Insufficient blood supply, vascular dysregulation, perfusion pressure and endothelial dysfunction may account for the pathogenic mechanism. OCT angiography (OCTA) measurements have been reported to be useful for glaucoma diagnostics. OCTA microvasculature could serve as a potential biomarker for glaucoma diagnosis. One of the important criteria for the treatment of NTG is the reduction of IOP, which is achieved by both conservative methods of treatment and laser and surgical interventions. With timely diagnosis, control of IOP and monitoring of morphofunctional changes in the eyes with NTG, it becomes possible to suspend the development of glaucoma optic neuropathy and preserve the patient’s vision for a long time.

The problem of diagnosis and treatment of fungal keratitis (FK) is very acute. Due to the slow development of clinical features and the absence of clear pathognomonic signs, this disease is characterized by a late start of the introduction of adequate etiotropic therapy. Often this leads to the development of large corneal defects requiring surgical intervention. Diagnostic methods are divided into invasive and non-invasive. Invasive methods include the study of scrapings from the surface of the cornea from the site of ulceration, biopsy of the corneal stroma or moisture of the anterior chamber using microscopic, cultural methods or polymerase chain reaction (PCR). Non-invasive techniques include confocal microscopy and optical coherence tomography of the anterior segment. They allow you to dynamically monitor the course of the pathological process and the response to ongoing therapy. Promising methods are also the detection of (1,3)-β-D-glucans in tears, the detection of the pathogen using MALDI-TOF MS. The gold standard for the treatment of FK in the world is the topical application of 5 % Natamycin (approved by the FDA, but not available in Russia). Fluconazole, Voriconazole and Amphotericin B, available in Russia, are also widely used, but their topical use is possible only in off label format. In the presence of hypopyon or an increase in the size and depth of the infiltrate, despite ongoing treatment, immediate surgical treatment is required in order to preserve the integrity of the eyeball. Such treatments include penetrating keratoplasty, anterior lamellar keratoplasty, amniotic membrane transplantation, conjunctival flaps, corneal collagen cross-linking (with unproven efficacy), and argon laser. A promising method for the treatment of FK can be the use of Ag(10 %):InP/ZnS MPA quantum dots as monotherapy or as a bioconjugate with known antifungal drugs.

This review presents well-known surgical techniques aimed at the treatment of unilateral limbal insufficiency syndrome. Among the many available techniques, one should especially highlight the so-called “simple limbal epithelial transplantation”, which has proven to be an effective, safe and generally available method of treating unilateral limbal insufficiency syndrome (SLN). It should be noted that the risks of recurrence of SLN remain significant, and the mechanisms of engraftment of transplanted limbal epithelial stem cells on the recipient’s eye are not fully understood. The review also considers options for new promising approaches to the possible solution of existing problems in the transplantation of limbal epithelial stem cells.

Phacoemulsification (PE) is a current ‘gold standard’ of the surgical treatment of the cataract. Apart from lens extraction and intraocular lens implantation, PE is accompanied by IOP changes in most cases. In cases of ophthalmic hypertension or primary open-angle glaucoma, IOP is most often decreased; however, the mechanism of this phenomenon is currently completely unknown. In closed-angle glaucoma, PE provides opening of the anterior chamber angle, which restores physiological outflow of intraocular fluid and leads to IOP stabilization. In some cases, however, PE may be accompanied by a short-term increase in IOP. The exact mechanism of this reaction is unknown, however, in most cases it is associated with the inflammatory response of the eye to surgical trauma.

Dry eye syndrome is a multifactorial disease of the ocular surface, which is based on the development of hyperosmolarity, inflammation and sensorineural disorders in the imbalance of the structural components of the tear film. The main complaints of refractive patients after keratorefractive surgery are a feeling of dryness in the eyes, a foreign body, redness, blurring of the image, which is due to the clinical manifestations of post-refractive dry eye syndrome. There are factors that contribute to the development of postrefractive dry eye syndrome, such as: neurotrophic epitheliopathy, postoperative inflammation, damage to goblet cells, toxic corneal epitheliopathy caused by preservatives contained in eye drops, leading to inadequate restoration of the tear film. In clinical practice, to assess the stability of the tear film, a method is used to determine the tear film rupture time using invasive and non-invasive methods. Invasive methods include: staining of the ocular surface with a solution of fluorescein during the Norn test. To date, laboratory diagnostics expands the understanding of the pathogenesis, etiology and mechanisms underlying the xerosis of the ocular surface at the molecular level, and also facilitates the diagnosis and prognosis of dry eye syndrome. Laboratory methods of the ocular surface include the study of biomarkers of lacrimal fluid, conducting impression cytology with an assessment of the condition of goblet cells. In this regard, it is necessary to have a deep understanding of the main etiopathogenetic links of dry eye syndrome, a wide range of diagnostics of the condition of the ocular surface before and after the surgical stage of patient management, which will determine the success of keratorefractive surgery and a stable course of the postoperative period.

