The purpose of this work is to review the literature data on the role of optical coherence tomography in the diagnosis of diseases of the closed angle of the anterior chamber. The analysis of the use of modern technical devices — optical coherence tomography of the posterior segment, models with a frequency-modulated source (Swept Source) is presented. The emergence of new imaging technologies such as SS-OCT contributes to understanding the pathogenesis of primary angle closure diseases in terms of involvement of the choroid in the process. A thicker choroid in the macular area may be an anatomical risk factor for closed angle disease. The expansion of an abnormally thick choroid in combination with the structural features of the anterior segment in eyes with a short axial length, including against the background of psychoemotional stress, can lead to an attack of angle closure. Visualization of the structures of the posterior segment of the eye is an important part of the strategy aimed at solving the problem of identifying risk factors, diagnosing, monitoring and evaluating the effectiveness of treatment of diseases of primary angle closure. Qualitative and quantitative data analysis based on optical coherence tomography significantly increases the diagnostic accuracy, allows to determine its progression and to predict its course. This plays a key role in the choice of treatment tactics for the anterior chamber angle closure. The review considers the effect of local antihypertensive eye drops on the choroid.

Conclusion. Optical coherence tomography is a standard in modern diagnostics and evaluation of the effectiveness of treatment of diseases of primary angle closure, allowing a better understanding of the pathogenesis of the disease and its complex nature. Imaging improves the ability to accurately diagnose and choose the right treatment strategy.

The authors presented a review of studies aimed at assessing the effectiveness of antiangiogenic therapy in patients with neovascular form of age-related macular degeneration. The purpose of this review was to clarify the prevalence of true refractory forms of WMD on literary data. The vast majority of experts consider the marker of “refractory” the exit of the dye from the vessels on fluorescent angiography (FAG), fibrovascular detachment of pigment epithelium with intraretinal and/or subretinal fluid on optical coherent tomography, an increase in hemorrhage on the eye compared to the initial level of post-loading phase therapy. The analysis showed a wide corridor of indicators, due to different approaches and timing of the assessment of the respondent’s status, as well as expert criteria for the effectiveness of antiangiogenic therapy. In addition, the authors drew attention to the different understanding of the terms tahiphylaxis and tolerance, presented by the researchers. Many papers are replacing these perceptions. The our work presents the fundamental differences of these biological phenomena in the clinic and morphometric data, as well as the timing of development. Meanwhile, overcoming resistance involves an accurate diagnosis of the pharmacological cause and a subsequent differentiated approach to solving the problem. An overview of the work on overcoming refractory to antiangiogenic drugs in various ways is presented.

Retinopathy of prematurity (RP) is a complex pathology among prematurely born children, which requires a comprehensive approach, including both prevention of the development of more severe stages of the disease, leading to poor vision and irreversible loss of visual functions, and the organization of dispensary observation and rehabilitation. Modern organization of dispensary observation, which is based on a detailed study of the etiology, pathogenesis, as well as the interaction of local and systemic factors on visual functions, can significantly reduce the visual disability of children as a result of this disease.

Aim. Analysis of the functional results of new IOL with an extended depth of focus implantation a in the short-term (6 months) follow-up period.

Patients and methods. The prospective study included 27 patients (40 eyes) after bilateral (n = 12) or monolateral (n = 15) implantation of EDOF IOL Tecnis Symfony with an average follow-up period of 6.5 ± 0.2 (6–7) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or removal of the transparent lens for refractive purposes. The age range was from 39 to 78 (60.6 ± 10.1) years. EDOF IOL Tecnis Symfony ZXR00 was implanted in 30 eyes, and toric EDOF IOL Tecnis Symfony ZXT100, ZXT150, ZTX225, and ZXT300 were implanted in 10 eyes in the presence of clinically significant astigmatism.

Results. An increase in UCNVA from 0.18 ± 0.04 to 0.79 ± 0.11, UCIVA from 0.21 ± 0.07 to 0.89 ± 0.10, UCDVA from 0.24 ± 0.06 to 0.95 ± 0.16, BCNVA from 0.61 ± 0.05 to 0.80 ± 0.03, BCIVA from 0.58 ± 0.10 to 0.97 ± 0.19, and BCDVA from 0.65 ± 0.08 to 1.0 ± 0.06 (p < 0.05 in all cases). The spherical equivalent of refraction decreased from –4.5 ± 1.8 in the preoperative period to –0.18 ± 0.92 in the follow-up period of 6 months after implantation of the Tecnis Symfony ZXR00 IOL. In the group with toric IOLs, a decrease in the cylindrical component of refraction was shown from 1.33 ± 1.02 (modulo) to 0.61 ± 0.44 (modulo) during the maximum observation period. In all cases, the rotational stability of the implanted IOLs was noted. In 9 patients out of 24 (37.5 %), permanent or periodic optical phenomena were detected, of which 4 patients (16.7 %) had halos, 3 (12.5 %) had glare, and 2 (8.3 %) had difficulty driving in the dark. These side effects did not affect the overall patient satisfaction — 22 patients (91.7 %) rated the result of the operation as “excellent”, and 2 patients (8.3 %) — as “good”.

Conclusion. The paper presents an analysis of the first experience in the Russian Federation of implantation of new IOLs with extended depth of focus and their toric version in 27 patients. Data on the effectiveness of this IOL for vision correction at all distances, low frequency of side optical phenomena, and high patient satisfaction are presented. Further comparative studies with other multifocal IOLs are needed.

In a number of complex refractive cases, the achievement of an accurate refractive result cannot be guaranteed. Simultaneous implantation of a toric or multifocal IOL for the correction of complex ametropias may be accompanied by a significant deviation from the target refraction. The tactics of two-stage implantation with the usage of an additional Sulcoflex IOL for the final correction of astigmatism and possible residual spherical ametropia allows achieving emmetropia. In our study, this method was used in 15 patients with difficult refractive cases. Toric, multifocal, and multifocal toric Sulcoflex IOL were used. Implantation of all Sulcoflex modifications was performed through a 2.4 mm temporal incision using wound assisted technology. In cases of high degree hypermetropia, preventive iridectomy was performed using a 23G vitrectome. The target refraction was achieved in the entire observation group. In the postoperative period, no significant level of ophthalmic hypertension was registered. No cases of introlens opacification, iridocyclitis, or rotational instability were registered either.The method of two-stage IOL implantation allows achieving the target refraction in difficult refractive situations with almost guaranteed accuracy. The calculation method provides good predictability of the refractive result. This technology significantly expands the indications for intraocular correction using toric and multifocal IOL, as well as the limits of correction of high degree astigmatism. Our Sulcoflex IOL implantation experience has shown their high efficiency and safety.

