To date, the choice of the optimal method of intraocular lens fixation in patients with weakness of the ligamentous-capsular apparatus of the lens remains an urgent problem of ophthalmic surgery. There are various methods of intraocular lens fixation, including pupillary, iris, sclera in the projection of the ciliary sulcus, anterior chamber fixation and others. The literature review allowed us to evaluate the advantages and disadvantages of each of the listed methods of intraocular lens fixation. Transscleral fixation is the most physiologic and anatomically correct. The most common variants of suture and sutureless transscleral fixation are discussed in this review. The lack of sufficient evidence on the superiority of this or that method of fixation allows us to continue the search in this direction.

An abnormal or compensatory head posture occurs when the head deviates from its normal primary position. The cause can be ocular, orthopedic, and neurological. Since the etiology is not always obvious, such patients need to be carefully examined, and sometimes a multidisciplinary examination should be carried out. Compensatory head position in ophthalmology is usually an attempt to improve visual acuity or create binocularity. An abnormal head position can be manifested by a change in the position of the chin up, down, tilting the head to the right or left, turning the face to the right or left, or a combination of both. The purpose of our review is to provide literature data of the most common ophthalmic diseases in children, accompanied by a compensatory head position “astrologer posture”. Methods used to find, select and obtain information as well as to synthesize the data are information search on the Internet through Google Scholar, PubMed and eLibrary. Number of sources: 35 (from 1905 to 2022).

For infectious and inflammatory eye lesions, the main methods of controlling pathogens include antibacterial agents of various classes and antiseptics. However, the use of these agents has a number of limitations: they are able to act primarily on the surface of the eye tissue, and in accordance with clinical recommendations, they should be used as an addition to antibacterial therapy.

Antibacterial therapy remains the main recommendation for the treatment of bacterial eye infections, both in the anterior segment and in deeper lesions. In most countries, drugs from the group of fluoroquinolones and aminoglycosides are more often prescribed empirically, to which an acceptable level of sensitivity of microorganisms remains. Among aminoglycosides, the greatest sensitivity of eye infection pathogens is currently determined to netilmicin.

The review examines the prospects and effectiveness of using netilmicin as monotherapy, as well as in combination with fluoroquinolones for topical treatment of bacterial infections in ophthalmology, and provides examples of the successful use of netilmicin.

Purpose. Analysis of modern aspects of cataract surgery from the standpoint of the medical and social model of health.

Methods. The analysis of literary data was performed in the RSCI and PubMed databases using the following keywords: “Medical model of health”, “Medical and social model of health”, “Phacoemulsification of cataracts” (PCE), “Quality of life” (QOL), “Calculation of intraocular lenses” (IOL), “Visually intense work”, “Ophthalmo-ergonomics”. The duration of the main retrospective analysis was 8 years (2017–2023) with citation (if necessary) of individual earlier sources.

Results. Based on the analysis, the following main modern aspects of cataract surgery were identified from the standpoint of the medical and social model of health: QOL study; assessment of ophthalmo-ergonomic indicators; medical and psychological aspects (correction of postoperative pain syndrome and dry eye syndrome, neuroadaptation after implantation, primarily trifocal IOLs, patient anxiety level).

Conclusion. Currently, the PCE procedure is almost completely optimized from a technical point of view. In this regard, consideration of the PCE effectiveness from the standpoint of the medical and social model of health seems relevant, since the main task of this model is the complete integration of an individual into society. The basic indicator reflecting the clinical effectiveness of PCE from the standpoint of the medical and social model of health is QOL. In this direction, the practical application of the «FEC-22» QOL assessment technique will ensure an increase in the level of clinical diagnostic research in cataract surgery when solving a number of urgent problems — comparative evaluation of IOLs, study of the effectiveness of postoperative rehabilitation methods for patients, selection of the optimal formula for calculating IOLs. In addition, from the standpoint of the medical and social model of health, further improvement of the ophthalmo-ergonomic indicators of the visual system and medical and psychological aspects associated with the patient is advisable. Ultimately, the development of a comprehensive system of measures to improve the clinical and diagnostic effectiveness of phacoemulsification based on the medical and social model of health will improve the level of ophthalmological care and prolong the professional longevity of patients (especially those with visual impairment) with cataracts.

Purpose: to analysis the results of combined implantation of non-diffractive IOL with extended depth of focus and injector preloaded monofocal IOL.

Patients and methods. 82 patients (164 eyes) after bilateral or combined implantation of AcrySof IQ Vivity (n = 72) and Clareon (n = 92) IOLs (Alcon, USA) with a mean follow-up of 6.2 ± 1.9 (6–8) months were included. 20 patients (40 eyes) with bilateral AcrySof IQ Vivity implantation formed group I, and 32 patients (64 eyes) with Clareon IOL implantation (n = 32) followed by Acrysof IQ Vivity implantation in the second (n = 32) formed group II. The comparison group (III) included 30 patients (60 eyes) with bilateral Clareon implantation. In group I, emmetropia was planned in the leading eye and myopia of 0.5–0.75 D in the nonleading eye; in groups II and III, emmetropia was planned in both eyes.

