Modern methods of corneal visualization (Placido disk keratotopographs, Schimpflug tomographs) play a key role in the diagnosis of various pathological conditions of the cornea, as well as in the planning of surgical interventions. However, despite the accuracy of these devices, there are potential risks of high measurement error associated with destabilization of the precorneal tear film and the presence of signs of dry eye syndrome. Analysis of literature sources revealed a high degree of study of this problem from the position of keratorefractive and cataract surgery. Studies show that tear film instability leads to significant variability of keratometry parameters, increased aberration indices, increased light scattering and appearance of artifacts on topographic maps. In case of dry eye syndrome detection, symptomatic treatment allows to minimize instrument measurement errors and increase functional results of the planned surgical intervention.

Of particular interest is the impact of dry eye syndrome on the diagnosis and monitoring of keratoconus, as the two conditions often co-occur. Despite the existence of only a single publication, there are reasons to assume that the combination of signs of dry eye syndrome and SP destabilization in KC may have a significant impact on the results of these diagnostic methods and their interpretation.

Introduction. This review article is devoted to the study of the current state of gene therapy using adeno-associated viruses (AAV) in the treatment of ophthalmic diseases.

Objective: The purpose: to evaluate the effectiveness and safety of using gene therapy in the treatment of hereditary and acquired eye diseases, as well as to discuss the latest achievements in this field. Materials and methods. A systematic review of scientific literature from the databases MEDLINE, PubMed, Cyberleninka, Mendeley, Web of Science and EMBASE was conducted. Key terms and their combinations were used for the search: “gene therapy”, “adeno-associated virus”, “ophthalmology”, “hereditary eye diseases”, “age-related macular degeneration”, “glaucoma”, “clinical trials”. The review includes clinical studies, expert articles, and meta-analyses focusing on the use of AAV in the treatment of ocular pathologies.

Results. Research shows that gene therapy using AAV represents a promising direction in the treatment of eye diseases due to the immune isolation of the eye and the effectiveness of vector systems. However, AAV-induced immune responses remain a challenge and require the development of specific strategies to suppress them. The importance of developing less immunogenic capsids and new vector delivery methods to improve the safety and effectiveness of therapy is emphasized.

Conclusion. Gene therapy using AAV opens up new possibilities for the treatment of hereditary and acquired eye diseases. Despite the existing problems associated with immune responses, modern advances in the development of vectors and methods of delivering genetic material portend high prospects for safer and more effective therapeutic approaches.

This literature review is devoted to one of the most challenging problems of ophthalmology — neuroprotective and neuroregenerative treatment of glaucoma and consists of two parts. The second part of the review deals with the role of glia, inflammation and autoimmunization in the pathogenesis of neuroretinal degeneration in glaucoma optic neuropathy (GON), new treatment strategies based on modern achievements of gene and immunotherapy. Special attention is paid to promising therapeutic approaches based on artificial intelligence application, usage of peptide bioregulators, immunomodulators and mixed-action drugs. Alternative methods of axonal regeneration, including gene therapy and stem cell therapy, are discussed.

A review of the literature describes various approaches to peeling the internal limiting membrane of the retina in the surgical treatment of penetrating macular holes. Particular attention is paid to the technology of the inverted internal limiting membrane flap for blocking the macular hole. Various modifications of this technology proposed by the authors over the years are shown: with preservation of the intact internal limiting membrane along the edge of penetrating macular holes, a single-layer flap of the internal limiting membrane, a temporal flap of the internal limiting membrane, with preservation of the intact papillomacular bundle, using “active drying” of the internal limiting membrane flap membranes, the formation of an upper inverted flap of the internal limiting membrane, the formation of a flap of the internal limiting membrane on a “pedicle”, etc. Methods for combining the technology of an inverted internal limiting membrane flap with the use of autologous blood components in the surgery of through macular holes are also described, variants of surgical tactics are considered in cases of non-closure of penetrating macular holes after primary surgery with the formation of an inverted flap of the internal limiting membrane, the use of fragments of various eye structures for blocking is described penetrating macular holes. The ongoing search for new solutions in the surgery of penetrating macular holes indicates the relevance of this problem. Despite the many described surgical techniques, there is no single approach to the surgical treatment of penetrating macular holes of the retina; each of the existing techniques has both advantages and disadvantages. Further study of the identified problem is necessary; systematization of available data and large-scale randomized clinical trials are required, aimed at choosing a method of surgical treatment of penetrating macular holes with the maximum anatomical and functional prognosis.

Objective: To evaluate the results of a differentiated approach in surgical treatment of patients with retroprosthetic membrane (RPM) after keratoprosthesis implantation.

Patients and methods. The study enrolled 26 patients (26 eyes) aged from 32 to 64 years with retroprosthetic membrane after keratoprosthesis implantation. All patients underwent surgical treatment, including keratoprosthesis implantation and surgical removal of the retroprosthetic membrane during different treatment periods. The stage and extent of surgery were determined individually, according to the initial patient’s clinical and functional data, retroprosthetic membrane thickness and previous optical reconstructive operations.

Results. All patients had good clinical and functional results. Best corrected visual acuity in the first group was 0.35 ± 0.13, in the second group 0.20 ± 0,15, in the third group 0,15 ± 0,05.

Conclusion. Retroprosthetic membrane removal in patients with keratoprosthesis is a complex task with the risk of intra- and postoperative complications at all stages of the treatment. If retroprosthetic membrane is diagnosed in the long-term period after the second stage of keratoprosthesis implantation, ND:YAG-laser discision is preffered; if this technique can not be done or in case of recurrence, surgical excision of the retroprosthetic membrane through the optical cylinder aperture should be performed, but no more than two times. In case of high density of RPM, or RPM combined with severe form of capsular bag fibrosis, or RPM recurrence, microinvasive three-port pars plana vitrectomy with removal of RPM using a vitreotome is recommended.