Purpose. To analyze the outcomes of the national polymer microshunt implantation in refractory glaucoma surgery and to show its efficacy and safety.

Patients and methods. We analyzed the results of treatment of 90 patients (90 eyes) with refractory glaucoma. All patients were divided into two groups: main group and comparison group. The patients in the main group (44 eyes) were implanted with the national polymer microshunt (Reper-NN). The patients in the comparison group (46 eyes) were implanted with Ex-PRESS. Control criteria in the postoperative period included visometry, tonometry by Maklakov, computed perimetry. The examinations were performed preoperatively, at discharge, in a month, in six months and later postoperatively.

Results. When implanting the national polymer microshunt we reached the significant decrease in the intraocular pressure in the postoperative period in comparison with the preoperative level. The implantation outcomes of the national polymer microshunt and Ex-PRESS were comparable in efficacy and safety. The easy implantation and special construction of the national polymer microshunt provided with the sufficient efficacy and safety in refractory glaucoma surgery and allowed recommending its further application in the clinical practice.

Conclusion. The use of Reper-NN microshunt is effective and safe method of treating refractory glaucoma. The implantation of this shunt may be the method of choice both in primary and secondary refractory glaucoma surgery. The least price of Reper-NN microshunt in comparison with the foreign analogue allows this surgery to be more available for patients with refractory glaucoma.

Purpose. To study the state of interface “intraocular lens (IOL) — posterior capsule (PC)” depending on diameter of capsulorhexis in phacoemulsification of senile cataract.

Patients and methods. 227 patients (227 eyes) were examined after phacoemulsification of senile cataract at LenSx femtosecond laser (Alcon, USA). The study did not include patients with corneal opacities, signs of axial displacement of lens, with irido- and phacodonesis, glaucoma, axial length less than 22 mm and more than 26 mm. Depending on diameter of performed capsulorhexis, we formed 3 groups: 1st group — 76 eyes with diameter capsulorexis 5.5 mm; 2nd group — 73 eyes with 5.0 mm; 3rd group — 78 eyes with 4.5 mm. We studied type of interface “IOL — PC”, the maximum value of PC diastasis and the maximum depth of its folds using an RTVue-100 Optical Coherence Tomography (Optovue, USA) on the first day after the operation.

Results. The maximum number of eyes with absence of contact between IOL and PC was noted in the 3rd group (62.8 %), the largest number of eyes with full contact between IOL and PC (63.2 %) was in the 1st group. The minimum average depth of the PC folds (111.1 ± 32.7 μm) was noted in the 1st group, and the maximum (165 ± 75.4 μm) — in the 2nd group.

Conclusion. The analysis showed that type of interface “IOL — PC” in the first day after phacoemulsification of senile cataract depends on diameter of capsulorhexis. The largest number of eyes (64.6 %) with full contact between IOL and PC was observed in the group of patients with capsulorhexis 5.5 mm, and the smallest (6.4 %) — in eyes with diameter capsulorexis 4.5 mm. Presumably, the main reason for the absence or incomplete contact between IOL and PC is the presence of viscous dispersive between them. The deformation of PC in the form of folds does not directly depend on diameter of capsulorhexis and, obviously, is due to the uneven tension of the capsular bag by the IOL haptics.

Purpose. To analyze the efficacy of the lower eyelid eversions surgical treatment.

Patients and Methods. We have analyzed the outcomes of treating patients with severe lower eyelid eversion during 2013–2019 — 153 patients, 156 operations. The patients were divided into 4 groups: atonic and paralytic eversion (109 eyes), traumatic tearing of the lower eyelid (8 eyes), cicatricial ectropion (28 eyes) and mechanical ectropion (in tumors) of the lower eyelid (11 eyes). The following surgeries were performed: duplicature surgery by Willer; by Kuhnt-Szymanowski; resection of the framework structure of the lower eyelid with fixation to the eyelid ligaments; implantation of various materials based on the orbital margin; sling to the eyelid ligaments; free skin plasty; local flaps; excision of tumors with one-stage reconstructive plastics.

Results. Postoperatively the improvement was observed in all cases. The lower eyelid eversion was eliminated. There were no any complications. The efficacy criteria was the level of the eyelid margin height with regards to limbus, absence or reduction of lagophthalmus. “Good” result — symmetrical width of the eyelid fissure, absence of lagophthalmus was achieved in 100 % of cases in groups IA and II, in 28.12 % — in group IB, in 71.43 % — in group III, in 63.63 % — in group IV. “Satisfactory” result — the difference in the eyelid fissure width was 1.0–2.0 mm, absence or reduction of lagophthalmus was achieved in 65.62 % of cases in group IB, in 21.43 % — in group III, in 27.28 % — in group IV. “Unsatisfactory” result — the difference in the eyelid fissure width was more than 2.0 mm, the presence of lagophthalmus was achieved in 6.25 % of cases in group IB, in 7.14 % — in group III, in 3.33 % — in group IV.

Conclusions. When operating the lower eyelid eversion it is possible to achieve good result. The pathogenically based combined methods of surgical treatment are the most effective. In case of traumatic tearing of the lower eyelid, we need to restore the lacrimal duct. In cicatricial ectropion it is possible to achieve engraftment of the skin graft, elimination of eversion and lagophthalmus. In mechanical eversion (due to eyelid tumors) it is necessary to perform radioexcision of the neoplasm with a single-stage reconstructive plastic surgery of the eyelid.

Purpose: to present analysis a case reports of 17 patients who had an acute transient macular edema appeared straight after uncomplicated cataract surgery.

Patients and Methods. Working with literature and retrospective observational case series reviewing clinical and imaging data from 17 patients (17 eyes) with acute transient macular edema.

