this article presents a review of available literature concerning basic directions of refractory glaucoma treatment. the surgical management of refractory glaucoma is presented by two main groups of surgical techniques: filtering surgery (including surgery with the use of antimetabolites and implants) and cyclodestructive procederes. types of glaucoma drainages are described, modern valve drainage system is presented.

this review presents a detailed analysis and an experience of surgical treatment of retinal detachment recurrence associated with light silicone oil tamponade of vitreous cavity. Approaches and variants of treatment were described in the historical aspect and till now. there are considered general and particular issues in case of retinal detachment recurrence appearance, expediency and volume of intraoperative manipulations, time of operation and choice of temporary substitute of vitreous body for a purpose of postoperative

tamponade of vitreous cavity.

this review presented advances in computer-assisted methods of retinal vessels caliber assessment. Current mathematical models and associated problems are discussed.

The review presents possibilities of dry eye prophylaxis and treatment caused blepharitis and blepharoconjunctivitis after refrac- tive surgery. Among modern prophylactic approaches therapeutic eyelids hygiene is most promising for the everyday clinical practice. 

In article the problems of a common and medical bionomics are presented. the modern problems of a state of an environment and health of the population stipulated by a sharp amplification of relative (mutual) negative influence of the man and the environment lighted. the place of diseases of an eye in a plane of ecological medicine surveyed. the number of the unfavorable ecological factors

influential in health of the medical workers is parsed.

Authors analyzed the baseline (Pershin K. B., 2000) and advanced (trubilin V. N Pozharitskii M. D., 2011) theoretical model of the cascade excimer laser effects on eyesight.
the analysis indicates a lack of elaboration of issues related to the cascade of «a priori measures» aimed at medical and psycho- logical prediction «quality of life» and post-operative rehabilitation. In theory, authors suggest further improvement of the cascade model of excimer laser irradiation on the organ of vision. the proposed theoretical concepts will provide a practical matter, improve
functional and subjective results of the excimer laser correction of refractive errors.

Purpose: to evaluate outcomes of the descemet-stripping automated endothelial keratoplasty using eye drops Kombinil-Duo dur- ing postoperative period.
Methods: 26 patients suffered from bullous keratopathy underwent descemet-stripping automated endothelial keratoplasty using our own technique. We applied eye drops Kombinil-Duo during postoperative period.
Results: 25 patients had clear corneas whole period of observation. Graft rejection occurred in 1 eye. Mean BSCVA was 0.47±0.21.
Conclusion: Kombinil-Duo has been allowed to avoid infectious complication and to increase efficiency of the operative interven-
tion during postoperative period.

Purpose: to determine the long-term efficiency and safety of implantation Ex-PRESS open-angle glaucoma device to patients at advanced stage of POAG.
Methods: Seven male patients underwent penetrating filtering surgery with implantation of the Ex-PRESS shunt over the lack of stabilization of visual functions on hypotensive drugs.
Results: Average monitoring of patients was 19.96±9.73 months. IOP in postoperative period was 16.14±3.67 mm Hg (by Makla- kov). the reduction of IOP was 12.72 mm Hg (40.2%). Cell density didn’t differ from double (2879±87 cell/mm2 и 2798±67 cell/mm2, p>0.05).
Conclusion: Long-term gradual reduction of IOP and safety of implantation Ex-PRESS glaucoma device may be a reason of choice
this type of surgery for patients at advanced stage.

Purpose: to determine whether there is any difference in autonomic innervation of the cardio-vascular system in normal tension glaucoma (NtG) patients and primary open angle glaucoma (POAG) patients.
Methods: 30 NtG patients, 30 POAG patients and 22 control group patients underwent photoplethysmography following cold provocation testing. Several parameters showing cardio-vascular innervation have been evaluated and compared in three groups.
Results: the three selected parameters demonstrated the dominance of the sympathetic nervous system over parasympathetic nervous system in both glaucoma groups (NtG and POAG) and not in the control group. In contrast to POAG and the control group, the NtG patients showed strong increase in sympathetic nervous system activity following the cold provocation test.
Conclusion: Our studies revealed the dominance of sympathetic innervation in glaucoma patients in general. the cold provocation
test results strongly suggest primary vascular dysregulation in NtG patients.

