In the modern world, glaucoma is one of the main causes of irreversible vision loss. Normal tension glaucoma (NTG) constitutes the major proportion of POAG, which is common in Asian populations. NTG is a disease resulted from the interaction of multiple genetic risk factors. But other factors are also important, such as thinning of the scleral lamina cribrosa and a lesion of the transmembrane pressure gradient. Central visual field defects and disc hemorrhage are characteristics finding that is highly associated with the progression of NTG.

Age-related cataract is the leading cause of vision loss in old people worldwide. According to the World Health Organization it accounts for 47.8 % of the total number of ocular pathologies in people over 50 years old. Despite the rapid development of cataract surgery technology, surgery remains a challenge due to its cost and the increasing number of patients. Literature review is devoted to current concepts of pathogenesis and molecular mechanisms of age-related changes in eye lens. There are the three main theories of cataractogenesis: oxidative stress; the impact of quinoid substances, which are formed due to the impairment of aromatic amino acid metabolism and the activation of aldo reductase enzyme with subsequent accumulation of sorbitol, reactive oxygen species (ROS) generation, dysfunction of Na⁺/K⁺ channels and calcium deregulation causing lens epithelial cells apoptosis. Theories of pathogenesis are linked and based on the development of age-related changes in protein metabolism (the majority of nuclear α-crystallins are insoluble), glucose metabolism (non-enzymatic glycosylation of proteins), lipid metabolism, enzyme activity and the loss of membrane potential of cells ( the increase of Na⁺ and Ca₂⁺ level and the decrease of K+ level). Key element of all theories of age-related changes in eye lens is the aggregation of high molecular weight proteins covalent-bonded of disulfide linkages. Based on molecular mechanisms of cataractogenesis, the development of pathogenetically oriented medical methods of correction of the age-related changes in lens is carried on. This review provides information on results of experimental and clinical studies which demonstrate the anti-cataract effect of Pirenoxine 0, 005 %.

Dosage forms for topical ocular administration are the basis of patient management in ophthalmology. The eye is a structure evolutionarily protected from the effects of xenobiotics by a number of physiological and anatomical barriers. The development of dosage forms, the targeted delivery into the eye structures is carried out due to the inclusion of special excipients, is aimed at improving the efficiency of managing patients with eye diseases. The action mechanisms of the most common groups of excipients used in ophthalmology underlie their effectiveness and safety, as well as create a basis for the various dosage forms development. Cellulose derivatives, due to their physicochemical and pharmacological characteristics, are one of the preferred groups for the development of topical dosage forms used in ophthalmology. Hypromellose (hydroxypropyl methylcellulose) is one of the most studied cellulose derivatives, which is characterized by a wide range of indications for both the active substance (artificial tear component) and the excipient. The favorable pharmacological properties of hypromellose (the ability to provide long-term exposure to effective concentrations of drugs used topically in ophthalmology, the ability to increase the degree of hydration of the cornea) contribute to the active study of this substance to assess the possibilities of its use in the development of new dosage forms (nanoparticles), as well as expanding the existing list of indications. This review is devoted to the analysis of clinical and experimental studies of the efficacy and safety of hypromellose.

Age related macular degeneration is a leading cause of vision loss and an increasing problem of disability throughout the world among adults. That revue covers historical points, risk factors, pathogenesis, classification and current treatment ways of that pathology. The causes of age-related macular degeneration are not fully understood, in spite of keeping a great amount of knowledge at etiology, pathogenesis, diagnosis and modern types of treatment. The problem of age-related macular degeneration treatment has remained actual nowadays. Now, the medicine doesn’t have etiotropic treatment of AMD, because we still don’t know a definite etiologic factor of this developing disease. The main treatment for wet AMD is the injection of medications called anti-VEGF agents. Currently, treatment of dry age-related macular degeneration includes modification of risk factors (stop smoking, healthy life style and etc) and dietary supplements containing a combination of certain ingredients (vitamin C, vitamin E, zinc, copper, and lutein with zeaxanthin or beta-carotene) may be able to slow the progression of the disease. The disadvantage of current treatment methods is a narrow focus at one of the pathogenesis components or using as symptomatic therapy. The analysis of literature date has allowed noticing of using of an extracorporeal hemocorrection as perspective way at exploration of new methods of treatment of dry age-related macular degeneration.

Currently, laser technologies are widely used in the treatment of diseases of the eye and its accessory apparatus. Basically, they are used in oculoplastic surgery during operations on the accessory apparatus of the eye, in refractive and corneal surgery, laser support for ultrasound cataract surgery, laser treatment of glaucoma, laser coagulation of the retina, thermotherapy of choroidal formations. In the 21st century, Nd: YAG laser treatment of floating opacities in the vitreous body began to be actively popularized with mixed results. In vitreoretinal surgery, which is improving every decade, laser technology remains at the level of the 20th century. In endovitreal surgery, the laser is still used only for endolaser coagulation of the retina, despite the fact that there is a huge potential for using lasers as a “laser scalpel” for removing the vitreous, precision removal of a retinal tear, epiretinal fibrosis, precision retinotomy, and choroidotomy. In this regard, it is necessary to search for the most suitable laser radiation, which will make it possible to carry out thin cuts on the retina and choroid with high accuracy, minimal damage to the surrounding tissues, and a sufficient degree of coagulation to prevent hemorrhages. This laser will allow for surgical interventions in the posterior eye segment with a lower risk of intra- and postoperative complications, as well as better anatomical and functional results. With further development, this new approach to laser ablation may become an alternative to mechanical instruments for surgical dissection and removal of pathological tissue from the surface of the retina.