It is not easy to assess surgery results, especially, when there are no quantitative criteria, at first sight. Results of the surgical interventions for paralytic lagophthalmos are especially difficult to assess, as the anatomic result of the surgery (position of the eyelids) influences on vision and patient’s appearance with an impact on their life quality. Purpose: to develop a complex approach to assess results of surgery for paralytic lagophthalmos. The proposed complex approach includes objective and subjective components. The objective component describes main functions of vision and dynamics of eyelids position with coefficient of symmetry and coefficient of surgical efficacy. The subjective component covers dynamics of ocular discomfort, patient significant eyelids and palpebral fissure deformity, and quantity of artificial tears dropping. The proposed approach can be used to assess results of surgery, including for comparison of the different surgeries, for paralytic lagophthalmos as well as for other ocular pathology with eyelids malposition and palpebral fissure deformity.

The purpose: to evaluate the results of applying the method to determine indications for surgery of initial cataracts with high visual acuity based on a correlation analysis of the relationship between higher order aberrations and subjective quality of vision.

Patients and methods. 243 patients (243 eyes) were examined at the JSC “Ekaterinburg Center of the Scientific and Technical Complex “Microsurgery of the Eye”. Patients were divided into groups by the type of cataract: patients with cortical cataract — 79 eyes, with nuclear cataract — 89 eyes, with posterior subcapsular cataract — 75 eyes. The age in the group ranged from 42 to 85 years, 103 men (42 %), 140 women (48 %). Determination of wavefront aberrations was performed on an aberrometer operating on the principle of ray tracing. Internal aberrations were assessed with drug-induced mydriasis, pupil diameter of 5 mm. The degree of visual impairment in patients with initial cataract and high visual acuity was determined based on objective and subjective assessment.

Results. The correlation between the values  of higher order internal aberrations (coma, trefoil, spherical aberration) and the data of the developed questionnaire was determined.

Conclusions. Different types of initial lens opacities can create a unique set of aberrations and change the quality of vision. These changes can be assessed using modern imaging techniques and questionnaires, which helps in diagnosis and decision-making on surgical treatmentю

Purpose. To conduct a prospective comparative study of the early results of mixed astigmatism’s correction by the Femto-LASIK method using the excimer laser Schwind Amaris 1050RS depending on the degree of astigmatism Patients and methods. This singlecenter, prospective study included 281 patients with mixed astigmatism, mean age 28.96 ± 7.92 years. Group I consisted of patients with astigmatism ≤3.0D; Group II — > 3.0D on the principle of one patient — one eye. All patients underwent laser correction with the Femto-LASIK method. 
Results. Three months after Femto-LASIK, the average uncorrected visual acuity (UCVA) in patients of the first study group was comparable with the preoperative value of best corrected visual acuity (BCVA) — 0.93 ± 0.11 and 0.91 ± 0.13, respectively (p = 0.5). In group II, it was equal to 0.73 ± 0.20 and statistically significantly (p = 0.01) exceeded the preoperative level of 0.68 ± 0.18. The efficiency ratio was 88.1% and 84.3% in groups I and II respectively. A decrease in BCVA by 0.2 was noted in 0.8% (1 eye) in group I and in 3.3% of cases (5 eyes) in group II, the safety ratio in group I was 99.2%, in group II — 96.7%. The spherical equivalent within ±0.50D was achieved in 89 eyes (70.1%) in group I and 79 eyes (51.3%) in group II, ±1.0D in 98.4% of cases (125 eyes) and 96.7% (149 eyes) in groups I and II respectively. The integral index of the CI value in the vector analysis according to Alpins N. in group I was 0.89 ± 0.10, in group II — 0.94 ± 0.05. After correction, patients of the studied groups showed an increase in HOA RMS and spherical aberration, as well as a significant decrease in the RMS value of astigmatism, all data were statistically significant (p < 0.05). In the second group, negative dynamics in the coma level were also noted (p < 0.05). 
Conclusion. The conducted prospective comparative study of early results of mixed astigmatism correction by Femto-LASIK using the Schwind Amaris 1050RS with cyclotorsion control, high pulse repetition rate and optimized aspheric ablation profile confirmed the safety, effectiveness and predictability of correction of this type of astigmatism regardless of its degree.

Purpose: to evaluate and compare the effectiveness of suture and combined methods of amniotic membrane fixation in surgical treatment of corneal persistent epithelial defects. Materials and methods: 50 patients (54 eyes) were included in the research. Etiology of corneal persistent epithelial defects: corneal traumas and burns, high-risk keratoplasty, repeated vitreoretinal interventions with corneal de-epithelization. Two groups were formed: the main group (combined method of amnioplasty with sutures and two-component autofibrin glue) and the control group (suture amnioplasty). In the course we studied: the area of corneal erosion before and after surgery, duration of surgery, amnion lysis time, OCT-characteristics of amnion position on the ocular surface, qualitative and temporal characteristics of surgery according to the survey among the surgeons.

Results. In the preoperative period, the average area of the epithelial defect in the main group was 27.5 (19.3; 32.8) mm², in the control group — 32.6 (20.5; 36.5) mm². The average operation time in the main group was 19 (17; 21) min and in the control group was 30 (25; 35) min. The average period of amnion lysis in the main group — 10 (9; 12) days, in the control group — 7 (7; 9) days. The size of the erosion area in the main group at the end of treatment was 4.3 (2.4; 5.3) mm², in the control group — 9.7 (7.5; 12.8) mm². Deformation of the amnion profile according to OCT data was observed in the control group — 40 % of cases. Detachment of the amniotic membrane from the cornea in the main group was in 15.3 % of cases, in the control group — in 53.3 %.

Conclusion. The combined method of amnion fixation to the ocular surface in the treatment of corneal persistent epithelial defects developed by us is proved to be significantly more effective and reliable. 

Purpose: To develop a method for simultaneous vitrectomy (VE) and cataract phacoemulsification (PEC) in surgical treatment of rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR).