Purpose: to study the informativeness of pseudoexfoliation syndrome (PES) signs for early diagnosis improvement.
Methods: 250 patients with PES were included in the study. Exclusion criteria consisted of aphakia, pseudophakia, previous eye surgery and diseases which can complicate PES diagnostics (uveitis, corneal pathology, ocular injury etc.). Each patient underwent complete ophthalmic examination, including slit-lamp examination under mydriasis, gonioscopy. Confocal microscopy was used as an additional diagnostic method in several patients (Confoscan-4, Nidek).
Results: Pseudoexfoliation material was found at the pupillary margin in 64.8% of patients, and on the lens capsule (central disc) in 71% of the test subjects. Peripheral depositions were present in almost all PES patients under mydriasis. Pupil dilation has been allowed to establish the diagnosis of PES additionally in 16% of patients. At the «mini-PES»-stage PES material was most frequently found in the superior-nasal quadrant of lens capsule (85.6%). Clinical asymmetry of several signs (pupil diameter, anterior chamber angle pigmentation, IOP level) should be taken into consideration in early PES diagnostics.
Conclusion: Examination under mydriasis and knowledge of PES micro-signs in some cases has been allowed to suspect PES
even at the preclinical stage.

Purpose: to examine the state rate parameters of cerebral and ocular vessels in patients with glaucoma combined with myopia of high degree.
Methods: the study involved 3 groups of patients aged 16-32 years: 1st — 30 patients (60 eyes) — with a stationary myopia of 6.5 to 9.0 D and normal intraocular pressure (IOP); 2nd — 23 patients (46 eyes) — with a high degree of progressive myopia and glaucoma with normalized intraocular pressure during instillation Azopt included 2 subgroups: subgroup A — 14 patients (28 eyes) — with ischemic variant of glaucoma; subgroup B — 9 patients (18 eyes) — with dyscirculatory variant of glaucoma; 3rd group (control) — 10 somatically healthy individuals of similar age. Following a standard ophthalmic examination techniques, as well as color Doppler mapping of the main arteries of the brain and the eyeball on the unit Acuson 128 HR/10 (USA) and hypocapnic (with O2) and hypercapnic (CO2) probe.
Results: In subgroup 2A patients showed significant (p <0.05) decrease in Vs in the central retinal artery and short posterior cili- ary arteries respectively 38.0% and 32.8% and increase the resistance index (RI) of vessels in 21.8% and 22.6%, increase Vs in the middle cerebral artery (MCA) at 11.5% and RI by 11.8% compared to the patients the third and first groups, with а hypocapnic test Vs in the MCA decreased by 35.4%, and increased with hypercapnic test for 23.0%; of the subgroup B in central retinal vein to 33.9% and 19.6%, lower Vs and RI in the vertebral artery (VA) by 20,0% and 9,1% respectively, with a hypercapnic test Vs in the MCA increased by 32.2%, and decreased during hypocapnic sample at 26.0%.
Conclusion: the predominance of the ability of MCA to vasoconstriction combined with reduced blood flow in central retinal artery and short posterior ciliary arteries and cause ischemica variant of glaucoma, slowing blood flow in the vertebrobasilar basin combined with a reduction of venous outflow of the of the eyeball and is accompanied by the development of glaucoma in dyscirculatory variant in patients with high degree of myopia.

Purpose: to evaluate the diagnostic capability of automated retinal vessels (RV) caliber estimation for hypertensive angiopathy.
Methods: this study included 146 patients (292 eyes) with arterial hypertension. All the subjects underwent fundus photography and RV caliber estimation. the latter was performed using newly developed computer-based method for automated vessel detection and central retinal arteriolar and venular equivalents determination (CRAE & CRVE). Sensitivity, specificity, and reproducibility of the method were estimated.
Results: the method of RV caliber assessment showed good reproducibility. the overall specificity and sensitivity were 74% and 80.77%, respectively. Computer-based method of retinal vascular caliber assessment revealed higher predictive value comparing with ophthalmoscopic assessment (AUC = 0.903 and 0.85, respectively). Retinal arteriolar and venular caliber and AVR tend to decrease with age. Higher blood pressure is associated with narrower retinal arterioles.
Conclusion: Novel method of RV caliber estimation demonstrated high information value. these findings are in good agreement
with data from major population-based studies.