Color Doppler imaging became widespread for study hemodynamics in patients with vascular eyes pathologies. A number of studies have shown changes in ocular blood flow velocity and Doppler indices in patients with diabetes mellitus in both the absence and presence of diabetic retinopathy. With the progression of diabetic retinopathy, an increase in parameters’ changes was revealed, variations in ocular blood flow were studied after conservative treatment, retinal laser photocoagulation, against the background of anti-VEGF therapy. Due to its non-invasiveness, color Doppler imaging is used to assess orbital blood flow in pregnant patients at any gestational age. The works of this direction concern the assessment the changes in orbital blood flow during the physiological course of pregnancy and preeclampsia. However, there is still no information on the state of ocular blood flow in pregnant women with diabetes mellitus, which can serve as a basis for further research.

Fungal keratitis (FK) is 8–30 % in the structure of infectious inflammation of the cornea. There are 2 main types of mushroom growth — mycelial and yeast. Mycelial (mold) fungi grow in the form of special branched microscopic tubes — hyphae. Yeast fungi form compact colonies of individual oval cells. Due to the peculiarities of the yeast structure, the tendency to rapid spread in the tissues is reduced, which determines the less aggressive clinical course of such keratomycosis compared to mold. Until the 50s of the 20th century, the occurrence of FK in the world was low. However, probably with the introduction of corticosteroid and antibacterial drugs into medicine, their prevalence began to grow. The highest frequency of occurrence of FK is in regions with a hot climate and high involvement of the population in agriculture. The main provoking factor for the appearance of FK is corneal injury with damage to the epithelium and adhesion to the Bowman’s membrane or stroma components. Highly adhesive fungi (Aspergillus spp., Candida spp.) trigger a cascade of immune inflammatory reactions, production of reactive oxygen species and matrix metalloproteases-9, which leads to the destruction of lamellae. Fungi with low adhesive ability (Fusarium spp.) can grow parallel to lamellae for a long time and indefinitely without inducing pronounced inflammation. Symptoms of FC are similar to those observed in other forms of infectious keratitis, but more often they develop more slowly (5–10 days) and are less acute. A defect against the background of mycelial FC is more often characterized by jagged edges, a raised slough, and a non-yellow color. Yeast FK is manifested by oval ulceration of the epithelium with expanding, more sharply demarcated, densely focal suppuration.

Purpose: to evaluate the incision width and implantation time of different IOL models using three preloaded and one manual injector. Patients and methods. 146 patients (160 eyes) including 94 females and 52 males were included in a prospective study. Group I — Isert® (28 patients, 32 eyes); Group II — Multisert® (27 patients, 30 eyes); Group III — Autonome® (45 patients, 50 eyes) and Group IV — Monarch® (46 patients, 48 eyes). mean age of patients was 71.8 ± 11.7 years, follow-up period — 3.0 ± 0.2 months. Results. There were no significant differences (p > 0.05) between the groups when comparing the incision width before IOL implantation. After lens implantation, the incision width in group I was significantly higher than in groups II (p = 0.04), III (p = 0.037) and IV (p = 0.029). There were no significant differences in incision width after IOL implantation between groups II, III, and IV (p > 0.05). The average increase in corneal incision width in group I was 0.6 mm, and for groups II, III, and IV it ranged from 0.2 to 0.3 mm. Groups II, III, and IV showed lower values of surgically induced astigmatism compared with group I (0.47 ± 0.06 D, 0.41 ± 0.06 D, and 0.44 ± 0.07 D compared with 1.12 ± 0.17 D, respectively; p < 0.05 for all groups). No significant differences were found between groups II, III, and IV. Minimum implantation time was observed for groups II and III, maximum for groups I and IV, with a mean difference of about 30 seconds. Differences when comparing the mean IOL implantation time were not statistically significant (p > 0.05). Conclusion. This paper presents the first worldwide comparative analysis of four IOL implantation systems, including Isert®, Multisert®, Autonome®, and Monarch®. The new Multisert® IOL implantation system has similar advantages to the known monofocal IOL injectors with respect to corneal incision width, surgically induced astigmatism magnitude, and time required for IOL implantation. IOL implantation time did not depend on the type of implantation (hydro- or viscous) and the type of injector.

Objective of the study. To analyze the effectiveness of accelerated local corneal cross linking in the treatment of keratoconus (KC). Patients and methods. Thirty-four patients (42 eyes) were included in the study: 19 people (24 eyes) with stage II keratoconus, 15 people (18 eyes) with stage III Amsler keratoconus. All patients were examined using the following methods: visometry, refractokeratometry, keratotopography, optical coherence tomography of anterior segment, endothelial cell density calculation before and after surgical treatment in 6 months, 1, 2 and 3 years. Results. Significant increase of uncorrected (UDVA) and corrected (CDVA) distance visual acuity was registered 6 months after operation in KC of the II and III stages. In KC stage II, the NCOZ and EOC were greater, from 0.39 ± 0.14 to 0.61 ± 0.18 by 0.22 ± 0.04 (p < 0.05) and from 0.60 ± 0.15 to 0.77 ± 0.12 by 0.17 ± 0.03 (p < 0.05), respectively, in stage III. — from 0.12 ± 0.03 to 0.23 ± 0.07 by 0.12 ± 0.04 (p < 0.05) and from 0.45 ± 0.10 to 0.53 ± 0.12 by 0.10 ± 0.02 (p < 0.05), due to decreased refractive indices in the central 3.0 mm zone. Refractive indexes of the central corneal zone, UVA and CVA in all patients after one, two and three years, as well as data of minimal corneal thickness and endothelial cell density did not change statistically significantly during the entire observation period.