Materials and methods. We observed 113 patients (113 eyes) aged 34 to 77 years (mean age 56.4 ± 1.9 years). Inclusion criteria for the study: total RRD complicated by stage B-C PVR, presence of a native lens, no history of previous surgical interventions for RRD. Surgical intervention was performed using the Alcon Constellation Vision System ophthalmologic surgical system, USA, and the Leica Proveo 8 microscope, Switzerland. The ophthalmologic status was assessed using standard methods based on ultrasound (Quantel medical compact touch, France), photo registration of the fundus condition and OCT of the macular area (on the Topcon 3D OCT-1 Maestro tomograph, Japan). A phacovitrectomy (PVE) technique was developed, illustrated by the techniques of the main stages of the operation.

Results and discussion. The obtained results of examining patients during the observation period of up to 6 months from the moment of silicone oil removal indicate that the use of the developed technique ensures complete anatomical attachment of the retina in 92 % of cases (104 patients). The main advantages of the developed technique are explained by the fact that removal of the lens before performing PVE improves visualization of the posterior pole, as well as the peripheral part of the retina, providing good access to the base of the vitreous body. Intraoperative cataract complications, such as rupture of the posterior capsule, do not cause concern, since the vitreoretinal surgeon has the ability to immediately solve such problems. When VE and cataract surgery are performed separately, the patient is sedated or anesthetized at least twice, and possibly three times if silicone oil removal is performed separately, which generally increases the anesthesia-related risks and overall treatment costs (hospitalization, visits, medications).

Conclusion. To date, there is no clear indication in the literature whether VE should be performed primarily without lens surgery or whether combined FVE may be a better strategy. The authors of this paper believe (based on the proposed surgical technique) that FVE is appropriate for RRD complicated by PVR.

Despite the widespread belief that blepharoplasty is a non-traumatic cosmetic intervention, clinical observations and analysis of scientific literature data indicate that the above-mentioned operation can cause a number of serious side effects, which, among other things, may be associated with impaired blood circulation in the eyelids and periorbital zone.

Patients and methods. There were 148 patients (296 eyes) in the study. All patients included underwent color Doppler mapping (CDM) of the right and left eyes to assess geomdignamic indicators in the lacrimal artery bed, the results were averaged and included in the protocol. CDM was performed using the transpalpebral method. All patients included in the study were divided into groups depending on the presence or absence of blepharoplasty in the anamnesis, as well as the time after blepharoplasty: 115 patients — the main group, which was divided into subgroups: 32 patients 1 month after blepharoplasty, 27 patients 3 months after blepharoplasty, 31 patients 6 months after blepharoplasty, 25 patients more than 12 months after blepharoplasty; 33 patients without blepharoplasty — the control group.

Results and conclusion. The study allowed us to establish that during the observation periods of patients after blepharoplasty of 1–3 months, there is a reliable increase in the systolic blood flow velocity — Vs according to color Doppler mapping, compared to patients who did not undergo this surgical intervention, which may be associated with the formation of scar tissue and the presence of a postoperative inflammatory process. Stabilization of the Vs index was determined at a 6-month observation period. In the group of patients aged 12 months or more, a reliable decrease in systolic blood flow velocity to a level that corresponds to similar indicators in the age group over 60 years without blepharoplasty is noted. The obtained data should be taken into account when preparing patients for planned ophthalmic surgery, which can be recommended for patients with a history of blepharoplasty no earlier than 6 months later, at the stage of stabilization of hemodynamic parameters. This will reduce the risk of complications in the postoperative period associated with changes in hemodynamic parameters of the eyelids, as well as carry out preventive treatment of dry eye syndrome in patients with a history of blepharoplasty, since trophism, including the meibomian glands, is impaired as a result of blepharoplasty

Aim: to formulate an algorithm for choosing surgical treatment for inferior recurrence of retinal detachments (RD) in eyes under silicone tamponade depending on the stage of APVR.

Materials and methods. This study included the results of surgical treatment of 114 patients with inferior recurrence of RD under silicone tamponade of the vitreous cavity with APVR. Patients were divided into three groups depending on the stage of APVR and into six subgroups depending on the tactics of surgical treatment. The main criteria are achieving anatomical success rate and improving visual outcomes were compared postoperatively.

Results. An algorithm for choosing surgical treatment for inferior recurrences of RD under silicone tamponade has been formulated depending on the stage of PPVR: at the initial stage of PPVR — performing only scleral buckling (SB); at an advanced stage of PPVR — performing vitreoretinal surgery in combination with SB; at an advanced stage of PPVR — performing vitreoretinal surgery in combination with retinotomy and short-term postoperative tamponade of the perfluorocarbon liquids.

Conclusion. The created algorithm for choosing surgical intervention for inferior recurrences of RRD complicated by PPVR, under silicon oil tamponade depending on the stage of PPVR, allows to improve the anatomical and functional results of treatment.

Aim of the study: to study the informativeness of new modes of standardized A-echography in the diagnosis of retinal detachment, vitreous adhesions, and retinoschisis.

Patients and methods. The study included 180 patients (180 eyes) with vitreoretinal pathology aged 40 to 78 years (mean age 62 ± 6.2 years): 70 patients (70 eyes) with local retinal detachment (RD), 70 patients (70 eyes) with vitreous adhesions, and 40 patients (40 eyes) with retinoschisis (RS). All patients underwent a comprehensive ultrasound examination, including B-echography and standardized A-echography in the modes of quantitative evaluation of echo signals Retina I (evaluation of the number of echo signal microoscillations) and Retina QII (evaluation of the difference in reflectivity (DR) in comparison with the sclera).