Results. There are several cases of acute macular hole development after cataract surgery (complicated and uncomplicated). Also there are reports of macular odema development after several weeks after uncomplicated phacoemulsification due to pseudophakic cystoid macular oedema (Irvine-Gass syndrome) or due to vitreomacular traction syndrome. We observed a series of transient macular oedema with 3.8 % incidence occurring on the first days after uncomplicated phacoemulsification with IOL implantation that had no signs of vitreomacular traction or aqute inflammation. Men suffer frequently than women (14:3). Systemic hypertension prevailed among these patients (15 from 17). Optical coherence tomography (OCT) was made in patients complaining on blure vision and who had signs of macular edema by ophthalmoscopy. By OCT high neuroepithelium detachment was observed at the first day after uneventful cataract phacoemulsification with intraocular lens implantation in 17 patients with quiet postoperative condition of the eye. The edema resolved on the 3–6-th day by standard phaco accompanying pharmacological treatment. In most cases posterior vitreous cortex was adjacent to the retina except 3 patients with posterior vitreous detachment (PVD) in macular area. We found a paper by Costen M.T.J. et al. (2007) about the same striking appearance of maculopathy called by authors “A-sign” maculopathy because of A-shaped pattern on OCT images in 3 patients after routine cataract surgery. Yaman A (2008) and Panagiotidis D (2010) also reported same findings after uncomplicated cataract surgery. We compared our findings with 3 papers mentioned above, as well as with typical pseudophakic cystoid macular edema (CME or Irvine-Gass syndrome) and vitreomacular traction syndrome. We also discussed possible ethiopathogenesis of thеse cases in terms of morphology of the macula region.

Conclusion. This article could improve our understanding of mechanisms of the interstitial fluid flow in the eye tissues. 

Objectives: To evaluate the effectiveness of the optimized technique of transcleral diode laser cyclophotocoagulation (DCPC) in patients with unstable glaucoma.

Methods. The retrospective analysis of outpatient records of patients diagnosed with open-angle compensated glaucoma, who underwent transcleral diodlaser DCPC in continuous-wave mode, has been performed. Totally, 44 outpatient records (44 eyes) have been analyzed.

Results. The course of the postoperative period, patients’ complaints, and the ophthalmological status have been evaluated. The level of intraocular pressure (IOP) was determined on the day after the procedure, a week, 1, 3, 6 and 12 months after the operation. 12 months after the operation, the level of IOP decreased by 42.9 %. The number of antihypertensive drugs used by the end of the follow-up period decreased by 66.6 %: from 2.75 ± 0.4 to 1.0 ± 0.7 drugs (p = 0.001). The frequency of side effects was low and comprised 11.3 %. In 40 % of patients, manifestations of toxic-allergic reactions of the ocular surface to antihypertensive drugs decreased due to the possibility to reduce the frequency of instillations. The MCVA indicators remained stable throughout the entire follow-up period.

Conclusion. Thus, the results of the conducted clinical study indicate that transcleral DCPC is an effective and safe technique with a high predicted result, since it compensates for the level of IOP, which allows to stabilize the progression of the glaucoma process. The method of trascleral DCPC provides a reduction and (or) correction of the hypotensive regime by reducing the number of antihypertensive drugs used. In patients with a toxic-allergic reaction from the ocular surface developed due to a prolonged use of antihypertensive drugs, it allows to reduce the symptoms and clinical manifestations by canceling and (or) reducing the number of antihypertensive drugs used, indirectly significantly improving the quality of life.

Diabetes mellitus (DM) is one of the most common and rapidly progressing diseases worldwide. Diabetic retinopathy (DR) is a common complication of diabetes and the main cause of vision loss in middle-aged and elderly people. The development and progression of DR is closely related to the duration of diabetes, hyperglycemia, and arterial hypertension. There is growing evidence that inflammation is one of the key links in the pathogenesis of diabetic retinal damage, but the exact molecular mechanisms remain to be known. Pancreas transplantation (PT) is currently the only effective treatment for diabetes that restores normal physiological glucose metabolism. Due to the limited number of PT surgeries associated with the severity of intra- and postoperative complications and the acute issue of organ donation, studies on the assessment of DR after PT are few and contradictory. There is a need for further studies of the DR state after PT with the study of the influence of risk factors, determination of the level of immunological markers and the use of modern instrumental research methods to create effective patient management regimens in the postoperative period.

Introduction. Primary angle-closure glaucoma (PACG) remains one of the leading causes of irreversible blindness. Up to date, a significant amount of data has been accumulated concerning the biometric parameters of the eye in PACG, however, there is a lack of information on the dynamic characteristics of these parameters.

Objective: to evaluate the dynamic biometric characteristics of the structures of the anterior segment of the eye in PACG.

Patients and methods. The results of optical coherence tomography were analyzed in 40 patients with PACG and in 40 patients without signs of hydrodynamic disorder. The studies were carried out under photopic and mesopic illumination conditions. The scanned images were obtained using an RTVue-100-2 optical coherence tomograph device (Optovue, USA). Biometric measurements were performed using standard tomograph software; volumetric studies were carried out based on the Pappus-Guldinus theorem with additional constructions. When analyzing the obtained images, 13 different linear and volumetric parameters were evaluated.

Results. A decrease in the parameters reflecting the features of the configuration of the anterior chamber of the eye was noted in the presence of PACG (width of the ACA, depth and volume of the anterior chamber). From the point of view of the possible influence on the state of the anterior chamber angle, it is necessary to highlight changes in such indicators as the area, volume and thickness of the iris. Regardless of the conditions of the examination, these indicators, on average, were significantly higher in the PACG and practically did not change with a decrease in the level of illumination. At the same time, in the absence of disturbances in hydrodynamics under mesopic conditions, despite an increase in the thickness of the iris, a significant decrease in its area and volume was noted.

Conclusion. Biometric changes in the structures of the anterior segment of the eye in the case of PACG relate not only to linear, but also to volumetric indicators. As a certain component of hydrodynamic disorders in the case of PACG, the revealed preservation of the iris volume during pupil dilation under mesopic illumination conditions should be considered, while in the absence of hydrodynamic disorders, this indicator decreased. Therefore, not only static changes in the biometric characteristics of the structures of the anterior segment of the eye, but also their dynamic fluctuations, should be considered as a risk factor for clinical manifestations of PACG, which determines the practical significance of dynamic biometric studies in the examination of patients with suspected PACG.

