Purpose: to evaluate the effectiveness of surgical treatment of acute retinal necrosis. Material and methods. The study involves 34 patients aged 18 to 74 with acute retinal necrosis. Surgeries were performed on 41 eyes. All patients received microinvasive (23 Ga) vitrectomy with membrane peeling, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. Operated eyes were divided into 3 groups. Group 1 included 25 eyes which had retinal detachment and vitreous fibrosis at the time of surgical treatment. Group 2 consisted of 9 eyes with retinal detachment but no vitreous fibrosis, and group 3 of 7 eyes with vitreous fibrosis and no retinal detachment. Prior to surgery, visual acuity varied from wrong light perception up to 0.15 with correction. Results. A stable anatomical and optical result was achieved in all cases, complete attachment of the detached retina amounted to 94.1 %, and partial attachment to 5.9 % of the eyes. In group 1, improved visual acuity was observed in 56 % of cases, whereby visual acuity of 0.1 or higher was obtained only in 24 % of the eyes. In groups 2 and 3, visual acuity improved in all cases and proved to be 0.1 or higher, which was due to the predominance of the peripheral necrotic lesion zone, as well as to lower frequency of macular edema and optical neuropathy. In retinal detachment with vitreous fibrosis, a high frequency (72 %) of necrosis spread to the posterior pole of the eye with irreversible damage to the macula and optic nerve was detected. Conclusion. Modern technologies of surgical treatment allow achieving good anatomical results in all patients with acute retinal necrosis. The highest functional results are achieved with peripheral or paracentral lesions, absence of macular edema and optical neuropathy, and macula affected by retinal detachment prior to surgery, which was observed in groups with isolated vitreous fibrosis or retinal detachment. For citation: Neroev V.V., Ilyukhin P.A., Fedotov R.A., Tankovsky V.E. Results of surgical treatment of acute retinal necrosis. Russian ophthalmological journal. 2018; 11 (1): 5-11. doi: 10.21516/2072-0076-2018-11-1-5-11 (In Russian).

According to literary data, 78.9 % of patients with cataract and glaucoma who receive cataract surgery have complications like sinechias, mioses, papillary membrane, or lens subluxation, which require additional surgical methods. Purpose: to evaluate the performance of a modified irrigation cannula applied in complicated cataract surgery in cases of a rigid pupil for the prevention of intra- and postoperative complications. Material and methods. The main group consisted of 30 patients (30 eyes) with narrow rigid pupils that were spread intraoperatively with an irrigation fork-shaped cannula, modified by the authors. The control group of 22 patients were operated using an iris retractor in the shape of hooks. Results. The evaluation took place during the surgery, in an early postsurgical period (up to 2 months) and in a late postsurgical period (1 year after the operation). During the surgery, 4 patients of the main group (13.3 %) and 11 patients of the control group (41 %) patients were found to have a hyphema. Patients without synechia had no hyphema. In an early postoperative period (1 week) 2 patients of the main group and 6 patients of the control group developed a 1-2 mm hyphema. In the late postoperative period all patients of the main group had round pupils with a diameter of 3-4 mm. In the control group, 3 patients showed a break in the pupillary edge of the iris, while 14 patients developed an irregular shape of the pupil which had total absence of reaction to light. Visual acuity of all patients of the main group was 0.7-0.8, while in the control group it was 0.4-0.6. Conclusion. When using the suggested fork shaped irrigation cannula in cataract surgery of patients with a narrow rigid pupil, there is no need for additional manipulations and multiple tools to check the capsular sack for lenticular masses, which reduces labor, risk of injury, and surgery duration. For citation: Kasimov E.M., Pirmetov M.N. Some aspects of complicated cataract surgery technique in patients with glaucoma. Russian ophthalmological journal. 2018; 11 (1): 12-5. doi: 10.21516/2072-0076-2018-11-1-12-15 (In Russian).

