Currently, the main applied physiotherapeutic methods of treatment, whale, as well as the features of their application are considered. The basis of the meibomian glands dysfunction treatment is the hygiene of the eyelids. There are many modifications to the application of eyelid hygiene, but its basic principle is the use of warm compresses and eyelid massage. There are many modifications of warm compresses. Using them, it is necessary to remember about the possibility of the appearance of the cornea with various types of thermal effects on the eyelids when dysfunction of the meibomian glands is detected, therefore it is important to carefully dose the time of thermal exposure and temperature regime, which allows you to avoid side effects. The classic tool that a doctor uses to treat MGD — eyelid massage on a glass rod, has now been replaced by many high-tech devices for heating, moisturizing and massage of the eyelid. All commercial devices for the treatment of MGD on the world market can be divided into several groups, according to their effect: device for light therapy. The most high-tech devices include the LipiFlow® device (combined heat and eyelid massage) and the device for IPL therapy with intense pulsed light. many studies aimed at studying the effectiveness of various research methods. It should be noted that it is not by chance that in modern ophthalmological practice the range of new methods for studying MGD has expanded so much. This is due to the annual number of patients suffering from this pathology. Therefore, the urgent task is to search for new methods of treatment aimed at restoring the functional activity of the meibomian glands. 

This review analyzes the data on the effectiveness of the use effectiveness of the use of laser methods for the treatment of patients with glaucoma, namely selective laser trabeculoplasty. The authors analyzed the sources of domestic and foreign literature for 1996–2020. The review reflects the history of application of this method, as well as the rationale for choosing it, as the treatment for various forms of glaucoma. The efficiency of once or repeatedly applied procedures, depending also on the modification of SLT used, are presented according different authors. So far, SLT has been proven to be the laser treatment that improves the safety and efficacy of glaucoma treatment. It is necessary to continue research to study the possibilities of using it as an alternative to local hypotensive therapy, when choosing a treatment strategy for newly diagnosed initial glaucoma. 

Uveitis is an inflammation of the uvea (iris, ciliary body, choroid) that can spread to the retina, vitreous and other structures of the eye. Non-infectious uveitis accounts for 31.5 to 82.9 % of cases. The prevalence of infectious uveitis ranges from 13.0 to 54.7 %. Verification of the etiological diagnosis of uveitis requires an individual approach in each clinical case and is based on a thorough analysis of the patient’s medical history, the presence of systemic diseases, and physical examination data, which is supplemented by various laboratory and instrumental examination. However, despite the widespread development of modern diagnostic capabilities, the etiology of uveitis remains unknown in 30–50 % of cases after non-invasive studies, and the treatment is prescribed empirically. At the present stage of studying this issue, the search for a pathological agent, that can play both an etiological role in the development of infectious uveitis and a trigger role in the non-infectious process, is still an urgent task. The article presents a review of the literature on the evolution of methods for the diagnosis of infectious and non-infectious uveitis in accordance with changing ideas about the etiology and pathogenesis of the disease, epidemiological, geographical and socio-economic factors, improving surgical techniques. Pathogenetic aspects and the role of infections in the development of non-infectious uveitis are discussed. 

The authors presented a complete comprehensive analysis of the combined data of 11 cross-sectional (static) and 11 longitudinal cohort studies with follow-up durations of 5 to 14 years, 16 case-control studies, as well as 3 systemic meta-analyses and 1 “umbrella” study evaluating the scientific hypothesis that hypermetropia is a risk factor for the development of age-related macular degeneration (AMD). In these studies, AMD was verified against the diagnostic criteria of three different classification systems: those of the National Eye Institute (USA), the International System for the Study of Age-Related Maculopathy, and the Wisconsin Classification WARMGS. A total of 82308 patients with AMD were enrolled. 3 baseline indicators in the population were analyzed: the initial hypermetropia, the spherical coefficient (SE) and the axial length of the eye (AL), on the one hand, and the prevalence of AMD, on the other hand. Traditional statistical indicators were calculated: the risk ratio (RR) of AMD among hypermetropes compared to emetropes and a 95 % confidence interval (CI). Pooled data from meta-analyses showed significant associations between farsightedness, SE, AL, and the prevalence of early AMD. The combined RR and 95 % CI were: 1.13 (1.06–1.20), 1.10 (1.07–1.14), and 0.79 (0.73–0.85), respectively. An increase in SE by diopter was correlated with early AMD (RR 1.06; 95 % CI 1.02–1.10). The late AMD did not confirm its association with the refractive error. The umbrella meta-analysis lowered the statistical significance of this association for early AMD (RR 1.08, 95 % CI 1.01–1.18); with late AMD (RR 0.84, 95 % CI 0.77–0.91). In general, experts came to the conclusion that the likelihood of developing AMD depends on the refractive status of the patient. 

Neurotrophic keratitis (neurotrophic keratopathy) (NTC) is a degenerative disease of the cornea accompanied with neurogenic inflammation. It is caused by a loss of sensitive innervation of the trigeminal nerve. Therapeutic measures are mainly reduced to maintenance therapy (antiseptics, artificial tears, corneal protectors), which does not affect the cause of the disease. The most affordable and updated therapy is the long-term topical use of auto- or heterologous serum. Recently developed specific approaches to the treatment of NTK — local therapy with recombinant nerve growth factor Cenegermin and corneal neurotization are aimed at the pathogenetic links of the disease and can restore the innervation and sensitivity of the cornea.