Endophthalmitis remains one of the most formidable complications of surgery in ophthalmology, leading to significant functional and anatomical changes. The “gold” standard of treatment for this pathology is the installation of intravenous injections of antibacterial drugs, but taking into account the number and type of pathogens, the growth of antibiotic resistance, the search for alternative methods of treatment of endophthalmitis remains relevant. Colloidal quantum dots, which are nanoscale semiconductor crystals with simulated optical and electronic properties due to changes in their volume, composition, and surface connections, are of interest for research in this direction. This article presents the process of synthesis of CT and bioconjugates based on them in order to assess ophthalmotoxicity with the prospect of further use in the treatment of endophthalmitis. The study was divided into 4 stages, starting with the determination of the required technical specification in order to select the appropriate type of quantum dots taking into account the physical and chemical characteristics (Stage 1), the synthesis of quantum dots (Stage 2), the preparation and titration of a solution of quantum dots of various concentrations for implantation in the vitreous cavity (Stage 3). The final stage was to evaluate the toxic effect of the quantum dot solution in its pure form, as well as in combination with antibiotics (ceftazidime and vancomycin) when administered intravitreally on an animal model. As a result of the study, quantum dots were synthesized and a solution based on them was obtained for introduction into the vitreous cavity. Based on the testing of the animal model (rabbits), a safe dose of the solution was determined, as well as the possibility of its use in combination with antibiotics.

Objective: to study the condition of the cornea, as well as its epithelial and endothelial cells, while maintaining in vitro at various temperature conditions, under the influence of a number of factors, including bioregulators isolated from blood serum and cornea of the bovine, and epidermal growth factor.

Methods. The study was carried out on rabbit corneas stored at temperatures of +4, –86 °C, as well as the cultivation of endothelial and epithelial cells isolated from the cornea after storage at these temperatures, followed by histological and immunohistochemical studies.

Results. Storage of the cornea at +4 °C for 10 days leads to corneal edema and significantly reduces their transparency, both bioregulators partially prevent a decrease in the transparency of the cornea, while the endothelial layer lyses in groups with the addition of epidermal growth factor and corneal bioregulator; but remains in the cornea with the addition of a serum bioregulator. All three factors contribute to the preservation of the Bowman membrane. In the corneas stored at –86 °C on the 30th day, a preserved endothelial layer was observed, and the epithelium retained its multilayering in all groups with the addition of factors other than the control group. In the control samples, the epithelial layer partially exfoliated, the endothelial layer was almost completely lysed. Both bioregulators stimulated the proliferation of cells isolated from the native cornea and enhanced the action of the epidermal growth factor. Similar results were obtained on cells isolated from stored corneas for 2 weeks at –86 °C. In the case of combined use of the epidermal growth factor and bioregulators on the 30th day, the endothelial layer was mainly preserved, the Descemet’s membrane was not broken. In the control samples, the epithelium was mainly single-layered, partially exfoliated, and the endothelial layer was completely lysed.

Conclusion. Storage of cornea during hypothermia (+4 °С) does not provide corneal viability for longer than 10 days. Storage under conditions of cryopreservation (–86 °C) ensures the viability of the cornea for 60 days. Adding bioregulators and an epidermal growth factor to the basic preservation medium allows one to obtain a structurally safe and viable cornea, while all cellular layers of the cornea, including the endothelial layer, are preserved and viable.

Uveal melanoma (UM) is less than 0.5 % in the spectrum of human tumors, and less than 5 % among all types of melanoma, therefore, it is considered to be rare. At the same time, UM is recognized as the most common intraocular malignant neoplasm. Its share among all intraocular tumors is 60 %. Radical local treatments are considered effective, but the frequency of distant metastases is unacceptably high, and the life expectancy of patients with metastatic stage of the disease is short and on average is 4–5 months. Survival rates have remained stable for the past 40 years, reflecting the lack of current effective system strategies. The tumor metastasizes in a haematogenic way, so it is not surprising that angiogenesis is constantly in the focus of scientific developments. The importance of studying angiogenesis in UM is due to the ability to predict based on the quantitative indicators of vessels inside the tumor and to search for potential targets of antiangiogenic therapy in the future. The authors used two methods of studying angiogenesis in UM: morphological with quantitative vascular counting and immunohystochemical method (IHC) with markers of endothelial cells CD34 and CD31, VIII factor, VEGF molecules, bFGF, thrombospondin and others. IHC-staining of vessels in UM allowed to visualize vessels that were not visible due to intense pigmentation of tumors or compression of vessels by tumor cells. Comparison of data obtained by the two methods demonstrated the advantages of IHS analysis over classical morphological methods. It was found that UM, as a malignant solid tumor, differs high averages of vessels per unit area. The highest rates are recorded in epitheloid melanoma, which is associated with a higher rate of growth, and more frequent metastasis, compared to similar rates in revere cell melanoma. The number of vessels per unit area in the viewing area in UM decreases with age, which explained the development of metastases in more distant after enucleation time in elderly patients. Differences in vascular density in tumors of different localization were revealed and described: they were the maximum in pre-equatorial tumors, and minimal — in iris tumors.

The purpose is to conduct an expert (medical) assessment of the main complaints of patients with symptoms of computer visual syndrome (CVS).

Methods: as part of the preliminary stage of work, an individual interview was performed (according to the standard developed methodology) with 100 patients aged 24–36 years, whose professional daily activity (at least 2 years) was characterized as visually-intense work associated with electronic systems displaying information (at least 4 hours a day) and with a fairly high level of responsibility for the final result. During the main stage of the study, a special questionnaire was developed, in which the identified complaints were transformed into questions. The task of the expert — ophthalmologist was to assess the relevance of each of the questions in terms of the severity of the impact on the “quality of life” of the patient. In this case, the assessment was carried out on a 10-point scale, where 0 points — the question is not relevant; 10 points — the question is very relevant. The study involved 96 ophthalmologists aged 41.3 ± 1.6 years (age range from 32 to 62 years) with an average of 17.3 ± 1.4 years of professional experience (range from 6 to 37 years).