Retinal detachment (RD) is the most serious problem of modern ophthalmology, often leading to a decrease or irreversible loss of visual functions. The literature review is devoted to the latest trends in the study of the mechanisms of development and course of rhegmatogenous retinal detachment (RRD) against the background of proliferative vitreoretinopathy. In the pathogenesis of RD, there are five theories, as well as nine main risk factors for development. It is known that the contact between the retinal neuroepithelium and the retinal pigment epithelium is maintained by physical and metabolic forces, as well as by the friction force of the outer segments of photoreceptors and RPE cells. With synchisis and simultaneous syneresis, vitreous detachment develops, with increased traction forces and the possible development of RRD. Retinal detachment is the most serious problem of modern ophthalmology, often leading to a decrease or irreversible loss of visual functions. The review of the literature is devoted to the latest trends in the study of the mechanisms of development and course of rhegmatogenous retinal detachment against the background of proliferative vitreoretinopathy. In the pathogenesis of RD, there are five theories, as well as nine main risk factors for development. It is known that the contact between the retinal neuroepithelium and the retinal pigment epithelium is maintained by physical and metabolic forces, as well as by the friction force of the outer segments of photoreceptors and RPE cells. With synchisis and simultaneous syneresis, vitreous detachment develops, with an increase in traction forces and the possible development of RRD. The presence of a retinal tear rarely leads to RRD. It has been established that a pronounced traction effect, rather than a through rupture of the retina, is a key factor in the development and progression of RRD. Traction occurs in the course of proliferative vitreoretinopathy and the epiretinal layer of the vitreum remaining in the posterior vitreous detachment. With the development of detachment, damage to the hematoophthalmic barrier occurs, leading to the release of cells into the vitreous cavity that affect the development of PVR (epi-, sub- and intraretinally) with the formation of an epiretinal membrane. At the same time, communication with the choroid is lost, hypoxia and acidosis develop. ERMs formed during retinal detachment include glial cells and their subtypes — fibrous astrocytes, Muller cells, microglia, hyalocytes, RPE cells, fibroblasts and myofibroblasts. However, the leading role in the formation and development of ERM belongs to Muller cells and astrocytes. Also involved in the pathological process of ERM formation are: transforming growth factor β2, fibroblast growth factor, nerve growth factor, vascular endothelial growth factor, platelet growth factor, laminin, fibronectin, thrombospondin-1, osteonectin, transcription factor. Against the background of ROS, one should not forget about the change in the chemical composition of the vitreous body (increased content): serum albumin, transferrin, antithrombin III, α1-antichymotrypsin, α1-antitrypsin, α2-HS-glycoprotein, hemopexin, transthyretin, apolipoprotein A1, and fibrinogen

Over the past 25 years, Xalatan (Latanaprost) has become one of the most effective first-line drugs in the treatment of glaucoma, due to its pronounced hypotensive effect, safety and convenience of a single instillation. The review article presents the historical aspects of the creation and mechanisms of action of prostaglandin analogs, the neuroprotective properties of latanoprost, as well as data from meta-analyses and clinical studies on the effectiveness of the drug in the treatment of glaucoma.

The purpose of the review is to evaluate the interaction of angiotensin-converting enzyme inhibitors in patients with glaucoma and concomitant arterial hypertension using literature data. Glaucoma is the main cause of blindness and visual impairment, as well as the main cause of irreversible blindness worldwide. Pharmacotherapy, laser or surgical treatments are used to reduce IOP levels, as well as prevent deterioration of visual field defects. However, 40 % of patients develop glaucomatous neuropathy despite ongoing therapy. This prompts the investigation of alternative causes of damage to the optic nerve, and abnormal blood pressure levels, both too low and too high, are considered as a possible risk factor. Arterial hypertension occurs in 48–65 % of patients with glaucoma and is the most common systemic disease in patients with glaucoma. Currently, angiotensin converting enzyme (ACE) inhibitors are considered the “gold standard” in the treatment of arterial hypertension, in the pathogenesis of which activation of the renin-angiotensin system (RAS) plays an important role. The renin-angiotensin system (RAS) is a hormonal system responsible for regulating blood pressure and fluid and electrolyte balance in the body. Local tissue-specific RAS were found, including in the structures of the eyeball: cornea, aqueous humor, iris, ciliary body, vitreous body, retina. These data indicate that the local RAS plays an important role in the regulation of the physiology of the eye and may become a target in the development of new antiglaucoma drugs. Animal studies, as well as studies in various patient groups, show that systemic antihypertensive drugs that inhibit the RAS, such as ACE inhibitors, reduce IOP. These studies support the concept that RAS inhibitory drugs may be potential antiglaucoma drugs in the future, as ACE inhibitors can improve the outflow of intraocular fluid, thereby reducing IOP.

To understand the current situation with the genetic epidemiology of primary congenital glaucoma (PCG) in the world, as well as to identify genotype-phenotype correlations, 87 publications were analyzed from the Pubmed and elibrary databases, mainly the latest 5 years. This publication presents the first part of the analysis, covering Arab and African countries, Turkey, the USA, Brazil, Australia and New Zealand. The second part of the review, which will be published in early 2024, will focus on data from East and South Asia, Western Europe and Russia. The highest incidence of PCG is typical for Arab countries, which is associated with the presence of a significant number of consanguineous marriages in these countries. In most countries, boys predominated among patients with PCG, and the process was often bilateral. In Australia female patients predominate. The PCG phenotype is more severe in patients with CYP1B1 mutations (early onset, bilateral involvement) than in patients without mutations, and in patients with consanguineous parents than in children from unrelated marriages. Among the genetic causes of PCG in different populations, the most common (from 30 to 86 % of cases) in Arab countries, Brazil and Turkey are mutations in the CYP1B1 gene. The spectrum of mutations varies depending on the region. In Australia and New Zealand, biallelic mutations were identified in the CYP1B1, CPAMD8 and COL18A1 genes, as well as heterozygous mutations in the TEK, FOXC1 and ANGPT1. Mutations in rare genes were also found in patients with PCG from Lebanon (ANGPT1 (p.K186N), Mauritania (NTF4 (c.601T>G, p.Cys201Gly) and WDR36 (c.2078A>G, p.Asn693Ser)). In the USA, the influence of the thrombospondin gene (THBS1) on the development of PCG is being studied. Based on the results of genetic and epidemiological studies, specific treatment, rehabilitation and preventive programs can be developed, which will determine the success of PCG therapy in children, preserving their visual functions.