Relevance. Modern keratorefractive surgery (CRS) is a high-tech field of ophthalmology aimed at solving various problems of correcting a wide range of ametropias. Increasing the security of the RFI is one of the priority areas Purpose. To analyze the clinical and functional results of the use of the “Olimp™-2000” solid-state laser system during CRS using the method of superficial and sublamellar laser keratoablation and formulate recommendations for the therapeutic management of patients. Materials and methods. 53 patients (106 eyes) were examined, the average age was 28.5 ± 2.4 years. The inclusion criterion was moderate myopia and the absence of contraindications to CRC. If sufficient, taking into account safety criteria, CRS was performed by sublamellar keratoablation, if insufficient, superficial keratoablation was performed. In both cases, ablation was performed using a domestic solid-state laser machine. The observation period was 3 months. Pharmacological support in all cases was standard, adopted for the management of patients in FCMMG “YourMed”. Results. An analysis of the clinical and functional results of CRS using a solid-state laser device showed full compliance with the criteria set by the Food and Drug Administration (FDA). The accuracy of hitting the target refraction in the range of ± 0.5 diopters was 99.2 %; in 3 months of observation, no regression of the obtained refractive result was observed in any case. There was no loss of lines in any case, the BCVA after the operation corresponded to or exceeded by 1–2 lines the BCVA before the operation. When performing superficial keratoablation, in two cases, the loss of line 1 of the NCVA was noted due to the development of early subepithelial fibroplasia, which required correction of the pharmacological support. Conclusion. The analysis of the clinical and functional results of the correction of moderate myopia using the “Olimp™-2000” solid-state laser device showed high efficiency in terms of efficiency, safety, and predictability, despite little experience in using solid-state ablation in clinical practice. The use of Floas Mono® did not cause side effects in all cases and contributed to the smooth course of the early postoperative period. Thus, this drug is effective in the postoperative period and can be recommended for use in patients after CRC. The generation of ultraviolet radiation by modern solid-state devices for the purpose of correcting ametropia is a promising direction in CRS.

This article presents a clinical case of intraocular lens (IOL) removal due to surface degeneration 2 years after implantation. Explantation was performed resulting from clinically significant clouding of the IOL and decreased visual acuity. The microscopic picture and microtopography of the explanted hydrophilic acrylic IOL with hydrophobic coating were studied using scanning electron microscopy. The opacities were total, located on the entire surface of the lens, including the supporting elements.

Background. The aim of this study is to evaluate the morphologic changes of the cornea and anterior chamber by using corneal topography (CT) in patients undergoing deep anterior lamellar keratoplasty (DALK) due to keratoconus. Patients and methods. This observational case-control study included total 53 eyes of 53 patients with keratoconus and underwent DALK surgery. All patients were evaluated preoperatively and 3 months after suture removal with CT. In CT, anterior chamber depth (ACD), iridocorneal angle (ICA), anterior chamber volume (ACV), central corneal thickness (CCT), maximum keratometric value (Kmax), flattest simulated meridian keratometry (SimK1), steepest simulated meridian keratometry (SimK2) and simulated keratometry average (SimKavg) results were compared before and after DALK surgery. Results. A significant increase was observed in CCT values after DALK surgery (p < 0.001). Patients showed statistically significant decrease in Kmax, SimK1, SimK2 and SimKavg values (p < 0.001 for all). Postoperative ACD and ACV values were significantly lower (p < 0.001). The ICA values showed no significant difference (p = 0.183) between preoperative and postoperative values (49,95 ± 5,85 and 46,30 ± 11,33 respectively). Conclusion. We determined a dramatic decrease in keratometric values, ACD and ACV values and an increase of corneal thickness after DALK surgery. Although DALK can be performed without interfering with the anterior chamber, has a significant effect in anterior chamber.

Purpose — a literature review of comparative studies of the clinical efficacy of IOLs based on extended depth of focus technology (EDOF) and trifocal IOLs (TFIOLs). Methods. Literature analysis was performed in the international database “PubMed”.The search keywords were “IOL with extended depth of focus (EDOF)”, “Trifocal IOL”, “Contrast sensitivity”, “Aberrometry”, “Defocus curve”. The choice of sources for the review was carried out in accordance with the criteria for prospective or retrospective studies. A total of 158 sources were analyzed, further using systematic review filters and the authors’ knowledge of the topic. The duration of the retrospective analysis was 8 years (2015–2022), some of the considered works were dated 2023. Results. The values of visual acuity for distance, near and at an intermediate distance in both studied groups did not differ significantly. When analyzing the defocusing curve, the preservation of visual acuity under load conditions from +1.0 to +3.0 diopters was determined for both types of IOL, respectively. At the same time, visual acuity was significantly better in the TPIOL group than in the EDOF group in the optical load range from -2.5 to -4.0 diopters. Most studies did not report significant difference between EDOF and TFIOL in terms of contrast sensitivity, the likelihood of postoperative “halo” effects, and “independence” of spectacle correction. The stated provisions are fully consistent with the results of the medical and technical evaluation of EDOF presented in the literature. Conclusion. The development of a new type of EDOF IOL seems to be a promising direction in cataract surgery, especially taking into account the possibility of using patients whose professional activities are associated with long-term visual work at intermediate distances (for example, users of personal computers). Further accumulation of clinical material is required in the context of the role and place of EDOF in the general system of aphakia correction, taking into account the IOL model and the conditions of the patient’s professional visual activity.