In recent years, due to advances in surgical technique, instruments and design of intraocular lenses (IOLs), patient expectations of cataract surgery have increased significantly, often matching those after refractive interventions. A number of factors affect postoperative visual acuity, including the presence of concomitant pathology in patients, the experience of the surgeon, the choice of IOL model and other factors. In the presence of “short” eyes, with an axial length of less than 22 mm, the formulas available in the arsenal for calculating the optical power of the IOL are less accurate than for eyes with normal sizes, which is of great difficulty for the surgeon. The most important factors include the choice of model and calculation of IOL optic power associated in case of failure with patient dissatisfaction with the treatment. The review discusses the definitions of the concepts of hyperopia, microphthalmos and nanophthalmos. The sources of errors are presented when choosing a formula for calculating the IOL optic power, including the use of various instruments for measuring axial length and other parameters of the eye. The necessity of optimizing the IOL constants for “short” eyes is given. The effectiveness of the main currently used formulas is considered, including Hoffer Q, Haigis, Holladay 1, Holladay 2, SRK / T, Barrett Universal, Super Formula, Olsen, T2, Hill-RBF, Kane. Progress in lens disease surgery does not stand still and is aimed at improving diagnostic equipment and standardizing and synchronizing various types of biometers, increasing the number of variables in formulas for calculating the IOL optic power, further standardizing diopter power in the manufacturing of IOLs, and the need to develop a unified formula for calculating optical power Artificial Intelligence IOL with the possibility of its constant access to a huge array of preoperative research data manhole and postoperative assessment of results. Management of patients with an axial length of less than 22.00 mm remains a challenge for ophthalmic surgeons, given the difficulties encountered in choosing an IOL and the complications of surgery. The available formulas for calculating the IOL optic powerneed to be adjusted for this group of patients. 

The balance between the efficiency of lens’ destruction and the safety of this process for intraocular structures is the most important aspect in the search for alternative energy approaches in cataract surgery. The article provides a literature review summarizing modern medical and technical solutions aimed at developing new and effective methods of cataract phacoemulsification. One of the main components of cataract surgery is the balance between the effectiveness of ultrasound destruction of the lens and the safety of this process for intraocular structures. Most of the available technical solutions designed to replace ultrasound do not yet allow this to be fully implemented, since they have insufficient destructive power or are technologically complex and expensive, which makes it difficult for their mass introduction into widespread practice. In this regard, it is urgent to search for alternative energy approaches aimed at increasing the efficiency of destruction without increasing the negative effects associated with an increase in ultrasound dose. 

The article describes the existing methods of preventing the occurrence and progression of capsule bag fibrosis. The types of used treatment are listed and structured. Key aspects of the principles of surgical treatment are highlighted. They are aimed to eliminate the dislocation of the IOL-fibrous capsular bag complex. Special attention is paid to the methods of suture and sutureless fixation of the IOL to the sclera or iris. The author’s techniques are given. Variants of fixing devices were used. The risks of possible complications were analyzed. Conclusion: capsular syndrome is an actual problem that requires attention and search for optimal treatment methods, depending on comprehensive assessment of the initial condition. 

Relevance. Today, keratorefractive surgery is a high-tech branch of ophthalmology and provides a predictable, high-precision, stable and safe refractive result in patients with a wide range of refractive disorders.

Purpose. To evaluate the clinical and functional results of myopia correction using the technology of fractional lenticular extraction performed using femtosecond VisuMax and LDV Z8 lasers.

Materials and methods. Within the framework of this work, 160 patients (160 eyes) with inpatient myopia of medium and high degree were examined and operated, with average keratometry parameters (43.0–45.0 dptr), aged from 18 to 36 years. The follow-up period was 1 month after the operation. The SMILE group was formed: a group of patients who underwent surgery using refractive lenticular extraction technology using a femtosecond VisuMax 500 laser (80 eyes); and the CLEAR group: a group of patients who underwent surgery using refractive lenticular extraction technology using femtosecond laser Femto LDV Z8 (80 eyes).

Results and discussion. Operations with SMILE and CLEAR technology were performed in the Department of refractive laser surgery of the FSAU NMIC MNTC “Eye Microsurgery” named after S.N. Fedorov of the Ministry of Health of Russia (Moscow) according to standard protocols. No intraoperative complications were recorded. The analysis of comparable clinical and functional results of myopia correction using the technology of fractional lenticular extraction performed using femtosecond VisuMax and LDV Z8 lasers was carried out.

Conclusion. Thus, the analysis of the clinical and functional results of correction of myopia of medium and high degree by the technology of refractive extraction of the lenticle performed using femtosecond lasers VisuMax and LDV Z8 showed their high comparability in terms of efficiency, safety, predictability and stability. A new technology of fractional lenticular extraction using a comprehensive assessment of the condition of the ocular surface at the preoperative stage, which allows to identify and eliminate the changes that have occurred, can be recommended for widespread clinical implementation. 

Objectives: To obtain information on the frequency of using preloaded IOL delivery system, the time of the IOL implantation procedure, the convenience of using various preloaded systems, the incidence of complications and the overall level of satisfaction during the work by ophthalmologists during a survey of experts.

Methods. A survey was conducted among 14 Russian experts from different regions who already have practical experience with the following preloaded IOL implantation systems: RayOne® Aspheric (RAO600C), iSert® (250/251), iTec (Tecnis®1) and AutonoMe™ (Clareon®). The evaluation was carried out on a 10-point scale for parameters related to IOL implantation safety when using preloaded systems, convenience and intuitive operation, the level of control over the IOL implantation process, and the overall total time required to complete the entire IOL implantation procedure.

Results. Among all the parameters, the experts gave the highest safety rating of the IOL implantation when using preloaded systems; in general, quite high scores were also assigned to the other parameters, reflecting satisfaction with the work by the experts. In a comparative analysis of the parameters of IOL implantation safety, convenience and intuitive operation, the level of control over the IOL implantation process, as well as the total time required for the entire IOL implantation procedure, depending on the type of preloaded systems, significant differences were obtained (p = 0.012, p = 0.001, p = 0.003, p = 0.014, p = 0.004, respectively). Frow the 4 analyzed system types, AutonoMe™ (Clareon®) achieved the highest scores across all dimensions (10.0, 9.0, 10.0, 9.0 and 9.5, respectively).

Conclusion. This experts’ survey is the first Russian experience of evaluating the real practice of working with different types of preloaded systems for implanting IOLs. The survey indicated that the greatest application experience currently exists with the preloaded AutonoMe™ (Clareon®) system, which scored higher across all analyzed parameters when compared to systems from other manufacturers. 

