The review presents data from studies of the ophthalmological consequences of the disease caused by SARS-CoV-2, especially regarding its rare manifestations. Clinical manifestations of the post-COVID-19 syndrome disappear within about two weeks in mild cases and 3 to 12 weeks in more severe cases. 80 % of patients have more than one, often more than two, and more than 10 symptoms. In general, patients improve spontaneously and continuously over time. The ophthalmic manifestations of COVID-19 vary in nature, severity, and timing, and are more common in patients with severe systemic disease, abnormal blood counts, and inflammatory conditions. Ophthalmic manifestations can develop at any time during the course of the disease. The median time to symptom onset since COVID-19 diagnosis is 5 days for neuro-ophthalmic manifestations, 8.5 days for the ocular surface and anterior segment of the eye, and 12 days for the posterior segment and orbit. COVID-19 causes ocular manifestations in approximately 11 % of patients. The most common ocular manifestation is conjunctivitis, which affects almost 89 % of patients with eye diseases. Other much less common anterior segment anomalies caused by SARS-CoV-2 include scleritis, episcleritis, and acute anterior uveitis. Posterior segment injuries caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Rare complications of COVID-19 include rhino-orbital-cerebral mucormycosis; retrobulbar optic neuropathy, papillitis, neuroretinitis, anterior ischemic optic neuropathy, non-arterial anterior ischemic optic neuropathy; retinal white spot syndrome (MEWDS); acute unilateral anterior uveitis, serpiginous choroiditis; bilateral central serous chorioretinopathy; bilateral acute depigmentation of the iris, bilateral acute transillumination of the iris; refraction changes; complications associated with drugs used to treat COVID-19 that have toxic effects on eye tissue; and vaccine-associated uveitis.

Uveitis is a term that combines an extensive group of diseases, which are based on inflammation of the choroid of the eyeball. A special place is given to non-infectious uveitis. This group of diseases has an autoimmune origin and the largest proportion of the incidence falls on them. The largest share of morbidity is from this group of uveitis. Despite the successes in modern approaches to the treatment of uveitis, the issue of timely diagnosis and treatment of diseases of the vascular eye membrane does not lose its relevance. The social significance of this pathology is determined by the growing rate of visual acuity decline, the development of complications and early disability. Many studies have revealed a relationship between the untimely late start of treatment and the likelihood of vision loss leading to a deterioration in the quality of life. The therapy of non-infectious uveitis is based on the suppression of the local immune response. Depending on the activity of the inflammatory process, it may include local treatment (instillation of corticosteroids, nonsteroidal anti-inflammatory drugs and mydriatics) and systemic immunosuppression using corticosteroids, alkylating agents (cyclophosphamide, chlorambucil), antimetabolites (azathioprine, methotrexate, mycophenolate mofetil), T-cell inhibitors (cyclosporine and tacrolimus). According to the experience of clinicians, the therapeutic efficacy of steroids even in high doses in treatment of the chronic uveitis provides only partial remission and is associated with the development of serious side effects. Positive results were found when using a combination of steroids with cytostatics, however, with their prolonged use, it is possible to manifest properties such as hepatotoxicity and nephrotoxicity, mutagenicity, carcinogenicity, sterilization, as well as bone marrow suppression, and, as a consequence, the occurrence of severe thrombocytopenic bleeding and granulocytopenic infections. In the case of intermediate, posterior and severe and moderate panuveitis that does not respond to immunosuppressive therapy with methotrexate and cyclosporine A, patients are transferred to therapy with genetically engineered biological drugs (GIBP). The drugs of biological therapy include selective regulators of cytokine levels. The mechanism of their action is based on the selective cytokines’ binding using monoclonal antibodies or soluble cytokine receptors. This article is devoted to evaluating the effectiveness of biological therapy as the drugs of choice.

Diabetic retinopathy (DR) is a disease that irrevocably leads to blindness, especially in the absence of proper monitoring and treatment. World statistics on its prevalence are not comforting. This pathology has always demanded and will continue to demand high attention from endocrinologists and ophthalmologists. In search of competent patient management, we have studied scientific papers on various treatment approaches with proven positive research results. We decided to analyze the drug Sulodexide, since in many studies it has proven to be a safe and effective direct anticoagulant with minimal side effects. As it turned out, Sulodexide is effective not only in relation to DR, but also in other pathologies of the fundus, which is described in this article.

Central serous chorioretinopathy (CSC) is a polyethological disease. CSC is one of the few eye diseases for which the relationship between the occurrence, course of the disease and patient psychosocial characteristics has been demonstrated including personality traits and the level of external stress factors. Excessive stimulation such as stressful living conditions, exogenous factors and personal predisposition can lead to CSH. The disease often occurs against the background of acute or chronic stress. Patients with central serous chorioretinopathy are characterized by certain personality traits i.e., type A personality, including a tendency to overachievement, competition, perfectionism, and a sthenic desire to maintain professional status. At the same time, insomnia and sleep apnea, depressive and anxiety states, post-traumatic stress disorder and alexithymia, high blood pressure, Helicobacter pylori, autoimmune diseases, psychopharmacological medication, hormone therapy are among the risk factors.