Results: more pronounced “ocular” manifestations of the CVS were established (mean score — 8.0 ± 0.2, range from 5.0 to 9.4 points, the highest scores for 8 complaints from 8.6 to 9.4 points) compared with “visual” (average score — 6.5 ± 0.2, range from 4.1 to 8.8 points, the highest scores for 5 complaints from 7.8 to 8.8 points). A sufficiently high level of practical significance of “professional” subjective manifestations of the CVS has been established.

Conclusion. The obtained data can be basic in the framework of the prospective development of a questionnaire for assessing the “quality of life” of patients with CVS symptoms, since the use of an expert (medical) assessment of identified complaints from the position of the severity of a change in subjective status significantly increases the level of reliability, reliability, as well as meaningful and constructive validity methods of assessing the “quality of life”.

Purpose. Determine the nature of tumor regression and possible complications associated with the retinotoxic effect of melphalan and carboplatin with local chemotherapy.

Methods. A histological analysis of 19 enucleated eyes from 19 patients with retinoblastoma was performed after combined organ-preserving treatment, including systemic chemotherapy and local chemotherapy in various doses. The enucleated eyes were fixed in 10 % formalin and processed routinely for histological examination.

Results. Significant changes in the tumor tissue such as tumor regression associated with the destruction of the tumor tissue and its replacement with fibrous tissue, glia proliferation, and the formation of petrificates were revealed. Complete regression of the tumor was detected in 3 out of 19 eyes, partial in 13 eyes. There were no signs of regression in 3 eyes. Tumor invasion into the choroid was found in 5 cases, into the anterior sector — in 3 cases, into the optic nerve — in 3 cases. The retrobulbar tumor was presented in 1 case. Retinotoxic complications revealed. Hemorrhagic changes associated with focal necrosis of the central retinal vessels (n = 4), destructive changes in retinal pigment epithelium (RPE; n = 10) associated with the accumulation of melphalan in RPE leading to atrophic processes in the retina. Complications in the form of secondary glaucoma, severe fibrosis and retinal detachment, despite the complete resorption of the tumor, led not only to loss of vision, but also hindered visualization of the fundus and substantiated the need for enucleation in 3 cases. In other cases, enucleation was performed due to continued tumor growth (n = 16) or progression during treatment (n = 3).

Conclusions. Retinoblastoma can be controlled with local chemotherapy. However, clinical and morphological examinations of enucleated eyes revealed and confirmed, along with tumor resorption, intraocular complications as a result of the toxic effect of the drugs and the presence of active tumor tissue to varying degrees of therapeutic pathomorphism, which can be explained by the resistance of RB to these drugs. Thus, a further search is needed for drugs that destroy the tumor and minimize the retinotoxic effect.

Purpose: to study the effect of bifocal soft contact lens (BSCL) with an ADD of 4 diopters on peripheral refraction (PR), optical and ergonomic eye parameters in children with myopia.

Patients and methods. 26 patients (52 eyes) with myopia –3.09 ± 1.13 diopters at the age of 10.04 ± 1.5 years without correction and with correction by BSCL Prima BIO Bi-focal ( Okay Vision Retail, Russia). All patients underwent a horizontal and vertical PR study on an open field autorefractometer Grand Seiko WAM-5500 (Japan), wavefront aberrations were studied on OPD-Scan III aberrometer (Nidek, Japan), contrast sensitivity under mesopic conditions were studied on a Mesotest 2 instrument (Oculus, Germany) and visual productivity was studied using test tables.

Results. The visual acuity of the distance with a BSCL correction of 0.98 ± 0.04 did not differ (p = 0.26) from the maximum visual acuity corrected by spherocylindrical glasses of 0.99 ± 0.04. BSCL induces myopic defocus in all peripheral zones, with a maximum value of 15° and a sharp decrease of 30°. Peripheral myopic defocus induced by the lens at a horizontal and vertical angle of 15 degrees did not depend on the initial degree of myopia. BSCL increases the total RMS from 0.07 ± 0.02 μm to 0.19 ± 0.07 μm in the 3 mm zone (p < 0.01) and from 0.27 ± 0.09 μm to 1.18 ± 0, 23 μm in the 6 mm zone (p < 0.01), mainly due to an increase in spherical aberration from –0.0005 ± 0.006 μm to 0.06 ± 0.01 μm (p < 0.01) and from 0.01 ± 0.09 μm to 0.58 ± 0.14 μm (p < 0.01) in the 3 mm and 6 mm zones, respectively. An increase in the overall RMS in BSCL reduces the quality of eye optics and contrast sensitivity under mesopic conditions, but does not impair visual productivity.

Conclusion. BSCLs with a high ADD of 4 diopters are capable of inducing significant myopic peripheral defocus due to the induction of spherical aberration, while maintaining high visual acuity and not changing ophthalmic ergonomics, which makes them a pathogenetically substantiated method for correcting myopia and preventing its progression in children and adolescents.

Glaucoma is the most severe eye disease that leads to irreversible blindness, and is a widespread pathology among the population of different countries and especially in the elderly. The urgency of the problem increases in connection with the demographic processes occurring in industrial countries, characterized by aging of the population. The development of glaucoma in the elderly exacerbates the image and quality of life of these patients, which must be taken into account in the implementation of medical and social and specialized ophthalmological care. However, the study of the quality of life in elderly glaucoma patients by a specific questionnaire was not carried out.

The purpose: to analyze the quality of life of elderly patients suffering from glaucoma for a long time.

Material and methods. The study of quality of life was carried out in the Tambov branch of the S. Fyodorov Eye Microsurgery Federal State Institution. In clinical conditions, a survey of 228 patients with glaucoma aged 60–75 years, who made up the main group. The survey was conducted on a special questionnaire-National Eye Institute Visual Functioning Questionnaire among patients of the above group by direct interviewing. The results were integrated into 122 scales for processing and analysis in accordance with the requirements of this questionnaire. Similarly, for comparison, the quality of life was studied in 178 patients of the same age with no history of glaucoma and at the present time. In assessing the quality of life, arithmetic averages and their errors were calculated, and the nonparametric t-white criterion was used to determine the reliability of the differences.

