Age-related macular degeneration (AMD) is a multifactorial disease. Age, light exposure, smoking, melanin levels and low-antioxidant diet are contributed to AMD development and progression. Cardiovascular disorders are of considerable importance as well. In macula, photoreceptor outer segments that are rich in polyunsaturated fatty acids (FA), particularly, docosahexaenoic acid (DHA), are susceptible to free radicals damage. High blood flow velocity and oxygen partial pressure as well as direct sunlight exposure induce oxidative processes. The source of free radicals in photoreceptor cells and retinal pigment epithelium (RPE) is an extensive mitochondrial metabolism, photoreceptor outer segments phagocytosis, lipofuscin phototoxic activity and hemoglobin or protoporphyrin precursors photosensitization. Oxidative stress is considered as an universal component of cell depth in necrosis, apoptosis and toxic damage. Antioxidant protective system consists of enzymes (superoxide dismutase, glutathione peroxidase and catalase) and non-enzymatic factors (ascorbic acid, alpha tocopherol, retinol, carotenoids). Specific antioxidant food supplement containing ascorbic acid (500 mg), vitamin E (400 IU) and beta carotene (15 mg) coupled with zinc (80 mg of zinc oxide) and copper (2 mg of copper oxide) results in 25 % decrease in late-stage AMD development rate. Amongst the agents that can protect retina from oxidative stress and AMD development, carotenoids are of special importance. Lutein and zeaxanthin containing in retina and lens screen blue light from central area of the retina. They also absorb blue light and inhibit free radicals generation thus preventing polyunsaturated FA light destruction. Association between lutein and zeaxanthin intake and late-stage AMD risk was revealed. Amongst the most important factors which deficiency favors macular degeneration are omega-3 FAs, i.e., DHA. DHA is the key component of visual pigment rhodopsin transformation. It requires for nerve impulse generation.

The data on different antimicrobial agents (fluoroquinolones, minoglycosides, macrolides, fusidic acid, chloramphenicol) and their activity against various microorganisms are reviewed. The findings from different researchers are analyzed. Considerable attention is devoted to the problem of antimicrobial resistance in ophthalmology. Pharmacokinetics of topical antimicrobial agents applied in ophthalmology, their safety and tolerability are described. The indications for topical antimicrobial agents use in ophthalmology approved in Russian Federation are presented. With regard for pharmacokinetics and pharmacodynamics, safety profile and good tolerability, it is concluded that fluoroquinolones are medication of choice for empirical antimicrobial treatment in ophthalmology.

H1‑receptor antagonists are drugs of choice to treat allergy. They work very fast as their therapeutic effect develops within 10‑15 min, have good tolerability and almost no adverse side-effects, and require no frequent instillations. Levocabastine quickly inhibits allergic reaction caused by specific allergen or histamine. Levocabastine while being a highly-selective H1‑receptor antagonist is the most perspective topical mono-drug used to treat acute allergic conjunctivitis. Levocabastine applied on a spot produces instant effect which persists for a long time so that instillations twice a day (BID) are enough. Levocabastine is more effective than other 15 antihistamines. In contrast to previous antihistamines, levocabastine blocks vasodilatation and reduces vascular permeability increase. Levocabastine eye drops have good tolerability comparable with cromoglicic acid eye drops and placebo. Levocabas tine is successfully used in allergic conjunctivitis (pollinosis, perennial, vernal, rhinoconjunctivitis) treatment in children. Its efficacy is the same or even higher than that of cromoglycate and azelastine. 20 clinical studies (more than 1200 patients) revealed that levocabastine eye drops are effective, work quickly and have good tolerability. This drug is efficient in allergic conjunctivitis treatment and acute infectious conjunctivitis complex therapy.

Aim. To discover and identify thyroid receptors in ocular tissues by means of immunohistochemistry (IHC).

Materials and methods.The objects of morphological studies were eyes enucleated for terminal painful glaucoma (n = 30). Thyroid receptors searching was performed in the retina and optic nerve, choroidal and optic nerve vessels. IHC reaction was considered as follows: negative — specific cellular staining is absent or less than 10 % cells are stained; mild positive — 10‑30 % cells are stained (+); moderate positive — 30‑75 % cells are stained (++); highly positive — more than 75 % are stained (+++). 

Results: Intensive (4+) IHC staining was revealed in the nuclei of inner and outer nuclear and ganglion cell layers. Mild positive (+) staining was detected in the inner segments of photoreceptors. Granular (3+) IHC staining was revealed in the nuclei of optic nerve glia. In choroidea, endotheliocytes nuclei and 20 % stromal cells nuclei were stained. IHC
reaction was detected in the cytoplasm of retinal pigment epithelium.