Results. According to B-echography, RD was diagnosed in 66 patients (94.29 %), vitreous adhesions — in 63 cases (90 %), retinoschisis — in 36 patients (90 %), in 15 patients (25 %) the assessment of the detected pathological intraocular abnormalities was complicated due to the similarity of the echographic image. According to standardized A-echography, RD was recorded in 65 cases (92.86 %). The results of the echo signal microoscillations assessment in the Retina A1 mode corresponded to “R++” and “R+++”, the DR in the Retina QII mode corresponded to 10.56 ± 3.18 dB. Vitreous adhesions were recorded in 63 cases (90 %). In the Retina A1 mode, the indicators corresponded to “M++” and “M+++”, the DR was 25.45 ± 5.56 dB (Retina QII mode). In patients with RD in the Retina A1 mode, the values  corresponded to “R++” and “R+++” in 32 patients (80 %) and “M++” in 8 patients (20 %), the DR in the Retina QII mode was 21.44 ± 6.78 dB. When comparing the DR values  (Retina QII mode) in the groups with RD and vitreous adhesions, the difference was statistically significant (p < 0.01). The difference in the DR values  in the RD group was significant when compared with patients with vitreous adhesions (p < 0.05) and insignificant when compared with patients with RD (p > 0.05).

Conclusion. New modes of standardized A-echography in combination with traditional B-echography makes it possible to significantly increase the informative value of ultrasound diagnostics of RD, vitreous adhesions and retinoschisis.

Objective: tо evaluate characteristic OCT biomarkers of onset and recurrent uveitic and radiation-induced macular edema (ME) and determine their significance in assessing best corrected visual acuity (BCVA).

Patients and methods. 48 patients (56 eyes) with radiation-induced (24 eyes) and uveitic (32 eyes) ME were enrolled in the study. All patients underwent OCT on Optovue RTVue XR Avanti. The following biomarkers were assessed to evaluate OCT morphostructural characteristics: foveal eversion, subretinal detachment, hyperreflective foci, ellipsoid zone disruption, disorganization of retinal inner layers (DRIL), and epiretinal membrane. Central retinal thickness was measured to analyze OCT morphometric characteristics.

Results. There was no statistically significant difference in OCT biomarkers between uveitic and radiation-induced ME except for epiretinal membrane — this OCT biomarker was more common in radiation ME (p = 0.041). The presence of hyperreflective foci, ellipsoid zone disruption and DRIL in radiation-induced and uveitic ME were associated with lower BCVA (p < 0.001). The presence of subretinal detachment was characteristic for the onset ME (p = 0.002), while recurrent ME associated with a greater central retinal thickness, ellipsoid zone disruption (p = 0.029) and DRIL (p = 0.036).

Conclusion. Radiation-induced and uveitic ME do not differ significantly in their OCT morphostructural characteristics and central retinal thickness. The recurrent course of radiation-induced and uveitic ME is characterized by the presence of ellipsoid zone disruption and DRIL, as well as greater central retinal thickness. Ellipsoid zone disruption, DRIL, and hyperreflective foci associated with lower BCVA in patients with uveitic and radiation-induced ME.

Juvenile open-angle glaucoma (JOAG) is a genetically determined disease of young age, which is diagnosed before the 40, which is based on anomalies in the structure of the drainage system of the eye.

Objective: to identify the features of morphometric and biomechanical parameters of the fibrous capsule in patients with JOAG.

Materials and methods. 19 eyes of 10 patients with JOAG were examined. In all cases, glaucoma was compensated, the initial stage was observed in 42 %, developed — in 31.5 %, advanced — in 21 %, terminal — in 5.5 % of cases. The control group consisted of 18 healthy eyes. IOP was studied taking into account the biomechanical properties of the fibrous capsule of the eye bIOP, DA Ratio, Integr. Radius (IR), SP-A1, SSI. Statistical processing of the obtained results was carried out using the standard statistical analysis software package “SPSS 16.0 for Windows”. The given parameters with normal distribution were presented in the format M ± m, where M is the mean value, m is the standard error of the mean.

Results. JOAG patients were younger than the control group — 30.1 ± 1.5 and 37.0 ± 1.9 years, p = 0.007, there were 58 % men versus 42 % women. In JOAG, there was a greater axial length of the eye — 25.81 ± 0.34 and 23.29 ± 0.13 mm, p = 0.000. When comparing the level of IOP, no differences were found between JOAG and healthy eyes. The DA ratio and IR parameters did not differ between JOAG and healthy eyes, SP-A1 was higher in JOAG compared to a healthy eye, but this difference was not reliable p = 0.384. When comparing BGF between the groups, despite the higher values i n JOAG — 16.68 ± 5.7 versus 7.44 ± 1.31 in the healthy eye, the difference is not significant, p = 0.131, but the dispersions for this indicator are not equal, p = 0.003. And only SSI was significantly lower in JOAG compared to the healthy eye — 0.93 ± 0.05 and 1.21 ± 0.05, p = 0.000, which is determined by the differences in the axial length (correlation between axial length and SSI r = -0.622, p = 0.004).

Conclusions/ Patients with JOAG differ from healthy eyes in increased axial length of the eye, in biomechanical indicators the difference was revealed only in SSI, which correlates with the axial length.

Normal tension glaucoma (NTG) is one of the difficult-to-diagnose clinical forms of primary open-angle glaucoma (POAG). One of the important links in the pathogenesis of this pathology is a violation of the blood supply to the optic nerve and retina.

Purpose. Comparitive study using optical coherence tomography with angiography (OCTA), indicators of vessel density of the optic nerve head (ONH) in patients with newly diagnosed NTG and hypertensive form of POAG. The material was based on the data of 65 patients (65 eyes) with newly diagnosed NTG, 88 patients (88 eyes) with a hypertensive form of POAG and 50 healthy people without glaucoma (50 eyes) aged 45 to 65 years at the Eye Microsurgery Department in Hospital 8 (Ufa). All subjects underwent an ophthalmological examination, including OCTA of the optic nerve head with measurement of vessel density using the Angio Disc 4.5×4.5 mm protocol on the Optovue XR Avanti device with the AngioVue function (Optovue, USA). According to the results of the study, in patients with the initial stage of NTG, a decrease in the vessel density of the ONH was revealed in comparison with healthy individuals. In the advanced stage NTG the vessel density of the peripapillary region was reduced in all sectors of the ONH and correlated with the thickness of the RNFL in the upper sector (r = 0.404, p < 0.05). In patients with POAG, compared with NTG, more pronounced changes in the microcirculation of the ONH were observed in both stages of the disease. The vessel density of the peripapillary region correlated with the thickness of the retina in the upper sector at the early stage (r = 0.324, p < 0.05), in the lower sector — in stages I and II of the disease (r = 0.322, p < 0.05 and r = 0.316, p < 0.05, respectively).