Results. It was found that the development of glaucoma in the elderly causes a significant decrease in the quality of life on all scales of the questionnaire, reflecting the specific manifestations due to visual impairment. At the same time, the most pronounced effect of glaucoma has on the reduction of distant vision — 19.5 ± 1.3 points against 69.5 ± 1.8 points (p < 0.001) in the control group. The defeat of glaucoma leads to a significant decrease in the quality of life of elderly patients and other indicators. In the main group, the overall score of vision (23.5 ± 1.5 points vs. 75.2 ± 1.9 points in the control), near vision (26.8 ± 1.6 points vs. 73.5 ± 2.0 points in the control), high dependence on outsiders in solving everyday problems (30.5 ± 1.6 points vs. 79.3 ± 1.8 points in the control) were significantly lower. To a lesser extent, with the development of glaucoma, color perception suffers.

Conclusion. The analysis of the quality of life in elderly patients with glaucoma is of practical importance for the organization of an individual treatment and prevention plan, since it takes into account the opinion of each patient about the perception of the disease.

Purpose — to analyze the literature data on the benefits of preservative-free medication therapy for glaucoma.

Materials and methods. 482 articles in the Pubmed database published from 1975 to 2020 were analyzed using the terms: “glaucoma”, “preservatives”, “preservative-free therapy”, “benzalkonium chloride”. The review includes 78 articles. Inclusion criteria: studies that examined the effect of local antihypertensive therapy on the condition of the ocular surface in comparison with preservative-free drugs.

Discussion. BAC is the most common preservative used in ophthalmology, accounting for 70 % of eye drop formulations. But it has a pronounced toxic effect on the ocular surface, so other classes of preservatives have been developed. These include polyquaternium-1 detergent; oxidizing preservatives — stabilized oxychlorocomplex and sodium perborate; ionic buffer preservative. However, most of the publications are devoted to BAC, as it is considered the most toxic and, at the same time, the most commonly used preservative. There is a large number of switching studies from preservative therapy to preservative-free, in which almost all groups of drugs used for the treatment of glaucoma were studied, but the use of antihypertensive drugs is associated not only with the action of preservatives, but also with the active substance, excipients and buffers. However, most switching studies demonstrate the benefits of preservative-free drugs. Other studies compared preservative and preservative-free drugs with the same active ingredients, in which a comparable hypotensive effect and safety profile was revealed, which indicates that BAC is not required for adequate penetration of the active substance to the point of application. At the same time, statistically significant advantages in the tolerability of preservativefree therapy were also revealed.

Conclusion. Glaucoma preservative therapy has a toxic effect on the ocular surface, which leads to a decrease in the quality of life and compliance. Switching to preservative-free drugs can help reduce iatrogenic complications during long-term treatment of patients with glaucoma

Relevance. Corneal refractive surgery is a modern, dynamically developing segment of ophthalmology that provides highly predictable, safe and stable refractive results in patients with a wide range of ametropias. Corneal refractive surgery, usually is chosen by patients who lead an active lifestyle and need rapid medical and social rehabilitation, people with high requirements for the quality of life and showing increased expectations for the result of correction. Perhaps this is due to the fact that, according to a survey at the exit of the Department of refractive laser Surgery of the S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, Moscow, conducted after consulting a surgeon with a description of the course of the operation and the postoperative course, about 1 % of patients refuse surgery, fearing painful sensations in the postoperative period, and 23.4 % of the expected postoperative discomfort causes strong concerns.

Purpose. To study the clinical efficacy and safety of Broxinac (0.09 % bromfenac solution) in the early postoperative period of corneal refractive surgery.

Materials and methods. The study included 168 patients (168 eyes) with moderate and high myopia after PRK (24 eyes), FemtoLASIK (78 eyes) and ReLEx SMILE (66 eyes), divided into equal subgroups: in the main group, Broxinac was instilled once 30 minutes after the operation, and in the control group — placebo. In the PRK subgroup of the main group, daily instillations of Broxinac were continued until complete reepithelization. The severity of the indicators “eye pain”, “photophobia”, “lacrimation”, “foreign body sensation” was evaluated on a five-point scale, the state of the corneal epithelium when stained with fluorescein, and overall satisfaction with the operation.

Results and discussion. It is established that the analgesic effect occurred on average after 4.4 ± 0.6 minutes. Broxinac had a rapid, pronounced analgesic effect in patients in the early postoperative period after keratorefractive surgery, without slowing of corneal reepithelization, and can be recommended for use in clinical practice for analgesia and relief of aseptic inflammatory reaction in the early postoperative period after FemtoLASIK and PRK. The ReLEx SMILE does not require pain relief.

Conclusion. Analgesia of the early postoperative period increases patient satisfaction with the result of the operation, popularizes it and helps to attract patients who previously refused surgical correction of ametropia due to fear of painful sensations.

Aim — to study of gene polymorphisms affecting the effectiveness of timolol treatment of primary open-angle glaucoma.

Patients and Methods. The study included 39 Russian patients (29 women and 10 men) aged 53 to 89 years old with a diagnosis of primary open-angle glaucoma (POAG). Intraocular pressure (IOP) was measured before the start of therapy and after 2 weeks during treatment. Сoefficient of decrease in IOP was calculated in percentage of its initial level (∆D). Patients were genotyped according to the polymorphic loci MMP1^-160insG, MMP12^A-82G, TIMP1^C536T, ADRB1^Arg389Gly, ADRB1^Ser49Gly, NAT2^Lys268Arg, GSTP1^Ile105Val using the corresponding SNP-express reagent kits (NPF Lytech, Moscow).

Results. No effect of MMP12^A-82G, TIMP1^C536T, ADRB1^Arg389Gly, NAT2^Lys268Arg polymorphisms on efficiency of reduction of IOP under action of thymolol in “best” eyes was revealed. The carriage of a homozygous genotype GSTP1Ile105Ile resulted in the best ophthalmic hypotensive effect of a timolol (∆D ≥ 20 %), which probability was 5.63 times higher in comparison with ∆D < 20 %. In the “worst” eyes, the association of carriage of a combination of wild genotypes GSTP1^Ile105Ile×NAT2^Lys268Lys with the best response of patients to timolol was revealed. The ophthalmic hypotensive effect of 10 ≤ ∆D < 20 % in such carriers was more than 11 times more likely than ∆D < 10 %.

Conclusion. The carriage of the wild genotype GSTP1^Ile105Ile determines the best ophthalmic hypotensive effect of timolol and can be a prognostic marker for the effective treatment of patients with POAG. The combination of wild genotypes GSTP1^Ile105Ile×NAT2^Lys268Lys can contribute to the better therapeutic effect of timolol, and mutant ones can prevent it.