Purpose. To evaluate the performance and the visual outcomes of Acrysof PanOptix trifocal IOL in terms of safety, efficacy, predictability and assessment of the quality of vision after implantation as regards; contrast sensitivity and ocular aberrations. Methods. A prospective interventional non randomized study that included forty eyes of twenty one patients with senile cataract. All surgeries were carried out between September 2019 and January 2020. Patients underwent phacoemulsification for cataract removal with IOL implantation. They were divided into two groups; group(A) included twenty eyes of eleven patients who were implanted with AcrySof IQ PanOptix trifocal IOL Model TFNT00. While group (B) included twenty eyes of ten patients who were implanted with monofocal AcrySof IOLs as a control group. Results. There were 21 subjects enrolled in our study. Mean age was 56.6 ± 6.9 years in group (A) and 62.8 ± 7.1 years in group (B),(range 50–70).We found statistical significant difference between both groups with group A showing better post operative uncorrected distance, intermediate, near, and best corrected near visual acuity . Group (B) showed statistically significant better post operative contrast sensitivity compared to group (A). Conclusion: In this study, Acrysof PanOptix trifocal IOL showed excellent safety, efficacy, predictability and spectacle independence at all distances, This prospective interventional non-randomized study showed excellent safety, efficacy and predictability of the PanOptix IOL with higher spectacle independence, slightly impaired contrast sensitivity without affecting daily activities. However, contrast sensitivity was compromised in comparison to the monofocal group and high order aberrations (coma, trefoil) were noted to be higher affecting the quality of vision but not the daily activities of the patient.

Objective: based on clinical and morpho — functional analysis of retinal restoration and assessment of the cellular composition of platelet-rich plasma, to determine its optimal fraction for surgical treatment of macular hole. Materials and methods. This study presents the results of 120 cases of surgical treatment of eyes with macular hole. The patients were divided into 2 groups. In the 1st group (60 eyes), the technology developed in our clinic was used without the use of postoperative tamponade of the vitreal cavity and the use of autologous platelet-rich plasma (PRP), in the 2nd — traditional technology for the treatment of macular hole s (60 eyes). The cellular composition of the PRP of 30 patients was analyzed. Results. 2 months after surgery, 119 patients had the restoration of all retinal layers in the macular hole area and positive dynamics of visual acuity was recorded in comparion with the preoperative period. After observation for 6 months after surgery, cases of recurrence of macular hole were not detected. Conclusion. The therapeutic value of BoTP lies in the tamponing and regenerative effect. According to the results of this study, for maculrupture surgery, it is rational to use plasma from a layer of pure platelet-rich plasma (P-PRP), which contains a sufficient number of platelets capable of having a positive therapeutic effect, and a minimum number of leukocytes capable of performing the functions of immune protion and repair of the retiand surrounding tissues.

Purpose: to conduct a prospective study of the results of surgical treatment of patients with pigment dispersion syndrome and complex myopic astigmatism. Materials and methods. As a result of a comprehensive examination of 10453 adult primary patients with complex myopic astigmatism, the diagnosis of pigment dispersion syndrome was made in 99 patients (0.94 %). The study group consisted of 22 people, 9 men and 13 women, with an average age of 29.4 ± 9.8. In the case of iridosonular contact, according to ultrasound biomicroscopy, laser basal iridectomy was performed at the first stage. In the case of normal intraocular pressure indicators, laser correction of myopia was made in patients of the study group within 6 months after laser basal iridectomy. Results. During biomicroscopy, a Krukenberg spindle was observed in 34 eyes (77.2 %), exogenous pigment was detected in 20 eyes (45.4 %) on the iris and lens, and sectoral illumination of the iris was detected in 5 (11.4 %). After laser basal iridectomy on 24 eyes (54.5 %) in all the studied meridians, we noted a tendency to deepen the posterior chamber, but the increase was statistically significant only at 12 hours (P < 0.05). The achieved decrease in the angle of the anterior chamber was statistically significant (P < 0.05) in the meridians of 3, 9 and 12 hours and ranged from 3.56 to 8.53 degrees in different meridians. Laser correction of complex myopic astigmatism was performed in 11 patients (22 eyes) using ReLEx® SMILE technology and 10 (20 eyes) patients using FemtoLASIK technology. At the end of the observation period after correction, refraction within ±0.5 dptr of the planned one was achieved in 88.1 % of cases (37 eyes), ±1.0 dptr — in 100 % of cases. The efficiency coefficient was 88.46 %, the safety coefficient was 92.8 %. Postoperative values of corneal-compensated IOP were comparable with preoperative indicators (P > 0.05). Conclusions. The analysis of the of surgical treatment results in the patients with pigment dispersion syndrome and myopia showed the absence of negative dynamics in the course, as well as high efficiency, safety and stability of the results achieved after laser correction. The applied algorithm for the management of patients with combined pathology with pigment dispersion syndrome and myopia is pathogenetically justified, safe, promotes the preservation of visual functions of patients and improves their quality of life.

Purpose. Comparative evaluation of the defocus curve (DC) of monofocal IOLs (MIOLs), extended depth of focus IOLs (EDОF) and trifocal IOLs (TIOLs). Patients and methods. We observed 90 patients (average age 57.8 ± 1.8 years) who underwent standard binocular phacoemulsification of cataracts in both eyes with emmetropic “target” refraction and postoperative monocular uncorrected distance visual acuity (UCVA) of at least 1.0 rel. units. All patients were divided into three groups equal in number of patients, age, gender and visual status, corresponding to three options of implantable IOLs: MIOL (“RayOne Aspheric”, model RAO600C); EDOF (RayOne EMV, model RAO200E) and THYOL (RayOne Trifocal). DC was performed binocularly based on a standard BCVA measurement with an optical load for defocusing from +3.0 D to -4.0 D with a “step” of +1.0 D and -0.5 D. Results. Under conditions of optical defocusing with positive lenses (1.0; 2.0; 3.0 D), all three types of IOLs maintained almost the same average BCVA (at +1.0 D, the BCVA range was 0.72–0.76 rel. units; at +2.0 diopters — 0.66–0.72 relative units; at +3.0 diopters — 0.52–0.56 relative units). In relation to the analysis of BCVA in conditions of defocusing with negative lenses, it was found that visual acuity was significantly better with EDOF than with MIOL, with a load from -1.0 to -4.0 diopters, while these differences were statistically significant and ranged from 0.14 to 0.27 relative units (p < 0.01). Along with this, it was determined that UCVA was significantly better in the group with TIOL than in the group with EDOF, with a load from -2.5 to -4.0 D. Moreover, these differences were statistically significant and ranged from 0.09 to 0.14 rel. units (p < 0.01). Conclusion. The design features of IOLs make it possible to consider implantation of EDOF as an option for an individual approach to the selection of IOLs, especially taking into account the possibility of use in patients whose professional activities involve long-term visual work at intermediate distances (for example, users of personal computers).