Results. There was an increase in UCNVA from 0.29 ± 0.08 to 0.62 ± 0.14 in group I and from 0.22 ± 0.04 to 0.59 ± 0.11 in group II, UCIVA from 0.21 ± 0.08 in group I to 0.84 ± 0.18 in   group II, UCDVA from 0.27 ± 0.09 to 0.92 ± 0.21 in group I and from 0.34 ± 0.10 to 0.89 ± 0.18 in group II during a maximum follow-up period of 6 months. There was an increase in BCNVA from 0.58 ± 0.04 to 0.68 ± 0.07 in group I and from 0.43 ± 0.04 to 0.64 ± 0.05 in group II, BCIVA from 0.55 ± 0.10 to 0, 91 ± 0.24 in group I and from 0.27 ± 0.04 to 0.7 ± 0.15 in group II, BCDVA — from 0.61 ± 0.12 to 1.0 ± 0.31 in group I and from 0.42 ± 0.09 to 0.9 ± 0.25 in group II. The differences between groups were not statistically significant (p > 0.1). In group III the values of UCDVA and UCIVA were significantly lower than in groups I and II (p < 0.05). Group I showed a decrease in spherical refractive equivalent from –2.50 ± 1.2 to –0.15 ± 0.59 in the follow-up period of 6 months, in group II — from –3.0 ± 1.2 to –0.25 ± 0.48, in group III from –1.75 ± 1.1 to –0.25 ± 0.41 (p > 0.1). When comparing the frequency of adverse optical phenomena between the groups, no significant differences were found (p > 0.1).

Conclusion. For the first time in Russia, a comparative analysis of the results of EDOF and monofocal IOL implantation compared to bilateral EDOF IOL and monofocal IOL implantation in patients with presbyopia was performed. The absence of significant differences between the groups allows to justify the implantation of non-diffractive EDOF IOLs in paired eyes in patients with previously implanted monofocal IOLs who wish to reduce dependence on spectacle correction at intermediate and near distances.

Introduction. This review presents the current knowledge about the methods of lens surgery for the correction of refractive errors in patients with presbyopia and other refractive errors. And also about possible methods of minimization of ultrasound load during the surgery.

Purpose. To present current relevant literature scientific knowledge on refractive lens surgery, possible ways of minimization of ultrasound load and new IOL models.

Material and methods. To perform the review the literature references were searched through the abstract databases PubMed and Scopus for the period up to and including 2023 using the keywords “zero phaco”, “refractive lens exchange”, “presbyopia”, “femtosecond laser”, “U/S phaco”, “premium IOL”, “refractive error surgery”, “endothelial dystrophy”. A total of 76 articles related to the review topic were selected.

Results. Multiple studies confirmed efficacy, safety and fast visual rehabilitation after lens surgery with maximal ultrasound load reduction, in particular in patients with metabolic disorders and predisposition to corneal dystrophies.

Conclusion. The literature review suggests that with increasing patient expectations and the use of premium IOLs in the era of refractive lens surgery, predictability and accuracy have become essential. Thus, the technology of safe lens femtosurgery has greatly improved surgical techniques and has revolutionized ophthalmic surgery in recent decades.

Purpose. To analyze the corneal indices obtained during examination with the Corvis® ST device of myopic patients — candidates for laser refractive surgery with dry eye syndrome (DES), before and after its treatment.

Patients and methods. Study group I consisted of 88 patients with mild to moderate dry eye syndrome according to the classification of the International Seminar on Dry Eye Syndrome (TFOS DEWS II Definition and Classification Report), group II — 88 patients with no signs of corneal-conjunctival xerosis with complex myopic astigmatism at the age of 18 to 45 years (29.01 ± 7.68). The study of biomechanical parameters of the patients’ cornea was carried out using Corvis® ST (Oculus, Germany).

Results. During the initial examination, six out of ten biomechanical indicators (DAM, A1T, A1V, A2T, A1L, SP_A1) in patients of study group I were significantly different (p < 0.05) from the indicators of study group II, the rest (A2V, A2L, HC_time, PD) were comparable (p > 0.05). Complex indices CBI, BAD_D in patients with DES were also statistically significantly (p < 0.05) different from those of patients without signs of DES and did not change after treatment for DES (p > 0.05). During the initial examination of patients in group I, 37 patients (42 %) had TBI in the range of 0.5–0.9. Against the background   of conservative treatment of dry eye syndrome, the number of such patients decreased to 20 (22 %), and with a TBI level of up to 0.3 it increased to 30 (34 %).

Conclusion. The values of corneal biomechanical parameters determined during examination on Corvis® ST in patients with dry eye syndrome are different from those of patients without symptoms of corneal-conjunctival xerosis. Improving the condition of the ocular surface against the background of drug correction of dry eye syndrome and, as a result, improving the TBI index, provides a better selection of patients for laser refractive surgery and the choice of method for its implementation. The influence of asymptomatic dry eye syndrome in a significant number of patients on the value of corneal parameters studied on Corvis® ST determines the need for preventive diagnosis of dry eye disease in the general algorithm for examining all patients before refractive surgery.

Glaucoma is one of the main causes of irreversible vision loss worldwide, its prevalence is increasing with age, reaching 10 % in individuals over 90 years old. Combined surgical treatment of cataract and glaucoma has proven to be safe and effective, reducing overall treatment costs. Minimally invasive glaucoma surgery (MIGS) combined with cataract surgery has become a popular alternative to traditional methods. One such intervention is endoscopic laser cyclodestruction (ELCD), aimed at reducing the production of aqueous humor.

Objective: To evaluate the conditions for achieving maximum efficacy and safety of endoscopic laser cyclodestruction (ELCD) in the combined surgical treatment of glaucoma and cataract.

