 2011, 925 cases were diagnosed. In Russia, the crude rate of malignant tumors of the eye and its adnexa (С69) has increased from 2011 to 2017 years from 0.65/100,000 in 2011 to 0.73/100,000 in 2017, respectively, +12.3 % (both sexes), standardized, eliminating the difference in the age composition of the population, remained almost unchanged –0.54 0/0000 and 0.53 0/0000. The standardized incidence rate in men of malignant tumors of eye and its adnexa (С69) in 2017 was 0.58 0/0000, women –0.49 0/0000. The state reporting for malignant tumors of eye and its adnexa (С69) does not provide for the distribution of these patients by age, stage and other parameters. State mortality statistics do not provide for the review of the C-69 heading ICD-10. All of this led us to conduct in-depth analysis of the dynamics of morbidity and mortality of eye cancer on the basis of the PRR database of SaintPetersburg. An insignificant increase in the incidence rate of the Russian population of the eye cancer, completely associated with the aging of the population, has been established. Positive increase in the observed and relative survival of patients has been also revealed. 

The spontaneous change of eyes’ color is a quite rare complain in ophthalmological clinical practice for young and middle-aged patients. We consulted the 18-year-old patient complained that a month ago she noticed a change of the iris’ color. It was symmetrical in both eyes, which had lightened and acquired a “spotty appearance”. Before the appearance of these complaints, the patient had eyes of a rich dark brown color. After a comprehensive examination, the bilateral acute iris depigmentation (BADI) was diagnosed. BADI is bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior segment. It is more common for young and middle-aged women, and is often asymptomatic. BADI has bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior eye segment of the eye, which may affect the trabecular network. A feature of this disease is the absence of transillumination, changes in the shape of the pupil, and an inflammatory reaction. In some cases, repigmentation may occur spontaneously during the next few years. Therefore, from a prognostic point this disease has a favorable prognosis. However, patients with BADI syndrome should undergo regular ophthalmological examinations, including measurement of intraocular pressure to exclude the development of secondary open-angle pigmented glaucoma, and use sunglasses when the sun is bright. BADI syndrome must be differentiated with the following diseases: Fuchs heterochromic iridocyclitis, viral iridocyclitis caused by HSV and CMV, pigment dispersion syndrome and pseudo exfoliative glaucoma, as well as bilateral acute iris transillumination (BAIT) syndrome to make a correct diagnosis and apply adequate treatment tactics.

There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.

Purpose: presentation of a clinical case of an idiopathic macular hole (IMH) recurrence after its successful closure augmented with platelet-rich plasma (PRP) and the results of repeated surgical treatment.

Methods. The patient underwent clinical examination and optical coherence tomography (OCT) of the retina before and after surgical treatment. А 2-stage surgical treatment of the left eye with an interval of 7 days: phacoemulsification (PE) followed by microinvasive vitrectomy with Internal limiting membrane peeling (ILM) and closure with the use of PRP. The patient was discharged with improved visual acuity and closure of the macular hole (MH). After 2 weeks vision deterioration was noted by the patient in the operated eye. Clinical examination revealed macular edema (ME) and recurrence of MH. Topical steroid eye drops were used to no avail, with increase of ME and MH via OCT control. Revision of the vitreal cavity augmented with PRP was performed.

Results. In follow-up a complete closure of the MH, resolution of ME and improvement in visual acuity after repeated surgery was confirmed.

Conclusions. A case of recurrent MH after primary closure with PRP is described. The case suggests a possibility of clinical improvement after repeated MH closure augmented with PRP. The causes and mechanisms of the recurrence of MH are still not clear. Despite the positive results of surgery subsequent OCT retina examination is necessary. 

Purpose. To study the influence of personal protective equipment (PPE) of the respiratory and visual systems on the development and progression of dry eye syndrome (DES) and its relationship with other risk factors for medical workers.

Patients and methods. The data of 243 people (male — 22.2 %, female — 77.8 %) were analyzed as part of a multi-center analytical scientific one-step study. Total tear production (Schirmer I test) was studied at the beginning and the end of the working day in persons used PPE of respiratory system (disposable medical face mask, gauze masks or different types of respirators), as well as PPE of the eyes (protective half-closed/closed glasses or protective screens). Risk factors for the development and progression of DES were registered (age, smoking, systemic hormones intake, soft contact lenses), as well as the use of artificial tears.

Results. A decrease in the Schirmer I test score at the end of a 7–8 hour work shift was found by an average of 3 mm (from 13 (9; 16) mm to 10 (6; 15) mm, p < 0.001). Statistically significant changes were typical mainly for medical personnel (p < 0.001) with the maximum severity in persons working in outpatient sector. The presence of at least one DES risk factor was found in 30.5 % of patients, two factors — in 3.0 %, and three or more — in 7.0 %. There was no influence of risk factors on the degree of changes in total tear production. Reduced tear production is typical for some PPE of respiratory system (disposable masks and respirators) and the eye (screens and half-closed glasses) (p < 0.001). In people who do not use PPE of the eye, significant changes were detected only in the presence of risk factors.

Conclusion. The negative influence of various PPE of the respiratory system and eye on the total tear production was established. The decrease in the results of the Schirmer I test by the end of the working day was 20–25 % of the basic level, regardless of the presence of traditional risk factors for DES. The severity of changes depended on the type of PPE used. The data obtained are particularly relevant during the new COVID-19 coronavirus pandemic and justify the need to establish specific prophylactic measures. One of the possible methods is the preventive use of artificial tears.