Purpose: compare the results of implantation of two types of premium IOLs (Synergy and PanOptix) according to several criteria.

Materials and methods. Patients were treated in the “EyeDoctor” ophthalmology clinic, Almaty, Kazakhstan. Synergy group: 8 people (4 men and 4 women.) PanOptix group: 25 people (9 men and 16 women).

Results. A month after the operation, results were special but comparable.

Conclusion. It can be concluded that the hybrid IOL Synergy is in not inferion in refractive results to well matched PanOptix.

Purpose. To evaluate clinical and functional results of implantation of a new hydrophobic acrylic monofocal IOL in a preloaded injector.

Methods. The prospective study included 60 patients (66 eyes) after Hoya iSert® 250/251 IOL implantation (31 patients, 35 eyes, group 1) and a new Hoya Vivinex Multisert® XY1-SP IOL (29 patients, 31 eyes, group 2). The mean age was 75.1 ± 7.9 years. The mean follow-up period after surgery was 3.1 ± 0.4 months. IOL viscoimplantation was performed in 100 % of cases in group 1, in group 2 — in 45.1 % of cases, and in 54.9 % — hydroimplantation was performed. Intraoperatively, the size of the corneal incision was measured with a ruler before and after IOL implantation. IOL optic power was calculated with SRK/T and Barrett Universal formulas. In the postoperative period, surgically induced astigmatism was assessed.

Results. In both groups, there was a statistically significant (p < 0.05) increase of UCDVA from 0.28 ± 0.09 in the preoperative period to 0.70 ± 0.17 3 months after surgery in group 1 and from 0.24 ± 0.10 in the preoperative period to 0.84 ± 0.18 3 months after surgery in group 2. Slightly lower values of UCDVA in group 1 may be associated with a higher level of SIA in this group. Similar dynamics were shown for the BCDVA (from 0.52 ± 0.21 before surgery to 0.95 ± 0.19 after 3 months of follow-up in group 1 and from 0.55 ± 0.20 before surgery to 0.98 ± 0.21 after 3 months of follow-up in group 2). No differences were found between the studied groups. After IOL implantation, there was an increase in incision size to 2.40 ± 0.12 mm in group 1 and 2.10 ± 0.08 mm in group 2 (p = 0.04). In group 1, the mean SIA after 3 months of observation was 1.10 ± 0.16 D and in group 2, 0.48 ± 0.07 D (p = 0.0007).

Conclusion. This study presents the first domestic experience with the implantation of a new monofocal hydrophobic acrylic Hoya Vivinex IOL in a Multisert® preloaded injector. A comparative analysis of implantation results with monofocal Hoya 250/251 IOLs in an Isert® injector was performed. The advantage of the new IOL implantation in reducing the incidence of surgically induced astigmatism was shown.

Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.

The purpose: to develop a technology for the surgical treatment of macular retinal tears using an “effective” fragment of the ILM with an optimal shape, size, and localization, and evaluate its anatomical and functional efficiency.

Methods. There were 10 patients (8 women, 2 men) with primary through macular holes of large diameter (more than 400 microns) under observation. The age were from 55 to 64 years old. The duration of macular tear existence ranged from 4 to 11 months. Patients underwent standard research methods, SOCT and microperimetry. To retain the point of visual fixation and eliminate the risk of retinal trauma, all patients underwent surgical treatment of macular tear using the developed method for the surgical treatment of macular retinal tears using an “effective” ILM fragment of the required shape, size and localization. Before the operation, individual parameters for each patient and zones of localization of the “effective” ILM fragment were calculated, which consisted of two parts: the upper inverted fragment and the intact foveolar fragment of the inner limiting membrane. The follow-up period was 1, 3, 6 months and 1 year after the operation.

Results. Surgical treatment of MR in all patients was carried out completely without complications. In all cases, it was possible to preserve the zone of the foveolar intact fragment of the ILM and form the upper inverted fragment of the ILM, which directly covers the macular hole. Improvement of the anatomical state of the retina in the foveal area was achieved according to SOCT data. After 1 month, all patients had a “defect” (hyporeflective area) in the ellipsoid zone of photoreceptors with a width of 112 to 357 μm. The outer boundary membrane was clearly visible and had a linear profile. A complete resorption of edema along the edges of the tear happened. An intact foveolar fragment of the ILM was visualized on the surface of the retina, blocking the macular hole. After 3 months, in 3 patients, the defect of the outer layers of the retina completely disappeared. After 3, 6 and 12 months, the state of the retina of these patients was unchanged. All patients showed improvement in functional outcomes after surgical treatment. There was an increase in BCVA at all terms.