Conclusion. The OCTA of the ONH makes possible to detect microcirculatory changes at an early stage of the disease in patients with the hypertensive form of primary open-angle glaucoma and in patients with normal tension glaucoma.

Purpose. To compare the iridotrabecular contact (ITC) parameters in patients with primary angle closure disease (PACD) and primary open angle glaucoma (POAG) based on SS-OCT data, and examine their relationship with other clinical and anatomical parameters.

Patients and methods. The retrospective study analyzed the data of 89 patients aged 32 to 89 years: 43 patients with PACD, 25 with POAG, and 21 controls. All participants underwent optical coherence tomography of the anterior segment of the eye using the SS-OСT “CASIA2” (Tomey Corporation, Nayoga, Japan), including assessment of the ITC Index and ITC Area.

Results. ITC parameters in PACD were significantly higher than in POAG and controls. ITC Index = 45.40 ± 21.80 % and ITC Area = 5.81 ± 3.90 mm² in the POAG group versus 0.01 ± 0.03 % and 0.1 ± 0.37 mm² in POAG, respectively, and versus 0.05 ± 0.11 % and 0.56 ± 1.17 mm² in the control, respectively, all p = 0.00. The values of ITC Index, as well as ITC Area in POAG and control were comparable, p = 0.21 and p = 0.25, respectively. A relationship was found between ITC Index and ITC Area in case of PACD with the depth of the anterior chamber (r = –0.42, p = 0.01 and r = –0.43, p = 0.00, respectively), the lens vault (r = 0.35, p = 0.02 and r = 0.36, p = 0.02, respectively), its thickness (r = 0.47, p = 0.01 and r = 0.44, p = 0.01, respectively) and the number of antihypertensive drugs (r = 0.63, p = 0.01 and r = 0.68, p = 0.01, respectively). No correlations were found in the POAG and control groups.

Conclusion. The high values of the parameters of the ITС and their correlation with other clinical and anatomical parameters in PACD compared with those in POAG indicate the role of the topography of the anterior segment of the eye in the formation of the leading mechanisms for the anterior angle closure.

The aim of the study was to evaluate the effectiveness and safety of primary trabeculectomy in comparison with drug therapy in patients with advanced open-angle glaucoma in order to determine the optimal approach to reducing intraocular pressure and maintaining the quality of life of patients.

Materials and methods. A randomized controlled trial was conducted involving 143 adult patients aged 60–85 years who were recently diagnosed with progressive open-angle glaucoma. The patients were divided into two groups: 75 people received trabeculectomy, 68 people received medical treatment. The main outcome is the quality of life after 12 months, assessed using the VFQ-25 questionnaire. Intraocular pressure, visual acuity, and average deviation of the visual fields were considered as secondary outcomes.

Results. At the end of 24 months, there were no significant differences in quality of life (VFQ-25) between the groups (p = 0.38). Trabeculectomy provided a more significant reduction in intraocular pressure at all stages of the study, reducing the need for topical medications. Complications were successfully resolved in both groups, and the frequency of serious side effects was comparable.

Conclusion. Primary trabeculectomy is an effective strategy for reducing intraocular pressure in patients with glaucoma, while maintaining quality of life at a level comparable to drug treatment. Despite the lower need for medications after the procedure, the risk of complications requires attention, emphasizing the need for an individual approach to treatment. Future research should focus on improving treatment methods to improve long-term therapy outcomes.

With aging, the prevalence of eye diseases such as primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD) increases, making them leading causes of vision loss in older adults. Recent studies suggest that a decrease in macular pigment optical density (MPOD), composed of lutein, zeaxanthin, and meso-zeaxanthin, may be associated with an increased risk of POAG. These carotenoids play a crucial role in protecting photoreceptors from oxidative stress, regulating light filtration, and providing neuroprotection. Studies have shown that patients with POAG exhibit lower MPOD levels, which may serve as an early biomarker of glaucomatous neurodegeneration. Moreover, supplementation with macular carotenoids has been found to increase MPOD, potentially improving visual function. Additionally, B vitamins and niacin offer further protection by supporting mitochondrial health and reducing oxidative stress in retinal ganglion cells. Thus, investigating MPOD as a modifiable risk factor for POAG presents new opportunities for disease diagnosis and management. Further research is needed to determine optimal nutraceutical strategies and to evaluate the impact of MPOD on glaucoma progression.

Purpose: tо compare the effectiveness of standard automated perimetry (SAP) and two non-standard perimetry methods in the diagnosis of the early stage primary open-angle glaucoma (POAG).

Patients and methods. The study involved 18 patients (32 eyes) with the early POAG, 10 women, 8 men (average age of 56.2 ± 1.4 years). The control group included 32 healthy people (32 eyes), (average age of 56.4 ± 3.9 years). In addition to the routine ophthalmic examination all subjects underwent SAP (Octopus 900, threshold strategy “G TOP”) and two methods of non-standard perimetry — the author’s own modification of Frequency Doubling Technology (FDT) Perimetry (threshold strategies “FDT-16” and “FDT-64”) and Pulsar perimetry (Octopus 600). Morphometric assessment of the optic nerve head was performed using stereoophthalmoscopy and retinotomography (Heidelberg Retina Tomograph 3 and RTVue FD-OCT). Optical coherence tomography was also used to assess the parameters of the retinal ganglion cell complex in the macular region.