The calculation of the optical power of the IOl for out-bag implantation remains one of the actual problems of cataract surgery. Purpose. Comparative study of the precision of calculating the optical power of the IOL for retropupillary fixation of an iris-claw lens, transscleral fixation of a rigid IOL with two flexible haptic elements and transscleral fixation of an soft hydrophobic IOL with two open haptic elements. Patients and methods. The study included 105 patients (108 eyes) with complicated phacoemulsification in combination with lens subluxation. First group included 39 patients (42 eyes) with complicated phacoemulsification and retropupillary implantation of an iris-claw lens. Second group included 29 patients (29 eyes) with complicated phacoemulsification and transscleral suture fixation of rigid PMMA IOL. Third group included 37 patients (37 eyes) with complicated phacoemulsification and transscleral suture fixation of an soft hydrophobic IOL with two open haptic elements. In the postoperative period we performed a comparative evaluation of visual acuity without correction and best corrected visual acuity, IOL optical power calculation precision within ±0.5 diopters, the average absolute error of IOL optical power calculation. Results. Three months after the operation the visual acuity of 0.8–1.0 without correction was obtained in 35,7 % of cases in the 1st group, 17.2 % in the 2nd group, 16.2 % in the 3rd group. The precision of postoperative refraction within ±0.5 diopters was 95.2 % in the 1st group, 86.2 % in the 2nd group 83.7 % in the 3rd group. The average absolute error of IOL optical power calculation was 0.33 ± 0.07 diopters in the 1st group, 0.57 ± 0.18 diopters in the 2nd group, 0.62 ± 0.19 diopters in the 3rd group (р < 0.05). Three months after surgery there were no significant differences in best corrected visual acuity and the degree of induced astigmatism. Conclusion. Retropupillary implantation of an iris-claw lens during complicated phacoemulsification significantly increases visual acuity without correction, frequency calculation precision within ±0.5 diopters, significantly reduces the average absolute calculation error compared to transscleral suture fixation of the IOL.

Diagnosis of conjunctivitis is an urgent problem in ophthalmic practice, since conjunctivitis is one of the most common reasons for patients to visit a doctor. An important aspect in diagnosing of the conjunctivа’s inflammation is to determine the intensity of the inflammatory process in each case, in which hyperemia is given priority, as the most demonstrative sign of inflammation. Currently, there are many subjective and non-invasive instrumental methods for assessing conjunctival hyperemia. Taking into account the fact that most of the instrumental methods are aimed to assess the state of the bulbar conjunctiva and there are practically no methods that allow assessing the severity of tarsal hyperemia, it is necessary to develop a methodology that allows to evaluate both these indicators in combination. In this regard, it is great interest to determine the degree of hyperemia during a biomicroscopic examination in combination with visualization and fixation of hyperemia indicators using the software of the MediWorks Dixion S 350 slit lamp (weak, medium, significant, severe) depending on the index of hyperemia obtained by fixing the image on the slit lamp. Standardization of the severity indicators of conjunctival hyperemia allows to obtaine objective data on the state of the tarsal and bulbar conjunctiva at all stages of observation. In addition, based on the above indicators in clinical practice, the ophthalmologist can prescribe an adequate amount of drug therapy, this will increase the level of safety and effectiveness of the therapy, which is especially important at the stage of primary outpatient admission, when treatment is usually prescribed empirically

Purpose — to study the dynamics of accommodative asthenopia (AA) in patients with visually stressful labor (VLT) after laser keratomileusis in situ (LASIK) with different degrees of myopia. Patients and methods. There were 300 patients with VLT under supervision, divided into three groups of equal age and gender, corresponding to weak (up to 3.0 diopters, 100 patients, 200 eyes), medium (3.25–6.0 diopters, 100 patients, 200 eyes) and high (6.25–8.0 diopters, 100 patients, 200 eyes) 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 (CMF). Diagnosis of the type of AA was carried out according to the following indicators: with CMF less than 53.0 rel. un. — asthenic form of accommodative asthenopia (AFAA); at CMF from 53.0 to 58.0 rel. un. — NORM; at CMF more than 58.0 rel. un. — habitual excess tension of accommodation (PINA). The survey was carried out before and three months after the operation. Statistical analysis of the results of the study was performed on the basis of the rate of occurrence (in % of the total number of eyes) of different dynamics (before-after surgery) AA (NORM-NORM; PINA-PINA; AFAA-AFAA; NORM-AFAA; NORM; PINA-AFAA; AFAA-NORM; AFAA-PINA). Results. The change in the form of AA varied from 2 % (APAA-PINA) to 18 % (PINANORM), averaged 15 % and was not statistically significant. The results obtained naturally reflect the state of AA as an adequate physiological response of the accommodative system of the eye to long-term, intense visual work with a fairly high level of responsibility for the result. Based on the above situation and the patient’s desire to maintain (in some cases even increase) the volume of daily visual load after the operation, it is unlikely to expect a significant improvement in the state of accommodation. Conclusion. LASIK with different degrees of myopia in patients with VLT has practically no effect on the dynamics of AA and requires a complex of therapeutic and restorative measures based on the development of methodological principles from the standpoint of a differentiated approach to the form of AA and the basic provisions of medical rehabilitaton.