Conclusion. The developed technology of surgical treatment using an “effective” ILM fragment is modern and safe in the treatment of penetrating primary macular retinal tears, and reduces the risk of intra- and postoperative complications.

Purpose: to evaluate the effect of primary open-angle glaucoma (POAG) as a comorbidity on cytokine expression in aqueous humor (AqH) of patients with Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK).

Patients and methods. In this prospective consecutive case study 58 patients (58 eyes) were divided into 2 main groups. Group 1 (22 patients with FECD) included 11 patients with coexisting POAG II–IIIA (group 1a) and 11 patients without ocular comorbidity (group 1b). Group 2 (28 patients with BK) consisted of 19 patients with coexisting POAG II–IIIA (group 2a) and 9 patients without ocular comorbidity (group 2b). Group 3 (control) included 8 patients with cataract. The patients of groups 1 and 2 underwent endothelial keratoplasty. Intraoperatively obtained recipients’ Descemet’s membranes (DMs) were investigated histologically (hematoxylin/eosin staining). A total of 58 AqH samples were collected from consecutive patients who underwent endothelial keratoplasty (groups 1a, 1b, 2a, 2b) or cataract surgery (controls). The AqH levels of cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p70), IL-13, IL-17, G-CSF, GM-CSF, IFN-γ, MCP-1, MIP-1β and TNF-α) were compared among the groups.

Results. Clinical diagnoses of FECD (group 1) and BK (group 2) were confirmed by the results of morphologic study. The levels of IL-8, MCP-1, IFN-γ were significantly higher in AqH samples from FECD and BK groups (regardless of the presence or absence of POAG) compared with the controls. IL-6 level was significantly elevated in FECD with coexisting POAG (group 1a) and BK (groups 2a and 2b) than in the controls. The influence of POAG on the local inflammation in FECD and BK is confirmed by the increased level of MIP-1β and the low concentration of GM-CSF compared with the controls. Among BK eyes (groups 2a and 2b), POAG as a comorbidity (group 2a) was associated with decreased level of IL-12. FECD with coexisting POAG was characterized with lower level of IL-13 in AqH than in the controls.

Conclusions. POAG as a comorbid pathology in patients with FECD leads to high immune response mediated by cytokines expression. BK regardless of coexisting POAG is associated with severe local immune inflammation.

Purpose: to expand and modernize the technology of primary microsurgical treatment of extensive scleral wounds due to simultaneous subtotal vitrectomy, primary treatment of retinal and choroid wounds, filling of tissue defects with autologous conditioned plasma (ACP), tamponade with silicone oil or C3F8 gas.

Methods. 15 patients (15 eyes) with extensive penetrating scleral and corneoscleral wounds ranging from 8 to 15 mm in length, with concomitant complex injuries of various structures of the eye: traumatic cataract, wound of the ciliary body, injury or loss of the iris, subtotal/total hemophthalmos, retinal detachment were monitored. All patients underwent primary surgery according to the original extended technique.

Results. The functional results of surgical treatment in patients, taking into account the severity of the injury, were high: in the early postoperative period, 1 month after primary surgery, visual acuity with correction ranged from 0.02 to 0.5. Signs of proliferative vitreoretinopathy were not observed in any case.

Conclusion. The proposed method of extended primary microsurgical treatment for extensive penetrating scleral and corneoscleral wounds with severe concomitant damage to intraocular structures is effective and has a number of advantages: early prevention of severe complications in the form of proliferative vitreoretinopathy, shortening the rehabilitation period. The method allows to achieve high functional results in the most severe cases of penetrating eye injury.

In the ground sealed station crew, during the 8 months international experiment SIRIUS 20/21 simulating an interplanetary flight, electrically induced phosphene (EIP) thresholds, which reflected the electrical sensitivity (ES) of the retina, and the optic nerve. ES&L was assessed using the “ESOM” device (“Neuron”, Ufa, Russia) once a month, twice a day (morning/evening), under mesopic conditions. An increase in ES and other patterns of changes in ES&L parameters during period of isolation were established, reflecting the adaptation of the crew to the conditions of the experiment and the reaction of the visual system to physical and psycho-emotional stress. Further study of the thresholds of the EIP and L of the optic nerve in experiments of increasing duration will make it possible to determine the biomarkers that differentiate the individual adaptive reaction of astronauts from dysfunction of the retina and optic nerve under real space flight conditions. The L of the optic nerve showed greater resistance to experimental conditions than the ES of the retina. The results suggest that the determination of the L in the ES&L test can become an express test on board the ISS to assess the functional state of the papillomacular bundle of optic nerve fibers, the risk of developing or diagnosing SANS (flight-associated neuro-ocular syndrome) in long-term space missions.