Results. Evaluating the sensitivity level of these 4 compared strategies (“FDT-16”, “FDT-64”, “Pulsar” Octopus 600 and “G TOP” Octopus 900) in patients with the early stage of POAG by mean MD index (87.1, 93.55, 54.84 and 80.65 % respectively) and by mean number of 10×10° squares with scotomas in the central visual field (90.32, 98.77, 51.61, and 83.87 % respectively) showed that both threshold FDT perimetry strategies were 7 to 15 % higher than the sensitivity of Octopus 900 (“G TOP”) and almost 2 times higher than the sensitivity of Octopus 600 (“Pulsar”). The specificity level of all three threshold strategies (“FDT-16”, “FDT-64” and “Pulsar”) of both non-standard perimetry methods was 100 %, and specificity level of SAP was 96.77 %. The correlation between the values of the MD index and the number of squares with scotomas in the central visual field according to the SAP data and all three threshold strategies data of the two non-standard perimetry methods was moderate and statistically significant.

Conclusion. For diagnosis of early POAG a combination of standard and non-standard computer perimetry methods is advisable. Both FDT perimetry strategies had a significant advantage in the sensitivity level of their results compared to Pulsar perimetry data.

Objective. To study the condition of the optic nerve head and the retinal ganglion cell complex (macula) using optical coherence tomography in patients in the post-COVID period.

Patients and methods. A total of 30 people (60 eyes) aged 61.7 ± 14.2 years on average were examined. All subjects had a history of a new coronavirus infection (COVID-19). The duration of the disease ranged from 1.5 to 48 (26.9 ± 12.7 on average) months. The parameters of the optic nerve head and macula were assessed using the Optopol SOCT Copernicus REVO NX device (Poland).

Results. Using OCT, the area of the optic nerve head, the area of the retinal ganglion cell complex, and the area of the optic nerve head excavation were significantly higher in patients in the post-COVID period compared to normal values (p < 0.05). The excavation volume of the optic disc of the left eye in patients in the post-COVID period was significantly lower than the norm (0.08 ± 0.07 and 0.15 ± 0.07, p = 0.003, respectively). The thickness of the peripapillary retinal nerve fiber layer in the upper quadrant of the right eye significantly exceeded normal values and amounted to 130.6 ± 17.7 (p = 0.03). Qualitative analysis of the state of the ganglion cell layer and the inner plexiform layer of the retina of the macula in individuals who had acute coronavirus infection showed that single areas of thinning were detected in 17 (28.3 %) of the 60 eyes examined, multiple — in 33 (55%).

Conclusion. Of particular interest is the study using optical coherence tomography of the state of the optic nerve head, nerve fiber layer, and retinal ganglion cell complex of the macular zone in a significant number of patients who have had COVID-19. The obtained changes in the morphometric parameters of the fundus may indirectly indicate the neurotropic effect of the COVID-19 virus on the fundus structures, and requires examination of patients after infection to develop a rehabilitation system.

This work describes the results of a multimodal examination of patients with rhegmatogenous peripheral vitreoretinal degenerations. Objective: to conduct a multimodal study of rhegmatogenous peripheral vitreoretinal degenerations and present an informative retinal map of peripheral retinal degenerations and breaks. Methods. Multimodal diagnostics included traditional and additional methods: the ultra-widefield fundus imaging with the Clarus 500 or VISUCAM 500 (Carl Zeiss Meditech Inc., Dublin, USA) and wide-field OCT scanning of the retina periphery with SOLIX and RTVue XR Avanti (Optovue Inc. USA). Results. During the period of 2014–2024, 614 patients (959 eyes) were examined and 1304 peripheral degenerations and retinal breaks were identified with the multimodal examination. Regmatogenic (vitreoretinal) degenerations were found in 437 patients: lattice degeneration — 197 (15.1 %), “snail track” — 95 (7.29 %); vitreoretinal tufts — 145 (11.12 %). Based on the study results, an informative map of the main peripheral retinal degenerations has been developed. Conclusion. In this article (part 3) the multimodal study of peripheral dystrophies allowed us to present the retinal map of regmatogenic peripheral degenerations and retinal breaks for the purpose of timely detection and adequate treatment.

Penetrating corneal transplantation or Penetrating keratoplasty (PKP) with native donor material is the method of choosing surgical treatment of purulent corneal ulcers with the threat of perforation or perforation, vascularized leucomas in the outcome of keratitis and keratouveitis, in these situations it is considered a high-risk keratoplasty for the development of graft disease. The pathological role of chronic inflammatory diseases of the nasopharynx and oral cavity as the cause of the formation of inflammatory pathology of the cornea, leading to corneal blindness, is little discussed at present. The publication describes a clinical case of successful phased bilateral UPC in a patient with bilateral vascularized corneal whiteheads in the outcome of recurrent keratouveitis, performed after complete rehabilitation of foci of infection in the oropharynx.

Conjunctivitis and blepharoconjunctivitis are common pathologies in the structure of inflammatory eye diseases. The article describes the experience of treating inflammation of the eyelids and conjunctiva of infectious and allergic etiology in an outpatient setting. Under the supervision of ophthalmologists, there were 64 patients with the above diagnoses, the treatment regimen of which included modern topical drugs, depending on the etiology and severity of inflammation. In accordance with the clinical recommendations developed by the Russian Association of Ophthalmologists, the following groups of drugs are recommended for use: antibacterial, antiseptic, antihistamines, glucocorticosteroids, non-steroidal anti-inflammatory. In the treatment of infectious blepharoconjunctivitis, a combined drug containing an antibacterial drug (tobramycin) and a corticosteroid (dexamethasone) — Rubrodex was successfully used. 0.05% moxifloxacin (Xaflom ®) eye drops have shown high efficacy, safety and good tolerability in the treatment of bacterial conjunctivitis in the context of an observed increase in antibiotic resistance of etiologically significant microflora. In relieving the symptoms of seasonal allergic blepharoconjunctivitis, efficacy and safety were demonstrated by the use of a new generation of dual-mechanism antihistamines epinastin 0.05% (Epinepta ®).