Conclusion. The data obtained account for the mechanism of neurohumoral associations at the cellular level. According to these data, eye can be considered as a target for thyroid hormones. The causes of morphological and functional abnormalities of visual analyzer peripheral part in thyroid gland disorders are revealed as well.

Aim. To describe the dynamics of vascular endothelial growth factor (VEGF) immune expression in the retina using the model of photoinduced branch retinal vein occlusion (BRVO) and to establish the terms of neovascularization appearance.

Materials and methods. BRVO was modelled on 21 chinchilla rabbits (21 eyes) weighing 1.5‑2 kg (fellow eyes served as controls). Photosensitizer «Fotoditazin» (2.5 mg / kg) was injected intravenously. 15 min later, transpupillary laser irradiation of branch retinal vein near the optic nerve head was performed. Irradiation energy density was 200 J / cm2. Histological analysis and immunohistochemistry of the retina was performed following 30 min, at days 1, 2, 3, 7, 14 and 30.

Results. Maximum VEGF accumulation in photoinduced BRVO model was observed on day 2. From day 3, direct neovascularization was confirmed. VEGF levels were stably high throughout the follow-up to the day 30 inclusive.

Conclusion. VEGF immune expression in the retina using the model of BRVO induced by photodynamic exposure was explored for the first time. These data can serve as the basis for future studies in order to define optimal anti-VEGF agent, its dosage and terms to manage this condition.

A novel method that provides complex assessment of meibomian glands morphological and functional state — biometry of meibomian glands — was developed. The results of complex examination (including meibomian glands biometry), correlation analysis data and clinical findings demonstrate direct association between the objective (i.e., meibomian glands dysfunction by biomicroscopy, tear film break-up time / TBUT, symptomatic TBUT, compression testing) and subjective signs of meibomian glands dysfunction (patient’s complaints) and the parameters of meibomian glands biometry. High direct correlation between biometrical index and compression test result was revealed (p = 0.002, Spearman’s rank correlation coefficient = 0.6644). Meibomian glands dysfunction is characterized by biometric parameters abnormalities, i.e., dilatation of meibomian glands orifices, decrease of distance between meibomian glands orifices, partial or total atrophy of meibomian glands (even up to gland collapse with its visual reduction and increase of distance between the glands). The suppression of inflammatory process and the recovery of meibomian glands secretion improve biometric parameters and result in the opening of meibomian glands orifices, liquefaction of clogs, evacuation of meibomian glands secretion, narrowing of meibomian glands orifices and increase of distance between them. The proposed method expands the armamentarium of meibomian glands dysfunction and lipid-deficient dry eye diagnosing. Meibomian glands biometry can be applied in specialized ophthalmological hospitals and outpatient departments. It is a simple procedure of short duration that does not require any special equipment or professional skills. Meibomian glands biometry enables to prescribe pathogenically targeted therapy and to improve quality of life.

Aim. To investigate orbital apex structures in optic neuropathy (ON) due to edematous exophthalmos.

Materials and methods. 172 edematous exophthalmos patients were examined. In 46 patients, ON was diagnosed. These patients were divided into 2 groups: early ON (29 patients / 58 eyes) and advanced ON (17 patients / 33 eyes). Standard computed tomography (1‑mm axial and frontal scanning) was performed in all patients.

Results.The volume of the orbit and its apex in ON patients was the same as the one in healthy individuals. However, the volume of extraocular muscles was increased in general (5.04±0.07 cm3 in early ON and 6.53±0.044 cm3 in advanced ON) and in orbital apex (1.56±0.02 cm3 and 2.4±0.036 cm3, respectively). The ratio of total orbit volume to extraocular muscles volume was reduced to 5.05 in early ON and to 3.9 in advanced ON. The ratio of orbital apex volume to extraocular muscles volume was reduced to 2.87 and 2.007, respectively.

Conclusion. In ON, the volume of extraocular muscles in orbital apex is significantly increased. This results in the severe disturbance of anatomic topographic relations of orbital soft tissues and the compression of neurovascular bundles.

Aim. To analyze the efficacy of Ologen® Collagen Matrix Implant in refractory glaucoma surgery.

Materials and methods. Classical non-penetrating deep sclerectomy (NPDS) with Ologen® implantation in the scleral bed was performed.

Results. Post-op, implant was visualized underneath the conjunctiva and moved within the scleral flap. Implant was resolved in 3 months with moderate filtering bleb formation. Following 12 months, visual acuity and visual fields were stable, IOP level was 12‑17 mm Hg.