Violation of the correct location of the complex IOL capsule bag (CICB) in the delayed postoperative period occurs with a frequency of 0.2 to 2.8 %. The basis of the pathogenesis of this complication is the destruction of the zonal ligament due to progressive pseudoexfoliative syndrome, as well as the process of fibrosing the capsule bag. The stage of the flow and the different degree of severity of each mechanisms determines the variety of clinical manifestations. CICB dislocation in combination of these two mechanisms requires a special approach to treatment.

Objective: to develop a system of surgical treatment of IOL dislocations in contract capsule syndrome, with varying degrees of severity, combined with the weakness of the ligament apparatus of the lens, and to present the results of its use.

Patients and methods. Retrospective analysis of 55 cases of CICB dislocations with the observation period of more than 4 years operated in 2014-2016. Number of dislocations with certain IOL type: Hydrophilic monolithic — 27, Hydrophilic monolithic — 11, Hydrophilic three-part — 10, Hard — 7. The selection criterion was the presence of CICB dislocation in the combination of weakness of the ligament apparatus (II–III st. of severity) and contraction capsule syndrome, with varying degrees of severity. A system is proposed to allow a low-invasive repositioning of intraocular lenses dislocated with a fibrous capsule bag with subsequent suture fixation to the iris. Signs used for choice of surgical technique: localization of capsule bag fibrosis, contract effect of capsule bag fibrosis on IOL position and correct location of haptic elements, size, and severity of equatorial lens masses (Semmering ring). In cases when insufficiency of the ligament apparatus prevails, with insignificant fibrosis of the capsule bag, without contractional influence, fixation of KIKM to iris is carried out without cutting of the capsule bag (method 1). As the fibrous changes of the front or back leaf of the capsule progress without changing the position of IOL inside the capsule bag due to contraction, along with fixation of KIKM, the fibrous front/back capsule is excised (method 2). The variant of complete removal of the fibrous capsule bag is used in faraway stages of CCS with further fixation of IOL to the iris (method 3).

Results. The data of BCVA and IOP of patients treated by a certain method (before the operation, early postoperative period (2–5 days), delayed period (more than 4 years)) are presented.

Conclusion. Surgical treatment of patients with CICB dislocation combining manifestations of Capsule contraction syndrome and weakness of the lens ligament apparatus can now be standardized using a proper approach and certain methods of treatment, but requires a comprehensive assessment of such parameters as the safety of the ligament apparatus, the localization and degree of fibrous changes of the anterior / posterior capsule, the contractional effect of the capsule bag fibrosis on the front position of the IOL optics and the correct location of the haptic elements, the severity of the ring. 

Objective: to analyze the results of treatment in patients with refractory glaucoma of various stages of the disease by microimpulse cyclophotocoagulation.

Patients and methods. We examined 43 patients aged 68.5 ± 13.2 years with primary open-angle repeatedly operated subcompensated glaucoma (POAG) of advanced (13) and advanced (30) stages before and after performing MCPC (SUPRA 810 device, QuantelMedical, France) using standard laser parameters: energy W = 2000 MJ, 31.3 % — duty cycle, exposure time — 80 seconds per hemisphere.

Results. The operation and postoperative period were uneventful. The hypotensive effect was achieved in all cases up to 6 months of follow-up. In the advanced stage of the disease, IOP decreased from 26.8 ± 7.8 mm Hg to an average of 17.1 ± 8.1 mm Hg (p < 0.05), and the amount of antihypertensive agents decreased from 2.89 ± 0.74 to 2.4 ± 0.6. in patients with advanced stage, IOP decreased from 29.9 ± 7.8 mm Hg to 21.0 ± 8.3 mm Hg (p < 0.05), and the amount of antihypertensive agents decreased from 3.1 ± 0.4 to 2.8 ± 0.5. The maximum corrected visual acuity (MCI) in all patients remained at the preoperative level during the entire follow-up period.

Conclusion. Analysis of the results has shown that the use of microcyclophotocoagulation in patients with refractory glaucoma has not led to the development of postoperative complications, reduced intraocular pressure by 36.2 % from baseline, when developed and 29.8 % in advanced stages of the disease, reduced the number of antihypertensive drugs was 17 % in the second and 10 % at third stage and have not led to a decrease in visual function at 6 months follow-up. Thus, it is proved that the use of a diode laser in micro-pulse mode during microcyclophotocoagulation is a safe and effective method of treating refractory forms of glaucoma at various stages of the disease. 

IOL power calculation after keratorefractive surgery is an important applied aspect of cataract surgery. The probability of refractive error is especially high when calculating in patients with a history of radial keratotomy. There is no unified approach to the tactics and methodology of calculation for this category of patients at the moment. The studies were conducted in a group of 17 patients (26 eyes) with a history of RK. The Haigis formula, which does not use keratometry to predict ELP, was chosen as the main one for the calculation. IOL calculation and biometrics were carried out on the IOL-Master, but corrected TCP IOL (Ray Traced) data obtained on the Galilei keratotomograph were manually entered into the optional keratometry fields. Thу Burrett True-K and Hoffer Q were used as verification formulas, the calculation was also carried out on IOL-Master, using corrected Galilei data. In all cases, postoperative refraction close to emmetropic was obtained. The spherical component of refraction ranged from +0.5 to -1.0 D, cylindrical — from 0.0 to 4.0 D, according to autorefractometry. Visual acuity without correction ranged from 0.4 to 1.0. Uncorrected visual acuity of 0.8 and higher was obtained in 65.38% of cases. The calculation algorithm implemented by us using the Haigis formula in combination with the use of individually adjusted keratometric TCP IOL data (Ray Traced, Galilei), allowed us to significantly improve the accuracy of IOL power calculating in patients with a history of RK and achieve target refraction even in cases of complex and irregular corneal topography. 

Purpose — to study visualized biomarkers before and after navigation laser treatment in patients with diabetic macular edema (DMO) using optical coherence tomography-angiography (OCT-A).