Purpose. Review surgical treatment clinical case of rhegmatogenous retinal detachment (RRD) from the standpoint of the effectiveness of single-stage combined phacovitrectomy (FVE), as a combination of microinvasive vitrectomy and cataract phacoemulsification (PEC). Patient and methods. A clinical case of a patient diagnosed with RRD, proliferative vitreoretinopathy (PVR) stage “C” posterior 1, moderate myopia, peripheral vitreochorioretinopathy is presented. Surgical intervention was performed using the ophthalmological surgical system “Alcon Constellation Vision System” (USA) and the microscope “Leica Proveo 8” (Switzerland). The ophthalmologic status was assessed using standard methods based on ultrasound examination (Quantel medical compact touch, France), photo recording of the fundus and optical coherence tomography of the macular region (on the Topcon 3D OCT-1 Maestro tomograph, Japan).

Results and conclusion. Surgical treatment was performed in the volume of combined FVE 25 Ga with implantation of an intraocular lens and tamponade of the vitreous chamber with “light” silicone oil with a viscosity of 2000 cSt. The results of surgical treatment indicate high efficiency and safety of the FVE technique, which is confirmed by the absence of recurrence of the disease and the need for additional surgical interventions during dynamic observation for up to 6 months. The presented clinical case demonstrates a number of significant advantages of the FVE method, which include, in particular, safe and controlled implementation of PEC, due to the support of the capsular bag by the preserved vitreous body, optimal visualization of the fundus structures and vitreous body peripheral parts, the absence of an additional stage of surgical intervention to remove cataracts associated with rehospitalization and psychoemotional stress directly affecting the patient’s quality of life.

Purpose: A clinical case of carotid cavernous fistula in ophthalmologic practice.

Methods. Patient M., 68 years old, came to the ophthalmologic department with complaints of decreased vision, redness, swelling of the right eye mucosa, and pain in the right parietal region. From the anamnesis morbi it is known that the above-mentioned complaints have been bothering for the last 3 months. She denies traumas. Аnamnesis vitae: Hypertensive disease for about 10 years, regularly takes hypotensive drugs. The polyclinic at the place of residence diagnosed chronic conjunctivitis of the right eye. The prescribed local treatment was followed, without positive effect. Standard ophthalmologic examination was performed; as a follow-up examination, duplex transcranial scanning of arteries and veins, duplex scanning of brachiocephalic arteries with color Doppler mapping of blood flow, MRI of the brain and orbit, CT angiography of cerebral vessels with contrast enhancement were prescribed. The patient was examined by a neurosurgeon and selective cerebral angiography of the brain with intravenous amplification was prescribed. The final diagnosis was made: Spontaneous carotid cavernous fistula on the right side. Endovascular embolization of vessels with occlusion of the indirect CSA of the right NSA basin with non-adhesive liquid composite material based on ethylene-vinyl alcohol copolymer (EVOH) was performed. Regression of ophthalmologic picture was noted in the postoperative period.

Results. Against the background of atherosclerosis of cerebral vessels, hypertension, the right external carotid artery basin (right middle meningeal artery) as well as meningeal branches of both internal carotid arteries with discharge into the right carotid-cavernous sinus and right ophthalmic vein was formed.

Conclusion. In spontaneous carotid cavernous fistula with small fistula size, the clinical picture of the disease may not have classical symptoms, causing difficulties in diagnosis and leading to inappropriate treatment tactics. To detect complex vascular disorders, it is important to use brain MRI in vascular mode as an additional method of investigation. Early diagnosis and targeted treatment are the key to a favorable outcome and successful rehabilitation of the patient.

One of the approaches to improve the adherence of patients with primary open-angle glaucoma (POAG) to IOP-lowering eye drops therapy is the use of fixed-combinations (FC), since this makes it possible to reduce treatment cost during combined therapy, reduce the number of instillations per day, minimize the risk of “missing” instillations and reduce the effect of the eye drops preservative on the ocular surface. Increasing patient compliance may also be associated with the use of generics that have pharmacological and therapeutic equivalence to original drugs at a lower cost. The article presents the clinical cases generic 1.0 % brinzolamide + 0.5 % timolol FC instillations in POAG patients. The 1^st-clinical case demonstrates comparable efficacy and safety of the generic brinzolamide + timolol FC, compared with the original medication, which is confirmed by the data of a number of authors (A.V. Sidorova et al., 2023), and allows us to talk about the possibility of patients transition from the original to the reproduced eye drops to minimize the cost of therapy. The 2^nd-clinical case illustrates the possibility and effectiveness of starting with combined IOP-lowering therapy (based on generic brinzolamide + timolol FC instillation) at the II-stage of POAG with high IOP level, as well as at the III-stage of POAG with an extremely high initial IOP level (brinzolamide + timolol FC and 0.03 % bimatoprost instillations). The 3^rd-clinical case shows that generic timolol + brinzolamide FC can be effectively used during maximum-IOP-lowering therapy in combination with prostaglandin and brimonidine.

The purpose of the study was to evaluate the therapeutic effect of the drug Quinax when administered by the method of three instillations for 6 months to patients with initial age-related cataracts.

Patients and methods. Treatment was given to 80 patients with an average age of 63 ± 2 years suffering from initial age-related cataracts. At the same time, the main group consisted of 40 patients who were injected with Quinax when it was administered by triplicate instillations for 6 months, the comparison group was 40 people who were treated with age-related cataracts using other conservative methods. Each patient underwent an ophthalmological study, which included: visometry, perimetry, refractometry, biomicroscopy, ophthalmoscopy, visual performance study, dark adaptation, and also analyzed the complaints presented in order to establish their impact on the quality of life of patients and disabled people with cataracts.

Results. The results of the study showed the effectiveness of the use of the drug Quinax when administered by the method of three instillations for 6 months and revealed stabilization of visual functions: visual acuity and visual field to white, red and green colors, a decrease in visual fatigue, due to a decrease in glare, stabilization of dark adaptation and refraction.