Purpose of the study: In vitro to study the degree of adhesion of vitreous substitutes, such as silicone oil of various viscosities and perfluorodecalin (PFOS), to hydrophobic acrylic polymer IOLs and evaluate the interaction of vitreous substitutes with the model MIOL-Soft-23 in the clinic. Material and methods. IOLs of the model MIOL-Soft-23 were taken for the experiment. MIOL-Soft-23 are included in the RPR-20 set. IOL of the model MIOL-Soft-23 is made by photopolymerization from a biocompatible spatially cross-linked hydrophobic acrylic polymer based on oligomers and monomers of the methacrylic series with filters in the ultraviolet region of the spectrum from 19 to 23 D. For the experiment, silicone oils of different viscosities were taken: RS-OIL 2000 (Alchimia), SIL-5000-S (DORC), Oxane 5700 (Bausch & Lomb), PFOS (perfluorodecalin) Dk-line (Bausch & Lomb). Also, saline sodium chloride 0.9 % (Solofarm) was used. Results. Revealed a decrease in the degree of silicone adhesion to the surface of acrylic hydrophobic IOLs as the temperature rises, not less than 1.5 %. The absence of dependence of the degree of adhesion on the degree of viscosity of silicone oil was confirmed, which corresponds to the literature data. For the first time, the average percentage of adhesion of perfluorodecalin to the IOL surface data were obtained, in particular, the MIOL-Soft-23 model. The range of values ranged from 0.7 to 7.2 %. The average coverage percentage is 1.9 ± 1.3 % (exposure at 37 ± 1 °C for up to 14 days) and 3.4 ± 1.5 % (exposure at room temperature for up to 14 days). This confirms the need for careful intraoperative monitoring of the completeness of removal of PFOS droplets from the IOL surface. Conclusion. The presence of the risk of adhesion of residual drops of silicone oil and PFOS to the surface of the IOL necessitates careful intraoperative control of the completeness of the removal of vitreous body substitutes, as well as further search for the best ways to eliminate this complication. The conducted complex of studies makes it possible to recommend the use of IOL model MIOL-Soft-23 in complicated cases of vitreal surgery.

Objective: to identify the features of biomechanical parameters of the fibrous capsule of the eye in patients after radial keratotomy (RK). Materials and methods. 87 eyes were examined after radial keratotomy, the average age was 59.8 ± 0.83 years. With glaucoma 47 eyes, without — in 40 eyes. Patients were divided into three groups: 17 eyes with a central corneal thickness (CCT) of less than 530 microns; 30 eyes with a CCT of 530–580 microns; 40 eyes with a CCT of more than 580 microns. The control group consists of myopic patients without glaucoma, without PES, over 45 years old. Corneal tomography and biomechanical parameters were measured using Pentacam (Oculus) and CorVis ST, respectively. Results. in the eyes after RK, the corneal stiffness (DA ratio, R) is higher in comparison with the control and increases with an increase in CCT. The stiffness of the fibrous capsule of the eye (SP-A1) after RK is reduced in comparison with the control and increases with an increase in CCT. The SSI analysis showed a higher stiffness of the eyeball than in the control, regardless of the CCT. BGF is higher in the eyes after RK compared to the control with the maximum value for thin corneas. Hyperopic shift (HS) after RK is distinctive for eyes with glaucoma. With a CCT of more than 580 microns, HS is a clinical glaucoma detector, with thin corneas, it is not. Conclusion. The eye after RC is characterized by an increase in the stiffness of the cornea, a decrease in the stiffness of the fibrous capsule of the eye, a general increase in the stiffness of the eyeball and HS.

Objectives: to evaluate the dynamics of changes in quality of life in patients with diabetic macular edema (DME) with vitrectomized and non-vitrectomized eyes after intravitreal injection of dexamethasone implant (IVD). Material and methods. 60 patients (60 eyes) were examined, divided into two groups with a diagnosis of diabetic retinopathy, DME and with different vitreous conditions. Group 1 — patients with non-vitrectomized eyes, group 2 — with vitrectomized eyes. Both objective and subjective methods of ophthalmological examination were used, followed by an assessment of the quality of life and visual functions based on the results of a questionnaire conducted to patients using VFQ-25 (visual function questionnaire — 25). Also, all patients of both groups were assessed for best corrected visual acuity (BCVA) before, 1, 3 and 6 months after IVD. Results. In both groups, an increase in the average BCVA after IVD was observed up to 3 months of monitoring (p < 0.01). In addition, the quality of life parameters increased after 1 month of steroid therapy in both groups (p < 0.05), and by 3 and 6 months this trend persisted mainly only for the group with vitrectomized eyes (p < 0.05). Conclusion. IVD in patients with DME can significantly improve the morphofunctional parameters of the macular zone in the eyes with both vitrectomized and non-vitrectomized eyes. The maximum effect of the drug according to the quality of visual functions assessment was observed in 1 month of monitoring in the group with non-vitrectomized eyes. At the same time, the longest increase in quality of visual functions parameters from 3 to 6 months was observed in the group with vitrectomized eyes.

Glaucoma is one of the most unfavorable neurodegenerative diseases of the eye. However, the etiology and pathogenesis of glaucoma have not been fully studied enough. Thus, for example, the issue of the primacy of damage to the fundus structures in the development of glaucomatous optic neuropathy remains debatable.This review presents a modern view of the main pathomorphological changes in the retina in chronically elevated intraocular pressure (IOP). The analysis of structural changes in various layers of retinal tissue, primarily retinal ganglion cells in glaucoma, is carried out. Attention is focused on the role of various pathogenetic mechanisms in the occurence and progression of dystrophic changes in the retina with an increase of IOP. The need for a comprehensive analysis of structural, functional and hemodynamic parameters in each specific clinical case is emphasized, which helps to increase the sensitivity of new methods for diagnosing glaucoma and optimize the treatment of the disease.