Relevance. In a number of pathological conditions accompanied by defects of the basal membrane, such as chemical or thermal burn, mechanical trauma, Schegren’s syndrome, herpetic keratitis processes of corneal epithelization are slowed down, and sometimes epithelization does not occur at all. Slow epithelization or its complete absence creates conditions for infection, thinning, and sometimes perforation of the cornea. That is why the problem of chronic corneal erosions is very relevant. The most perspective method of treatment is the use of autologous platelet-riched plasma (PRP). Presence of platelet growth factors, adhesive molecules and cytokines in PRP allows to use it for acceleration of regeneration of corneal defects, and the presence of live platelets allows to refer this procedure to autologous cell transplantations.

Objective: To evaluate the clinical and morphological features of corneal epithelium regeneration in response to the application of PRP in conditions of experimental chronic corneal erosion (ECCE).

Materials and methods. Researches were carried out on 12 rabbits of Chinchilla breed (24 eyes). At first stage the model of ECCE was reproduced for all animals: local ultraviolet (UV) irradiation with the exposure time of 45 min. on the preliminary de-epithelized corneal surface. At the second stage all animals under study were divided into three groups (4 rabbits in each group). I-st main group (MG) was instillated with PRP at a rate of 1 drop / 1 min within 10 minutes (total of 10 drops) once, in the II MG treatment was carried out according to the above method, every day for 5 days. In the control group (CG) PRP treatment was not applied.

Results. 45-min. UV irradiation causes persistent ECCE up to 30 days of the experiment and reverts only after surface vessels are ingrowed in the affected area. Single use of PRP has insufficient therapeutic effect. Instillation within 5 days accelerates the cornea reparative regeneration in ECCE conditions. The absence of epithelial defect, newly formed vessels and corneal clouding was registered on the 9th day. Histologically, on the 30th day a normal multilayer non-squamous epithelium was found, while the stroma had an organized structure with no signs of inflammation.

Conclusions. Therapeutic effect of PRP in ECCE conditions is based on reforming of the normal «adhesion complex» between epithelium, olfactory membrane and multifactor stimulation of reparative regeneration due to growth factors located in it, adhesive molecules and cytokines, as a result of which the typical corneal epithelium is restored.

Objective: The study was aimed to estimate primary glaucoma incidence in a cohort of nuclear workers occupationally exposed to ionizing radiation over prolonged periods.

Materials and methods. The cohort considered in the study included workers of the Mayak Production Association. All glaucoma cases that were reported in the study worker cohort regardless of its type were identified using the medical and dosimetry database ‘Clinic’. Statistical analyses were performed to estimate non-standardized (crude) and standardized incidence rates for primary glaucoma. Standardization was carried out indirectly using age distribution for the whole cohort as an internal reference. Incidence rates were estimated per 1000 person-years in accordance with conventional medical statistics.

Results. At the end of the follow-up period, 476 primary glaucoma cases were reported in the study worker cohort over 482,217 person-years of the follow-up. The standardized primary glaucoma incidence was estimated to be 1.00 ± 0.05 in males and 0.70 ± 0.07 in females. Crude primary glaucoma estimates in both males and females increased with the increasing attained age of the workers. Crude incidence rates in males were significantly higher than in females for age 50–69. The standardized primary glaucoma incidence in males was also significantly increased compared to females. The standardized primary glaucoma incidence rates were increasing throughout the period from 1960s to the end of the follow-up.

The problem of diagnosis and treatment of inflammatory eye diseases takes a leading place in Russia and in the world, but the most important thing is the correct choice of treatment methods. Purpose of the work: collection and analysis of data on doctors’ preferences under prescribing therapy in patients with inflammatory eye pathology in routine clinical practice. As a result, 5960 clinical cases from 47 Russian cities were analyzed. This article compiles data from October to November 2020. 151 medical researchers were taken part in the participation of the recruitment. Doctors made different diagnoses for referring patients, but significantly more often diagnosis H10.3 was detected — 17.99 % (in 1072 patients). Ophthalmologists preferred to prescribe the following combination of drugs: 1 — antibacterial local, 2 — local antiseptics, 3 — non-steroidal anti-inflammatory local, a combination (antibiotic and glucocorticosteroid), antiallergic in the form of drops of local action. The choice of drugs for inflammatory eye disease is determined by their high efficiency of use for a given disease: antibiotic Signicef® (levofloxacin 0,5 %), nonsteroidal anti-inflammatory drug Broxinac® (bromphenac 0,09 %), fixed combination Kombinil® (ciprofloxacin 0,3 % + dexamethasone 0,1 %), Visallergol® (olopatadine 0,2 %) in the form of topical eye drops.

Objective. In February 2019, we completed work on creating a unified database of the population cancer registry of the NorthWestern Federal district of the Russian Federation. The development of data on the material of a large area significantly increases the reliability of the material under study, especially for RARE localities of malignant tumors, which include tumors of the eye and and adnexa.For the first time in Russia to present an analysis of the effectiveness of anti-cancer activities in relation to malignant tumors of the eye and adnexa (C69) at the Federal district level with calculations of 5-year survival rates of patients taking into account sex, age and histological structure of tumors.

Methods. The development of the 5-year survival rate of patients with malignant tumors of the eye (C69) included information from the database created by us Population cancer register of all administrative territories of the North-Western Federal district of Russia for the period from 1999 to 2013, more than 1000 observations (1022).

Results. The study revealed a positive dynamics of survival in patients of the North-Western Federal district of Russia with malignant tumors of the eye. The 5-year survival rate increased among males from 58.8 to 63.1 %, and among females from 64.7 to 69.6 %. A significant overestimation of the proportion of early stages among primary patients with malignant tumors of the eye and adnexa (C69) was found, which may be due to medical errors. Calculations of patient survival (with careful tracking of the deceased) allow us to get a more objective picture.