Conclusion. Assessment of the effectiveness of the use of the drug Quinax when administered by the method of three instillations for 6 months to patients with initial age-related cataracts showed a statistically significant positive therapeutic effect (89 %) in the form of stabilization of visual functions, and a positive ergonomic effect in the form of increased visual performance was noted. No side effects were observed among patients who received Quinax instillations.

Purpose: to determine the variants of the severity of the course of ophthalmic herpes on the extensive retrospective material.

Material and methods. A retrospective cohort multicenter study was conducted from 2010 to 2020 inclusive. Medical outpatient records and case histories of inpatients were studied. 1142 patients with the following diagnoses were included in the retrospective analysis: “herpetic keratitis”, “recurrent corneal erosion”, “herpetic keratoveitis”, “herpetic corneal ulcer”, “herpetic iridocyclitis”, of which 470 (41 %) were men and 672 (59 %) were women. The mean age was 44.1 ± 1.3 years. Subjects analyzed were: clinical form of ophthalmic herpes; record of primary ophthalmic herpes case or relapse, total timing of complaints, doses of systemic therapy with nucleoside analogs; total timing of episode treatment and record of ophthalmic herpes outcomes in completed cases; presence/absence of trigger factors; presence/absence of manifest comorbid diseases/conditions/events. The localization and frequency of extraocular herpes were recorded. The variant of laboratory confirmation of herpetic etiology of ocular inflammation, if present, was noted.

Results. The specific weight of clinical forms of ophthalmic herpes (according to the results of retrospective analysis): epithelial forms — 263 patients, stromal forms — 650, anterior uveitis — 229. In the majority of cases (n = 799; 70 %) patients had a history of recurrent course of keratitis (keratouveitis) by the time of initial examination, whereas first detected ophthalmic herpes was noted in 343 (30 %) cases. Depending on the duration of active complaints the patients were distributed as follows: with complaints from 1 day to 1 month — 113 (10 %), from 2 to 3 months — 517 (45 %), from 3 to 6 months — 272 (24 %), from 6 months and more — 240 (21 %). The mean duration of complaints was 64.5 ± 6.5 days. Epithelial keratitis has the least tendency to form a protracted course: in more than a half of cases (192 patients out of 263) the period of complaints did not exceed 3 months. Among 1142 patients there were 235 completed cases of keratitis and keratouveitis (20.5 %) with remission. The most frequent (422 cases) provoked ophthalmic herpes was different systemic infectious processes. The second place by the frequency of provoking factors is occupied by a group of causes related to corneal damage of different genesis (285 patients). In the third place by frequency are emotional or physiologic stresses. Next in frequency of ophthalmic herpes provocation are problems of the middle zone of the face — 240 cases. Manifest infectious-inflammatory diseases of the nasopharynx and respiratory tract are leading among background conditions (753 patients). The second place among the causes of comorbidity is occupied by cumulative immunosuppression (n = 217). In the third place by the frequency of comorbid pathology are gastrointestinal diseases — 126 patients (11 %). Herpesvirus etiology was investigated by ELISA in 546 (48 %), in the other 52 % — not confirmed by any laboratory method.

Conclusion. As a result of the conducted study, a significant cohort of patients with characteristics of ophthalmic herpes of severe course was identified: deep forms of ocular tissue lesions, prolonged duration of complaints, recurrent forms. These characteristics were accompanied by the use of low (not more than 1.5 g) daily doses of oral nucleoside analogs. Division of patients by severity of ophthalmic herpes course into mild and severe forms may allow to distinguish a cohort of patients requiring deeper diagnostic examination, consultations of related specialists, as well as higher daily doses of systemic antiviral therapy. Given that herpesvirus etiology has not been confirmed or investigated by ELISA, the development of clear diagnostic criteria through the use of molecular biological methods is necessary. The dominance of such comorbid diseases as sinusitis and tonsillitis (66 %) dictates the need to study the state of the paranasal sinuses in ophthalmic herpes of severe course.

Purpose. To evaluate the efficacy and safety of therapy in patients with bacterial conjunctivitis using Moxioftan^® eye drops, 5 mg/mL, 5 mL (JADRAN-GALENSKI LABORATORIJ, Croatia), and Vigamox^® eye drops, 5 mg/mL, 5 mL (Alcon Laboratories, Inc., USA).

Patients and methods. A multicenter, open-label, randomized, comparative clinical trial included 220 patients who were randomized into the Moxioftan^® (moxifloxacin) group (n = 110) as the main group or the Vigamox® (moxifloxacin) group (n = 110) as the control group. The primary efficacy endpoint was the frequency of clinical cure, defined as the disappearance of clinical signs of bacterial conjunctivitis at the final study visit (visit 5, day 9 ± 1). Secondary efficacy endpoints included the degree of bacterial eradication, defined as the absence of growth of the primary pathogen identified in the baseline conjunctival smear by day 9 ± 1, dynamics of clinical symptoms of bacterial conjunctivitis, treatment efficacy assessed by both investigators and patients. The safety evaluation included an assessment of the incidence of adverse events, serious adverse events, and their potential relationship to the investigational and comparator drugs. Statistical analysis was performed using the R statistical package v. 3.2.1 and Statistica 10.

Results. The clinical cure rate by day 9 ± 1 of the study (visit 5) was 100 % in both the main and control groups. The severity of clinical symptoms of bacterial conjunctivitis decreased equally in both groups by the final study visit: –5.32 ± 1.71 and –5.55 ± 1.40 points in the main and control groups, respectively (p > 0.05). By day 9 ± 1 of the study, the overall efficacy rating of “good” prevailed in both groups. According to patients, good efficacy was noted in 97.27 % and 94.55 % of cases in the main and control groups, respectively. According to investigators, good efficacy was observed in 96.36 % and 94.55 % of patients in the main and control groups, respectively. The safety analysis demonstrated a comparable safety profile for Moxioftan^® and Vigamox^®. The incidence and nature of adverse events were similar between the groups.

Conclusion: The study demonstrated comparable efficacy and a similar safety profile of Moxioftan^® eye drops compared to Vigamox^® in the treatment of patients with bacterial conjunctivitis.