Purpose: study of uveal melanoma (UM) cells receptor status to estrogen (ER) and progesterone (PR). Material and methods. 22 patients (8 men and 14 women) with UM aged 22 to 76 (mean 54.3 ± 2.2 years) were subjected enucleation (n = 20) or fine-needle aspiration biopsy, depending on clinical indications. The material for cytological examination (n =22) was obtained from enucleated eyes by imprinting. A routine cytological study was performed to confirm the diagnosis, while at the second stage the method of immunocytochemistry (ICC) was used to differentiate the melanocytic nature of the tumor. Results. The cytological diagnosis of melanoma was established in all patients, including two urgent cytological tests on the operating table. In 80 % of melanomas, a positive expression of HMB 45 (melanocytic differentiation marker) and cocktail Melan (a melanoma-associated marker) were observed, which confirmed the melanocytic nature of the tumor. A weak reaction to S100 (neuronal differentiation marker) was noted. In all cases, a pronounced reaction to vimentin was observed, which manifested itself as a brown coloration of the cytoplasm. When studying the expression of ER and PR, a negative result was obtained; none of the studied samples displayed a quantitatively positive reaction. Conclusions. In our investigation, based on UM samples study, 22 patients had no positive expression of estrogen and progesterone receptors in the tumor tissue, which correlates with literary data. For citation: Saakyan S.V., Zhiltsova M.G., Valskiy V.V., Tsygankov A.Yu. Estrogen and progesterone receptors expression in uveal melanoma tumor cells. Russian ophthalmological journal. 2018; 11 (1): 17-23. doi: 10.21516/2072-0076-2018-11-1-17-23 (In Russian).

Purpose: to identify treatment efficiency factors in various forms of amblyopia. Material and methods. Histories of 31945 amblyopic children aged 17 or under over a 5-year period were analyzed retrospectively. The analysis showed that 30 % of patients (9587 children, 14431 eyes) were diagnosed with amblyopia during this period. The treatment methods included a laser ophthalmotherapeutic device “Speckle-M”, an Ambliokor-0 complex, and a Vizotronik eye muscle training device and relaxer. Results. Of the 14431 eyes with amblyopia, 4101 eyes (28.4%) received no treatment or irregular treatment. In treated patients with low amblyopia, had pre-treatment visual acuity of 0.62 ± 0.02, which increased to reach 0.88 ± 0.08 after the fifth course of treatment. Conclusion. Amblyopia was diagnosed for the first time at an age over 6 years in more than 30 % of children, which is an unfavorable factor affecting the prognosis of amblyopia treatment. Despite the absence or irregularity of instrumental treatment, patients with refractive amblyopia showed an increase in visual acuity over the 5-year period. Instrumental treatment is necessary for patients with anisometropic, dysbinocular and obscuration amblyopia. For citation: Chuprov A.D., Borshchuk E.L., Voronina A.E. Certain aspects of amblyopia treatment in children. Russian ophthalmological journal. 2018; 11 (1): 24-9. doi: 10.21516/2072-0076-2018-11-1-24-29 (In Russian).

Purpose: to evaluate the effectiveness of integrated methods of prevention dacryocystitis recurrences in external dacryocystorhinostomy. Materials and methods. 120 patients (120 eyes) with dacryocystitis, 85 women and 35 men, aged 21 to 75, were divided into 2 groups. The main group of 60 patients (60 eyes, 40 women and 20 men) whose mean age was 65 ± 12.5 years were subjected to external dacryocystorhinostomy with the use of a specially modified device, trepanation fraise, for the formation of the bone window and a binary stent to ensure the tamponade of a formed anastomosis. The control group was formed by the remaining 60 patients (60 eyes, 45 women and 15 men) with a mean age of 69 ± 16.2 years, who underwent regular operations according to Addeo Toti. Results. In the main group, recuperation was noted in 49 cases (82 %) and improvement in 10 cases (17 %). 1 case (1.6 %) showed a recurrent dacryocystitis. In the control group, recuperation was achieved in 38 cases (63.3 %), improvement in 17 cases (28.3 %) and the recurrence of the condition occurred in 5 cases (8.3 %). Conclusion. The proposed method enables an effectiveness increase of external dacryocystorhinostomy surgeries. For citation: Shikhunov D.Sh., Aliev A-G.D., Aliev A.A.-G., Abdulaev A.B.. The experience of prevention of dacryocystitis recurrences in external dacryocystorhinostomy. Russian ophthalmological journal. 2018; 11 (1): 30-4. doi: 10.21516/2072-0076-2018-11-1-30-34 (In Russian).