Conclusion. Excellent achievements in the treatment of patients of advanced research centers and institutes can be welcomed only if similar successes are recorded at the population level and are available to all patients. Our in-depth development of population data in the Federal district confirmed the success in the treatment of patients with the malignant tumors of the eye and adnexa (C69), and the patterns we found first in the database of the Population cancer register of St. Petersburg, and now in the North-Western Federal district of the Russian Federation. Similar studies in other Federal districts could be an important component in the planning, monitoring and evaluation of anti-cancer measures in relation to the malignant tumors of the eye and adnexa (C69).

Central retinal artery occlusion (CRAO) is a relatively rare form of acute retinal arterial ischemia that results in unilateral vision loss. The incidence of transient vision loss is estimated at approximately 14 cases per 100,000 people per year, while the incidence of CRAO is approximately 1–2 cases per 100,000 people. In the foreign literature, there are more and more publications about the development of iatrogenic vision loss after dermal cosmetic injections. We would like to present a clinical case that should be interesting for both practicing ophthalmologists and specialists of related specialties, especially for cosmetologists. Patient M., 42 years old, came to us with complaints of a sharp loss of vision to light perception in the right eye. From the anamnesis, it is known that two hours earlier, the patient was injected into the temporal region (plasma, anesthetic, epinephrine) in the cosmetology office. Lightning-fast deterioration of vision occurred at the time of the drug administration. The patient arrived at the clinic 2 hours after the onset of complaints. We conducted an ophthalmological examination of the patient, the diagnosis was made: occlusion of the central artery of the retina of the right eye, and immediately performed standard emergency therapy. After a course of conservative treatment in an ophthalmological hospital, a persistent decrease in visual functions and a violation of arterial blood circulation in the central retinal artery basin remained. The progressive increase in the number of minimally invasive cosmetic procedures in recent years, in particular, injections of dermal fillers, is associated with rare, but often fatal complications. This clinical situation should attract the attention of practicing ophthalmologists and cosmetologists to these types of complications, and improve the quality and speed of emergency medical care.

Purpose: To provide a clinical case of recurrent keratoconus from our practice.

Materials and method. A patient came to the clinic with a complaint of decreased visual acuity in the right eye. A series of standard instrumental examinations and Scheimpflug keratotopography were performed, and astigmatism of the right eye was diagnosed. Similar examinations were carried out during the patient’s attendance at follow-up examinations.

Results. Based on the results of scanning Scheimpflug keratotopography, the diagnosis of keratoconus (forme fruste) was made. On examination after 1 year, there were no complaints of decreased visual acuity and data from the same instrumental examinations indicating keratoconus. After this examination, the patient came 3.5 years later with complaints of a new decreased visual acuity in the right eye. During instrumental examinations and keratopography, data were obtained indicating the presence of posterior keratoconus. After 1 year, a follow-up examination took place without complaints. The data of instrumental studies are identical to the previous visit; keratotopography revealed a decrease in posterior elevation.

Discussion and conclusion. It was revealed that the patient was constantly taking the hydroxyurea drug against the background of systemic disease up to the 3rd visit, at the time of the 4th visit she had not taken it for 1 year. There are publications in the literature on the effect of this type of drugs on the collagen of the dermis of the skin, the type of which corresponds to the collagen of the cornea. We hypothesize that drugs may have an effect on the biomechanical properties of the cornea, which requires further in-depth study.

An analysis of the case of applying a course of fibrinolytic therapy and one intravitreal injection of an angiogenesis inhibitor in a patient with traumatic rupture of the choroid complicated by choroidal neovascularization (CNV) is presented. Patient B., 20 years old, complained of a lack of objective vision after a blunt injury to his right eye in March 2018. Visual acuity decreased to 0.01 (ETDRS 0 characters). During the examination revealed: partial hemophthalmus, rupture of the choroid, Berlin retinal opacification. Local fibrinolytic conservative therapy with positive dynamics was carried out in the form of increasing visual acuity to 0.3 (ETDRS 21 characters) and partial resolution of hemophthalmus. According to optical coherence tomography angiography (OCTA), minimally active CNV was detected. Due to the weak activity of the pathological process, a decision was made on dynamic observation. A follow-up examination in August 2018 revealed an increase in CNV activity according to OCTA and fluorescence angiography (FAG), in connection with which intravitreal administration of ranibizumab (lucentis) was performed. Subsequently, the patient was under dynamic observation for one year. Positive dynamics was revealed in the form of an increase in visual acuity, first to 0.7 (ETDRS 48 characters) 3 months after intravitreal injection, and after a year — to 0.9 (ETDRS 55 characters). After treatment according to OCTA and FAG, the activity of CNV was not determined. Despite the favorable result of treatment, further monitoring of the patient is necessary, since the long-term prospects for maintaining the achieved high visual functions remain unclear due to the insufficient experience in treating patients with this pathology according to the literature.

Toxacariasis is a parasitic disease from the group of nematodoses, the causative agents of which are toxocaras of dogs and cats (Toxocara canis and Toxocara mystax). Most often, the source of human invasion is dog — the main host of the parasite. Invasion occurs when helminth's eggs are ingested by means contaminated food, water, accidental geophagy, and direct contact with a dog. In the human gut, the larva releases from the egg and migrates, causing a general parasitic infestation known as “visceral migrating larvae” (Visceral larval migrans). Toxocara settles in various organs (lungs, spleen, liver, eyes, brain), which causes the local inflammatory and allergic reactions. The incidence of toxocariasis is a serious problem in recent years, especially in large cities. Each year, relatively low rates of toxocariasis and sporadic ocular infestations are recorded. This situation does not indicate stability of the situation, but rather may be due to insufficient alertness of ophthalmologists in relation to the toxacarous etiology of the inflammatory process in the eye, which leads to incomplete examination of patients and diagnostic errors. An ocular form of toxocariasis may manifest as granulomatous choroiditis, chorioretinitis and parsplanitis with the formation of peripheral granulomas and vasculitis. Complications of these inflammatory diseases are traction retinal detachment, and with a long course, chronic endophthalmitis which develops with the outcome in subatrophy and atrophy of the eye-globe, leading to its death. The disease occurs in children and adult patients. The ophthalmologists should be on the alert to the toxacariasis etiology of the inflammatory process in the choroid and retina. The article cites two case reports of toxacarous chorioretinitis (females of 53 and 57 y.o.) with development of posterior vitreous detachment and hemophthalmos. The dynamics of the pathological process, diagnostic approaches and treatment tactics are described.