This literature review is devoted to one of the most complex ophthalmology problems — neuroprotective and neuroregenerative treatment of glaucoma and consists of two parts. The first part considers the main mechanisms of neurodegeneration and the main aspects of therapeutic control related to these mechanisms (excitotoxicity, mitochondrial dysfunction, oxidative stress). The main aim of the conducted literature analysis is to provide a comprehensive overview of both existing neuroprotective strategies and promising areas of therapy based on neuroprotective agents in the potential treatment of glaucoma. A wide range of approaches to neuroprotection demonstrates the great potential for effective treatment of neurodegeneration in order to preserve visual functions in patients with glaucoma.

Today, cataract surgery is almost always accompanied with aphakia correction by implantation of an intraocular lens (IOL). In addition to the constant improvement of surgical techniques, special IOLs with improved characteristics are being developed, allowing any optical task to be solved with a minimum of side effects. Since the appearance of the first polymethyl methacrylate IOL, flexible silicone and acrylic IOLs have become available, and the optical design of the lens allows a choice between a single and multiple foci or increased depth of field within a single focus. Optimization of the material, shape and optical design of IOLs remain.

For the treatment of myopia and myopic astigmatism, the most commonly performed laser refractive surgical technique is Laser in situ keratomileusis (LASIK). In recent years, minimally invasive lenticule extraction (SMILE) has emerged as a promising alternative to LASIK, requiring only a femtosecond laser to create the intrastromal lenticule. LASIK and SMILE have comparable visual outcomes in terms of safety, efficacy, and predictability. SMILE has been shown its result in less severe postoperative dry eye symptoms and faster corneal sensitivity recovery than LASIK. However, several authors have noted a clear trend toward undercorrection in SMILE, which is more pronounced in cases where preoperative astigmatism is greater. Astigmatism correction with femto-LASIK is more advantageous than with SMILE. The reason for this is cyclotorsion, which is not controlled when using the VisuMax platform. Cyclotorsia is a common problem when correcting astigmatism, as a cyclotorsional error of just a few degrees is a source of astigmatic undercorrection. Although dynamic cyclotorsion should not be a problem when performing SMILE due to the fixation of the eyes during laser treatment, static cyclotorsion must be compensated for, as proper axis alignment and pupillary centration are critical to achieving refractive results.

Purpose: to access accuracy of 10 intraocular lens (IOL) calculation formulas.
Patients and methods. 784 patients (784 eyes) formed study group. Every patient underwent phacoemulsification (PE) with IOL implantation. Biometry for IOL calculation was performed on IOL-Master 500 and 700 (Carl Zeiss, Germany). 1 month after PE spherical equivalent of refraction (Topcon-8800, Japan) was assessed. To compare refractive results of formulas, mean calculation error (ME), mean absolute calculation error (MAE) and formula performance index (FPI) were assessed.
Results. The following formulas are presented in descending order of the FPI: Kane (10.20), Hill RBF (10.00), Barrett (9.62), Holladay I (9.52), Hoffer QST (9.26), Ladas Super Formula (9.17), EVO (9.09), Hoffer Q (8.40), SRK/T (8.13), Pearl DGS (8.00). The lowest MAE shows Kane formula (0.33 ± 0.25), Hill RBF (0.33 ± 0.24) and Barrett (0.34 ± 0.25). The greatest MAE — SRK/T (0.36 ± 0.27), Hoffer Q (0.36 ± 0.25) and Pearl DGS (0.39 ± 0.37).
Conclusion. The highest accuracy was demonstrated by Kane, Hill RBF and Barrett formulas, however, other formulas (SRK/T, Holladay I, Hoffer Q, Ladas Super Formula, EVO, Hoffer QST, Pearl DGS) demonstrate comparable results with the above.

Purpose: to study the effectiveness of scleral buckling in recurrent retinal detachment after previously performed vitreoretinal surgery in patients with advanced stage PDR.
Patients and methods. The results of treatment of 30 patients with recurrent retinal detachment after previously performed vitreoretinal surgery were analyzed. Depending on the initial localization of fibrovascular tissue and tractional retinal detachment, patients were divided into 2 groups of 15 cases each: group 1 — localization in the lower quadrants, group 2 — localization in the upper quadrants. In group 1, the average age was 44.2 ± 1.8 years, the gender distribution was as follows: 10 women and 5 men, according to the type of diabetes mellitus: type 1 diabetes — 86.6 %, type 2 diabetes — 13,3 %. In group 2, the average age was 65.8 ± 1.2 years, there were 6 men, 9 women, type 1 diabetes — 20 % of cases, type 2 diabetes — 80 % of cases. The observation period ranged from 14 months to 18 months. After detection of recurrent retinal detachment, all patients were treated with buckling within 3 weeks from the moment of relapse using local anesthesia and intravenous sedation. In all cases, a buckle made of fine-pored silicone with a diameter of 5 mm of the required length was used. Normalization of intraocular pressure was performed by dosed drainage of silicone oil into the vitreal chamber.
Results. In all cases after scleral buckling retina is attach. 6 months after the buckling, silicone oil was removed from the vitreous cavity. With a follow-up period of 3 months after removal of silicone oil, a recurrence of retinal detachment was detected in 2 cases in group 1. Long-term functional results in both groups from 14 to 18 months after completion of treatment demonstrated a significant increase in BCVA.
Conclusion. The results obtained indicate that proposed method of surgical treatment for recurrent retinal detachment after previously performed vitreoretinal surgery in patients with advanced stage PDR, provides a high level of safety and clinical effectiveness, which is confirmed by the high probability of retinal reattachment (above 93 %), low recurrence rate of retinal detachment, as well as positive dynamics of BCVA at the end of treatment.