Purpose: to study optical coherence tomography (OCT) characteristics of intravitreal particles in vitreous hemorrhage and posterior uveitis. Patients and methods. 29 patients with posterior uveitis (43.1 ± 19.4 years, 10 females and 19 males) and 29 patients with vitreous hemorrhage (62.3 ± 11.6 years, 9 females and 20 males) were included. All patients received standard ophthalmological examination and multimodal imaging, including OCT. The size and reflectivity of preretinal intravitreal particles was assessed on crosssectional OCT scans. Results: Intravitreal particles in eyes with posterior uveitis had a statistically significantly larger size compared to the particles in vitreous hemorrhage, 47.0 ± 29.0 and 41.3 ± 22.6 pixels, respectively (p < 0.001). At the same time, intravitreal particles in eyes with posterior uveitis had lower mean reflectivity compared with eyes with vitreous hemorrhage, 126.0 ± 10.5 and 135.2 ± 11.1, respectively (p < 0.001). The maximum reflectivity of intravitreal particles in eyes with posterior uveitis was also lower than that of particles in eyes with vitreous hemorrhage, 186.2 ± 24.9 and 166.3 ± 23.7, respectively (p < 0.001). Conclusion. Intravitreal particles displayed with OCT in posterior uveitis are less reflective and larger than those in vitreous hemorrhage.

Background. Particular vigilance in timely detection of retinal dystrophies (RD) in children is necessary as effective measure to prevent formation of rhegmatogenous retinal detachment. Purpose. To study frequency and structure of clinical forms of RD in children of different age groups to find out most typical age of their primary formation, to assess the proportion of their prognostically hazardous forms. Materials and methods. Clinical material — 314 children aged 5 to 17 years, on average 11.0 ± 0.6 years, who applied with various ophthalmological pathologies in the Department of Pediatric Ophthalmology of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from July 2020 to April 2021. All children underwent biomicroscopy, ophthalmoscopy with in-depth examination of the state of the equatorial and periphery parts of the retina in condition of maximum cycloplegia. All 4 quadrants of the fundus were examined using binocular indirect ophthalmoscope with 20D lens. The presence and frequency of RD, their clinical varieties, according to the classification of E.O. Saksonova (1979), were ascertained in each of the studied age groups. Their localization, their length, and eye refraction were also assessed. Results. Presence of RD was revealed in 34 (11 %) children. In structure of identified clinical forms of RD, 11 children had its prognostically non-hazardous forms of RD, 23 children had prognostically hazardous forms (33 % and 67 % respectively). According to our data, the earliest age of detection of RD was 6 years. Further progression of RD was noted in 2 out of 6 children after restrictive photocoagulation of prognostically hazardous forms of RD. Conclusion. Formation of RD occurs not only at puberty, but also at an earlier age, according to our data, from 6 years of age. In view of this, it is necessary to conduct a thorough ophthalmoscopic examination of the periphery parts of the retina, even in young children.

Purpose: сomparative clinical and diagnostic efficiency of the quality of life (QОL) according to the PHEC-22 and Catquest-9SF questionnaires after bilateral cataract phacoemulsification and monofocal IOL implantation. Patients and Methods. We observed 148 patients with binocular cataract (mean age 58.6 ± 1.8 years). All patients underwent standard cataract phacoemulsification with implantation of a monofocal IOL. Patients were examined before and after (one month after surgery on the second eye) surgery. The results of the survey on the questionnaires PHEC-22 and Catquest-9SF were evaluated by the general indicator of testing (GIT) as the sum of points for all questions (taking into account the “weight” coefficients in the questionnaire PHEC-22). Along with this, each of the patients underwent a study of binocular BCVA. Results. A statistically significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire compared to Catquest-9SF was established, which is confirmed by a higher (by 0.17 rel. units, p < 0.01) level of correlation with BCVA, as well as a higher probability of compliance of the QOL level with the BCVA range, especially at low (0.4 and less rel. units, by 18.5 %, p < 0.01) and medium (0.5–0,8 relative units, by 7.3 %, p < 0.05) values of BCVA, while in the range of BCVA 0.9–1.0 relative units, no significant differences between the questionnaires were found (p > 0.05). Conclusion. The results of a comparative study after bilateral cataract phacoemulsification and monofocal IOL implantation using the PHEC-22 and Catquest-9SF questionnaires revealed a significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire, which is associated with the methodological principles for developing a questionnaire based on the “social model” of health with the involvement of expert ophthalmologists and the use of the optimal procedure for scaling the patient’s responses. The results obtained (taking into account clinical normalization) allow us to recommend the PHEC-22 questionnaire for inclusion in the complex diagnosis of patients with cataracts both before and after surgery in solving a number of urgent problems — a comparative assessment of IOL, a study of the effectiveness of methods for postoperative rehabilitation of patients, the choice of the optimal formula for calculating IOL and some others.