Рurpose — to study the frequency of occurrence of various forms of accommodative asthenopia (AA) in patients with visually stressful work (VSW) with different degrees of myopia planning LASIK.

Methods. As part of the preoperative examination, 300 patients with VSW were under observation. There were three groups of equal age and gender, corresponding to weak (up to 3.0 diopters, 100 patients), moderate (3.25–6.0 diopters, 100 patients ) and high (6.25–8.0 diopters, 100 patients) degrees of myopia. All patients underwent objective accommodation using the Righton Speedy-I device (Japan) with further calculation of the coefficient of microfluctuations of the ciliary muscle of the eye (KMF). Diagnosis of the type of AA was carried out according to the following indicators: with KMF less than 53.0 rel. un. — asthenic form of accommodative asthenopia (AFAA), pathology; at KMF from 53.0 to 58.0 rel. — norm; at KMF more than 58.0 rel.un. — Habitual Excessive Tension of Accommodation (HETA), pathology.

Results. The incidence of AA (any form) was 51–57 % and weakly depended on the degree of myopia. A significant increase (compared with the literature data) in patients with AA according to the results of this work is due to the following factors: the examination of patients exclusively with VSW, who daily perform professional visual activity at the time of the examination, as well as a wide (24–34 years) the age range of the subjects. The probability of occurrence of HETA and AFAA is quite comparable and amounted to 29–36 % and 21–23 %, respectively. The obtained results are illustrated by typical accomodograms. Conclusion: the high incidence of both forms of AA actualizes further research aimed at assessing the dynamics of the state of the accommodative system of the eye after excimer laser surgery for myopia, as well as the development of a method for correcting AA, taking into account a personalized approach that allows performing the correct diagnosis of various forms of AA (HETA, AFAA), which, ultimately, will provide adequate treatment from the position of choosing both the actual method (physical factor) and the required optical, amplitude and time parameters of exposure.

Relevance. Diabetic retinopathy occupies one of the leading places in the frame of blindness and low vision. The very first changes in the retina in diabetic retinopathy are disorders of microcirculation and blood supply in the small vessels of the macula. There are few effective drugs that can restore perfusion in the small retina’s vessels. In this connection, it is relevant to search for anticoagulants that allow restoring blood supply in the macular area in diabetic retinopathy in the early stages.

The purpose. To analyze the research of a domestic direct-action anticoagulant from animals, a drug of the heparin group Pyavit, both in ophthalmology for diabetic retinopathy and in other fields of medicine. The analysis of publications on eLibrary and PubMed resources for the last 30 years was done, by the keywords: direct-acting anticoagulants, diabetic retinopathy, hirudins, hemodynamics, optical coherence tomography (OCT), hemostasis. The data on the study and application of the drug from its development to its use in diabetic retinopathy, retinal vascular pathology, and pregnancy was analyzed. Researchers have studied the importance of the salivary gland secretion of a medical leech, which is a regulator of the hemostasis system. In 1992 I.P. Baskova patented a new drug Pyavit, which is officially approved for use in medical practice (registration number No. 000363/02). Dosage regimen: 300 mg three times a day for 20 days, and repeat the course through 1–2 months. In ophthalmology, researchers have proven the positive effect of the drug on the retina in diabetic retinopathy with an improvement in visual acuity, retinal thickness according to objective indicators of optical coherence tomography, fluorescence angiography, and hemostasis system.

Conclusion. The analysis of scientists’ research allows us to expand knowledge about the positive effect of the drug Piavit on the path of diabetic retinopathy. Based on this review, the authors plan to further study the drug, which will assess the importance and significance of improving microcirculation in the macular area of the retina using the anticoagulant Pyavit to preserve visual functions.

Background. Diabetic retinopathy is a very common, debilitating disease that requires early diagnosis and treatment. The development of new screening methods is a priority area of medicine in recent years. Purpose: Approbation of the software (SW) based on algorithms for automatic segmentation of signs of DR “Retina AI” in clinical practice, the study of the capabilities of the software “Retina AI” in the diagnosis of vision-threatening DR.

Methods. Analysis of clinical data obtained from patients undergoing diagnostics and treatment at the Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia and the Moscow Regional Scientific Research Clinical Institute. 123 photographs of the fundus were analyzed using the RETINA.AI platform. Fundus photography was carried out using a fundus camera VISUCAM 500 (Zeiss).

Results. In the process of analyzing fundus photographs with Retina AI algorithms, a high efficiency of automatic detection of vision-threatening retinopathy was revealed. The accuracy of the method in diagnosing vision-threatening DR was 95 %, sensitivity — 96.59 %, specificity — 91.4 %, ROC AUC — 0.94.

Conclusion. The DR diagnostic program based on adaptive segmentation algorithms is a tool for solving the DR screening problem.