We have proposed a method for fixing an autolimbal graft using a two-component autofibrin glue. The use of this adhesive composition is justified by the formation for strong adhesion and tissues fixation, as well as the relief of local inflammatory reaction due to the platelet-rich plasma (PRP) included in its composition.
Objective. To compare the effectiveness of autolimbal transplantation using a two-component autofibrin glue and suture fixation in multiple recurring pterygium over a two-year follow-up period.
Patients and methods. The study included 19 patients (20 eyes) with repeatedly recurring pterygium. The autolimbal graft was fixed using two-component autofibrin glue in the study group and using suture material (10/0 silk) in the control group. Using optical coherence tomography of the anterior segment, we assessed the adaptation of the graft in the bed and used a questionnaire to analyze the degree of discomfort in the postoperative period. A comparative analysis of the operation’s duration, epithelialization, and rehabilitation period was performed between the study groups, and cases of pterygium recurrence were recorded throughout the entire observation period (2 years).
Results. A comparative analysis of the effectiveness of various methods of autolimbal graft fixation revealed a statistically significant reduction in the operation’s duration, the time to achieve complete epithelialization, and rehabilitation using two-component autofibrin glue. A lower level of discomfort in the postoperative period was noted in the study group. During two years of observation, 1 case of pterygium recurrence was recorded in each group.
Conclusion. The advantages of using an adhesive composition for fixing an autolimbal transplant are the low level of surgical trauma and rapid rehabilitation of patients. Two-component autofibrin glue can act as a full-fledged replacement for the suture method of tissue fixation in the treatment of repeatedly recurring pterygium.

Purpose: analysis of the results of using CLEAR technique on a significant sample of patients with myopia of various degrees.
Patients and methods. A total of 700 patients were included. There were 518 female (74%) and 182 male (26%) aged 18 to 50 (28.4 ± 7.6) years. Patients underwent CLEAR surgery (corneal lenticule removal for advanced refractive correction) in both eyes on the FEMTO LDV Z8 multifunctional femtosecond laser system. The average follow-up period for the patients was 6 months.
Results. A statistically significant increase of UCDVA from 0.21 ± 0.14 before surgery to 0.95 ± 0.07 in the maximum follow-up period was shown (p < 0.05). Significant positive dynamics of the spherical component of refraction was noted (p < 0.05), with mean values of 0.14 ± 0.34 at the 6-month follow-up period, which corresponded to the target emmetropia. When analyzing the dynamics of the cylindrical component of refraction, its decrease from –0.82 ± 0.39 in the preoperative period to -0.40 ± 0.40 in the maximum followup period was shown (p > 0.05). Keratometry parameters K1 and K2 also showed a tendency to decrease after 1 day of observation with a subsequent increase in the observation period of 6 months. The greatest decrease in corneal thickness was noted on the next day after surgery (from 551.9 ± 34.3 to 439.4 ± 41.8 μm). Further, the increase of this index up to 455.7 ± 34.4 μm in the maximum observation period was noted. Among the complications we noted the loss of vacuum in two cases (0.28 %) at the initial stage of mastering the technique, incisional tear in 6 cases (0.85 %), opaque bubble layer in 7 cases (1 %), single subconjunctival hemorrhages.
Conclusion. Our own experience of corneal lenticule removal for advanced refractive correction in 700 patients showed that the technique was easy to master, comfortable for surgeon and the patient, safe and effective in the correction of myopia and myopic astigmatism, and there were no significant decrease in corneal thickness during the follow-up period of 6 months.

Relevance. Retinal laser photocoagulation (RLP) for proliferative diabetic retinopathy (PDR) is an important component of treatment at various stages including vitreoretinal surgery. The issue of the optimal intraoperative RLP area and localisation does not have a consensus; therefore, its clarification is an urgent task.
Purpose: to evaluate the effect of intraoperative RLP area and localisation on the incidence of PDR surgical treatment complications.
Patients and methods. The difference was in the use, area and localisation of RLP application: in group 1, RLP was not performed; in group 2, panretinal RLP was performed in four quadrants on the near and middle periphery (1000–1500 coagulates); in group 3, peripheral RLP was performed from the retinal equator to the ora serrata (600–800 coagulates). Intermediate treatment results were assessed within 1 month of surgery, and long-term results — after 12 months.
Results. In the early postoperative period there were no statistically significant differences between groups. In the long-term follow-up period group 1 revealed a higher incidence of vitreous haemorrhage and anterior segment neovascular complications — rubeosis iridis and neovascular glaucoma. An unexpected increase in the incidence of diabetic macular edema in the long-term period after panretinal intraoperative RLP. The lowest frequency of complications was found in group 3 (after peripheral RLP).
Conclusion. The study obtained and confirmed previously identified data on an increased risk of developing postoperative complications (vitreous haemorrhage, rubeosis iridis and neovascular glaucoma) in patients whose treatment did not include intraoperative RLP. The lowest frequency of complications was found in the group after peripheral RLP, which makes the proposed coagulation method promising in terms of application and further study.

Objective: to present the main methods of reactivation and maintaining the activity of shunt systems (Ahmed valve drainage, PRESERFLO shunts) in cases of reducing the effectiveness of their work in the early or late postoperative follow-up due to proliferative changes in the filtration zone.
Methods: an experimental study involving, n = 10 eyes (10 patients). After PRESERFLO implantation: patients underwent needling with dexamethasone injection into the area of the filtration bleb in 2 cases, open plastic surgery of the filtration bleb with cleaning of the distal end of the tube from fibrous tissue and treatment of the filtration area with mitomycin in 3 cases, and reimplantation of the shunt into another sector of the eye in 2 cases. In the case of the Ahmed shunt, in all 3 cases, an open plastic surgery of filtration bleb was performed with excision of a dense fibrovascular membrane around the shunt body.
Results. As a result of surgical reactivation of the shunts, compensation of IOP in the early postoperative period was achieved in all cases.
Conclusion. The use of shunts made of modern polymers to create an alternative drainage system has reduced the problem of tissue proliferation response on newly created aqueous humor outflow paths, but has not completely solved it. Reactivation of shunts is a routine type of surgical treatment for glaucoma. This article presents the main methods to reactivate and prevent malfunction of the Ahmed and PRESERFLO shunts.