Relevance. Many studies have shown a relationship between higher order aberrations and refractive errors in children without comorbidities, but these studies have not been conducted in children with pseudophakia. Purpose. Evaluation of corneal aberrations after congenital cataract (CC) extraction with intraocular lens (IOL) implantation in infancy, and their impact on the dynamics of eye growth and myopia progression. Materials. Thirty-two children (the median age 9.35 ± 3.31 years; range 4–15 years) with pseudophakia were divided to: group 1, planned refraction (17 children, 23 eyes) and group 2, pseudophakic myopia (15 children, 23 eyes). Twelve children (24 eyes; the median age 11.67 ± 2.43 years) with moderate and high myopia without ophthalmic pathology were examined as a comparison group. Keratometry and aberrometry were performed on a Scheimpflug Galilei G2. Results. Total corneal aberrations root mean square (RMS) and higher order aberrations (HOA) were higher in pseudophakic children (2.77 and 1.13 µm in group 1, 2.48 and 1.15 µm in group 2) when compared with children with acquired myopia (1.58 and 0.44 µm; p < 0.05). Oblique astigmatism and negative oblique trefoil were the highest in pseudophakic myopia (0.63 and (-)0.48 µm). There were positive correlations between eye growth in 4 years and HOA (r = 0,699; p < 0,01), eye growth during the total follow-up time and oblique astigmatism (r = 0,393; p < 0,01), and negative correlation between eye growth during the total follow-up time and oblique trefoil (r = -0,322; p < 0,05). Conclusion. Corneal incision with forced corneal suture during surgery in infants leads to an increase in HOA, especially oblique astigmatism, and oblique trefoil. Correlations between corneal aberrations and the dynamics of globe axial length growth indicate the effect of monochromatic aberrations on eye growth already in the early postoperative period.

Purpose. To study state of ocular hemodynamics in pregnant women with disorders of carbohydrate metabolism using color Doppler imaging. Patients and methods. 147 pregnant women were examined: 40 of them had type 1 diabetes mellitus (DM), 87 had gestational diabetes (GD); in 20 — pregnancy proceeded physiologically. Examination of pregnant women with DM was carried out in each trimester and 3 months after delivery, pregnant women with GD and control groups — once in the third trimester. The parameters of hemodynamics in the central retinal artery (CRA) and in the short posterior ciliary arteries (SPCAs) were studied using color Doppler imaging. Results. It was found that the peak systolic velocity (PSV) in the CRA was significantly lower in the GD and DM groups, while PSV in the SPCAs and end-diastolic velocity (EDV) in the CRA were higher in the control group compared to the GD. In SPCAs, the resistive index (RI) was the highest in the DM group, and the lowest in the GD group. Conclusion. In patients with GD in the third trimester of pregnancy, there is a statistically significant decrease in PSV and EDV in the CRA and SPCAs, combined with a decrease in RI in SPCAs, compared with patients with a physiological course of pregnancy. In patients with diabetic retinopathy (DR) in the third trimester of pregnancy, PSV and EDV in the CRA and SPCAs were significantly lower, and the pulsatility index (PI) and RI were significantly higher compared to pregnant women with DM without DR. In pregnant women with DR during gestation, there was a decrease in PSV and EDV against the background of an increase in RI and PI in the CRA and in the SPCAs. In pregnant women with DM and absence of DR during gestation, there was an increase in PSV, EDV and PI in the CRA and SPCAs from the first to the third trimesters. The revealed features of the state of hemodynamics in the CRA and SPCAs in pregnant women with DM with presence or absence of DR can become the basis for creating criteria for manifestation and progression of DR.

Purpose: To evaluate the the effects of seasonal allergic counjunctivitis (AC) and its treatment upon choroidal structure such as choroidal thickness (ChT) and choroidal vascular index (CVI) through the use of topical antihistamine agents. Methods. The 60 eyes of 30 patients were included in the AC group. Another 30 patients were included in the control group. The choroid was imaged by using enhanced depth imaging optical coherence tomography (EDI-OCT) instrument without pupillary dilation. ChT was defined as the area between the outer hyperreflective border of the RPE and the sclerochoroidal border at the fovea, 750 µm temporal to the fovea and 750 µm nasal to the fovea. Image J was used to measure CVI. With the images obtained from EDI-OCT, the total choroidal area (TCA), luminal area (LA), stromal area (SA), and CVI were calculated using the binarization method. Results. The mean ChT value in the AC group was 358.5 ± 93.8 µm at baseline and 356.8 ± 86.6 µm following 1 month of treatment. Meanwhile, the mean ChT in the control group was 316.6 ± 60.7 µm. The mean CVI value was 66.65 ± 2.98 in the control group, 70.75 ± 3.26 in the AC group at baseline, and 69.50 ± 3.17 following 1 month of treatment. Statistically significant difference was tracked between control and AC group (p = 0.028) and control group and posttreatment values (p=0,031). There were no statistically significant difference between initial AC treatment values and posttreatment values for all of the measurements. Conclusion. ChT and CVI can increase in patients with AC due to inflammation and increased vascular permeability. Although symptoms and signs related to AC may disappear after the treatment, effects in the choroid do not immediately normalize.