Methods. A clinical study was conducted involving 110 patients (56 males and 54 females) with a mean age of 73.7 years, who underwent combined surgery (phacoemulsification + ELCD). Inclusion criteria were stages I-IV glaucoma and initial complicated cataract, while exclusion criteria included lens subluxation and presence of uveal processes or their consequences. ELCD was performed using the Endo Optiks Inc (USA) video-endoscopic ophthalmic laser device. Patients were evaluated preoperatively and followed up at 1, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months postoperatively. The primary safety outcomes included the frequency of intraand postoperative complications, and efficacy outcomes were based on intraocular pressure (IOP) reduction.

Results. No hemorrhagic complications were noted. An inflammatory reaction was observed in 18.2% cases, which was managed with subconjunctival injections of prourokinase. The frequency of postoperative IOP elevation correlated negatively with preoperative IOP levels. ELCD demonstrated a statistically significant reduction in IOP and medication burden, with a complete success rate of 52.7 % and a partial success rate of 90.3 %. The extent of cyclodestruction (180–360°) did not significantly affect IOP reduction outcomes.

Conclusion. ELCD, performed as part of combined surgery for glaucoma and cataract, proved to be effective and safe, achieving significant IOP reduction and decreasing the need for antiglaucoma medications. Recommendations include avoiding vaporization effects during surgery and preferring patients with preoperative IOP above 27 mm Hg for optimal outcomes.

Purpose. To analyze changes of the corneal topography in the long-term period after hyperopic FS-LASIK in patients with low, moderate and high hyperopia.

Patients and Methods. This retrospective non-randomized study included data of 174 patients (174 eyes). All patients were performed hyperopic FS-LASIK. All patients were divided into three groups. Group I included patients with low hyperopia (34 eyes), group II included patients with moderate hyperopia (97 eyes), group III included patients with high hyperopia (43 eyes). Before the surgery, the mean cycloplegic spherical equivalent in group I was +1.94 ± 0.61 D, in group II +3.8 ± 2.19 D, in group III +5.7 ± 0.9 D. The stability of corneal topography after surgery was analyzed: mean keratometry, Surface Asymmetry Index (SAI), Surface Regularity Index (SRI). The results were evaluated the day after the surgery, 1 month later, 6 months later, 1 year later and 3 years after the surgery.

Results. There were no statistically significant changes in keratometry in groups I and II on the first day after surgery and 3 years later (p > 0.05). In group III, there was a statistically significant decrease in keratometry at 6 months after surgery by 1.35 ± 2.48. D (p = 0.003); however, keratometry remained stable for 3 years thereafter (p > 0.05). In groups I and II, SRI increased at all periods after surgery (p < 0.05), in group II there was an increase in SAI (p < 0.05), in group III, SRI and SAI increased at all periods after surgery (p < 0.05). Although the increase in the indices was statistically significant, it slightly exceeded the normal limits.

Conclusions. After correction of low and moderate hyperopia by FS-LASIK, corneal topography remains stable for 3 years after surgery. Correction of high hyperopia is associated with gradual flattening of the cornea within six months after surgery, but then keratometry remains stable for 3 years. It is important to take it into account in clinical practice.

Ultraviolet cross-linking (CXL) of corneal collagen is one of the promising methods for treating bacterial corneal ulcers.

Purpose of the work: to evaluate the effectiveness and safety of the use of a new domestic device for corneal CXL KERATOLINK in the treatment of patients with a bacterial corneal ulcer.

Materials and methods. Local CXL was performed in 24 patients (24 eyes) aged from 18 to 74 years, who made up the main group. The comparison group included 10 patients of the same age group. To treat ulcerative lesions, drug therapy (antibacterial, corticosteroid, tear replacement and reparative) was used in both groups, but CXL was also used in the main group. The CXL procedure was performed for 5 minutes using the “accelerated cross-linking 2 — ACL 2” program. Each patient underwent 3 procedures with an interval of 2 days. Ophthalmological examination in the main group before treatment, 3 days after the 1st, 2nd and 3rd procedures, as well as 1, 3, 6 months after completion of CXL included visometry, tonometry, microbiological examination of discharge, determination of the size of the defect, optical coherence tomography of the anterior department of the eye (OCT-AS). The comparison group was examined at the same time using the same set of methods.

Results. All CXL procedures were completed without complications, no adverse events were identified, and in all cases the recovery period was uneventful. 6 months after CXL, the average uncorrected visual acuity increased from 0.029 ± 0.026 to 0.195 ± 0.175. Already 3 days after the third CXL procedure, there was an absence of microorganisms in the cultures, a significant decrease in the area and depth of the corneal defect (associated with its almost complete epithelization) and a decrease in inflammatory edema according to OCT-АS data. The average period of epithelization of the ulcerative defect was 12 days. Subsequently, stable healing was observed for 6 months, no relapses were detected. In the comparison group, on the 15th day of observation, complete epithelialization was achieved in only 40% of patients.

Conclusion. CXL using the KERATOLINK device is a technically simple, minimally invasive method for treating corneal ulcers. A significant reduction in epithelialization time and an increase in visual acuity indicate the effectiveness and safety of the accelerated CXL procedure. The use of an accelerated local CXL protocol with a significant reduction in exposure time helps to increase the comfort and tolerability of the procedure, as well as reduce the risk of complications.

To identify and evaluate risk factors that contribute to the development of graft rejection after corneal transplant, and to create a predictive model for this condition in patients at high risk.

Patients and methods. This study included the outcomes of penetrating keratoplasty in 120 cases (108 patients) from the Moscow City Ophthalmological Center (MCOC), “Botkin Hospital” of the Moscow Department of Health, from July 2020 to December 2021. All procedures were classified as high risk for graft disease development. The patients were followed for 12–36 months after surgery. To assess the relationship between transplantation outcomes (loss of transparency/engraftment) and other factors, local and general health conditions were evaluated, as well as donor material characteristics. Kaplan-Meyer and Cox regression methods were used to analyze graft survival and risk factors for graft disease.