Purpose: to compare the efficacy of existing glaucoma surgery after phacoemulsification (PE) and femtosecond PE (femtoPE).
Patients and methods. Study included 30 patients (30 eyes) who have undergone a non-penetrative glaucoma surgery with Burrato II cataract. Patients were evenly distributed to the PE and femtoPE groups. Cataract surgery was performed from 3 months to 1 year after glaucoma surgery. Intraocular pressure (IOP) was evaluated before surgery, on week 1, months 1, 3, and 6.
Results. Baseline IOP was comparable in both groups: 17,5 ± 1,3 mmHg in a PE group and 17,9 ± 1,5 mmHg in a femtoPE group. In a PE group a statistically significant IOP increase happened on week 1 and month 1, in a femtoPE group it happened only on week 1. In comparison to the femtoPE group, the PE group was associated with bigger IOP increase after 1 week and 1 month (week 1: 17,0 ± 3,6 and 13,2 ± 1,9 mmHg, respectively; month 1: 13,5 ± 2,2 and 13,0 ± 0,7 mmHg, respectively). In months 3 and 6, there was no intergroup difference (12,2 ± 2,1 and 12,5 ± 1,6 mmHg, respectively; 13,3 ± 1,0 and 12,1 ± 1,8 mmHg, respectively). In all follow-up terms amount of hypotensive eyedrops was bigger in the PE group.
Conclusion. FemtoPE is safer than PE in eyes with previous glaucoma surgery. Such eyes are more likely to require hypotensive therapy after PE, rather than after femtoPE, for IOP compensation.

The first part of the article presented the developed clinical classification of the severity of dry eye syndrome 2024, which takes into account not only objective indicators of the state of tear production and the degree of inflammation of the tissues of the ocular surface, but also subjective indicators — patient complaints (SPEED quality of life scale). This classification allows to determine the severity of dry eye syndrome (DES), which in turn makes it possible to choose an adequate volume and type of therapy for this disease. The study presented in this article, conducted on the basis of a questionnaire of ophthalmologist experts (Delphi method), made it possible to formulate an algorithm for treating dry eye syndrome using the developed comprehensive clinical classification of the severity of this pathology. The ophthalmologist expert determined the indications for prescribing various groups of drugs — tear substitutes, corneoprotectors: gels containing dexpanthenol, ointment forms. Anti-inflammatory therapy — dexamethasone, antiallergic, nonsteroidal anti-inflammatory drugs, blood products (autologous/alogeneic serum, PRP), cyclosporine, antiseptics. Physiotherapeutic treatment — eyelid hygiene: warm compresses/irrigation of the eyelid surface with warm water + eyelid self-massage, IPL therapy, Aktiva system, Plasma jett system. The algorithm allows to determine indications for 13 types of dry eye syndrome therapy recommended for use by the international working group The Tear Film & Ocular Surface depending on the severity of dry eye syndrome (mild, moderate, severe), the presence of concomitant pathology or taking medications on an ongoing basis, as well as the duration of dry eye syndrome. Given the high level of expert agreement in the assessment (Randolph kappa coefficient above 0.6) when compiling the algorithm, it can be recommended for use in a wide ophthalmological practice, including primary outpatient care.

The work is devoted to one of the actual problems of modern ophthalmology — the study of the possibilities of using liquid crystal glasses in the functional treatment of patients with congenital partial atrophy of the optic nerve (PAON).
The purpose is to evaluate the effectiveness of the use of liquid crystal glasses in the functional treatment of congenital partial atrophy of the optic nerve.
Patients and methods. 22 patients with congenital PAON aged from 10 to 25 (on average 16.3 ± 0.8) years were observed. Along with a standard ophthalmological examination, the deviation value and amplitude of fusion were evaluated using the computer program “Klinok”, as well as visual memory indicators were determined using the computer program “Expo”. To assess the severity of the stereokinetic effect, a computer program containing a ring image was used, the rotation of which on the computer monitor screen, it caused the illusion of a three-dimensional figure; the threshold of electrical sensitivity (ES) and electrical lability (EL) were determined using a standard technique using a percutaneous electrical stimulator “ESOM”. As a method of functional treatment, the liquid crystal glasses (Strabo Glasses), were used. Results. the visual acuity of the better-seeing eye increased on average from 0.32 ± 0.04 to 0.44 ± 0.04 and the worse-seeing eye from 0.25 ± 0.03 to 0.4 ± 0.04 (p < 0.001) in combination of improved electrophysiological parameters — a decrease in ES and an increase in EL (p < 0.001). A decrease in the deviation value and an increase in the fusion amplitude (p < 0.001) were observed. The number of patients with stable binocular vision increased from 59.1 % to 77.3 %. There was an improvement in visual memory indicators in the study with both color and achromatic visual stimuli (p < 0.05). The severity of the stereokinetic effect increased in monocular observation conditions and decreased in binocular (p < 0.05), which indicated normalization of the interaction of monocular and binocular mechanisms of spatial perception.
Conclusion. Visual training with Strabo Glasses is a fairly effective method of functional treatment of congenital PAON. This method allows to increase monocular and binocular visual acuity; improve electrophysiological parameters; reduce the deviation value and increase the amplitude of fusion; improve the nature of vision; normalize the interaction of monocular and binocular mechanisms of spatial perception; improve visual memory.