Purpose. The continuous use of mask wear from pandemic induces instability in tear film due to the air blown up from the mask. The study’s objective was to assess the effect of type of mask wear and duration, including short-term wear of mask on TBUT.

Design and methods. This was a cross-sectional, comparative study. A total of 90 (180 eyes) subjects (76 females) were involved in the study and were categorized into three groups, each comprising 30 subjects. Either the groups were given a surgical, cloth, or N95 masks to wear. Baseline TBUT was collected after 30 mins without mask wear; next TBUT was measured immediately after 1 min of mask wear and subsequently after every 30 mins for 3.5 hours among all the three groups. TBUT changes within the groups and between the groups were compared using Friedman ANOVA and the Kruskal Wallis test.

Results. There was a significant decline in TBUT after 30 mins of mask wear only among surgical & cloth mask users and was stable in N95 wearers. There is no influence on TBUT for 1.5 hours among all the mask wearers. However, a subsequent continuous significant difference was evident from 2 hours among surgical and cloth mask users and at 3.5 hours within N95 users. N95 wearers have a higher TBUT, and surgical have the least TBUT.

Conclusion. Surgical mask wears significantly influence tear film stability, followed by cloth mask wear because of air leak from nose wire. TBUT is minimally affected by N95 wear.

Purpose: to study the severity of dry eye symptoms in patients who wear contact lenses and in those who underwent laser keratomileusis a long period ago according to OSDI questionnaire.

Methods. 88 patients with various refractive disorders were included in the study, there were 33 men and 55 women. Mean age was 30,11 y.o. All patients were divided into 3 groups according to method of refractive disorder correction. Groups were equal in age and gender. The first included 27 patients wearing soft contact lenses for more than 5 years. The second group contained 33 patients who didn’t use contact lenses. The third one included 32 patients who underwent refractive surgery (LASIK, Femto-LASIK) more than a year ago. Assessment of severity of dry eye symptoms was performed according to questionnaire data (patients’ subjective feelings), objective data was not taken into account. Survey was performed with the use of OSDI questionnaire.

Results. According to the symptoms presented the incidence of dry eye syndrome was 73.91 % in patients of the first group and it was 56.25 % and 66.66 % in the second and third one, moreover, the prevalence of DES in each of the groups was higher among women and amounted to 94.11% in the first group; 63.63% — in the second and 61.11% — in the third group. Mean OSDI in the first group was 31.48 ± 22.17; and it was 18,83 ± 14,00 and 22,25 ± 15,53 in the second and third group respectively. The obtained data corresponded to moderate severity of dry eye syndrome in all groups. DES was more prevalent among women in each group.

Conclusion. The prevalence of DES according to the severity of symptoms was 65.6 %, the severity of DES was predominantly moderate. There was definite connection of symptoms and such risk factors as female sex and contact lens wear. Despite the connection with underlying pathogenetic mechanisms, the spread and severity of dry eye symptoms in patients a year after refractive surgery were significantly lower compared to those who didn’t undergo any refractive surgical procedures.

Purpose: to study the relationship of various forms of accommodative asthenopia (AA) with the characteristics of the professional activity of patients with visually stressful work (VSW) with the phenomena of computer visual syndrome (CVS).

Methods. There were 150 patients with VSW — professional users of personal computers (mean age 28.8 ± 1.4 years) with myopic refraction (mean value of spherical equivalent 2.8 ± 1.1 diopters) under observation. The patients were divided into three groups: “normal” (50 patients); asthenic form of accommodative asthenopia (AFAA, pathology, 50 patients); habitual excessive tension of accommodation (HETA), pathology, 50 patients). All patients underwent a comprehensive ophthalmological examination for 13 parameters. As a basic diagnostic method, a specially developed questionnaire aimed at assessing professional activity was used. Statistical analysis of the results of the study was performed on the basis of an assessment of the average values of the correlation coefficients (ACC) between the patient’s responses (in points) and the studied indicators of the visual system.

Results. High ACC were determined on issues characterizing the amount of daily visual load. However, no differences were found between APAA and HETA. The occurrence of AFAA is more often associated with the input of information, HETA — with reading. Evaluation of issues related to the regularity of the use of optical correction revealed differences in ACC (p < 0.05) between the “normal” group and the “pathology” groups, while in the “normal” group, optical correction was used in most cases “often” or “constantly”, in the “pathology” groups — “sometimes”.

Conclusion. The results of the correlation assessment of the relationship between various types of AA in patients with VSW with the characteristics of professional activity and the parameters of the visual analyzer indicate the leading role of the duration and nature (input, reading of information) of daily work at a personal computer. One of the leading risk factors for the development of AA is inadequate optical correction. At the same time, there were no significant differences between AFAA and PINA. The most informative parameters of the accommodative system of the eye are the volume of absolute and relative accommodation (by the subjective method), as well as the coefficients of microfluctuations and stability of accommodogram (by the objective accommodation method).