Methods. 85 patients (85 eyes) with focal DMO were under observation. The patients were divided into two groups, depending on the method of laser treatment used: group 1 consisted of 50 patients (50 eyes) who underwent navigation sub-threshold laser exposure in micro-pulse and continuous modes with individual selection of energy parameters according to the developed technology (patent RF for invention No. 2752544 of 27.01.2021), in group 2 (35 patients, 35 eyes) laser coagulation was performed according to the type of “modified grid”. The treatment was carried out on the NAVILAS 577S navigation laser system (“OD-OS”, Germany). All patients in both groups underwent high-resolution OCT-A according to the Angio Retina 3×3 mm and HD Angio Retina 6×6 mm protocol. The following biomarkers were evaluated by the OCT-A method: vascular density of the superficial vascular plexus (SCP), deep vascular complex (DCP); the number of microaneurysms and hyperreflective points; the area of the foveal avascular zone, as well as cysts and zones of disorganization of the inner layers of the retina (DRIL), at various times before and after (1, 3 and 6 months) treatment.

Results. According to OCT-A, as a result of treatment in group 1, there was an increase in total vascular density from 38.45 ± 0.4 % to 44.85 ± 0.66 % in SCP and from 43.55 ± 0.38 % to 44.85 ± 0.66 % in DCP by 6 months of follow–up. In group 2, the total vascular density in SCP increased from 37.4 ± 0.36 % to 37.85 ± 0.34 %, in DCP from 43.35 ± 0.38 % to 44.05 ± 0.41 %. The number of microaneurysms decreased on average from 12 ± 0.42 to 9 ± 0.3 by 3 months and 7.5 ± 0.26 by 6 months in group 1 and, from 19 ± 0.7 to 15.5 ± 0.6 (3 months) and 13 ± 0.5 (6 months) — in group 2. The number of hyperreflective points decreased in terms of 3 and 6 months in both groups. The area of cysts progressively decreased, and the area of FAZ and DRILS was stable throughout all the follow-up period.

Conclusion. OCT-A is a highly informative diagnostic method that allows noninvasively to identify visualized OCT-A biomarkers, as well as to evaluate the effectiveness of navigation laser exposure in patients with diabetic maculopathy with focal diabetic macular edema. 

Neurotrophic keratopathy (NTK) is an orphan, polyetiological disease that has recently been identified more frequently. Drug-resistant stages of NTC often require urgent surgical treatment. Subsequently, such patients need to be done keratoplasty, the consequences may be unsatisfactory in the presence of a significant impairment of innervation.

Purpose: to evaluate the effectiveness of lamellar anterior keratoplasty in patients with the outcome of stage II and III NTK.

Material and methods. The study included 22 patients (22 eyes) aged 21 to 88 years. All patients were divided into two main groups. The first group consisted of 12 patients with NTC as a result of damage to the main stem of n.trigeminus and its branch n.ophthalmicus, the second group consisted of 10 patients — NTC as a result of toxic damage due to uncontrolled instillation of local anesthetics and eyedrops with preservatives. Before inclusion in the study, 14 patients underwent autoconjunctivoplasty for the treatment of drug-resistant NTK stage II and III, 8 — corneoscleral flap coating. All patients underwent lamellar anterior keratoplasty. The following parameters were assessed: maximally corrected visual acuity (MCVA) and coefficient of corneal sensitivity reduction in an approximate way before and after 1 day, 2 weeks, 1 and 3 months after surgery; tear film break- up time (Norn test) and Schirmer’s I.

Results. In the second group an increase in the level of BCVA and a clear graft was observed in all patients, while in the first group, the level of BCVA worsened, and the graft was with reduced transparency. Significant difference between the examined and the fellow eye in the compared groups according to the tear film break-up time test was not detected. In the first group statistically significant decrease of tear production according to the results of the Schirmer’s test was identified. A weak correlation was found between corneal sensitivity and BCVA after surgery in group II.

Conclusion. We have demonstrated the high efficiency of automated layered anterior keratoplasty in the outcomes of advanced stages of NTK of toxic etiology. In patients with NTC outcome as a result of stem injury, surgical treatment led to a satisfactory cosmetic result, but visual acuity did not change significantly. 

Relevance. Modern keratorefractive surgery is a high-tech field of ophthalmology aimed at solving various problems of correcting a wide range of ametropias.

Objective: to formulate recommendations for refractive surgeons when planning the correction of hypermetropic refraction using modern keratorefractive surgery.

Materials and methods. An analysis of 20 literature sources and a retrospective analysis of outpatient records of 188 patients with hypermetropia who underwent surgery were carried out.

Results. The analysis of the literature and our own clinical study allows us to recommend focusing on the final keratometry after keratorefractive surgery, which should not exceed 48 diopters. Among the analyzed charts of patients in compliance with these criteria, the accuracy of hitting the target refraction in the range of ± 1 D was 98.9 %, the regression did not exceed 0.5 D from that obtained 1 month after surgery in 96.8 %, and the loss of 1 line of BCVA was 3.7 % of cases. Among patients with achieved keratometry above 48 diopters, the loss of line 1 BCVA was 13.8 %, line 2 — 2.7 %.

Conclusion. Thus, the tactics of correction of hypermetropia by CRC methods require an integrated approach to the assessment of visual functions, drug preparation for surgery, careful implementation of the surgical stages of the intervention, and rational postoperative pharmacological support. 

Purpose: to develop a comprehensive method of meibomian gland dysfunction (MGD) treatment, including the periorbital zone massage, aimed to improving the microcirculation of the eyelids and the functional activity of the meibomian glands, evaluating its effectiveness and safety.

Patients and methods. The study included 92 patients (184 eyes) with all forms of permanent residence in accordance with the international classification of the DEWS working group, 32 of them were men and 60 women. All patients included in the study at the first stage of work were randomly divided into 3 groups, depending on the type of therapy. The first group included 34 patients (68 eye), in which complex therapy was carried out in the form of eyelid hygiene + massage in the periorbital zone according to the methodology developed during the study, the second group included 30 patients (60 eyes) who underwent IPL therapy (the use of intense pulsed light in the periorbital zone), the third group included 28 patients (56 eyes) who were treated in the form of eyelid hygiene (warm compresses + eyelid self-massage).