Relevance. Angiogenesis inhibitors in the treatment of age-related macular degeneration (AMD) do not eliminate the oxidative stress associated with this pathology.
Purpose: evaluation of complex therapy for neovascular AMD (nAMD) combining the nutraceutical Resvera Forte® (VISUS LAB LLC) with intravitreal administration of aflibercept.
Patients and methods. The study involved 36 patients (36 eyes) with nAMD, aged 72.0 ± 3.8 years. Two groups were formed, comparable by gender and age. In the main group (20 patients), in addition to aflibercept therapy, an oral course of the multivitamin complex Resvera Forte® (712 mg) was prescribed. In the comparison group (16 patients, 16 eyes), aflibercept therapy was administered. The observation period was 1.5 years.
Results. After three “loading” intravitreal injections of aflibercept, all 36 patients showed a decrease in macular neovascularization activity, the interval was increased by 2 weeks. By 12 months, no patient in the main group had AMD activity, the central retinal thickness (CRT) decreased to 251.5±9.1 μm, and the best-corrected visual acuity (BCVA) increased to 0.8 ± 0.06. The average number of intravitreal injections per year in the main group was 7 ± 1. In the comparison group, six patients showed resumption of AMD activity, which required an increase in the number of injections to 9–10 per year. CRT was 293.0 ± 20.3 μm versus 251.5 ± 9.1 μm in the main group (p < 0.08). The BCVA in the comparison group was 0.8 ± 0.06 versus 0.6 ± 0.09 in the main group (p < 0.05).
Conclusion. Supplementation of anti-VEGF therapy for nAMD with the oral nutraceutical Resvera Forte® contributed to an objective improvement in the morphofunctional results of its treatment.

Actuality. Maintaining a healthy eye surface is very important both for performing high-quality visual work and for maintaining a socially active lifestyle. A stable and functional tear film is necessary to protect and maintain the normal balance of the eye surface.
Purpose: to determine the density of goblet cells of the bulbar conjunctiva in refractive profile patients at the pre- and postoperative stages, taking into account the condition of the ocular surface.
Patients and methods. Within the framework of this work, 62 (62 eyes) refractive profile patients were examined, their average age was 26.5 ± 2.1 years. In addition to the standard refractive diagnosis, which determines the possibility of safe keratorefractive surgery, all patients underwent an assessment of the status ocular surface: Schirmer-1 test, Norn test, staining of the ocular surface with 0.1% fluorescein and 0.1% lissamine green, determination of tear film break up time and loss of meibomian gland secretion during upper meibography and the lower eyelid on the diagnostic module of the Mediworks slit lamp (China). The follow-up periods were before surgery, 1 week, 1, 3 and 6 months after surgery.
Results. The results of this study showed an uneven distribution of goblet cell density in all study groups, followed by recovery the 6th month.
Conclusion. Thus, the results of assessing condition of the ocular surface using standard ophthalmological research methods and using a modern diagnostic module for screening dry eye syndrome corresponded to the normal course of the recovery period after keratorefractive surgery against the background of prescribed targeted therapy in the fight against induced dry eye syndrome, while a study of the number of goblet cells showed the presence of changes, in groups with the initial presence of dry eye syndrome, this confirms high informative value and diagnostic significance of impression cytology.

The purpose: to compare the effectiveness of combination treatment of patients with diabetic macular edema (DMO) and to assess the correlations of clinical, functional and aberrometric indicators.
Patients and methods. 47 patients (56 eyes) were examined, 27 were women and 20 were men with DME, the average age was 61.3 ± 1.8 years. The 1st group included 22 patients (27 eyes) who underwent intravitreal administration of the neoangiogenesis inhibitor (IA IN) aflibercept followed by laser retinal coagulation (LRC). The 2nd group included 25 patients (29 eyes) who received a combined surgical intervention, including IA IN aflibercept and one-time subtenon administration of the prolonged corticosteroid betamethasone followed by laser coagulation of the retina. Best corrected visual acuity (BCVA) in the 1st group was 0.51 ± 0.2 digits, in the 2nd group 0.44±0.3 digits. Patients of both groups underwent an average of 5.48 ± 1.5 IVs of IV aflibercept. The observation period was 12 months.
Results. According to research data, it was revealed that in the 1st group the BCVA by the end of the treatment period was 0.59 ± 0.22 (р = 0.02), and in the 2nd group this indicator was 0.66 ± 0.25 (p = 0.02). After the 5th injection, there was a statistically significant decrease in CRT by an average of 270.17 ± 92.37 μm in the 2nd group (р = 0.05), and a less significant morphological result was noted in the 1st group (р < 0.05). In both groups, a statistically significant decrease in all components of higher-order aberrations was noted already after the first 3 injections, however, in the 1st group, the result was unstable (p = 0.04).
Conclusions. The obtained results indicate that in patients from the 2nd group it was possible to achieve high morphofunctional results and maintain them at a statistically significant level by the end of the observation period in 89% of cases, and in patients of the 1st group in 68% of cases, however, the results turned out to be unstable.

Relevance. Evaluate the effect of surgical treatment of epiretinal fibrosis and postoperative drug therapy on visual functions in a patient with retinitis pigmentosa.
Purpose. Patient K., 56 y.o., applied to the Moscow City Ophthalmological Center, S.P. Botkin Hospital with complaints of a decrease vision, distortion of straight lines in the left eye, floating opacities in both eyes. For 15 years, the patient notes that she sees worse at night and in rooms with little lighting. According to the results of the examination, the diagnosis was established: OU Epiretinal fibrosis, Synchysis Scintillans, retinitis pigmentosa, initial cataract. Due to the presence of specific complaints in the left eye, optical coherence tomography data, and low visual acuity (0.2), the patient underwent surgery: OS Microinvasive subtotal vitrectomy + epiretinal membrane removal + tamponade of the vitreal cavity.
Results. On the next day, there was a decrease in metamorphopsies and an increase in visual acuity to 0.5. One week after surgery, there was a decrease in visual acuity in the operated eye to 0.4, an increase in the number of metamorphopsies and the development of the clinical picture of cystic macular edema. Combined postoperative conservative therapy, which included the installation use of a glucocorticosteroid, a nonsteroidal anti-inflammatory drug and a carbonic anhydrase inhibitor, allowed to achieve a decrease in macular edema and an increase in visual acuity to 0.8.
Conclusion. Surgical treatment of epiretinal fibrosis in combination with postoperative conservative therapy, including a carbonic anhydrase inhibitor and a nonsteroidal anti-inflammatory drug, in patients with retinitis pigmentosa can lead to an improvement in the anatomical picture of the macular profile and an increase in visual acuity.