Conclusion. Within 12‑months follow-up, Ologen® implantation in the course of glaucoma surgery prevents scleral conjunctival scarring, provides long-term IOP-lowering effect and preserves residual visual functions.

Aim. To reveal early glaucoma diagnostic criteria in high-degree axial myopia based on the morphometric analysis of the retina and optic nerve.

Materials and methods. Standard ophthalmic exam, OCT of the retina and optic nerve as well as macular pigment optical density (MPOD) measurements were performed in three cohorts of patients with axial myopia (normal IOP, glaucoma, ocular hypertension / OHT). In OHT group, the data obtained were analyzed by the parameters for which significant differences between normal IOP and glaucoma cohorts were demonstrated.

Results. Significant differences were identified between study (axial myopia and OHT) and control group (axial myopia and normal IOP) by the following parameters: 1) IOP measured by pneumotonometry (20.5±3.1 vs 13.3±0.8 mm Hg, respectively); 2) corneal-compensated IOP estimated by Ehlers based on 5‑g Maklakov applanation tonometry
(19.1±2.8 vs 15.1±1.0 mm Hg, respectively); 3) ganglion cell complex and inner plexiform layer thickness in the superior macular region (73.4±7.0 vs 81.0±3.2 μm, respectively); 4) retinal nerve fiber layer thickness in the inferior peripapillary area (99.6±14.9 vs 121.9±9.4 μm, respectively); 5) choroidea thickness in foveal center (258.1±48.1 vs 315.8±29.5 μm, respectively) and 3 mm nasally to foveal center (130.0±32.1 vs 161.0±29.8 μm, respectively).

Conclusion. It is reasonably to isolate axial myopia and OHT patients into glaucoma high-risk group that requires careful dynamic follow-up and therapy correction. Glaucoma diagnostic criteria should be also revaluated as the possibilities of modern diagnostic base and its resolution increase.

Aim.To study the effect of terahertz (THz) radiation at atmospheric oxygen frequency (129 GHz) on cardiovascular and hemodynamic parameters of orbital arteries following the irradiation of bioactive points in healthy volunteers and age-related macular degeneration (AMD) patients.

Materials and methods. 18 healthy volunteers (36 eyes) and 20 AMD patients (34 eyes) were examined. Blood pressure (BP), heart rate (HR), systolic and diastolic blood flow velocities, resistance index (RI) in orbital arteries before and following THz radiation of two bioactive points VB1 and TR23 at atmospheric oxygen frequency 129 GHz in continuous
wave generation mode were measured.

Results. First data on the effect of THz waves at atmospheric oxygen irradiation and absorption molecular spectrum frequency (129 GHz) in continuous wave generation mode on ocular hemodynamics in healthy persons and AMD patients are presented. Following THz irradiation at atmospheric oxygen frequency (129 GHz), common hemodynamic
parameters (BP, HR) decreased. In healthy volunteers, systolic and diastolic BP reduced by 22.83±4.09 and 8.82±0.98 mm Hg, respectively (р<0.05), HR reduced by 6.11±0.15 bpm (р<0.05). In AMD patients, systolic and diastolic BP significantly decreased by 45.55±0.43 and 9.56±1.42 mm Hg, respectively (р<0.05), HR decreased by 6.15±1.1 bpm (р<0.05). In AMD patients, systolic blood flow velocity significantly reduced by 2.89±0.1 cm / sec in central retinal artery and increased by
0.9‑5.97 cm / sec in short posterior ciliary arteries and ophthalmic artery. RI in these vessels decreased by 0.13, 0.11, 0.13 and 0.12, respectively.

Conclusion. THz waves at atmospheric oxygen irradiation and absorption molecular spectrum frequency (129 GHz) are safe and cause no side effects on general health of healthy volunteers and AMD patients. Besides, this method improves ocular hemodynamics.

Clinical case of acute hydrops treatment using subtotal penetrating keratoplasty (PK) is presented. The diagnosis of acute hydrops was based on clinical and functional evaluations including optical coherent tomography (OCT). A part of diseased cornea was removed and examined under a light microscope. These studies revealed morphological changes in almost all corneal layers. OCT and histology demonstrated that PK was indicated to this patient. Recent literature data on the epidemiology and pathogenesis of acute hydrops are presented. This rare disease results from tears in the Descemet’s membrane that allow aqueous humor to enter the stroma. Current treatment is aimed to suppress corneal inflammation, restore endothelium and Descemet’s membrane integrity and drain stromal cysts to optimize cornea healing. In this case, subtotal PK was performed due to the significant corneal thinning and a high risk of its melting. «Material for corneal graft» (iLab, Moscow, Russia) was used as a donor material.