Results and discussion. A technique of massage in the periorbital zone was developed, its effect on hemodynamic parameters of the eyelids was studied, and to assess its effectiveness, a comparison of hemodynamic parameters of the eyelids was carried out with two other methods of thermal exposure — eyelid hygiene (warm compresses + eyelid self-massage) and IPL therapy. It was found that all three types of exposure — IPL therapy, eyelid hygiene and eyelid hygiene + massage in the periorbital zone, carried out according to the original technique, lead to an increase in hemodynamic parameters of the eyelids and in the lacrimal artery (according to laser Doppler flowmetry and color Doppler mapping) to varying degrees of severity, which should contribute to an increase in the metabolism of Meibomian glands, therefore, and the improvement of their functional activity. At the same time, 3 months after the treatment starting, the improvement of the the meibomian glands’ functional activity of was higher in the group of patients in which IPL therapy and complex effects — eyelid hygiene + massage in the periorbital zone were performed, compared with the group with only eyelid hygiene. However, after 6 months, high indicators of the functional activity of the meibomian glands remained only in the group with complex effects — eyelid hygiene + massage in the periorbital zone. Such a therapeutic effect, according to the results of the study, improves the patients’ quality of life according to data of the SPEED questionnaire and directly depends on adherence to treatment on the Morisky scale (MMAS).

Conclusions. The presented complex of therapy can be recommended for wide application in ophthalmological practice for the treatment of dysfunction of the meibomian glands. 

Purpose: to study the level of pro- and antiangiogenic growth factors in the vitreous fluid of the eyes with the neovascular form of agerelated macular degeneration (nAMD) against the background of antiangiogenic therapy.

Patients and methods. The concentration of proangiogenic (IL-8, angiogenin, TNF-α, VEGF, bFGF) and antiangiogenic (IFN-α, TGF-β IFN-γ) growth factors in the vitreous fluid of nAMD patients was determined by multiplex flow cytometry. Patients with senile cataracts without signs of AMD and cataract patients burdened with naïve (untreated) nAMD were in the comparison groups.

Results. Compared with senile cataracts, proangiogenic cytokines TNF-α were present more frequently and at a higher level in the vitreous fluid of the eyes with treated nVMD (75 % vs. 47.5 %, p < 0.05; Msr ± m: 2.4 ± 0.5 vs. 1.4 ± 0.3 pg/ml, p < 0.05), IL-8 (100 % vs. 75 %, p < 0.01; 492.9 ± 75.7 vs. 8.5 ± 1.5 pg/ml, p < 0.01), angiogenin (3822.4 ± 498.6 vs. 2820.2 ± 319.3, p < 0.01) and FGFb (58.3 % vs. 26.7 %, p < 0.05; 10.1 ± 5.9 vs. 2.7 ± 1.0, p < 0.01). In both groups of patients, antiangiogenic factors IFN-γ and TGF-β were practically not detected, but the concentration of IFN-α was significantly higher (6.4 ± 1.7 versus 4.4 ± 0.4, p < 0.01). VEGF levels in both nosological groups were almost identical: 17.5 ± 14.0 (with nAMD) versus 18.4 ± 3.2 (n/a), while VEGF was found in vitreous fluid in the cataract group significantly more often (68.2 % vs. 17 %, p < 0.01). By way of explanation, the authors suggested that since patients with nAMD had previously been administered the anti-angiogenic drug Ranibizumab, it is possible that the VEGF production was under the control of the drug, that is, suppressed or blocked.

Conclusion. Elevated levels of proangiogenic growth factors IL-8, angiogenin, TNF-α and bFGF in vitreous fluid with nAMD against the background of antiangiogenic therapy with ranibizumab suggest the presence of other, independent of VEGF, acting mechanisms for stimulating angiogenesis. The absence of antiangiogenic growth factors IFN-γ and TGF-β in the vitreous fluid allows us to think about the presence of a defect in the control and regulation of angiogenesis in nAMD. The rare detection of VEGF in combination with a significant decrease in its concentration compared to senile cataracts against the background of treatment with ranibizumab of the eyes with nAMD demonstrates targeted inhibition in practice. Against the background of treatment with angiostatic drugs, an inversion of the angiogenic phenotype occurs with the formation of new workarounds of angiogenesis, which apparently dictates the connection of drugs with other mechanisms of action. 

Purpose. Conduct extended analysis of cytokine status and its role in inflammatory processes in uveal melanoma based on multiplex analysis of blood serum.

Patients and methods. Immunological studies of blood serum and lacrimal fluid were performed in 80 patients with uveal melanoma and 38 healthy donors (control group). The average age of the surveyed was 53.7 ± 12.2 years. Group 1 included 32 patients with small-sized choroidal melanoma (T1NoMo), group 2 consisted of 26 patients with medium-sized tumors (T2NoMo), group 3 — 22 patients with large tumor size (T3NoMo). Cytokine content was determined in blood serum by the method of multiplex analysis on the xMAP platform in the Luminex xPONENT 3.1 program using 47 plex kits (ProcartaPlex, eBioscience, Austria).

Results. In blood serum — increase of pro-inflammatory (LIF, RANTES, IP-10), anti-inflammatory (TGF-1β), proliferative (IL-15), pro-tumor (EGF), angiogenic (PIGF-1 and SDF-1α) cytokines compared with control group, p < 0.05.

Conclusion. In response to the manifestation and growth of uveal melanoma, many chemoattractant mediators of proinflammatory, angiogenic, proliferative action are produced that promote metastasis. The study of cytokines at the systemic level in serum leads to a deeper understanding of the pathophysiology of carcinogenesis and to facilitate the development of targeted therapies for inhibiting tumor growth. 

Purpose: to study the hemodynamic parameters in the eye’s vessels in children with endogenous uveitis, depending on the localization and degree and activity of the inflammatory process.