Purpose: To study the short-term outcomes of anti-VEGF therapy in neovascular age-related macular degeneration (nAMD) in patients with initially low visual acuity.
Patients and methods. Treatment-naive nAMD patients with best-corrected visual acuity (BCVA) less than 0.1 were included. All participants received three monthly injections of brolucizumab. Outcome measures were evaluated at two months after the last injection. At the beginning and at the end of the follow-up, all patients received standard ophthalmic examination and optical coherence tomography (OCT) to assess anatomical changes in the macula.
Results. The study included 23 eyes (17 males and 6 females, 79.2 ± 7.1 years). During the study period, BCVA changed from 1.47 ± 0.36 to 1.36 ± 0.31 LogMAR (p = 0.77), central retinal thickness decreased from 393.1 ± 159.8 to 348.3 ± 199.2 µ m (p = 0.11). Macular volume decreased from 7.3 to 6.0 mm3 (p < 0.05). Severe morphological changes of the macula were found at baseline, including retinal pigment epithelium atrophy, subretinal fibrosis, giant intraretinal cysts and/or subretinal hemorrhages.
Conclusion. Patients with nAMD, low visual acuity, and severe anatomical changes in the macula have a very limited or no benefits from anti-VEGF therapy.

Purpose: To study the possibilities of a modern multimodal ultra-wide field fundus imaging system based on a confocal scanning laser ophthalmoscope (cSLO) in the pre- and postoperative examination of patients with rhegmatogenous retinal detachment (RRD).
Patients and methods. 20 patients (20 eyes) with RRD aged 45.4 ± 14.8 years (12 women and 8 men) who underwent local scleral buckling were examined. As part of the preoperative examination, all patients underwent a standard ophthalmological examination (including an examination of the fundus with a Goldmann three mirror lens and a 78D lens). As an additional diagnostic method, a study was performed on a Mirante device (Nidek, Japan) before and 3 days after local scleral buckling. We compared the number of patients with RRD who had primary breaks and zones of rhegmatogenous peripheral degenerations detected using standard preoperative ophthalmoscopy and imaging in various diagnostic modes on a multimodal ultra-wide field cSLO platform (color image cSLO, infrared imaging, retro-mode, optical coherence tomography (OCT) of the macular area and the periphery of the retina).
Result. cSLO imaging in various diagnostic modes revealed a primary retinal break in all 20 patients (100 %) with RRD, including three patients whose breaks were not detected during a standard preoperative fundus examination with a Goldmann three mirror lens and a 78D lens. The multimodal approach made it possible to document the initial retinal status, the boundaries of the detached retina, the localization of the breaks and the zones of the rhegmatogenous peripheral degenerations. In the postoperative period, ultra-wide field imaging in combination with peripheral OCT made it possible to objectively document the attachment of the retina, the blocking of breaks and areas of rhegmatogenous degeneration by through external scleral indentation.
Conclusions. The use of the multimodal opportunities of the ultra-wide field diagnostic system has shown high informativity in the examination of patients with RRD, makes it possible to accurately identify and document the boundaries of RRD, retinal breaks, their morphometric features, as well as other features of the patient’s retinal status, and to conduct detailed monitoring of the anatomical success of surgery after surgery.

Purpose: to study the role of personalized risk factors for poor response to angiostatic therapy based on a regression model of the disease.
Patients and methods. The study had a retrospective cohort design, including 84 patients (92 eyes) with a newly diagnosed MNV and evidence of disease activity. In 18 (19.5 %) people, the process was bilateral. Personalized retinal morphometrics and intraocular pressure (IOP) in eyes with MNV treated with fixed intravitreal injections (IVI) of Eylea in correlation with treatment response were studied. Treatment response was ranked into five types. Treatment results were assessed clinically and morphometrically by optical coherence tomography (OCT). Based on the results of correlations, logistic regression models of the disease were built. They studied the role of various factors in the treatment of the disease and the strength of their association with an adverse outcome.
Results. 2 models of the disease have been developed and presented in the form of logistic regression equations with formulas for calculating the prognosis of the effectiveness of treatment with angiostatics. The strength of the risk factors association for an adverse response was analyzed, such as the height of pigment epithelial detachment, the presence of intraretinal edema, personalized intraocular pressure indicators of the affected eye, the patient’s disease belonging to the hereditary form of AMD, the presence of bad habits (smoking). It is shown that an increase in the height of pigment epithelial detachment (marker PED_H = 170 microns) by 1 micron, with other unchanged predictors, increases the ratio of the chance of a negative outcome to a positive one by 1%. At this marker value, the sensitivity of the poor response to angiostatic treatment was 0.493 and the specificity was 0.737. When intraretinal edema occurs, the ratio of the chance of a negative outcome to a positive outcome increases by 68 %. In conditions of increased intraocular pressure, the risk of a poor response increases by 4 times. The prognosis for a smoker is 30% worse compared to a nonsmoking patient. Hereditary AMD increases the risk of developing a poor response to treatment by 25 %. Conclusion. A logistic regression model of the disease is presented, which correctly predicts 94 % of non-response, which makes the prognosis reliable, reliable and accurate. Modifiable (smoking, PED_H > 170 microns, presence of IRF, increased IOP) and non-modifiable (hereditary norm of the disease) risk factors that are important in practical ophthalmology and increase the likelihood of developing an unfavorable outcome of angiostatic treatment were analyzed.