Proliferative vitreoretinopathy is a multifactorial pathological process of formation of epiretinal membranes on the surface of the retina. The main method of treatment of this disease is vitreoretinal surgery. To increase the effectiveness of treatment, intravitreally administered antiproliferative drugs are used. Purpose: to study the effect of intravitreally administered medication Melphalan in varied concentrations on the retina and retinal pigment epithelium (RPE), in the experiments on rabbits. Materials and Methods. An experimental morphological study was performed on 28 eyes of 14 Chinchilla rabbits, divided into 4 groups depending on the concentration of Melaphan (0.02 mg, 0.01 mg, 0.0075 mg and 0.005 mg) administered intravitreally once. Results. Four types of morphological changes in the retina and RPE are described, depending on the medication dose administered. The target of Melphalan accumulation in the retina is RPE, which brings about metabolism disorders in the outer layers of the retina and the appearance of atrophic foci. The dynamics of these foci and their reversibility is discussed. Conlusion. The study of morphological changes of the retina in cases of introvitreal administration of Melphalan showed that they are dose-dependent. The minimum retinal toxicity is observed when low concentrations of the drug are used: 0.0075 and 0.005 mg. For citation: Khoroshilova-Maslova I.P., Leparskaya N.L. Retinal changes after intravitreal injections of various concentrations of antiproliferative medication Melphalan: an experimental and morphological study. Russian ophthalmological journal. 2018; 11 (1): 36-40. doi: 10.21516/2072-0076-2018-11-1-36-40 (In Russian).

The paper justifies the hypotheisis that active accommodation for far vision really exists. Ultrasound biomicroscopy is used on medication models of the accommodation tone to demonstrate the motor activity of the coronary ciliary body controlled by the sympathetic department of the autonomic nervous system. Clinical evidences of the involvement of the sympathetic innervation into the dynamic refraction of the eye are given. Possibilities of clinical measurement of accommodation for far vision are presented. For citation: Strakhov V.V., Klimova O.N., Korchagin N.V. The clinical picture of active accommodation for far vision. Russian ophthalmological journal. 2018; 11 (1): 42-51. doi: 10.21516/2072-0076-2018-11-1-42-51 (In Russian).

Two rare cases of mucopolysaccharidosis (MPS) I in children are presented. In the first case, the ophthalmologist suspected a Hurler syndrome in a child aged 1 year with corneal opacities in both eyes, taking into account the unusual appearance of the child, which gradually formed over the year after birth, retarded psychic and speech development and the presence of hypoxic ischemic central nervous system injury (CNS) with hypertensive syndrome, hepatomegalia, and mitral valve prolapse. The diagnosis was confirmed by the results of a biochemical blood test, which showed a decrease in the activity of the enzyme of alpha-L-iduronidase. Genetic testing was recommended for the determination of the proband genotype. The second case was a boy S., aged 3 years and 7 months, with Hurler - Scheie syndrome. Numerous comorbidities (CNS, hypertensive syndrome, hip dysplasia, kyphosis, ambilateral inguinal hernia, etc.) combined with gradual formation of grotesque facial features by the age of eighteen months suggested that genetic testing should be taken during the second year of life. As a result, Q 70X mutation was identified in the heterozygous state and replacement therapy with Aldurazyme was prescribed. Clinical polymorphism and different severity of symptoms combined with rare occurrence was the reason why difficulties were experienced in the early identification of MPS I. Early diagnosis is very important so that the children could be timely referred to experts of the interdisciplinary center with an experience in the specific treatment, which is the most effective in the early stages of the disease. For citation: Babushkin A.E., Khusnutdinova E.G., Ryskulova E.K., Mukhametshina R.M. Rare cases of mucopolysaccharidosis type I in children with Hurler and Hurler - Scheie syndromes. Russian ophthalmological journal. 2018; 11 (1): 53-8. doi: 10.21516/2072-0076-2018-11-1-53-58 (In Russian).

Dystrophy of the cornea is a pathological condition characterized by various manifestations of chronic corneal nutrition disorders. Surgical treatment of corneal dystrophy remains insufficiently available in many regions of Russia. Conservative therapy of corneal dystrophy can prevent the progression of the dystrophic process, retard the opacity of the cornea and maintain the visual acuity and the patient's ability to work for a sufficiently long time. Repeated courses of complex conservative therapy in primary corneal dystrophy allow: delaying the progression of the disease and stabilizing the dystrophic process in 23 to 65 % of cases, increasing visual acuity (averagely by 0.2-0.3) or maintaining the available vision in 35-72 % of patients, preventing the relapse of corneal erosions or ulcers, improving the quality of life and self-appraisal of patients with corneal dystrophy, maintaining their ability to work and professional fitness for a long time (up to 15-30 years). For citation: Vakhova Е.S., Yani Е.V., Seliverstova К.Е. Modern aspects of therapy of primary and secondary dystrophies of the cornea. Russian ophthalmological journal. 2018; 11 (1): 59-65. doi: 10.21516/2072-0076-2018-11-1-59-65 (In Russian).