Patients and methods: 67 children aged 6 to 18 years were examined. Of these, 19 people (35 eyes) were diagnosed with anterior uveitis, 20 (38) — peripheral, 8 (14) — posterior, 10 (20) — panuveitis. There were subgroups according to the degree of inflammation activity in each group. There were 10 healthy children (20 eyes) in the control group. The maximum systolic (Vsyst), final diastolic (Vdiast) blood flow rate and resistance index (RI) in the ocular artery (GA), central retinal artery (CAC), posterior short ciliary arteries (ZCCA), central retinal vein (CVS) and superior ocular vein (VGV) were detected with the method of the Color Duplex Scanning (CDR).

Results. The maximum systolic and final diastolic blood flow rates in GA decrease, and in panuveitis, on the contrary, increase in anterior uveitis on the location of active inflamation. In panuveitis, the blood flow rate in the HBV also increases. In peripheral uveitis, there is a decrease in systolic and diastolic blood flow rates and an increase in the resistance index in CAC and WCC. With posterior uveitis, the blood flow in the HBV slows down and the RI in the CAC and WCC increases.

Conclusion. In children with active uveitis, according to the CDR, hemodynamic changes in the vessels of the eye are observed, it depends on the localization of the inflammatory process. They have multidirectional nature. In most cases, a decrease in blood flow rate and an increase in RI are detected. The study of the eye’s hemodynamics can be an additional criterion for assessing the activity of inflammation and the effectiveness of therapy, as well as differential diagnosis of various localization of the uveitis. 

The introduction of OCT-angiography was a milestone in studying the early stages of diabetic retinopathy (DR). The latest findings show significant changes in foveal avascular zone (FAZ) parameters (FAZ area, FAZ perimeter, acirculatory index, axis ratio, FAZ angle) in diabetes mellitus (DM) patients with no ophthalmoscopic signs of DR. Many research groups evaluate vessel density (VD) in superficial and deep plexuses in these patients using different methods of image postprocessing, different qualitative and quantitative parameters. Nonperfusion areas (NA) are very important findings at the preclinical stage of DR, which can be detected in superficial and deep layers. With OCT-A it is possible not only to reveal them but also to calculate their area. Vascular tortuosity (VT) was described earlier using fundus photography. Nowadays VT can be assessed at the microcirculation level in OCT-A scans. Microaneurysms are the earliest clinical sign of DR. They can be missed in fundus photos, but easily detected with OCT-A. The aim of the current review is to analyze the latest OCT-A findings at the preclinical stage of DR and to discuss the future diagnostic value of OCT-A in DR. 

Purpose. Development of the final version of the “quality of life” (QoL) questionnaire for a patient after cataract phacoemulsification (PEC) based on an expert assessment by ophthalmologists.

Methods. According to the results of the previously completed stage of work, 35 possible complaints of the patient were identified. The study was performed with the participation of 47 expert ophthalmologists with professional experience from 7 to 35 years (average 19.2 ± 1.4 years), including experience in performing PE from 1 to 24 years (average 11.9 ± 1. 7 years). Each of the experts performed three main tasks: analysis of the primary version of the questionnaire for adding and (or) correcting questions; assessment of the relevance of each of the questions from the standpoint of the degree of influence on the patient’s QoL (0 points — the question is not relevant; 10 points — the question is very relevant); assessment of the “severity” of the complaint in terms of the frequency of occurrence (in the range from 10 points — the occurrence of a symptom does not determine the severity of the disease, to 0 points — the occurrence of a symptom determines the highest severity of the disease). At the same time, the following scaling procedure was used: “Practically no problems” (occur during 0–4 % of the patient’s total active time), “Mild problems” (5–24 %), “Moderate problems” (25–49 %), “Severe problems” (50–95 %), “Absolute problems” (96–100 %). “Virtually no problems” was indicated as 10 points.

Results. As part of the solution of the first task, the number of questions was increased from 35 to 52. Mathematical analysis of the results of the second task was carried out on the basis of calculating the basic parameters of descriptive statistics for all 52 questions — the arithmetic mean (as a “weight” coefficient of the question) and standard deviation (as indicator of consistency of the position of the respondents). Subsequently, the “ejection” of insignificant questions was performed (according to the Pareto method with 80 % of the “pool” of questions with the maximum contribution to relevance), as well as the clinical association of similar questions and the assessment of statistical validation (feasibility) of such an association.

Conclusion. An expert assessment of ophthalmologists confirmed the validity of using the “social model” of health based on the development of “domains” of the international classification of functioning when developing the QoL questionnaire after FEC. The final version of the «FEC-22» questionnaire fully complies with the content validity requirements. 

Diabetic retinopathy (DR) have been taking a leading position among retinal disorders, causing a persistent and significant decrease in visual functions. The base of the disease is a retinal vascular microangiopathy, which induces a tissue ischemia and excessive production of vascular endothelial growth factors. The main method of treatment for this pathology is a laser photocoagulation. However, it is not always possible to perform appropriate laser photocoagulation, by that limiting its efficacy (cases of hard cataract and hemophthalmos). In addition, this type of treatment might have a number of serious complications, such as macular oedema, recurrent vitreous hemorrhages, the occurrence of fibrosis, atrophic changes in the retina, which leads to a decline in visual acuity and contrast sensitivity, worsening the visual field. Over the past 10 years, vascular endothelial growth factor inhibitors have been introduced into clinical practice, and showed their benefits in the treatment of disorders leading to a pathological angiogenesis. But due to the limited number of systematic observations, assessing the impact of these drugs, is necessary to investigate their efficacy and safety in patients with proliferative DR, in order to develop indications for their use. The purpose of the review is evaluation of the effect of vascular endothelial growth factor inhibitors on active neovascularization in patients with proliferative diabetic retinopathy. There is a literature of international clinical guidelines, randomized clinical trials with a varying level of evidence, articles and publications by groups of authors in the article. 

Objective: to analyze the biomechanical parameters of the eye fibrous membrane and the biomechanical glaucoma factor (screening index for low-pressure glaucoma) studied by the Oculus Corvis ST device in various clinical situations.