Purpose. Clinical and physiological substantiation of the use of ophthalmochromotherapy in the complex restorative treatment of patients with visually intense work (VIW) with accommodative asthenopia (AA).
Methods. We observed 22 volunteer test subjects (males aged 22–24 years, average age 22.2 ± 0.4 years) with the following inclusion criteria for the study: no visual organ pathology, normal color perception, microfluctuation coefficient of the ciliary muscle of the eye (CMF) according to objective accommodation data (on the Righton Speedy-I device, Japan) from 53.0 to 58.0 relative units, which corresponds to the “norm” and indicates the absence of habitual excess accommodation tension (HEАT) or asthenic form of accommodative asthenopia (AFAA), absence of subjective manifestations of AA. Each of the test subjects underwent a CT session on the ADFT-4 RAINBOW device. The variable parameters during the study were color (red, yellow, green, blue) and stimulus presentation time (10, 20, 30 min.), a total of 12 single impacts performed on different days, while the time and color parameters of the stimulus were changed randomly. The CMF index was recorded before and after each single impact (monocularly).
Results. Pronounced, statistically significant changes were found in relation to stimulation with red and green colors. It was determined that stimulation with red color increases CMF, while stimulation with green color decreases this indicator, and in both cases a very high frequency of occurrence (91–95 %) of the revealed dynamics in specific patients is noted.
Conclusion. The results indicate the prospects for the use of CT in the complex restorative treatment of patients with VIW with AA phenomena. A multidirectional nature of the effect of red color (stimulation of the accommodative muscle) was established compared to green color (relaxation). In the framework of further studies, it is advisable to evaluate the use of green color in patients with HEАT and, accordingly, red color in patients with AFAA. In this case, the exposure time (taking into account the time of the traditional approach to restorative treatment and the general principles of the impact of physical factors on the body) should not exceed 20 minutes.

Purpose. Clinical standardization and assessment of the prospects for using the ophthalmoergonomic test “Glazomer” (TG) in a comprehensive examination of the functional state of the visual analyzer of patients engaged in visually intense work (VST).
Methods. The test methodology involves sequentially presenting geometric figures (square, circle, rhombus, etc.) on a computer screen that have signs of geometric symmetry and a circumscribed circle diameter of 4–7 cm (angular size of 3.8–6.70 from a distance of 60 cm). The patient’s task was to position the cursor in the center of the figure and fix this position using the “mouse”. There were 12 figures, the presentation time was unlimited or 3, 5 and 10 seconds. The study involved 34 male volunteers aged 28–36 years (mean age 32.4 ± 1.1 years) with no visual organ pathology and cognitive impairment. Based on the study results, two parameters were calculated to assess the accuracy of the eye: the average value of the positioning error — the deviation from the test object center (VOC, mm) and the standard deviation of the error — the spread value (SV, mm).
Results. The data obtained indicate that with a decrease in the test presentation time, there was a deterioration in the accuracy of the eye. At the same time, the standardized indicators for the TG are: VOC — no more than 2.54 mm; SV — no more than 0.52 mm. It is important to emphasize that the accuracy of the eye under time “deficit” (3 sec) is a sufficiently informative indicator that determines, along with traditional approaches, the clinical effectiveness of the proposed technologies for treating VST patients with cataracts and accommodative asthenopia after refractive (LASIK) surgery. In particular, it has been established that the presence of anisometropia in a patient after surgical intervention is accompanied by a significantly more pronounced (compared to patients without anisometropia) deterioration in visual performance under conditions of time “deficit”.
Conclusion. Practical implementation of TG in a comprehensive examination of the functional state of the visual analyzer of patients with VST with cataracts or accommodative disorders will ensure an increase in the level of diagnostics from the standpoint of the “medical and social” health model.

Purpose: to study the main indicators determining the “quality of life” (QOL) of a patient engaged in visually intense work (VIW), from the standpoint of the medical and social health model) after phacoemulsification (PEC) of bilateral cataracts.
Methods. We observed 134 patients (264 eyes), 76 % men and 24 % women, aged 42 to 68 years (mean age 57.2 ± 1.3 years) with the following inclusion criteria for patients in the study: the presence of binocular uncomplicated cataract with best-corrected distance visual acuity in the worst eye no more than 0.4 relative units; in the best eye — no more than 0.6 relative units; everyday activities were characterized as visually intense work (at least 4 hours a day); motivation for cataract surgery sequentially on both eyes; absence of alternative pathology of the organ of vision. All patients underwent ultrasound PEC with intraocular lens (IOL) implantation under local anesthesia using the standard technique through a 2.2–2.4 mm corneal incision. All patients were operated on by the same surgeon (N.I. Ovechkin). The operation on the second eye was usually performed 7–10 days after the operation on the first eye. In this case, a monofocal IOL “Flex HB Medicontur” (Switzerland) with a predicted emmetropic “target refraction” (TR) was implanted to correct aphakia. A comprehensive examination of the state of the organ of vision was performed 2–3 months after the operation on the second eye using the following 39 indicators of the visual system. The research questionnaire QOL “PEC-22” was used as the basic parameter of the examination with the calculation of the total testing indicator as the sum of points for all questions.
Results. The leading place in predicting the QOL of a VIW patient after binocular cataract surgery is occupied by anisometropia at all studied distances (far, 60 and 40 cm) measuring uncorrected distance visual acuity (correlation coefficient, CC 0.54–0.66) and the ophthalmoergonomic test “Eye-meter” with a minimum (3 s) time of presentation of the test object (CC = 0.62).
Conclusion. The developed predictors are effective methods for assessing the clinical effectiveness of phacoemulsification from the standpoint of the medical and social health model.