Results. The multivariate analysis revealed several significant indicators of development graft disease. Among these, the following factors were found to significantly increase the risk of graft failure: a high level of vascularization in the recipient’s eye, a history of ophthalmological or systemic conditions, the size and location of the pathology in the cornea, and the presence of an identified pathogen. Based on these findings, a new method for predicting graft failure in patients undergoing penetrating corneal transplantation has been proposed (RF Patent No. 2023109334, issued on April 13, 2023).

Conclusion. In assessing the risk factors for corneal graft disease during high-risk operations, factors of the local and general somatic status of the operated eye turned out to be significant. The proposed method is simple, accessible and practical for assessing the prospects for transparent engraftment in patients in the high-risk keratoplasty group.

Phacoemulsification of cataracts in modern ophthalmological practice has reached its peak in terms of safety, predictability of the result and patient satisfaction with the result obtained. The effect of dry eye syndrome on the effectiveness of this surgical intervention has been studied to a large extent, but new risk factors affecting the development of dry eye syndrome arise, such as cosmetic intervention in the periorbital zone (botulinum toxin injections in the periorbital zone, eyelash extensions, blepharoplasty). The effect of these risk factors for the development of dry eye syndrome (DES) on the course of the postoperative period has not been sufficiently studied. An important aspect in preparing patients for ophthalmic surgery, in particular, for phacoemulsification of cataracts, which has moved into the category of, among other things, refractive surgeries, is stabilization of the ocular surface and relief of signs and symptoms of DES.

Materials and methods. The study included 117 patients who were planned to undergo phacoemulsification of cataracts. All 117 patients were female for the unification of the study. The first group included 85 people with risk factors for developed dry eye syndrome (botox, tattooing, eyelash extensions, blepharoplasty) in the preoperative period of at least 3 years after cosmetology intervention in the periorbital area. The second control group included 32 patients without risk factors for development in the form of cosmetology intervention in the periorbital area in the preoperative period. The first group was divided into 3 subgroups depending on the type of patient preparation for surgery: 1A (main group) — 30 patients: tear replacement therapy without complex therapy (eyelid hygiene according to the developed technique + massage in the periorbital area), 1B — 29 patients: tear replacement therapy + complex therapy according to the developed technique; 1B — 26 patients: tear replacement therapy + complex therapy according to the standard technique. As the study showed, in the presence of risk factors for the development of dry eye syndrome in the preoperative period before phacoemulsification, including a history of cosmetic interventions in the periorbital area, an increased risk of developing a severe form of dry eye syndrome and an inflammatory process in the early postoperative period was noted at a 2-week observation period. This group of patients is recommended to undergo a set of therapeutic physiotherapeutic procedures — eyelid hygiene + massage in the periorbital area, aimed at restoring the functional activity of the meibomian glands and increasing the stability of the tear film, which reduces the incidence of severe dry eye syndrome and inflammation in the postoperative period after cataract phacoemulsification by 19.89%.

Retinal vein occlusion is a severe vascular pathology of the retina, leading to a significant decrease in vision and blindness. Fundus lesion manifests itself as cystic edema of the macular region, long-lasting persistent macular edema is a poor prognostic sign.

The purpose: to analyze the relationship between the clinical course of retinal vascular occlusion and the content of VEGF and MCP-1 in lacrimal fluid. The content of MCP-1 lacrimal fluid and VEGF lacrimal fluid was studied in 3 groups — in group I (patients with the central retinal vein occlusion, in group II (patients with the central retinal artery occlusion), in the control group (practically healthy individuals). The clinical course data are presented by data on best corrected visual acuity (BCVA) in patients of groups I and II and data on retinal thickness in fovea centralis (according to the results of OCT fovea centralis) in patients of group I. Statistical analysis showed no correlation between the studied biomarkers. The results showed a significant correlation of BCVA with retinal thickness in fovea centralis and a significant correlation with lacrimal fluid VEGF in group I patients, as well as a moderate correlation between lacrimal fluid VEGF and retinal thickness in fovea centralis.

Purpose. To substantiate and study the effectiveness of intravitreal injection of dexamethasone implant (“Ozurdex”) based on OCT study of morphostructural biomarkers of post-radiation macular edema (PMO) in different terms of its detection.

Patients and methods. 28 patients with PMO after Ru-106 ± Rh-106 (BT) brachytherapy for choroidal melanoma (CM). Study group (IG 1) — 18 patients with PMO detected up to 9 months after BT, IG 2 — 10 patients with PMO detected 9 months or more after BT. OCT parameters studied: height of foveolar and parafoveolar zones, presence of neuroepithelium detachment, disorganization of inner layers, hyperreflective foci, pigment epithelium atrophy, as well as the form of edema (diffuse, cystic) and ellipsoid zone disorder. Intravitreal injections of dexamethasone implant (“Ozurdex”) were used as drug therapy of PMO.

The results showed that OCT morphostructural changes such as neuroepithelial detachment were significantly more frequent in patients with PMO diagnosed before 9 months, while hyperreflective foci, disorganization of the inner retinal layers, and ellipsoid zone disorder were more frequent in the comparison group. At the same time, there was no statistically significant difference in the macular and parafoveal edema height, frequency of edema form and presence of such a sign as pigment epithelium atrophy in both groups. Evaluation of the efficacy of intravitreal injection of “Ozurdex” implant in both groups showed that after 1–2 months from the beginning of treatment in the group with early detection of PMO complete regression was obtained in all patients, while in the second studied group complete regression occurred only in one third of patients. The regression of PMO was accompanied by improvement of BCVA in the first group from 0.4 to 0.7, in the second group — from 0.3 to 0.6. Out of 28 patients, 3 patients required re-injection of the implant in average 11 months after the first injection.