Congenital and hereditary forms of ophthalmic pathology claim over 90 % of cases of vision disability in children. The main functional eye disorders affecting the fundamental categories of life quality of a disabled child are visual acuity and visual field impairment. Child disability is often characterized by the fact that visual defects are accompanied by musculoskeletal pathologies, hearing impairment, diseases of internal organs, and psycho-neurological impairments. The purpose of this paper is to increase the awareness of ophthalmologists in measures taken by various institutions and organizations in accordance with the individual rehabilitation or habilitation program for disabled children developed by the Bureau of the medical social expertise. Medical rehabilitation includes: rehabilitation and reconstructive therapy, prosthetics, provision of technical rehabilitation facilities depending on the child’s visual acuity and visual field state, eye pathology, and age. Psychological and pedagogic rehabilitation of disabled children includes pre-school education, general education and psychological correction. For citation: Egorova T.S. The importance value of an individual rehabilitation (habilitation) program for visually impaired children. Russian ophthalmological journal. 2018; 11 (1): 67-73. doi: 10.21516/2072-0076-2018-11-1-63-73 (In Russian).

Myopathic ptosis can occur in mitochondrial myopathies, oculopharyngeal muscular dystrophy or myotonic dystrophy and have common clinical characteristics. The management of myopathic ptosis is challenging due to a high risk of postoperative lagophthalmos. In this study, we report the results of surgical treatment in patients with myopathic ptosis. Purpose: to evaluate the results of treatment of patients with myopathic ptosis of the upper eyelids, operated in various ways, and propose an algorithm for choosing the method of treatment. Materials and methods. A retrospective study of 11 patients (10 females and 1 male) with myopathic ptosis was conducted. Surgical treatment included frontalis suspension using mersilene mesh with levator function ≤ 4 mm, (6 patients), resection of the levator and muscle of Muller with levator function ≥5 mm (5 patients). If excess skin of the upper eyelids was available, resection of the skin and orbicularis was additionally performed in both surgery techniques. Results. In all cases, positive values of the postoperative Marginal Reflex Distance (MRD1 = 0.5-2 mm) were obtained. Postoperative lagophthalmos was observed in two patients who underwent a recession of suspensions in an early postoperative period. In one case, the mersilene mesh was exposed on both eyes 12 months after surgery. Conclusion. The positive effect of the surgical treatment of myopathic ptosis is determined by eyelid opening to reach the values of MRD1 of at least 0 mm and a complete absence of lagophthalmos. The choice of the method of treatment is based on the correlation of levator function and the mobility of the eyebrows. In excess skin, both surgical methods are supplemented with skin and orbicularis resection. The appearance of any lagophthalmos in the postoperative period is an indication for an early corrective operation. For citation: Zakharova M.A., Kataev M.G. Surgical treatment of patients with myopathic ptosis. Russian ophthalmological journal. 2018; 11 (1): 74-9. doi: 10.21516/2072-0076-2018-11-1-74-79 (In Russian).

Purpose: to analyze the effectiveness of therapeutically covering cornea perforation in a cancer patient with auto conjunctiva. Material and methods. A patient with a diagnosis of cancer of the right kidney pT1N0M1, ST 4, metastasis in the left kidney and L 1-2 vertebrae; cancer rectum pT3N0M0, liver metastases in the form of a hypodense focus underwent several surgeries: radical nephrectomy of the right kidney; anterior resection of the rectum; atypical liver resection (S3, S4, S5). Over the 5-year period of treatment in an oncology hospital the patient received 48 courses of immunotherapy (the most recent session took place in June 2014). Starting from September 2014, the patient was treated for keratouveitis of both eyes. The vision of both eyes dropped drastically from 1.0 to 0.01 (uncorrected) in just 2 months. On April 6, 2015 the patient was admitted to the Ophthalmological hospital, diagnosed with corneal ulcer perforation complicated by a cataract of the right eye, corneal dystrophy of the cornea, and complicated cataract of the left eye. He was treated by covering corneal perforation with a flap of autoconjunctiva and blepharorhaphy of the right eye. Results. In the right eye, a vascularized wall-eye in the lower third of the cornea with a stable plugging effect was formed. On Sept. 24, 2015 (5.5 months after autoconjunctiva covering and blepharorrhaphy), cataract phacoemulsification with implantation of an intraocular lens in the right eye was performed (at the date of discharge, uncorrected OD vision was 0.1 not correct). On Nov. 23, 2015 the same procedure was repeated in the left eye (at discharge vis OS = 0.4 uncorrected). After 1.5 years, the vision remained stable (OD = 0.1, OS= 0,4 uncorrected). Conclusion. The clinical case demonstrates a high risk of corneal ulcer perforation in cancer patients caused by reduced immunity after chemotherapy. Eye preserving coverage of corneal perforation with an autoconjunctiva flap accompanied by blepharorhaphy showed a satisfactory result of sealing the perforation of the cornea. The vascularized wall-eye formed affected the optical part of the cornea with minimal losses, which later allowed performing a cataract extraction with the restoration of visual functions. For citation: Ivachev E.A. Surgical treatment of corneal perforation by auto tissue: a clinical case. Russian ophthalmological journal. 2018; 11 (1): 80-4. doi: 10.21516/2072-0076-2018-11-1-80-84 (In Russian).