Objective: To evaluate the long-term results of local application of transpupillary photodynamic therapy (PDT) with chlorine photosensitizer in isolated organ-preserving treatment of uveal melanoma (UM) and to determine predictors of its effectiveness.
Patients and methods. Retrospective analysis of transpupillary PDT efficacy in 38 patients (38 eyes) diagnosed with choroidal melanoma (CM) treated between 2016 and 2024. The median follow-up time was 24 months. The mean age was 62.77 ± 10.89 years. Distribution according to TNM: I (n = 12), IIA (n = 20), IIB (n = 6). According to ultrasound Doppler, the initial tumor thickness before treatment ranged from 1 mm to 5.2 mm, with a median value of 2.95 (2.2; 4.0). Distribution by degree of vascularization: avascular СM (n = 4), hypovascular CM (n = 12), hypervascular CM (n = 22); by degree of pigmentation: weak (n = 22), moderate (n = 11), severe (n = 5). In a multivariate statistical analysis of predictors of transpupillary PDT efficacy, the following features were taken into account: tumor thickness, the degree of pigmentation, and the degree of UM vascularization.
Results. Complete regression was achieved in 32 of 38 patients (84 %). After treatment, the tumor thickness ranged from 0 to 4 mm, the median value was 0.5 (0.3; 1.0). Mean best corrected visual acuity before treatment was 0.70 ± 0.34 and 0/38 ± 0.37 after treatment. Multivariate analysis of predictors of treatment efficacy reveal that the most significant criterion was the degree of CM vascularization (AUC = 0.906 (0.802; 1.000), p = 0.002). Complete regression was achieved in 100 % of cases with hypervascular UM, 75 % with hypovascular, and 25% with avascular (p = 0.001). Complete regression was significantly more often observed in small CM (AUC = 0.922 (0.795; 1.000), p = 0.001). The optimal threshold values of the CM thickness for transpupillary PDT in an isolated treatment were obtained: 3.9–4.5 mm. It has been proved that the degree of CM pigmentation is a significant predictor of the absence of complete regression (AUC = 0.805 (0.595; 1.000), p = 0.019), so in the weakly pigmented variant, the formation of an atrophic scar was determined in 21 of 22 patients (95.5 %), in the moderate variant — in 9 of 11 cases (81.8 %), in the case of severe pigmentation in 2 of 5 (40 %) patients (p = 0.012).
Conclusions. Transpupillary PDT efficacy in the isolated treatment of small and medium CM is determined by the possibility of achieving complete regression in 2/3 of patients. The identified predictors should be taken into account when conducting this type of treatment.

The purpose of our work was to study the influence of the biomarker of foveal eversion on the morphological and functional results of treatment of DME.
Materials and methods. A retrospective analysis of medical records of patients who received treatment for DME at the Surgut District Clinical Hospital in the period from 2019 to 2024 was carried out. All patients underwent a standard ophthalmological examination.
Results. A total of 20 patients (25 eyes) with foveal eversion at the initiation of therapy were recruited for the study. Baseline BCVA averaged 0.35. The CRT at the start of therapy averaged 720 µ m. The number of aflibercept injections and dexamethasone implantations in first year of therapy was 7.5 and 1, respectively. At the end of the observation period, the average CRT was 310 μm, and BCVA ranged from 0.2 to 0.7, with an average of 0.43.
Conclusion. The presence of a biomarker of foveal eversion is an unfavorable prognostic factor and is associated with a high probability of developing persistent DME and unsatisfactory morphofunctional treatment results.

Background. Performing a three-port vitrectomy with the adjunction of silicone oil (SO) for internal tamponade is the most common surgery in the treatment of complicated pathology of the posterior eye segment. A possible complication of this surgery is the development of secondary silicone oil induced glaucoma (SIG).
Methods. This article presents a retrospective analysis of the medical histories of 400 patients who underwent vitrectomy with SO adjunction and its subsequent removal, analysis of the patient’s anatomical and functional data, and determination of the risk factors for SIG development. A review of the literature was also conducted, aimed to identify SIG risk factors, and the data of the retrospective analysis were compared with global data.
Results. SIG was established in 56 (14%) of 400 patients within 1 to 34 months after vitrectomy. The most significant risk factor for the development of SIG is the duration of tamponade of the vitreal cavity with SO. Also, according to our data, the likelihood of SIG increases in eyes after IOL implantation and in patients with aphakia, in myopic patients, as well as in males and in younger patients. These data are consistent with global trends. There was no increase in the risk of SIG depending on the nosology that led to vitrectomy, the presence of diabetes mellitus, which is also confirmed in the literature. The difference was in growth of SIG risk in patients after scleral buckling (according to the literature, the risk has to be reduced).
Conclusion. Further investigation of the problem of SIG and risk factors understanding will enhance the visual prognosis after surgery and improve the quality of patient’s life.

The article describes a clinical case of the unilateral process development of Pseudoexfoliative glaucoma (PEG), in a young man, 38 years old, who had previously undergone a penetrating keratoplasty of both eyes. This case is interesting for the early development of the glaucoma process, the severity of manifestations of pseudoexfoliation syndrome at an atypical age.
Objective: present the features of the clinical course, evaluate the atypicality of the onset and course of the glaucomatous process, the effectiveness of medication, treatment of POAG in the context of a corneal transplant, which leads to tonometric errors. Clinical case of 38-yearold patient of Caucasian origin (Armenian), who underwent sequential penetrating keratoplasty of both eyes in the city of Yerevan in 2000 and 2007. At the time of the examination, open-angle developed decompensated (II C) glaucoma and pseudoexfoliation syndrome of the right eye were detected, confirmed by available research methods. Local drug therapy was prescribed: FC brimonidine 0.2 % + timolol 0.5 % and brinzolamide 1 %, 1 drop 2 times a day in the right eye, as a result of which IOP was compensated.