Conclusion. The OCT biomarkers of PMO should be considered in treatment planning and subsequent dynamic follow-up. Early diagnosis of PMO, as well as the use of intravitreal dexamethasone implant (“Ozurdex”) determines high efficiency of treatment and maximum visual rehabilitation of patients.

Purpose: to evaluate the variability of cefuroxime concentration for intracameral administration during preparation of ex tempore solutions under conditions of real clinical practice.

Materials and methods. Two operating room nurses participated in the study, each prepared 20 samples of cefuroxime solution for intracameral administration according to a uniform dilution protocol. The concentration of antibiotic in the solutions was measured by photocolorimetric method.

Results. The experiment modelling the conditions of real clinical practice demonstrated a significant difference of cefuroxime concentrations in solutions prepared ex tempore. The mean antibiotic concentration in samples prepared by 2 nurses was 1.189 [1.075; 1.383] mg/ml and 1.019 [0.984; 1.10] mg/ml, respectively, p = 0.0002. The range of variation was 0.4 mg/ml, or 40.5 % of the minimum recorded value.

Conclusion. High variability of cefuroxime concentration during ex tempore preparation may lead to a number of undesirable events. Unintentional overdosing causes the development of serous retinal detachment and anterior chamber toxic syndrome. Low antibiotic content can be considered as one of the reasons for the development of infectious complications caused by cefuroxime-sensitive bacterial strains. Improvement of approaches, substances and routes of administration of antimicrobial agents to improve the safety of cataract surgery in the conditions of changing structure and increasing resistance of ocular microbiota seems to be an urgent scientific task.

Relevance. Currently, a number of numerous publications have proven the comorbidity of keratoconus (CC) with dry eye syndrome (dry eye). The modern method of optical rehabilitation of CC includes scleral rigid gas-permeable lenses (SGCL). In addition to compensating for refractive disorders, this type of lens has increasingly been used in the treatment of SSG, in order to protect the cornea and tear film. Purpose: to assess the change in the state of the precorneal tear film in CC in combination with SSG against the background of wearing SGCL.

Patients and methods. 31 patients (62 eyes) with bilateral stabilized non-operated CC of various stages were examined, for whom individual SGCLS were selected. A comprehensive assessment of the condition of the tear film included the following methods: biomicroscopy of the anterior segment of the eye using vital dyes, functional tests (Norn, Schirmer, Jones test), OCT-meniscometry, as well as filling out the OSDI questionnaire by patients and an oral survey on subjective sensations against the background of wearing this type of lenses. The studies were carried out before, after 1 and 3 months on the background of wearing lenses.

Results. Prior to the selection of SGCL, an increase in the areas of staining of the ocular surface with vital dyes, a decrease in the results of functional tests and OCT meniscometry, as well as high scores according to the OSDI questionnaire were recorded. After 1 month of wearing lenses, the indicators of all studies showed a tendency to improve the condition of the tear film, and after 3 months there were significant changes relative to the initial data. An oral survey showed full adaptation to the SGCL and wearing comfort in 87 % of cases.

Conclusion. A comprehensive assessment of the condition of the tear film in CC in combination with signs of SSG before and against the background of wearing individual SGCL indicates an improvement in the condition of the ocular surface and stabilization of the precorneal tear film, which proves the effectiveness of this type of correction for both optical and protective purposes.

Purpose: to conduct a comparative analysis of the clinical efficacy of a fixed combination of antihypertensive drugs: brinzolamide 1 % = timolol 0.5 % and dorzolamide 2 % = timolol 0.5 % for the prevention of intraocular hypertension in patients with silicone oil tamponade of the vitreal cavity.

Patients and methods. The study was conducted in the Orenburg branch of S. Fyodorov Eye Microsurgery Federal State Institution during 2022. A retrospective analysis of case histories of 60 patients with retinal detachment and severe proliferative syndrome was carried out. All patients underwent subtotal vitrectomy. To prevent intraocular hypertension after tamponade of the vitreal cavity with silicone oil, patients were prescribed antihypertensive drugs: group 1 (n = 30) — a combination of brinzolamide 1 % = timolol 0.5 %; group 2 (n = 30) — dorzolamide 2 % = timolol 0.5 %. The therapeutic result was evaluated after 2 weeks, 1, 2 and 3 months. The observation included an ophthalmological examination, as well as a questionnaire to assess drug tolerance.

Results. IOP after silicone oil tamponade and before the application of drugs had no statistically significant differences between the studied groups and amounted to 27.15 ± 3.56 mm Hg — in group 1 and 28.53 ± 5.99 mm Hg — in group 2. Both studied combinations provided a decrease in IOP, however, a more pronounced effect after 2 weeks of therapy with subsequent maintenance of a normal IOP level for 3 months was recorded in group 2 when using the dorzolamide / timolol combination, despite the appearance of minor discomfort during instillation. A decrease in IOP from baseline was found to be 43.5 % (p ≤ 0.01) with the combination dorzolamide/timolol and 33.3 % (p ≤ 0.01) for brinzolamide/timolol.

Conclusion. The results of the study showed that both fixed combinations of drugs provide a decrease in IOP in patients after silicone tamponade, but the dorzolamide/timolol combination had a more pronounced therapeutic effect.