Introduction. Recently, there have been a number of reports of damage to the posterior segment of the eyeball (retina and vascular tract) as a complication of coronavirus infection. Moreover, such lesions occur in the long term (after a few weeks or more). We also observed similar changes, sometimes with the development of a second wave of the disease. At the same time, early diagnosis of damage to the microcirculatory bed and phenomena — precursors of thrombosis (blood clotting disorders) is very important.

The aim of the study was to determine the types of complications of coronovirus infection on the part of the organ of vision and their clinical form. Creation of methods for early diagnosis of the progression of possible thrombogenic processes in the anterior and posterior segments of the eyeball.

Methods. The object of the study were patients with various types of complications due to coronavirus infection. The state of the bulbar microcirculation and the diagnosis of thrombotic symptoms caused by complications of coronavirus infection (COVID-19) were studied.

Results. The types of complications of coronovirus infection on the part of the organ of vision and their clinical forms were determined. Methods for early diagnosis of the progression of possible thrombogenic processes in the anterior and posterior segments of the eyeball have been developed.

Conclusion. As a result of a survey of 75 patients who had a coronavirus infection, it was revealed that the most common eye complications are anterior and posterior blepharitis, in addition, in some cases, damage to the microcirculatory bed of the bulbar conjunctiva was found in the form of arteriolar and venular angiitis and damage to the vessels of the posterior segment of the eyeball.

Color Doppler imaging allows a detailed non-invasive assessment of the state of blood flow in the retrobulbar vessels in patients with various vascular pathologies. Malignant hypertension (MH) is a clinical syndrome characterized by severe diastolic arterial hypertension (140 mm Hg or more), leading to ischemic damage to various organs — kidneys, heart, brain, eyes. Patients with MH often present with thrombotic microangiopathy (TMA), a rare life-threatening condition characterized by multiple systemic thromboses of the microvasculature.

Purpose: to assess the state of blood flow in retrobulbar vessels by color Doppler imaging in TMA associated with MH.

Methods: 10 patients (20 eyes) (age 43.5 ± 6.2 years) with TMA associated with MH underwent a study of the state of blood flow in the vessels of the retrobulbar space by color Doppler imaging. Qualitative and quantitative analyzes of retinal and choroidal circulation were assessed.

Results. Analysis of the Doppler spectrum of blood flow in TMA associated with MH revealed a statistically significant increase in maximum systolic (Vsyst) and finale diastolic blood flow velocity (Vdiast) in the ophthalmic artery (OA), as well as Vsyst in the medial short posterior ciliary arteries (SPCA), compared with the control group (p < 0.05). In 2 patients (20 %) of the study group, a significant bilateral decrease in the diastolic component of the spectrum was found up to the isoline (Vdiast = 0) and a maximum increase in the peripheral resistance index (RI = 1.0). Statistically significant correlations were found between some laboratory parameters of blood serum (hemoglobin, lactate dehydrogenase, creatinine), as well as the estimated glomerular filtration rate and hemodynamic parameters in the central retinal artery (CRA), lateral (SPCA) and OA (p < 0.05).

Conclusion. The results of the study of ocular hemodynamics using color Doppler imaging in TMA associated with MH are presented for the first time. TMA associated with MH is characterized by a statistically significant increase in the maximum systolic blood flow velocity in the OA and SPCA with the development of an ischemic state in the retinal and choroidal microcirculation in some patients. An increase in TMA activity in MH leads to a change in the microcirculation of the retina and choroid of an ischemic nature. An increase in blood creatinine in patients with TMA with MH is statistically significantly associated with a decrease in systolic blood flow velocity in the CRA.

Acute inflammatory diseases of the ocular surface occur in case of epitheliopathy. As a result, most patients complain of discomfort and persistence of residual inflammation after the infection has been stopped.

The purpose: to assess the degree of damage to the ocular surface as a result of bacterial conjunctivitis and keratitis, as well as the regenerative effect of dexpanthenol 5 % eye gel on the healing and restoration of the functional activity of the ocular surface epithelium.

Methods. A non-randomized case-control study was performed in patients with a bacterial infection of the conjunctiva and cornea. Under supervision there were 23 patients (46 eyes) diagnosed with bacterial conjunctivitis and 31 patients (31 eyes) with bacterial keratitis. According to the study design, patients were divided into two groups. After stopping the acute process, dexpanthenol 5 % eye gel was prescribed. To control the effectiveness, the tear film rupture time, the degree of damage to the mucin coating and surface epithelial cells were evaluated. Diagnostic tests with vital dyes (fluorescein (FA) and lyssamine green (LG)) were performed before the appointment of the gel, then seven and thirty days after the appointment of the drug.