A clinical case of surgical treatment of a patient with von Hippel-Lindau disease complicated by retinal detachment is presented. Intravitreal injection of ranibizumab was performed 7 days before vitrectomy. Laser photodestruction of retinal capillary hemangiomas was performed intraoperatively with an increased exposure and reduced inter-pulse interval. A 1 year follow-up showed a stable functional and anatomic result, and lack of relapse. Details of surgical treatment and advantages of the method proposed are discussed. For citation: Neroev V.V., Ilyukhin P.A., Ryabina M.V., Novikova A.Yu. Surgical treatment of von Hippel-Lindau disease complicated by retinal detachment: a clinical case. Russian ophthalmological journal. 2018; 11 (1):85-92. doi: 10.21516/2072-0076-2018-11-1-85-92 (In Russian).

Inflammatory lesions of the sclera have a recurring course with a wide range of clinical manifestations and are hard to treat by medications. Purpose: to develop a combined therapy pattern with the use of medications Broxinac® (bromfenac) and Visallergol (olopatadine 0.2 %) in patients with sclerites of rheumatoid genesis. Materials and methods. 26 patients diagnosed with scleritis were divided into 2 groups. Group 1 included 12 patients (18 eyes) who received instillations of diclofenac 4 times a day. Group 2 consisted of 14 patients (19 eyes) who received instillations of bromfenac once a day and olopatadin 0.2 % once a day. All patients had a diagnosis of rheumatoid arthritis, positive HLA-B27. Results. A decline in activity of sclerites on the McCluskey scale in the course of treatment was recorded in both study groups. By the concluding 40th day of treatment, a more significant clinical effect was noted in the group receiving bromfenac andolopatadin : 0.6 points as compared to 1.4 points in group 1. After anti inflammatory treatment cessation in group 1, exacerbation of scleritis was noted in 5 cases during the 3rd to 5th week of the cessation. In contrast, group 2 showed only 1 case of exacerbation four weeks after the cessation. Conclusion. Sclerites therapy requires a long time and is associated with the development of complications in the treatment process. To increase the effectiveness of therapy of these diseases and reduce the risk of complications, modern NSAIDs with a minimum number of instillations are needed. For citation: Yani Е.V., Vakhova Е.S., Seliverstova К.Е. The tactics of treatment of sclerites of rheumatoid genesis. Russian ophthalmological journal. 2018; 11 (1): 93-7. doi: 10.21516/2072-0076-2018-11-1-93-97 (In Russian).

The literary review focuses on the studies of the posterior segment of the eye in patients with keratoconus. Anomalies in the development of the optic disk and changes in the macular area in keratoconus as well as in keratoconus combined with optic neuritis were detected using OCT, laser tomography and visual evoked potentials. The issue has not received complete solution yet. The publications are few due to the fact that it is difficult to visualize the fundus in patients with keratoconus because of high refraction errors and astigmatism of the cornea, which hampers the assessment of changes in the eye fundus. For citation: Ioyleva E.E., Safonenko A.Y. Changes in the posterior segment of the eye in patients with keratoconus. Russian ophthalmological journal. 2018; 11 (1): 99-102. doi: 10.21516/2072-0076-2018-11-1-99-102 (In Russian).

In the second part of review (see Part 1 in ROJ, 2017, issue 4), secondary cataracts’ risk factors and ways of prevention of epithelial cells migration within the capsular bag are updated. For citation: Toropygin S.G., Glushkova E.V. Secondary cataracts after in-the-bag intraocular lens implantation: risk factors and ways of prevention. Part 2. Russian ophthalmological journal. 2018; 11 (1): 103-10. doi: 10.21516/2072-0076-2018-11-1-103-110 (In Russian).