Currently, surgical treatment of ptosis of the upper eyelid does not always lead to a good anatomical and physiological result — the frequency of dissatisfaction with the results of treatment is 8–26 %, and repeated operations on the muscle that lifts the upper eyelid are performed in 8.7–18 % cases. An important aspect of the successful treatment of upper eyelid ptosis is the preoperative examination of the patient; however, standard diagnostic methods do not provide complete information about the functional features of the upper eyelid levator. The purpose of the study is to improve the algorithm for preoperative examination of the upper eyelid in ptosis with the study of the contractility and fatigue of the upper eyelid levator. On the basis of the Helmholtz National Medical Research Center of Eye Diseases in the period from 2021 to 2022, 63 patients (67 eyes) aged from 5 to 78 years with different types of blepharoptosis admitted for surgical treatment were examined. We have developed a comprehensive dynamometric preoperative assessment of the upper eyelid levator with a study of the contractility and fatigue of this muscle using weights. For comparison and determination of normal parameters, the study was also carried out on paired intact eyes (59 eyes) and in 40 healthy people. Indicators of contractility and fatigue of the levator of the upper eyelid were obtained in normal conditions and with ptosis of the upper eyelid, and differences in these indicators were revealed in congenital and acquired blepharoptosis. With congenital ptosis of the upper eyelid, the contractility and fatigue of the levator of the upper eyelid is low, while with acquired ptosis (senile), the contractility is medium, and fatigue is medium or high. A gradation of the values of contractility and fatigue of the upper eyelid levator in blepharoptosis was developed, on the basis of it an algorithm for choosing a method for surgical correction of upper eyelid ptosis was proposed. The developed method of dynamometric preoperative study of the anatomical and functional features of the upper eyelid levator using weights is a simple and affordable method for objectively assessing the state of contractility and fatigue of the levator, which can improve the efficiency of surgical correction of upper eyelid ptosis.

Purpose — to study the effect of a mid-infrared laser with a wavelength of 3.0 μm on the eye tissue. Materials and methods. An experimental laser device “Laser scalpel in the middle infrared range 2–8 μm for precision surgery” was used. The range of the radiation spectrum generated by this laser coincides with the spectral absorption peaks of such biological tissue chromophores as water, proteins and cholesterol esters, which makes it possible to use this laser in precision surgery (ophthalmology, neurosurgery, vascular surgery). In this study, we chose a wavelength of 3 µm, which coincides with the peak of the spectral absorption of water. The retina, choroid, sclera of porcine and cadaveric eyes was used as biological tissue. The effect of laser radiation on tissue was carried out in air. The application of coagulates was performed in different modes: 1) single pulses, 2) continuous mode. The impact of laser radiation on eye tissues was assessed using a scanning electron microscope. Results. When exposed to a single laser pulse with an energy of even 1 mJ, a through defect of the retina was observed. When exposed to a single laser pulse on the choroid with an energy of 1 to 3 mJ, the depth of the crater was 110–130 µm, the width of the crater was 97–122 µm, and the zone of collateral damage was 22–28 µm. When exposed to a single laser pulse on the sclera with an energy of 1 to 3 mJ, the depth of the crater was 170–201 µm, the width of the crater was 260–303 µm, and the zone of collateral damage was 57–72 µm. With continuous exposure to laser radiation on the choroid and sclera, the depth, width of the coagulate, the zone of collateral damage with similar laser parameters were greater than with a single pulse. Conclusion. Using this laser at a wavelength of 3 μm, it is possible to dissect eye tissues, which can be useful in vitreoretinal surgery for retinotomy, cutting out the choroid-pigment epithelium complex, and in antiglaucoma surgery for non-penetrating deep sclerectomy. However, further research is needed to optimize such laser parameters as the number of pulses in a packet, pulse duration, and pulse energy.

In recent years, the Delphi method (DMt) has been widely used in scientific practice. It is based on an expert assessment of the object under study, which is formed on the basis of a survey of a group of experts in a particular field. The application of the Delphi method in various areas of ophthalmological practice has made it possible to develop practical recommendations for the diagnosis of visual stress, methods for diagnosing and treating keratoconus, to develop clinical guidelines for the diagnosis and treatment of patients with Sjögren’s syndrome, to classify the signs and symptoms of dry eye syndrome in accordance with the main mechanism of its occurrence and etc. A survey ophthalmologist expert conducted during the study, performed in accordance with the Delphi method, aimed at developing a differential algorithm in the treatment of patients with one of the most common pathologies among diseases belonging to the category of “red eye syndrome” — conjunctivitis, allowed identify key symptoms for prescribing different groups of drugs. In accordance with the clinical guidelines developed by the Russian Association of Ophthalmologists, the following groups of drugs are recommended for use: antibacterial, antiseptic, antihistamine, non-steroidal anti-inflammatory drugs, steroidal anti-inflammatory drugs, antiviral drugs. This article presents the results obtained in determining the indications for the use of non-steroidal anti-inflammatory therapy in the treatment of conjunctivitis. These include: the presence of a history of systemic diseases, the duration of inflammation for more than 7 days, the absence or presence of mucous discharge, complaints of a feeling of pain, discomfort in the eyes, their redness, as well as biomicroscopic signs of inflammation, which manifest themselves as mild to moderate conjunctival hyperemia expressiveness. The result obtained is of fundamental practical importance for primary outpatient ophthalmologists for choosing rational drug therapy in the treatment of one of the most common pathologies encountered in ophthalmic practice — conjunctivitis. A differentiated approach in choosing the volume and type of drug therapy based on the severity of the inflammatory process will reduce the drug load on the ocular surface. In accordance to the data presented in the first part of this article, it will lead to a decrease the risk of developing signs of dry eye syndrome against the background of a stopped inflammatory process in the long-term period and improving the quality of life in patients.