Chronic myeloproliferative diseases (CMPD) are tumor diseases of hematopoietic tissue with increased proliferation of one or more lines of myelopoiesis. Quite often with this pathology there are find references to damage to the organ of vision. With CMPD changes in the composition of peripheral blood are observed, leading to changes in the rheology of blood and contributing to the deterioration of microcirculation of eye tissues. In addition, abnormal proliferation of hematopoietic cells and prolonged specific therapy weaken the body’s immune system, contributing to the development of systemic inflammation. These processes can lead to deterioration of blood supply to eye tissues, in particular in the macular region. Purpose. To evaluate vessel density (VD) in the superficial and deep vascular plexuses of retina and the area of foveolar avascular zone (FAZ) using optical coherence tomography with angiography function (OCTA) in patients with CMPD. Patients and methods. The study included 25 patients with CMPD (50 eyes) and 20 volunteers (40 eyes), comparable in gender and age, without a history of hemoblastosis. All the examined patients underwent comprehensive ophthalmological diagnostics, including OCTA. Results. According to the results, patients with CMPD revealed a significant decrease in VD in all sectors (except the foveolar zone) in both studied vascular plexuses, as well as a significant increase in area of FAZ compared to the control group. Conclusion. A decrease in VD in the vascular plexuses of the retina, as well as an increase in area of FAZ, are signs of deterioration of retinal blood supply and retinal ischemia. It is possible that these changes may lead to violations of blood rheology, as well as chronic systemic inflammation observed in patients with CMPD. Deterioration of blood flow and prolonged retinal hypoxia can contribute to serious visual impairment of patients. In this regard, patients with CMPD require more detailed monitoring, possibly with correction of the main treatment.

In connection with the problem of formation of strains of pathogenic microflora resistant to antibacterial drugs, research on the use of nanoparticles, namely quantum dots, has been actively conducted recently. Quantum dots can be used as an anti-infective agent, a means for visualization of intraocular structures, drug delivery, as well as a means for electrical stimulation of the retina. Successful application of quantum dots as an anti-infective agent necessitates the study of their penetrating ability into the anterior chamber. The aim of the study was to experimentally investigate the penetration ability of InP/ZnSe/ZnS 650 QDs in the anterior chamber of the eye at topical application. The object of the study was InP/ZnSe/ZnS 650 quantum dots. The study was carried out on laboratory rabbits (#6), which were divided randomly in pairs into groups. In rabbits #1 and #2 the eyes remained intact, #3 and #4 — a bandage soft contact lens was placed on the cornea of the right eye, #5 and #6 the cornea of the right eye was de-epithelialized. All experimental rabbits during the day 6 times instillation of 10 % solution of InP/ZnSe/ZnS 650 quantum dots was performed, and at the end 0.2 ml of moisture was taken from the anterior chamber of the right eye. The left eyes in all individuals were the control group. Identification of quantum dots into the anterior chamber was performed using a highly sensitive spectrophotometer UV-3600 (Shimadzu). The experimental study of the ability of InP/ZnSe/ZnS 650 quantum dots at topical application to penetrate into the intraocular cavity by the claimed detection methods did not allow their detection in the anterior chamber moisture even in minimal concentration.

The aim of the study was to evaluate the efficacy and safety of brolucizumab in the Russian population of patients with diabetic macular edema. Patients and methods: 41 patients (29 women and 12 men) with diabetic retinopathy and diabetic macular edema of comparable age were included in the study. The patients were divided into 2 groups depending on the previous DME treatment. The first group included 24 patients (24 eyes) who had not previously received treatment: 9 men and 15 women, the average age of patients was 62.9 ± 9.3 years, the average best-corrected visual acuity was 0.40 ± 0.23, CTS 332 ± 87 microns, MV 9.65 ± 1.2 mm3. There were 17 patients (17 eyes) in the second group, they had previously received other antiangiogenic drugs, but retained the activity of the disease against the background of the treatment (1 man and 16 women), the average age of patients was 60.6 ± 8.3 years, the average best-corrected visual acuity was 0.40 ± 0.27, CTS 351.6 ± 149.0 microns, MV 9.3 ± 1.8 mm3. All patients received at least 5 intravitreal injections of brolucizumab (205 injections in total) at intervals of 6 weeks. The control examination was carried out 6 weeks after the last injection and a month after the fifth injection. The best-corrected visual acuity, intraocular pressure, central retinal thickness (CTS), macular volume (MV) were evaluated according to optical coherence tomography. Results. In the first group, a statistically significant increase in the best-corrected visual acuity was revealed from 0.40 ± 0.23 to 0.575 ± 0.27 (p = 0.05), the indicators of CTS and MV statistically significantly decreased. In the second group, only a decrease in CTS was detected, while the indicators of BCVA and MV did not show statistically significant changes. Conclusion. Patients with DME, who were treated with brolucizumab and who had not previously received treatment with other drugs, showed an improvement in anatomical and functional parameters, patients, who retained the activity of the disease against the background of the treatment, showed a slight decrease in the activity of the disease.

Glaucoma is a chronic neurodegenerative disease that eventually leads to irreversible blindness. The main risk factor for the development and progression of glaucoma is elevated IOP. In cases where the use of prostaglandin analogues is limited, brimonidine is the most rational choice as initial therapy. It is the only molecule that both reduces aqueous humor production and enhances uveoscleral outflow. The use of several hypotensive drugs for a long time can lead to pronounced changes in the tissues of the anterior segment of the eye. In this case, there are complaints characteristic of the dry eye syndrome. The aggravation of this condition can affect the adherence of patients to treatment and worsen the course of the disease. Therefore, it is important to prescribe hypotensive drugs that have a sufficient hypotensive effect with a good safety profile. Purpose. To evaluate the efficacy and safety of Brimonidine SZ in combination therapy for glaucoma after changing the hypotensive regimen. Patients and methods. The study was conducted in a group of 50 patients (50 eyes) with initial or advanced drug-compensated primary open-angle glaucoma (mean age 64.8 years), among them there were 27 (54 %) women and 23 (46 %) men. In patients included in the study, brimonidine 0.15 % or 0.2 % was replaced with Brimonidine SZ as part of combination hypotensive therapy. To analyze the results obtained, data on corneal-compensated IOP, the degree of corneal staining with fluorescein, assessments of conjunctival hyperemia, indicators of the OSDI questionnaire and the level of adherence to treatment at the initial visit, as well as 1 and 3 months after changing the hypotensive regimen, were compared. Results. There were no statistically significant differences in the level of IOP at different times after changing the hypotensive regimen. Objective indicators of the state of the tissues of the anterior surface of the eye did not change. According to the results of the evaluation of the main signs of dry eye syndrome (OSDI) and the degree of adherence of patients to treatment, no significant changes were found either. Conclusion. Brimonidine SZ has a similar hypotensive efficacy with brimonidine 0.15 % and 0.2 % as part of combination hypotensive therapy. The safety profile of Brimonidine SZ is comparable to analogues, which allows us to consider this drug as a possible alternative when choosing hypotensive therapy.