Patients and Methods: the study included 382 eyes, 181 eyes with glaucoma (47 %), 201 eyes without glaucoma (53 %). Patients were divided into groups: without glaucoma, with glaucoma (POAG, NTG, PEG), with keratotomy, depending on the CCT and axial length. Corneal tomography and biomechanical parameters were measured using Pentacam (Oculus) and Corvus ST, respectively.

Results in patients without glaucoma, the stiffness of the eye increases with age (increasing SSI). Even higher SSI in the PEX group. Higher BGF values compared to the control. With PEG, the CCT is thinner, p = 0.005, bIOP is higher than p = 0.038, SSI is higher than p = 0.00 than in the control. With NTG, the CCT is thinner, p = 0.002, bIOP is lower than p = 0.000, DA ratio, R is higher (p = 0.000) than in the control. In all groups, BGF is higher than in the control (POAG p = 0.016, PEG and NTG p = 0.000). With ketatotomy, DA ratio, R and SP-A1 p = 0.000, lower than with myopia, and SST is higher, p = 0.000, BGF is almost twice as high. With a thin cornea, the DA ratio, R, SP-A1 (p = 0.000) and SSI p = 0.044 are lower than in the control, BGF is higher than p = 0.000. With a axial length of more than 24.00 mm below the DA ratio p = 0.034, BGF above p = 0.000.

Conclusion: with age, with different CCT, with increasing axial length, with different forms of glaucoma and keratotomy, the indicators of the fibrous membrane of the eye change. 

The organ of vision is one of the target organs, which is negatively influenced by a number of harmful factors of the working environment and the labor process. Under their influence, the functioning of the visual analyzer can be disrupted, the risk of developing various diseases and injuries increases. The problem of the ophthalmopathology development in persons employed in hazardous industries is relevant, since the protection of the health of the working-age population is of great socio-economic importance. The proposed review of the literature presents the structure and frequency of occurrence of ophthalmopathology in workers of the cement industry, oil refining and petrochemical industries, metallurgical industry, coal and mining industries, manganese ore industry, synthetic rubber production, rubber technical products, synthetic ethyl alcohol, bakery, aviation production, also workers of the underground and railways of the main professions, including those who service underground tunnels. The data of the nosological structure of ophthalmopathology of various hazardous industries workers in Ukraine, India, and some African countries are presented. Among the professionally conditioned pathology of the vision organ, diseases of the anterior part of the eyeball are most common: chronic conjunctivitis, blepharitis, blepharoconjunctivitis, dry eye syndrome. In the general diseases’s structure of the vision organ, the first place is occupied by anomalies of refraction (from 14.3 to 88.9 %). The share of eye injuries ranges from 4 to 12.5 %. The frequency of occurrence of various ophthalmopathologies increases among workers with more than 10–15 years professional experience, which is typical for all industries and industries; there is also a direct connection between diseases of the organ of vision and the class of harmfulness of working conditions. 

This article is a continuation of a series of publications on the results of an experimental study on the possibilities of using quantum dots, as well as bioconjugates based on them as a promising treatment for inflammatory diseases of the eye. Of the whole variety of microorganisms, Pseudomonas aeruginosa (Pa) is the most formidable pathogen, leading to pronounced, sometimes fatal, changes throughout the body in general, and in the eye in particular, in connection with which it receives close attention from bacteriologists and specialists dealing with the treatment of pathologies caused by this microorganism. Now, the search for effective methods to combat this pathogen is one of the priorities of world health care.

This article presents an analysis of the anti-infectious activity of bioconjugates based on quantum dots KTCdTe / CdMPA710 and KTInP / ZnSe / ZnS650 in synergy with III generation cephalosporin (Cefotaxin) against nosocomial Pa strains. Cultures of microorganisms, in the amount of 30 Petri dishes, were incubated in a thermostat at 350C for 18 hours (in the dark and under a source of photoexcitation). As a source of photoexcitation (the emission spectrum of the source corresponded to the absorption spectrum of QDs), we used an LED strip connected to an uninterruptible power supply battery placed in a thermostat. Evaluation of the effectiveness of the impact was carried out using the disk-diffusion method with the measurement of effective growth retardation zones (GRZ). According to the results of the study, it was revealed that the use of the obtained bioconjugate (QD + AB) significantly increases the ZZR. 

Purpose. To study the morphometric features of macular edema in occlusions of the retinal veins, to determine and systematize the conditional gradations of the degrees of its severity.

Patients and methods. 67 patients (67 eyes) were recruited using a continuous sampling method. Their age ranged from 38 to 84 years (on average 60.0 ± 10.5 years). Among them there were 27 men and 41 women. In 19 patients, there was an occlusion of the central retinal vein (28 %), in 48 people — occlusion of its branches (72 %). The lesions of the superior temporal branch prevailed — 32 people (65 %), 16 patients had occlusion of the inferior temporal branch (35 %). Systematization of the obtained data was carried out with the allocation of morphometric gradations of the severity of macular edema against the background of retinal vein occlusions.

Results. According to our data, the morphometric parameters of the macular retina in the presence of macular edema were characterized by a wide range of gradations in the thickness of the foveal retina and the volume of the macular retina (from 239 to 861 μm and from 10,4 to 17,4 mm3 respectively).The morphological features of macular edema in retinal vein occlusions are the formation of cystic cavities in the outer and inner layers of the retina, convex deformation of the retinal profile, and the development of neuroepithelial detachment in 21 % of cases. Taking into account the data obtained, we proposed a conditional morphometric classification of the severity of macular edema in retinal vein occlusions. A mild degree of macular edema was characterized by values of the foveal retinal thickness index up to 400 μm; for medium — from 401 to 600 microns; for severe macular edema — over 600 microns. In accordance with our own conditional clinical morphometric classification of the severity of macular edema, mild macular edema was determined in 32 %, medium degree — in 43 %, severe — in 25 % of patients’ eyes.

Conclusion. The identification of various clinical and morphometric degrees of severity of macular edema, in our opinion, is of practical importance, since it will allow more optimal and objective selection of the most optimal treatment tactics, taking into account the individual morphometric characteristics of the patient’s macular region. 