Relevance. Despite the development of modern technologies of lamellar keratoplasty, keratoconus (KK) remains one of the most common indications for penetrating keratoplasty (PKP). However, transparent engraftment of donor tissue is not enough to achieve high visual acuity. Postoperative astigmatism remains an urgent problem. In this regard, in 2015 we proposed a method for intraoperative prevention of postkeratoplastic astigmatism.
Objective: to present the long-term clinical and functional results of treating a patient with KK after PKP with one-stage implantation of an open ring into the graft.
Patient and methods. First time the patient came to the clinic in 2012 with a history of high myopia (HM) and complaints of decreased visual acuity (VA) in both eyes. The patient underwent a comprehensive primary diagnosis, based on the results of which the following diagnosis was made: HM, KK stage 3–4 in both eyes. In 2012, PKP was performed on OD, in 2015, PKP with femtosecond accompaniment and one-stage implantation of an open ring into the graft on OS. In 2023, phacoemulsification of cataracts (PEC) was performed on both eyes with implantation of: OD — a toric intraocular lens (tIOL); OS — a monofocal aspheric IOL. Results. After 12 years (OD) and 10 years (OS) of follow-up after multi-stage surgical treatment, the graft is transparent, the IOL is in the correct position; on OS, the intrastromal ring is in the correct position, adapted in the stroma. VA was OD = 0.9 n/c; OS = 1.0, while the amount of astigmatism according to keratopography on OS was -0.9D, on OD -3.2D.
Conclusion. This clinical case demonstrates remote clinical and functional results, where over a follow-up period of more than 10 years, there is no intrastromal ring dislocation and no graft reaction, stable IOL position, and minimal astigmatism. Carrying out SKP with one-stage implantation of an open ring into the graft is a safe and effective method of treating patients with CC.

Purpose: to evaluate the anatomical and clinical results of using femtosecond laser for cutting out an intrastromal pocket in a vascular leucoma during the first stage of keratoprosthesis.
Patients and methods. This article is a retrospective analysis of 3 patients who underwent the first stage of keratoprosthesis the implantation of a keratoprosthesis supporting plate into an intrastromal pocket formed using femtosecond laser in the thickness of a vascular leucoma. After applanation of the laser handle to the patient’s cornea and previously known data on the thickness of the cornea, the intrastromal pocket was positioned at a depth of 2/3 of the vascular leucoma, then the femtosecond laser was activated and the intrastromal pocket was formed. After the laser work was completed, the intrastromal pocket was revised and the supporting plate was implanted.
Results. When biomicroscopy and optical coherence tomography data measured the thickness of the cornea in the area above and below the supporting plate of the keratoprosthesis in the long-term postoperative period at a period of 6 months, in all three cases, we observe the stable position of keratoprosthesis supporting plate without any signs of protrusion and displacement. This fact made it possible to successfully perform the second stage of keratoprosthesis — installation of an optical cylinder.
Conclusions. The use of a femtosecond laser at the first stage of keratoprosthesis is a possible, safe and faster method in keratoprosthetics of vascular leucoma in patients whom optical corneal transplantation or limbal stem cell transplantation are not indicated. This technology makes it possible to form an intrastromal pocket uniformly in the thickness of the vascular leucoma of the patient’s cornea without the need for transplantation of the keratoprosthetic complex, reducing the risks of protrusion of the keratoprosthetic supporting plate in the long-term postoperative period, which ultimately allows achieving a high functional result. In addition, the use of a femtosecond laser at the first stage of keratoprosthesis reduces the overall operation time and makes this technology available for widespread use in the clinic.

The article describes a clinical case of a patient who underwent LASIK surgery to correct hyperopia in both eyes. In the early postoperative period, episodes of increased intraocular pressure up to 27 mm Hg were noted, which were relieved with medication. In the late postoperative period, severe corneal syndrome and decreased visual acuity appeared. After a thorough inspection on OU a diagnosis was put forward: Ocular hypertension. Condition after keratorefractive surgery (LASIK), primary Fuchs’ endothelial corneal dystrophy, mild hyperopia, early cataract, OS fluid accumulation under corneal flap, mild amblyopia. The decision was made to transplant the endothelium with Descemet’s membrane to the OS. The operation went as usual, the donor Descemet’s membrane was fully flattened, but it did not result in a reduction of corneal stromal edema and disappearance of the intracorneal gap filled with fluid. The patient was administered additional hypotensive therapy after which positive dynamics of stromal edema were observed. Later, the patient underwent cataract phacoemulsification under the control of intraoperative optical coherence tomography. The article presents the analysis of this clinical case, discusses the choice of treatment tactics and specifies the diagnosis as a manifestation of Chandler’s iridocorneal endothelial syndrome after keratorefractive surgery.

Senile scleral plaque (SSP) is a degenerative disease of the sclera, characterized by the appearance of gray spots with well-defined borders located anterior to the horizontal rectus muscles. Hyaline degeneration of the sclera was first described by J.H. Parsons in 1904. Currently, it is believed that the primary cause of SSP formation is collagen degradation, reduced elastin content, and the deposition of calcium and lipids. This condition closely resembles sclerochoroidal calcification (SCC); however, SSP is localized in the anterior eye segment and is associated with the risk of complications that could threaten visual function or lead to eye loss. SSP appears as a gray spot with distinct irregular borders located anterior to the horizontal rectus muscles. On optical coherence tomography (OCT), it presents as an intrascleral cavity with hyporeflective contents and clear borders defined by unaltered scleral fibers. This article describes a clinical case of bilateral symmetrical eye involvement. During ultrasound biomicroscopy of the anterior segment in the area of interest, a localized scleral defect was visualized, above which a hyperechoic linear thickening of the coats was detected.