Purpose: To compare the effectiveness of trabeculectomy and evaluate the change of the state of the tissues of the anterior segment of the eye in patients with long-term use of preservative and non-preserved hypotensive therapy before surgery. Patients and Methods. The study was conducted in a group of 30 patients (30 eyes) aged from 58 to 77 years with uncompensated primary openangle glaucoma, who were admitted to the glaucoma surgery. The patients were divided into 2 groups depending on the hypotensive regimen used before surgery: group I - patients who used preservative-containing local hypotensive drugs; Group II - patients who used Traviolan© and other non-preservative hypotensive drugs before antiglaucoma surgery. At the initial examination, the collection and analysis of patient complaints, visometry, tonometry, and biomicroscopy of the structures of the anterior segment of the eye were performed. Patients complaints were assessed on the OSDI test questionnaire. The study of total tear production was investigated using the Schirmer test. The tear film break time study investigated the Norn test. Observation and re-examinations were performed a week, 1 month and 3 months after trabeculectomy. Results. A week after glaucoma surgery, there was a short-term deterioration in the parameters by which dry eye disease (DED) was assessed: in group I, OSDI was 11.8 ± 3.3, Schirmer and Norn tests — 5.3 ± 1.3 mm and 4.3 ± 1.0 sec, respectively. In group II OSDI was 10.7 ± 3.5, Schirmer and Norn tests were 8.2 ± 2.2 mm and 4.7 ± 1.3 sec, respectively. After 1 and 3 months, the DED indicators improved, more pronounced in group I: after 1 and 3 months, OSDI was 12.9 ± 3.7 and 12.9 ± 4.2, respectively; Schirmer’s test — respectively, 7.4 ± 1.9 and 7.0 ± 1.8 mm; Norn’s test — 5.1 ± 0.8 and 5.2 ± 0.9 sec. In group II, 1 and 3 months after trabeculectomy, OSDI was 12.4 ± 3.0 and 12.4 ± 2.4. Schirmer’s test was 9.9 ± 2.1 and 9.5 ± 1.7 mm, Norn’s test was 5.5 ± 1.2 and 5.5 ± 1.3 sec, respectively. At all follow-up periods, except for week 1, there was a significant intergroup difference between the studied parameters of dry eye disease (p < 0.05). Conclusion. Long-term use of preservative-containing hypotensive therapy contributes to the development of chronic toxic-allergic conjunctivitis, which affects the long-term prognosis of trabeculectomy and the quality of life associated with DED. One of the ways to minimize such negative effects is the use of preservative-free drugs in the selection of glaucoma therapy. The use of a preservative-free form of travoprost is justified due to its high selectivity for FP-prostanoid receptors, which ensures high efficiency and less side effects. The improvement in DED parameters associated with cancel of therapy after surgery is more pronounced in the group of patients who initially took preservative-free drugs.

Purpose: to evaluate the netilmicin efficacy and safety in chronic blepharitis treatment. Methods: 30 posterior or mixed chronic blepharitis (CB), meibomian gland dysfunctions (MGD) and dry eye (DE) patients were examined. All patients received 0.3 % netilmicin (Nettacin; instillations, 3 times a day) and 0.3 % netilmicin (Nettavisk; applications, at night) for 14 days. Evaluated: integral indicator of СB subjective symptoms (II-SS, scores); integral indicator of CB objective signs (II-OS, scores); OSDI (scores); tear film brake up time (TBUT, s); lower tear meniscus height (LTMH, µm; OptoVue); Bijsterveld`s xerosis index (XI, scores); Korb`s MGD severity (MGD-S, scores). Control points: 1 — when included in the study, 2 — 15 days of observation. The criteria for the therapy effectiveness included the II-OS and II-SS positive dynamics, and the safety criteria included the absence of significant negative dynamics of OSDI, TBUT, LTMH, XI, MGD-S. Statistics: M ± s calculation, Wilcoxon t-test (differences were considered significant at p < 0.05). Results. At the 2nd control point, there was a statistically significant decrease in II-SS (from 3.62 ± 0.49 to 2.47 ± 0.50) and II-OS (from 3.58 ± 0.50 to 2.45 ± 0,50). Also, at the 2nd control point, a significant decrease in OSDI was recorded (from 35.40 ± 3.59 to 26.40 ± 3.06) and insignificant trend towards a decrease in LTMH (from 325.10 ± 21.26 to 319.80 ± 41 26), an increase in XI (from 5.10 ± 0.40 to 5.23 ± 0.50), an increase in TBUT (from 5.47 ± 0.57 to 5.63 ± 0.56) and a decrease in MGD-S (from 2.16 ± 0.38 to 1.97 ± 0.18). Conclusion. As a result of the use of 0.3 % netilmicin, a significant decrease in the severity of CB symptoms and signs was noted, which indicates a good clinical effectiveness of the therapeutic effect. At the same time, the absence of significant negative dynamics of indicators characterizing the state of the ocular surface (OSDI, TBUT, LTMH, XI, MGD-S) during therapy indicates the safety of using 0.3 % netilmicin for the CB treatment in conditions of comorbidity, including MGD and DE.