This part of the work describes the results of a multimodal examination of patients with non-rhegmatogenous chorioretinal peripheral degenerations.

Objective: to conduct a multimodal study of the vitreoretinal interface of chorioretinal degenerations, to determine their place in the classification of peripheral degenerations to create an informative retinal map of peripheral retinal degenerations.

Materials and methods. Patient examinations included traditional and additional ones: the ultrawide-angle fundus imaging with the Clarus 500 or VISUCAM 500 (Carl Zeiss Meditech Inc., Dublin, USA) and wide-field OCT Line scanning using the “sliding method” with SOLIX and RTVue XR Avanti (Optovue Inc. USA).

Results. During the period of 2014-2024, 1304 peripheral degenerations and retinal tears were identified through the multimodal examination of 614 patients (959 eyes). Chorioretinal dystrophy was found in 134 patients: paving-stone degeneration — 75 (5.75 %), retinal drusen — 45 (3.45 %), Doyne honeycomb retinal dystrophy — 8 (0.61 %), retinal pigment epithelium hypertrophy (RPE) — 6 (0.46 %). Based on these studies, a clinical and topographic classification of peripheral degenerations and retinal tears is presented.

Conclusion. In this article (part 2) we present studies of a group of nonrhegmatogenous chorioretinal degenerations with no changes in the vitreoretinal interface. The multimodal diagnostics of peripheral retinal degenerations have enabled the creation of a retinal map in order to systematize knowledge and improve treatment tactics.

In recent years, there has been a rapid increase in the number of patients with a history of cosmetic interventions in the periorbital area who applies to ophthalmologists with various complaints. Such interventions include the introduction of dermal fillers, blepharoplasty, botulinum toxin injections for aesthetic purposes, mesotherapy, eyelash extensions and eyelid tattooing. It should be noted that patients may present the most unexpected complaints, which, if the doctor is not informed in this widely used area, cannot always be associated with cosmetic procedures in the anamnesis. This article will discuss complications associated with blepharoplasty, present clinical examples illustrating the varying degrees of lagophthalmos severity at different observation periods after upper and “circular” blepharoplasty, in accordance with which indications are determined for choosing the tactics of managing this group of patients at an outpatient appointment with an ophthalmologist. Before carrying out cosmetic procedures in the periorbital zone, in particular before blepharoplasty, it is necessary to conduct a comprehensive examination of patients, including an assessment of the biochemical blood test, immunological and endocrine status of the patient. If complex cosmetic procedures in the periorbital zone are detected and/ or changes in the somatic status are present, it is necessary to inform the patient of the high risk of complications associated with these procedures. If lagophthalmos caused by blepharoplasty is detected during an ophthalmological examination, the patient should be referred to the operating plastic surgeon for a comprehensive rehabilitation, including eyelid massage, performed to increase the area of the skin surface of the eyelid and eyelid gymnastics. These procedures are effective for one month after blepharoplasty until the stage of formation of gross cicatricial changes in the skin. If lagophthalmos persists for more than 6 months, repeated reconstructive blepharoplasty is recommended to eliminate lagophthalmos. Blepharoplasty, especially “circular” blepharoplasty, which involves expanding the surgical intervention area, is recommended to be performed in specialized certified ophthalmological clinics, it will reduce the risk of complications associated with this type of surgical intervention.

The article describes a clinical case of retinal light burn in a child as a result of careless handling of a household laser device, with an ophthalmological picture of macular edema with detachment of the pigment epithelium, and also presents the results of the treatment.

Relevance. Dry eye syndrome is an important medical and social problem due to its high prevalence and impact on visual functions in human daily life. In cataract surgery, the result of the operation and the patient’s satisfaction directly depends on the preoperative examination, in which, as a rule, the indicators of tear production and the condition of the tear film are most often not taken into account. In this regard, the calculation of the intraocular lens may be incorrect.

Purpose. To evaluate the effectiveness of an integrated approach in preparing a patient for cataract surgery with the implantation of a “premium” lens and full recovery in the postoperative period.

Materials and methods. A patient applied to YourMed and underwent a standard examination for a refractive patient, including a comprehensive assessment of the condition of the ocular surface. Based on the results of the identified changes, complex therapy was proposed and EDOF IOL with an elongated wavefront was performed. When conducting a study of the condition of the ocular surface using a slit lamp with a module for diagnosing dry eye syndrome (MediWorks, China), signs of an evaporative form of mild (right eye) and moderate (left eye) degree were revealed: the average tear film rupture time was 9.68 (OD) and 2.83 (OS) seconds, the height of the lacrimal meniscus is 0.22 mm (OD) and 0.17 mm (OS), the thickness of the lipid layer is grade 3 (OD) and grade 2 (OS), the percentage of non-functioning meibomian glands is 35 % (OD) and 44 % (OS). In this regard, a comprehensive treatment of SSG has been prescribed (eyelid self-massage, instillation of drops). Two weeks after the therapy start and against its background, the patient again underwent a repeated examination of the condition of the ocular surface, in which positive dynamics was noted. A sequential uncomplicated surgery was performed to replace the lens with an intraocular IOL with an elongated wavefront, first to the left, and after 1 week to the right eye. The patient does not notice any discomfort (dry eyes, watery eyes) that were present before the start of therapy before surgery.

Conclusion. Diagnosis of dry eye syndrome, differentiation of the form of this pathology and mandatory complex therapy before lens replacement surgery plays an important role in cataract surgery, which allows you to obtain stable indicators of visual functions in a shorter period after surgery.