Results. After the relief of bacterial inflammation, 86.9 % patients with conjunctivitis and in all cases of keratitis had complaints (unpleasant sensations and redness of the eyes, blurred vision). There was a decrease in tear break-up time (TBUT) test, a significant accumulation of dye in the conjunctiva in both study groups and a partial accumulation of FA in the cornea, more intense in keratitis. After 7 days Corneregel use, there was an increase in TBUT compared to the baseline level, with a further increase in this indicator after a 1 month, a decrease in the manifestation of conjunctival epitheliopathy and the degree of corneal staining.

Conclusions. The appointment of dexpanthenol 5 % eye gel after stopping a bacterial infection helps to relieve discomfort, accelerates the restoration of regeneration of the epithelial cells of the ocular surface, and increases the strength of the tear film.

Every practicing ophthalmologist, regardless of the scope of their clinical and scientific interests, is faced with a dilemma — what treatment to prescribe to a patient who applied for a primary outpatient appointment with signs of red eye syndrome? Prescribing an adequate amount of pathogenetically substantiated therapy will reduce the potential risk of developing complications associated with drug therapy.

Purpose: to study the effectiveness of the treatment the blepharoconjunctivitis, episcleritis and keratitis, the regimen of which included the non-steroidal anti-inflammatory drug Okofenac 0.09 % (Otisipharm, Russia), the main active component of which is bromfenac, showed that the average term for stopping the inflammatory process in in all groups of patients included in the study, was 7–14 days, which indicates a high level of effectiveness of the treatment. At the same time, the maximum amount of drug therapy — more than two groups of drugs was prescribed to patients with keratitis. The quality of life according to the SPEED questionnaire, which reflects the symptoms characteristic of dry eye syndrome, was significantly lower in patients in the keratitis group, which suggested a relationship between the amount of drug therapy and the onset of dry eye syndrome in the long-term period — 1 month. This assumption was confirmed by a correlation analysis, which revealed a direct correlation between the number of prescribed drugs at the beginning of treatment and the quality of life according to the SPEED questionnaire after 1 month in all three groups of patients included in the study. Since this study was aimed at studying the effectiveness of anti-inflammatory therapy in the treatment of different, not only in terms of pathogenesis, but also the localization of the process, it only revealed certain trends in the relationship between the number of prescribed drugs at the beginning of treatment and the development of dry eye signs in the long-term period. Therefore, further research is needed to study the above trend in detail.

In addition, as the analysis of literature data has shown, there are currently no indications for prescribing one or another type of drug therapy in the complex treatment of inflammatory diseases related to the “red eye syndrome”. In order to form criteria that take into account the history data — somatic status, duration of the inflammatory process, complaints of patients characterizing the inflammatory process, as well as biomicroscopic signs of inflammation, to select one or another pharmaceutical group of drugs, a survey of expert ophthalmologists was conducted. Based on the data of the survey, an algorithm for rational therapy of one of the most common pathologies included in the group of diseases red eye syndrome — conjunctivitis was formed. The above algorithm will be presented in the second part of this article.

Ophthalmological manifestations in COVID-19 infection are diverse, manifesting themselves in all anatomical structures of organ of vision, they occur both in the acute period of the disease and in the post-COVID period. Currently, the literature describes changes in the anterior segment of the eye more often, and also there are publications describing pathological changes in the posterior segment, and acute vascular pathology of the retina after COVID-19 infection in particular. It has been established that the comorbid background of the patient is of great importance in the development and the course of the disease. These findings are also confirmed by our two clinical observations of acute ocular vascular pathology after COVID-19. In the first case, retinovasculitis of the right eye complicated by thrombosis of the inferior temporal branch of the central retinal vein was described. The development of vascular pathology of the eye in this case was observed 1.5 months after the onset of the first symptoms of COVID-19 infection. The patient promptly turned to an ophthalmologist and was hospitalized to an eye hospital, where she received anti-inflammatory, hemostatic, anticoagulant, antibacterial, angioprotective, antioxidant therapy. As a result of treatment — the improvement of condition, restoration of visual functions. In the second presented case, we observed the development of an acute ischemic circulatory disorder of the retina of the left eye (thrombosis of the central retinal vein) 2.5 months after the onset of the disease with a new coronavirus infection. The treatment in an ophthalmological hospital included: steroid and non-steroidal anti-inflammatory drugs, antibiotics, mydriatics, haemostatics, angioprotectors, antioxidants, anticoagulants, vitamins. On discharge from the hospital, there was a slight improvement, but after 2 months, the condition of the left eye worsened again. The pathology of the organ of vision proceeded with the development of complication — secondary neovascular glaucoma of a refractory nature with an outcome to subatrophy of the eyeball. It was facilitated by the comorbid background of the patient: hypertension, type 2 diabetes mellitus, dyslipidemia.