Purpose of the study: to evaluate the efficacy and feasibility of using brimonidine 0.2 % in the additive therapy of patients with advanced stages of glaucoma. Materials and methods. There were 59 patients (77 eyes) with advanced stages of primary open-angle, glaucoma (POAG) aged 68 to 83 years in the study. Patients were randomized into 2 groups depending on the received antihypertensive therapy. The first group (I) included 32 people (41 eyes) who used a fixed combination of a prostaglandin analogue (APG) or a carbonic anhydrase inhibitor (CAI) with a beta-blocker (BB) for the treatment of POAG. The second group (II) consisted of 27 patients (36 eyes) who had the α2-adrenergic agonist brimonidine — S3 added to the previously available combination of APG or ICA with BB. The observation period was 6 months. Results. Application of brimonidine — SZ in the additive therapy of advanced stages of glaucoma led to an additional hypotensive effect. By the end of the observation period in the group of patients treated with brimonidine, intraocular pressure decreased by an additional 10 % from the initial level. A good hypotensive effect contributed to an increase in functional parameters. Analysis of the results of static automatic perimetry showed a positive trend in the mean deviation (MD) and standard deviation pattern (PSD), which may indicate a neuroprotective effect of the drug. All patients noted good tolerability of treatment. Throughout the observation period, patients maintained a high level of adherence and performance.

In the article various ophthalmic manifestations of hemoblastoses will be discussed. Detailed descriptions of the most common variants of damage to the organ of vision in the oncohematological process are presented. Here we also present the clinical symptoms and development mechanisms associated with both direct leukocyte infiltration of various structures of the eye, occurring against the background of the underlying disease, and concomitant conditions, such as violation of the hemostasis system, anemia and thrombocytopenia resulting from the progression of blood cancer. It is also considered the cases of ophthalmic manifestations of hemoblastoses developing against the background of an immunity decrease associated oncohematological disorder, or as a result of the toxic effect of chemotherapy drugs, radiotherapy and bone marrow transplantation, as well as targeted therapy.

Objective: to study the effectiveness of the hypromellose-based medicine Artificial Tears®, eye drops, in the treatment of dry eye syndrome in students with myopic refraction. Patients and methods. A total of 147 students of Academician E.A. Wagner Perm State Medical University with different types of clinical refraction were examined. Among them 63 students with myopic refraction of various degrees in 110 eyes were included in the study (mean age — 22.6 ± 0.16 years, 49 (78 %) women, 14 (22 %) men). Dry eye syndrome was detected in 49 (78 %) participants in 82 eyes (74.5 %). According to the myopia correction method, 3 groups were formed: Group 1 — students with eyeglasses; Group 2 — students constantly using soft contact lenses; Group 3 — students who had excimer laser correction by LASIK method. The remaining students (n = 14) had no dry eye syndrome. The study was conducted in two stages: at baseline and then repeated after 4 weeks in students with dry eye syndrome who used daily the medicine Artificial Tears®. Subjective assessment was based on the Ocular Surface Disease Index (OSDI) questionnaire. Оbjective assessment included function tests, characterizing the precorneal tear film stability and total tear production level. Results. In the process of treatment a good tolerance of the given medicine was reported. Analysis of the overall results showed that the mean OSDI score decreased statistically significantly from 26.92 to 20.29 seconds (p ≤ 0.0001). The mean tear film break-up time increased from 7.95 to 11.25 (p ≤ 0.0001). The mean Schirmer’s test score was slightly changed: from 13.98 to 14.07 mm due to the presence of increased tear production in some students, which is characteristic of the dry eye syndrome initial manifestations. Conclusion. The medicine Artificial Tears® in the form of eye drops is well tolerated and is sufficiently effective in eliminating the dry eye syndrome manifestations after only 4 weeks of use. The treatment with the medicine Artificial Tears® showed a statistically significant reduction in the disease severity (according to the OSDI questionnaire data) and an increase in the tear film break-up time. The received results allow us to recommend the medicine Artificial Tears® for medical use in patients with various degrees of myopic refraction, regardless of the myopia correction method used.