Purpose. To examine clinical examples of the visual organ condition in patients with visually intense work (VIW) after cataract phacoemulsification (CEP) from the standpoint of ophthalmo-ergonomic indicators and “quality of life” (QOL).

Methods. Clinical examples are based on observation of CEP patients after standard bilateral CEP and implantation of an intraocular lens (IOL) with an extended focal depth (“RayOne EMV”, model RAO200E, “Rayner Intraocular Lenses Limited”, Worthing, UK). Three months after the surgery on the second eye, patients underwent a comprehensive examination of their vision based on standard clinical methods (visometry, keratorefractometry, etc.), assessment of functional (objective accommodation) and ophthalmo-ergonomic (“Eye meter”, “Visual search” tests) indicators, as well as a study of QOL (according to the “FEC-22” questionnaire). The article presents two clinical examples, each of which comparatively discusses the examination data of two VIW patients — air traffic controllers.

Results. The first clinical example presents a significant (15.9 %) deterioration in visual performance (VP) according to the “Eye meter” test under conditions of a deficit (3 sec) of time for presenting the test task, which is associated with the patient’s anisometropia (0.2 relative units). The second example presents a decrease (20.8 %) in VP according to the “Visual search” test due to the patient’s impaired accommodative function of the eye (habitual excessive accommodative tension). In both cases, the identified dynamics are accompanied by a decrease in the QOL indicator (by 3.7–5.8 %, respectively) according to the “FEK-22” questionnaire, which is associated with the methodological features of the development of this questionnaire.

Conclusion. Conducting an ophthalmo-ergonomic examination in cataract surgery reflects the “social model” of health, which considers limitations of life activity as a social problem and, therefore, the goal of treatment is the complete integration of the individual into society or, in other words, preserving the “professional” vision of the VIW patient and continuing (after surgery) everyday visual activity with the required indicators of visual performance. Ophthalmo-ergonomic indicators closely related to the patient’s QOL allow us to determine the “reference points” for conducting the necessary set of therapeutic and preventive measures to preserve the “professional” vision of the VIW patient.

Blepharophimosis syndrome (palpebral syndrome) is a sporadic or hereditary genetic disease, manifested mainly by changes in the eyelids in the form of blepharophimosis, ptosis of the upper eyelid and reverse epicanthus. Often, the classical triad is complemented by other anomalies: telecanthus, thickening and fibrotization of the skin of the eyelids and subcutaneous structures, expansion and rounding of the medial angle of the eye slit, lateral displacement of the lower lacrimal point, ectropion of the lower eyelid. In order to correct the epicanthus and the zone of the medial angle of blepharophimosis syndrome, many techniques have been proposed. Despite this, the choice of surgical treatment method is not unambiguous and remains controversial.

Purpose. Development of a new method for surgical correction of the shape of the medial angle of the eye in patients with blepharophimosis syndrome. Patients and methods. We have proposed a method for surgical correction of the medial angle shape in patients with blepharophimosis syndrome. Two clinical cases have been described. Each patient underwent surgery according to the proposed method. Before surgery, patients underwent a standard ophthalmological examination, lacrimal lavage before surgery or intraoperatively, an objective examination, including an assessment of the shape of the medial angle, the position of the lower eyelid, determining the length of the eye slit, the distance of the lower lacrimal point from the medial junction. Examination of patients and evaluation of the results of surgical treatment were carried out on the following days, 2 and 3 months after the operation.

Results. In each of the 2 cases, a positive cosmetic effect was achieved, the desired shape of the medial angle was achieved and, at the same time, tear drainage was not disturbed. Conclusion. The presented method of reconstruction of the medial angle of the eye allows you to get a more correct, narrowed shape, correct the abnormal position of the lower lacrimal point, while maintaining normal lacrimal drainage.

Purpose: To demonstrate a case report of successful implantation of multifocal IOL in patients with Marfan syndrome.

Materials and methods. A young patient with Marfan’s syndrome asked to the clinic. Examination revealed ectopia of the lens in both eyes. Given his active lifestyle and the desire to get rid of glasses, he was offered surgical treatment with implantation of a multifocal IOL. Lens phacoemulsification was performed with implantation of a modified capsular tension ring, and a trifocal IOL (PanOptix) in the bag.

Results. In the late postoperative period, the maximum corrected visual acuity for near in the right eye was 0.9, in the left — 0.8; for the average distance — 0.7 on both eyes; for the distance on the right eye — 1.0, on the left — 0.8.

Conclusion. This clinical case demonstrated that in some cases, ectopia of the lens in Marfan syndrome is not a contraindication to the implantation of a multifocal IOL.

Purpose: to evaluate in experiment the dynamics and intensity of vascular sprouting in the donor cornea during keratoplasty against the background of pre-existing neoangiogenesis when using a conditioned medium of mesenchymal stem cells.

Materials and methods. The object of the study was 15 rabbits (10 recipient rabbits, 5 donor rabbits) of the gray Chinchilla breed weighing 2.5–3.2 kg. The experiments were carried out in two stages. At the first stage, 10 animals were simulated with a unilateral thermal burn of the peripheral zone of the cornea with limbal involvement. Penetrating keratoplasty was performed using standard technology on the 15th day of the experiment. At the second stage, the recipient rabbits were divided into experimental and control groups. 5 rabbits, 5 eyes, in the control group and 5 rabbits, 5 eyes, in the main group. In the main group, instillations of paracrine factors of mesenchymal stem cells were used as postoperative treatment from the 1st to the 30th knocks four times. In the control group, treatment was carried out by instillation of antibiotics (Oftaquix) and keratoprotectors (Korneregel) three times for 30 days. Research methods included biomicroscopy, photographic recording of the anterior segment of the eye, examination using a Pentacam AXL device, and histological examination. The observation periods were 1st, 3rd, 7th, 14th, 30th day.