Currently, one of the actual problems of pharmacotherapy is the treatment of recurrent corneal erosions. Traumatic and postoperative damage to the cornea can disrupt the connection between the basement membrane and the epithelium. One type of such predisposing factors that disrupt the connection between the epithelium and the basement membrane is a previously performed anterior radial keratotomy. This article describes a clinical case using off-label “Protector of corneal epithelial SPHERO®oko gel” within the complex treatment of traumatic corneal erosion for a patient after radial keratotomy. A conservative treatment includes applying 5 % dexpanthenol gel, 0.05 % picloxidine solution, a tear substitute and Corneal Epithelium Protector (BIOMIR Service, Russia) 4 times a day until the erosion was closed and then again during 2 weeks. On the 14th day complete epithelization of the cornea was achieved. Within 2 weeks the condition remained stable. Protector of corneal epithelial showed its effectiveness in complex treatment of traumatic corneal erosion for a patient after radial keratotomy. 

Purpose. Analysis of two clinical cases of immediate sequential bilateral cataract surgery according to the developed modified algorithm (mаISBCS).

Materials and methods. The results of two clinical cases of mаISBCS are presented. In both cases, ultrasonic cataract phacoemulsification (FEC) was performed with implantation of an intraocular lens (IOL) under local anesthesia according to the standard technique through a corneal incision of 2.2–2.4 mm. IOL calculation was performed for emmetropic refraction. The modification (compared to the traditional one) of the technology of surgical intervention was based on the inclusion in the algorithm of a long (at least 60 minutes) break between operations for the purpose of a comprehensive ophthalmological examination with a further decision to perform an operation on the second eye.

Results. In the first clinical case, the patient failed to measure the anterior-posterior axis by optical biometry before surgery. In such situations, the A-scan is used, which is considered less accurate due to human error and often leads to errors in the calculation of the IOL. In addition, a certain alertness was introduced by the fact of a significant (4 diopters) difference in the preoperative refraction of both eyes. Considering these provisions, after the first operation, after 60 minutes, the correctness of the IOL calculation was monitored by two methods — by measuring (optical biometrics) the anterior-posterior axis of the eye (APA, while the differences were less than 0.3 mm, which confirmed the A-scan data), as well as autorefractometry, which showed almost no deviation from the “target”. The presented results allowed us to formulate a decision to carry out the second operation. In the second clinical case, despite the absence of risk factors (optical biometrics was taken in two eyes, similar APA values), a postoperative refraction of +1.5 diopters was determined in the operated eye, which, apparently, is associated with the identified decrease (by 0.93 diopters) corneal curvature due to hydration of the corneal stroma in the area of surgical accesses and (or) changes in the tear film. The presented results allowed us to formulate a decision to postpone the second operation. At the same time, after a week, the restoration of the corneal tissue was noted, which was proved by the required (0.37 diopters) deviation of refraction from the target values.

Conclusion. The use of mаISBCS technology provides the required clinical efficacy and can be recommended taking into account the epidemiological situation, especially for people with visually strenuous work. 

Injuries cause serious disturbance of the form and function of the organ of vision due to the damage and accompanying or remote complications and therefore have a high proportion to the structure of low vision, blindness and disability. One of the complications of penetrating wounds of the eye is iris cysts. Iris cyst can increase and cause pupillary block, secondary glaucoma, uveitis, corneal dystrophy, and therefore it requires surgical intervention. The goal of surgical treatment of an iris cyst is to ensure complete removal of the cyst.

Objective: to estimate the clinical and functional results of treatment in a posttraumatic iris cyst, posterior subcapsular cataract and myopic astigmatism patient.

Patient and methods. Patient B., 49 years old with posttraumatic retention iris cyst, posterior subcapsular cataract, compound myopic high astigmatism was examined. To determine the tactics of surgical treatment of the patient, a complex of General ophthalmology was perfomed (visometry, IOP measurement, autorefractometry, biomicroscopy, ophthalmoscopy), as well as special (B-scanning, optical coherence tomography of the retina) research methods. The follow-up period was 1 year.

Results and discussion. To improve visual functions and prevent the development of secondary glaucoma, the patient was offered surgery - excision of the iris cyst and cataract phacoemulsification with toric intraocular lens. Simultaneous carrying out of two stages of the operation reduced the risks of postoperative complications and shorten the rehabilitation period.

Conclusion. Positive optical and therapeutic effects were achieved as a result of the surgical treatment 44 years after an open eye injury: the eye is calm, the iris cyst is not detected, visual acuity has increased. The postoperative period showed the saving the stable and high visual and functional result with no recurrence of the iris cyst. 

The World Health Organization announced a new coronavirus pandemic on 11 March 2020. It is known that the most frequent clinical manifestation of a new coronavirus infection is lung damage with the evolution of pneumonia, as well as respiratory distress syndrome. The highest risk of severe traction and death is known to occur in the immunosuppressive group of patients. These patients include rheumatologically patients. Currently, there is no complete understanding of the pathogenesis of the development of covid-19, as well as the pathogenesis of the development of autoimmune diseases. In a pandemic, the question of how the coronavirus infection proceeds in patients on immunosuppressive therapy, in particular on anti-B cell, is relevant. In our case report presents a 69-year-old female with ANCA-associated vasculitis remission having received a B-cell-depleting therapy with rituximab (RTX), who had an ocular lesion as a clinical manifestation of Coronavirus disease 2019 (COVID-19). Two months after RTX treatment, COVID-19 was diagnosed. The patient had extrapulmonary manifestations including central nervous system involvement and ocular symptoms such as conjunctivitis, without respiratory pathology. In this clinical observation, the patient’s disease manifested itself with right-sided conjunctivitis, which is a rare manifestation as the first symptom. This article describes the features of the course and outcome of the disease, as well as, the protective effect of RTX in course of COVID-19 is discussed. A comparative analysis of cases of COVID-19 with eye damage is being carried out. This clinical observation is of great value for doctors of all specialties, especially ophthalmologists. A multidisciplinary approach is crucial to manage COVID-19.