Purpose: to evaluate the effectiveness of a fixed combination of 0.24 % hyaluronic acid, carbomer, glycerol and a lipid component in the hyposecretory dry eye treatment. Patients and methods. We examined 35 hyposecretory moderate dry eye (DE) patients in conditions of lipidaquas-mucin deficiency and meibomian gland dysfunction (MGD). All patients included in the study received instillations of a fixed combination of 0.24 % hyaluronic acid (in the form of sodium hyaluronate), carbomer, glycerol and a lipid component (in the form of medium chain triglycerides) — Artelak Night (3 times a day, 2 months). The main criterion for the effectiveness of therapy was the tear film brake up time (TBUT, Norn’s test, s). In addition, the dynamics of the following indicators were taken into account: OSDI (scores), “lid-wiper’ symptom (LWS, scores), lower tear meniscus height (LTMH, μm; OCT, OptoVue), Bijsterveld`s xerosis index (XI, scores; lyssamine green stained). Control points: at inclusion in the study; examination after 1 and 2 months of therapy. Statistics: calculation of the mean and its standard deviation (M ± s); assessment of the reliability of differences in indicators characterizing the state of the ocular surface before and after therapy (Wilcoxon t-test). Results. The patients showed a statistically significant increase in TBUT at the second and third control points, which indicated the effectiveness of DE therapy. The increase in TBUT was accompanied by a significant decrease in the severity of DE subjective symptoms at the same control points (OSDI). On the background of therapy, a trend towards a decrease in LWS was recorded, which was statistically insignificant. Apparently, a significant increase in TBUT and a decrease in OSDI were associated with a significant increase in LTMH at the third control point (decrease in the severity of aqua-deficiency) and a significant decrease in XI at the second and third control points (decrease in the severity of mucose-deficiency). Conclusion. A fixed combination of 0.24 % hyaluronic acid, carbomer, glycerol and a lipid component proved to be effective in the treatment of hyposecretory moderate DE in conditions of lipid-water-mucin deficiency, which was accompanied by a significant increase in TBUT and LTMH, as well as a decrease in OSDI and XI.

Aim: to evaluate the effectiveness of treatment with Optinol on the condition of the ocular surface in people over 35 years of age with refractive error. Patients and methods. The study was carried out in two clinical and in the control group. The first group included 74 patients (148 eyes) with moderate (group 1a) and high (group 1b) myopia, mean age 38.3 ± 0.4 years. The second group consisted of 49 patients (98 eyes) with moderate (group 2a) and high (group 2b) hypermetropia, mean age 42.3 ± 0.5 years. The control group included 25 healthy individuals (50 eyes), mean age 38.2 ± 1.4 years. The anamnesis of patients, complaints and concomitant diseases were assessed by the questionnaire method. Conclusion. The results of the study proved the influence of moderate and high hypermetropia on the likelihood of dry eye syndrome (DES).

The article presents a clinical case of penetrating keratoplasty performed in a patient after corneal perforation against the background of dacryoadenitis. The importance of the condition of the precorneal tear film for the normal functioning of the cornea and how dry eye syndrome affects the condition of the cornea before and after surgery are discussed. Relevant and open, in the article, remains the issue of the development of such complications as a corneal ulcer with perforation, against the background of dry eye syndrome that developed more than 10 years after the keratorefractive operation. Data on the state of the penetrating corneal graft after 6 months of dynamic follow-up are presented.

The purpose: to analyze the clinical and functional results of the complex staged treatment of graft disease in patient with an implanted iris lens diaphragm and concomitant postkeratoplastic ametropia using descemet’s stripping endothelial keratoplasty using a femtosecond laser (FS-DSEK) and MyoRing implantation into a corneal graft using a femtosecond laser on the example of a clinical case. Methods. Patient M., 51 years old, was admitted with a diagnosis of the left eye: corneal transplant disease, condition after penetrating keratoplasty, iridoartifakia, avitria, optic nerve subatrophy, high myopia. To treat the graft disease, the patient underwent FS-DSEK using a FemtoVisum 1 MHz (Troitsk, Russia). Twelve months after FS-DSEK to correct irregular postkeratoplastic astigmatism and concomitant high-grade myopia detected after restoration of the transparency of the penetrating corneal graft, the MyoRing was implanted into the penetrating corneal graft using a femtosecond laser. Results. After performing FS-DSEK, the transparency of the penetrating corneal graft was completely restored, visometry, refractokeratometry, and keratopachymetric data were stabilized by 6 months after the operation. 12 months after FS-DSEK, uncorrected visual acuity (UCVA) increased from 1.6 to 1.2 LogMAR, best corrected visual acuity (BCVA) increased from 1.6 to 0.8 LogMAR. Loss of endothelial cell density of the posterior layered graft was 27.4 %. MyoRing implantation into a penetrating corneal graft made it possible to significantly increase the UCVA from 1.3 to 0.3 LogMAR and the BCVA from 0.8 to 0.2 LogMAR. The spherical component of refraction decreased from -6.25 to -0.75 D, the cylindrical component of refraction — from -9.25 to -1.25 D, the regularity, sphericity of the corneal graft and its biomechanical properties increased (corneal resistance factor increased from 8.2 to 9.4 mm Hg, corneal hysteresis — from 7.9 to 9.1 mm Hg). Conclusion. A complex staged technique of descemet’s stripping endothelial keratoplasty using a femtosecond laser followed by MyoRing implantation into the corneal graft using a femtosecond laser is an effective and safe method for treating graft disease in a patient with an implanted iris lens diaphragm and concomitant postkeratoplastic ametropia.

Bacterial corneal ulcers in patients with comorbid pathology are a complex clinical situation with a high risk of complications — corneal perforation. The article presents four clinical cases of bacterial corneal ulcers in patients with chronic latent sinusitis. The publication discusses the issues of diagnostic tactics, provides an analysis of the results of instrumental and laboratory tests in each case. The results of corneal ulcer therapy are presented taking into account antibioticograms.