Purpose: to evaluate the efficacy and safety of preservative free travoprost generic in primary open-angle glaucoma patients. Patients and methods. 40 patients with compensated primary open-angle glaucoma (POG) and dry eye (DE) were examined: 1st group (20 patients) with the initial stage of POG (travoprost with a preservative monotherapy), 2nd group with an advanced stage of POG (travoprost with a preservative in combination therapy). In all patients, travoprost with a preservative was replaced with preservative free travoprost (Traviolan, 1 time per day, in the evening). Control: 1 — when included in the study; 2 — 4 weeks after replacing travoprost with a preservative for preservative free travoprost. Efficiency criteria: absence of negative dynamics of intraocular pressure (IOP) and MD and PSD perimetric indices (dB; Optos). Safety criteria: absence of OSDI (scores), tear film brake up time (TBUT; Norn’s test, s), lower tear meniscus height (LTMH, µm; OptoVue) and Bijsterveld’s xerosis index (XI, scores) negative dynamics. Results. At the 2nd control point, all observed did not have a statistically significant dynamics of IOP, MD, PSD. In patients of both groups, at the 2nd control point, there was the OSDI and TBUT statistically significant positive dynamics, and in patients of the 1st group — XI statistically significant positive dynamics. The trend towards to XI decreasing in 2nd group patients and the LTMH dynamics in both groups turned out to be statistically insignificant. Conclusion. Preservative free travoprost has shown efficacy comparable to that of travoprost with preservative in both monotherapy and combination therapy. Significant positive dynamics of OSDI and TBUT in patients of both groups and XI in 1st group patients after switching to preservative free travoprost indicates a good “safety profile” of therapy in terms of its effect on the ocular surface state in DE conditions, which, from our point of view, may contribute to maintaining the “quality of life” and patients compliance.

Purpose: To evaluate the clinicopathologic features of failed endothelial keratoplasty. Methods. In this study 11 patients (11 eyes) with recurrence of bullous keratopathy (BK) were included. Group 1 consisted of 4 patients who underwent repeat Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), group 2 included 7 patients who underwent penetrating keratoplasty (PK) after failed Descemet Membrane Endothelial Keratoplasty (DMEK). Preoperative anterior segment optical coherence tomography (OCT), RTVue-100, Optovue, USA, was performed. Intraoperatively aqueous humour (AqH) samples were collected for multiplex cytokine analysis. During keratoplasty failed grafts/corneal buttons were obtained and then investigated histologically (hematoxylin/eosin staining, primary antibodies to pancytokeratin, vimentin, collagen III). Results. Recurrence of BK in all clinical cases manifests by the increase of inflammatory factors in AqH, corneal edema, neovascularization and remodeling to fibrosis. Glaucoma may induce DMEK/ DSAEK graft failure due to chronic local inflammation. In the clinical cases recurrence of BK was caused by peripheral and central graft detachment, rebubbling, graft upside-down orientation and donor corneal genetic disorders. Conclusions. Chronic local inflammation (including corneal morphological changes) in patients with BK recurrence is an indication for reoperation. The modification of keratoplasty — DMEK/DSAEK/PK — is determined according to slit-lamp and OCT images of the cornea. High-level risk of immune reaction (especially in cases of three and more times repeated keratolasty) is the reason for systemic corticosteroid and, sometimes, cytostatic therapy.

Purpose. Demonstration of non-standard clinical case of removing large fragment of metal wire from the eye. Patient and methods. Patient, 37 years old, with penetrating right eye injury with intraocular foreign body (IOFB) introduction — a fragment of metal wire. After unsuccessful attempt to remove IOFB during primary repair of eye injuries lacerations by ophthalmologist of the surgical department of the district hospital, he was sent to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. On admission: VIS OD — 0.01 uncorrected, intraocular pressure (IOP) — 16 mm Hg (noncontact tonometer TOMEY, Japan). OD — metal IOFB protrudes by 1.0 mm from the corneoscleral laceration in projection of corneal limbus at the 13 o’clock position, postoperative aphakia; according to B-scan ultrasonic data: metallic foreign body of linear shape, 14.3 mm long, about 1.5 mm thick. There is hemorrhage in the vitreous cavity. Results. Initially, conditions for visualization of the vitreous cavity were created by performing 25G vitrectomy. The course of wire location was specified: under the choroid and retina, going out through the sclera in the equatorial region. After conjunctival tweezers expanded wound edges, the embedded fragment of wire was delicately remove: 25 mm in length and 2 mm in diameter. A single retinal break was delimited by cryotherapy and laser photocoagulation. On the 2nd day: VIS OD — 0.3 with diaphragm, uncorrected; IOP — 13 mm Hg. After 3 months: VIS OD — 0.01 sph + 13.0 D = 0.7, IOP — 14 mm Hg. Silicone removal was combined with intraocular lens implantation model RSP-3 (+23D). The next day: VIS OD — 0.3 with diaphragm, 0.5 cyl — 6.0 D ax 170 = 0.5; IOP — 16 mm Hg. Conclusion. Use of 25G vitrectomy for removal IOFB localized between the inner membranes of the eye created optimal conditions for visualizing depth of its penetration, which minimized traumatic impact and avoided severe intra- and postoperative complications.

Infectious crystalline keratopathy (ICK) is a sluggish infectious inflammation of the cornea. Described for the first time in 1983, it is currently a rare pathology. Most often, the etiological factor is gram-positive bacterial flora, which causes the typical formation of “crystals” in the anterior layers of the corneal stroma. Less often, infiltrates are formed by gram-negative bacterial flora, which is characterized by its location mainly in the posterior parts of the stroma. Atypical etiological agents include Mycobacteria and fungal microflora. The main predisposing factors for the development of ICK are drug immunosuppression and previous corneal surgery (through keratoplasty, layered keratoplasty, laser keratomilesis in situ — LASIK). This article describes an atypical clinical case of monolateral postoperative infectious crystalline keratopathy. The patient’s medical history includes bilateral LASIK surgery followed by drug therapy for postoperative keratitis of the right eye for 1 month.

A clinical case of bilateral implantation of EDOF IOL in a patient after LASIK is presented. The standards for assessing visual acuity at an intermediate distance are indicated. A modified version of the test table for the intermediate distance is presented. The obtained functional result corresponds to theoretical ideas about the potential of IOL with a prolonged focus. When calculating the IOL after LASIK, a sufficient degree of accuracy was provided by the formulas Haigis-L, Barrett True-K. The use of data on the total refractive power of the cornea is promising.