Results. The results of postoperative treatment at the second stage of the experiment, as well as the results of histology, showed a pronounced antiangiogenic effect of the conditioned medium of mesenchymal stem cells. This was confirmed by the absence of pronounced vascularization of the donor cornea, the attenuation of the inflammatory reaction and the formation of a scar on the 30th day of drug instillation. In the control group, graft disease developed from the seventh day.

Conclusion. The results obtained during the work seem promising. The use of the conditioned medium of mesenchymal stem cells demonstrated a sufficiently pronounced effectiveness compared with standard drug therapy in the postoperative period after high-risk end-to-end keratoplasty in experimental animals performed on a model of post-burn corneal neovascularization.

Purpose of the study: to evaluate the influence of the level of anthropogenic load on the frequency of surgical treatment and age status of people with senile cataracts living in various territories of the Kemerovo region — Kuzbass.

Materials and methods. From 2015 to 2019, 228 372 patients from 7 cities and regions with a high level of technogenic load and from 6 cities with a low level of technogenic load were operated on for age-related cataracts in a 24-hour hospital stay.

Results. The absolute number of operated persons was greater in territories with a high level of technogenic load compared to a low level of technogenic load (187 876 versus 40496) and on average exceeded 4.6 times annually (37 575 versus 8099). The number of operated persons, taking into account the dynamics of the population due to decline and birth rates in different territories over the years, fluctuated per 10 000 population, and exceeded in territories with a high level of technogenic load by an average of 27.0 %. The average age of operated patients with cataracts differed little in populations with high and low levels of technogenic load. However, in territories with a high level of technogenic load compared to a low level of technogenic load, there were 2.5 times more operated people aged 51–60 years.

Conclusions. The number of operated people with senile cataracts over a five-year period per 10 000 population averaged 176.46 in areas with a high level of technogenic load and 134.14 with a low level, with a numerical advantage over decades from 9.67 % to 45.47 %, (annual average 27.0 %). There were 2.5 times more operated patients with age-related cataracts aged 51–60 years (4.9 % versus 1.9 %) in areas with a high level of technogenic load compared to a low level, with an average age of 72.02 ± 8.32 and 71.04 ± 10.11 years, respectively.

Introduction. Presbyopia is a global problem affecting more than 1.5 billion people worldwide. Projections indicate an increase in the average age of the population to 40 years by 2050, which is associated with an increase in the presbyopia incidence and corresponding economic losses. Despite the widespread prevalence of presbyopia, there are currently no effective methods for early prevention and restoration of dynamic accommodation and a standardized approach to assessing age-related changes in the lens that underlie presbyopia. The purpose: to study the effect of age-related changes in the lens on accommodation and to consider modern pharmacological approaches to the prevention and treatment of presbyopia.

Methods. A multicenter prospective study was conducted, including analysis of visual acuity, the nearest point of clear vision and the volume of accommodation in individuals aged 40 to 55 years. Study participants were prescribed pyrenoxine (Catalin) as eye drops three times daily for 4 months. The study included 382 questionnaires collected from 29 ophthalmologists.

Results. As a result of the study, the average distance to the nearest point of clear vision decreased slightly, but the reserve of accommodation remained at the same level. This indicates the absence of significant progression of age-related decrease in the reserve of accommodation as one of the manifestations of presbyopia and the possible effectiveness of pyrenoxine in preserving the elastic properties of the lens.

Conclusion. The study confirmed the effectiveness of pyrenoxine in the prevention of presbyopia and the preservation of accommodative abilities in middle-aged people. The concept of Dysfunctional Lens Syndrome may be useful for clinical practice by providing opportunities for early diagnosis and treatment of presbyopia. Incorporating this concept into clinical guidelines may improve approaches to the treatment and prevention of age-related lens changes.

One of the main causes of visual impairment in children is visual impairment (myopia, hypermetropia, astigmatism), which are associated with refraction, and affect visual performance and school performance of children, as well as have a negative impact of binocular vision disorders.

Purpose: To study the peculiarities of the development of individual eye structures in preschool and school-age children.

Materials and methods. 5896 children (11 582 eyes) of preschool and school age (1–14 years old) were examined. Healthy children were examined. All children underwent a comprehensive clinical and instrumental ophthalmological examination, which included: visometry, biomicroscopy, refractometry, ophthalmoscopy, tonometry, pachymetry, ultrasound biometry and ophthalmometry.

Results. As a result of the study, the dynamics of eye development in children was studied depending on age, the eye parameters, clearly change and the growth of the eyeball ends by the age of 14. It was found that in children aged from 1 to 14 years vision, refraction, anterior-posterior axis length, lens thickness, anterior chamber depth and vitreous volume significantly increased, and accurate indicators were obtained.

Conclusion. The data obtained make it possible to understand the dynamics of the development of the eyeball in preschool children and help in predicting the occurrence of various pathologies and their prevention. The conducted studies have shown some differences in the anatomical and optical environments of the eyes in children of Turkmenistan, whose climatic conditions in evolution led to the development of an adaptive mechanism that determined the corresponding parameters of the organ of vision and its ethnic peculiarity. Based on a large number of studies (5896 children), specific sizes of anatomical and optical eye media in children of Turkmenistan have been established.