Purpose: UBM-investigation of the periphery of retina and adjoining vitreous body with different peripheral retinal degeneration.
Methods: Forty-seven eyes of 37 patients were studied by biomicroscopy with free-miror lens. In the first group (28 eyes) were included patients with different peripheral retinal degeneration, the second group (19 eyes) — without changes of the peripheral retina and adjoining vitreous body. UBM-investigation of the periphery of retina and vitreous adjoining body was carried out device of com- pany «Sonоmed» (USA) with frequency of sound — 50 mHz and resolving capacity 50 mc.
Results: Retinoschisis of the different studies was revealed in 86% сases with peripheral retinal degeneration and in 42% without it. In 22 eyes (78.6%) were observed the changes of adjoining vitreous body to peripheral retina in the form of whitish packing, that was considered as initial vitreoretinopathy.
Conclusion: Peripheral retinosсhisis different intensity was determed by ultrasound biomicroscopy in 86% сases with peripheral retinal degeneration and in 42% without it. Peripheral retinosсhisis was attended changes of adjoining vitreous body in the form, that was considered as initial vitreoretinopathy.

Purpose: to study the morphometric changes in retina and the state of regional hemodynamics for chorioretinites of different etiology, to draw parallels between these methods of study with evaluation of their diagnostical significance.
Methods: Clinical and instrumental examination was performed in 15 patients (15 eyes) — group 1 — with the verified diagnosis of toxoplasmous chorioretinitis and in 13 patients (13 eyes) — group 2 — with the diagnosis of tuberculous chorioretinitis. Control (group 3) consisted of 20 subjects (40 eyes), 9 males, 11 females, without any pathology of organ of vision. Complex ophthalmologic examination was performed in all the patients; the examination included the following procedures: determination of visual acuity with correction, computer perimetry, biomicroscopy of eye fundus, inspection of eye fundus using Goldman lens, optic coherent tomogra- phy (OCt), ultrasound Dopplerography (USDG) of eye vessels.
Results: the following was determined by OCt data: subclinical serous retinal detachment, isolated cells of cyst-like edema, cyst- like edema in macular zone, unevenness of hyperreflective band of pigment epithelium, thinning of neurosensory retina in the area of scarry focus, hyperreflectivity of the zone of the fibrosis being formed, architectonics disorder of NE layers in foveolar zone and para- foveally at the expense of the presence of small hyperreflective parts. In the presence of proliferative process in the vascular coat the reliable decrease of blood flow maximal and minimal velocities in the posterior short ciliary arteries, maximal and minimal velocities of blood flow in the posterior long ciliary arteries in comparison with the values of patients from control group. the data obtained are supposed that proliferative processes in the vascular coat are accompanied by marked local hemodynamic disorders, which should be taken into consideration when complex therapy is prescribed.
Conclusion: Dynamic observation using OCt and monitoring of regional hemodynamics using USDG in patients with chorioreti- nites of different etiology are visualized the complications of the posterior part of the eye at early stages, to determine inflammatory process reactivation in time, as well as the dynamics of inflammation curing processes through the treatment performed. the prelimi- nary results obtained, as well as further studying this problem will allow to develop more constructive approaches to chorioretinites diagnostics.

We report two cases of an 18-year-old boy with a left optic disc pit and associated retinal edema of the macula and 47-year-old woman with an optic disk pit and associated retinal detachment of the macula. First was treated by intravitreal injection of Lucentis. Woman was treated by gas tamponade as a primary procedure. Both procedures resulted in complete resolution of subretinal fluid and
increase of visual acuity. We conclude that microinvasive surgery can be effective treatment of this disease.

Purpose: to study the dynamics of the volume was an accommodation during the day.
Methods: We investigated the amount of accommodation in 36 patients (men aged 25-30 years) without pathology of the vision five times during the day.
Results: the highest rates were observed in the amount of accommodation from 12 to 16 hours, the maximum oscillation is 1.34 D or 24.3%.
Conclusion: the analysis of the accommodative function of the various problems of ophthalmology and alternative specialties (neurology, rehabilitation medicine, etc.) must be compared the identified changes in the state of the accommodative apparatus of an eye to possible biological rhythms during the day.

the aim of this research is to obtain comparative characteristics of the age of persons first recognized as disabled due to oph- thalmopathology. Comparison of the age composition of the disabled due to corneal diseases, the lens, retina, eyeball, optic nerve, macular degeneration, glaucoma, myopia, trauma and anophthalmos was conducted. It has been established that very early disability is characteristic of myopia, anophthalmos, eye trauma, optic atrophy and eyeball diseases. Primary disability due to diabetic retinopa- thy, uveitis and glaucoma comes much later. It is considered that the age of the patient at the moment of primary disability should be
used to characterize medical and social burden of ophthalmopathology.