Based on the results of the analysis of clinical observations, the specific features of ophthalmological changes, their severity and dynamics on the background of comorbidity and the received therapy were established. The relationship between COVID-19 infection and complications of the organ of vision has been shown.

The neuro-ophthalmic symptoms and signs associated with COVID-19 infection are varied and span the course of the infection to the convalescent phase. In addition to the anterior segment of the eye, there is a possibility of damage to the posterior segment of the eyeball. The described cases are isolated and there are no results of treatment of patients who have undergone COVID-19.

Purpose: To describe the outcome of treatment of bilateral optic nerve edema after COVID-19.

Methods. A 59-year-old man with reduced visual functions in the post-surgical period was examined. A standard ophthalmological examination was performed. In addition, spectral optical coherence tomography (OCT) of the macular area of the retina and optic disc (OND) was performed using the RTVue XR Avanti apparatus (Optovue, USA). The patient underwent a laboratory study.

Results. Bilateral papilledema was detected in a patient after COVID-19. According to OCT data, a thickening of the nerve fiber layer of the retina of both eyes was revealed, according to OCT angiography, a decrease in the density of the RPC. Conducted a course of conservative and physiotherapy treatment.

Conclusion. The COVID-19 epidemic poses several challenges for the ophthalmological community: to determine algorithms for timely diagnosis and treatment, as well as to ensure the prevention of complications from the organ of vision in patients who have undergone COVID-19. It may make sense to screen for coronaviruses in patients with inflammatory diseases of the posterior segment of the eye of unknown etiology. The inclusion of spectral optical coherence tomography with the function of angiography in a comprehensive examination of patients is important for the early detection of microcirculatory and morphometric changes in the optic disc, macular and peripapillary retina. It is advisable to use physiotherapeutic methods of treatment in patients with visual impairment in the post-COVID period, which will reduce the long-term drug load and increase the effectiveness of treatment.

A case is described of a 47-old man with anterior megalophthalmos, high myopia (>31.0 mm) and who underwent bilateral consecutive phacoemulsification. In addition a bilateral dislike corneal opacity was present which was classified as central cloudy corneal dystrophy of Francois. Special attention must be paid to both surgical technique and IOL selection. In the first eye a single-piece foldable IOL was implanted into a capsule bag, in the second eye three-piece foldable IOL were sutured fixed to the iris. In the meantime, phacoemulsification in patients with dystrophy of Francois safe and does not lead to progression. We calculated the IOL power for our case with the Haigis and Barret II Universal formula retrospectively.

Purpose: to evaluate the results of a new combined method for the treatment of corneal and graft ulcers in preschool children, including local ultraviolet crosslinking (UVA CL) of corneal collagen and amniotic membrane transplantation (AMT).

Methods. 1 patient 4 years old with a corneal ulcer and transplant disease after penetrating subtotal keratoplasty and 1 child 6 years old with a corneal ulcer of herpetic etiology was under observation for 1 year. The treatment included 3–5 consecutive procedures of local UVA CL of the cornea lasting 5 min. and amniotic membrane transplantation (AMT) after the first CL procedure. Biomicroscopy with fluorescein test and optical coherence tomography (OCT Spectralis, Heidelberg Engineering, Germany) were used to dynamically monitor the clinical course of corneal and graft ulcers. Local CL was performed using a new Keratolink device (OA Elatomsky Instrument Plant, Russia). Immediately after the 1st CL procedure, a TAM operation was performed under operating conditions under anesthesia, after which 2–4 more local CL procedures were performed sequentially every 3 days.

Results. During treatment with each subsequent CL procedure, the clinical condition of the eyes improved: inflammation was relieved, photophobia, lacrimation, blepharospasm disappeared, a gradual increase in the epithelium from the periphery of the cornea with the formation of a gentle translucent opacification was noted, vascular activity decreased, and visual acuity significantly increased. After 2–10 months, in both cases there are no active complaints, the eyes are calm, infiltrates were not determined, in their place a gentle cloud-like translucent opacity formed, including in a child after keratoplasty. Vessels are empty.

Conclusion. Combined treatment of corneal and graft ulcers in children (local UVA CL together with TAM) demonstrated high therapeutic efficacy, ensured stable corneal epithelialization in a short time and improved visual functions at the end of the inflammatory process. This method can significantly expand the possibilities of treating ulcerative lesions of the cornea and graft in preschool children.

A clinical case of congenital aniridia in combination with high degree hyperopia, congenital cataract, ophthalmohypertension, foveal hypoplasia is presented. The article analyzes the results of a complex of morphofunctional studies conducted before and after cataract surgery, presents practical data on the differential diagnosis of glaucoma and ophthalmohypertension and analyzes therapeutic approaches, including the use of a diaphragm contact lens and a three-component tear substitute Stillavit.