Purpose: Investigation of microflora of conjunctiva and its resistance to antibacterial drugs in healthy children and patients with various inflammatory eye diseases.
Methods: We examined 402 children (421 eyes) in the age from 1 month till 17 years: 62 healthy children (70 eyes) and 340 pa- tients with different inflammatory diseases of anterior segment of eye (351 eyes). the smear was done in all children for plating and definition of sensitivity of microflora to antibacterial drugs by method of diffusion to agar.
Results: the plating was positive even in 72.9% of healthy children who entered the hospital for the planned surgery. Most often we revealed Staphylococcus epidermidis (44.3%), Staphylococcus aureus (12.8%), Streptococcus faecalis (5.7%) and Enterobacter (2.9%). In children with inflammatory diseases Staphylococcus epidermidis and Staphylococcus aureus (62.6%) were found fre- quently. the analysis of data showed high level of resistance of all microflora to aminoglycosides (neomycin 37.8% and tobramycin 32.7%) and chloramphenicol — 37.1%. the lowest resistance of all microflora was registered to levofloxacin (11.1%) and ciprofloxacin (10.5%). In gram-negative microflora we revealed the maximal sensitivity to ciprofloxacin, in gram-positive — to levofloxacin.
We detected the maximal resistance of microflora to ampicillin (66.1%), and minimal — to cephalosporines (4.5%) among the antibiotics of systemic application.
Conclusion: the findings allow us to recommend drops containing levofloxacin (Signicef) for clinical practice in pediatric ophthalmology.

Purpose: the estimation of the results of a randomized study of the effectiveness of vitamin-mineral complex «Focus Forte» at myopia.
Methods: this study included 60 young patients (in age from 16 to18 years, university students, full-time education) in the context of complex treatment within 2 months. Patients were randomized to receive the preparation (n=30) or into the control group (standard therapy, n=30). On the day «0» and the day «60» over 80 parameters of vision were measured using a special software package.
Results: the comparisons of the studied parameters of vision on the day of «60» shown statistically significant differences in electrosen- sibility (O. R. 4.6, 95% C. I. 1.4-16, p=0,03), spatial contrast sensitivity (O. R. 9.0, 95% C. I. 1.5-17, p<0,006) and luminance sensitivity (O. R. 5.6, 95% DI 1.7-19; p=0,003) as well as a significant reduction of clinical symptoms of zinc deficiency and hypovitaminosеs A, C, E, B2 (p<0,001).
Conclusion: «Focus Forte» helps to improve visual function among the students with myopia, helping to compensate for deficiency of vitamins and micronutrients, which is required for the physiological support of the molecular processes of vision.

Purpose: to assess the effect of vascular endothelial growth factor inhibitors on choroid in patients with myopic macular choroid neovascular membrane.
Methods: 12 eyes (12 patients) aged 19-47 years with myopia and macular choroid neovascular membrane (mCNV) were enrolled in a study group. A control group included fellow eyes with early «dry» form age-related macular degeneration. Eyes with mCNV under- went one intravitreal injection of vascular endothelial growth factor inhibitor Ranibizumab 0.5 mg. Retina and choroid examination was performed with SPECtRALIS HRA+OCt (Heidelberg Engineering). Eyes were examined before treatment, in 1 month and in 3 months after treatment.
Results: Mean best corrected visual acuity in 1 moth after ranibizumab 0.5 mg injection improved from 0.37±0.18 to 0.47±0.24. In 3 months after treatment best corrected visual acuity was 0.53±0.24. Mean foveal retinal thickness before treatment was 311.4±57.2 μm; 1 month and 3 months after treatment mean foveal retinal thickness decreased to 229.1±41.8 μm and 221.8±29.3 μm, respec- tively. Mean choroid thickness in 1 moth decreased from 54.4±23.7 μm to 37.4±17.0 μm, in 3 moths mean choroid thickness was 48.9±20.1 μm. In the control group best corrected visual acuity was 0.79±0.18, mean foveal retinal thickness and mean choroid thick- ness were 187.1±10.5 μm and 93.7±24.5 μm, respectively.
Conclusion: Injection of vascular endothelial growth factor inhibitor allowed transient choroid thinning.