The review presents the analysis and possible ways of solving the issues of treatment of age related macular degeneration (AMD) based on pharmacogenetic approaches. The AMD problem is relevant because of the growing number of resistant neovascular membranes, an increase in the number of older-age patients, and a large number of complications from frequently used anti VEGF therapy as described in the literature. According to literary data, currently the most probable genes whose polymorphisms can affect the metabolism of drugs used, and hence the tactics of AMD treatment are: 1) CFH gene [complement factor H, chromosome 1q32 locus)]; 2) IL-8 gene; 3) ARMS2 gene of increased sensitivity to AMD; 4) VEGF-A gene; 5) NR3C1 gene. The need for diagnostic pharmacogenetic panels to select targeted AMD therapy is discussed. For citation: Bakunina N.А., Shcherbo S.N., Kolesnikova L.N. The prognostic value of pharmacological and genetic testing in medical therapy of age-related macular degeneration. Russian ophthalmological journal. 2018; 11 (2): 58-61. doi: 10.21516/2072-0076-2018-11-2-58-61 (In Russian).

The paper discusses the key role of VEGF and PlGF in the pathogenesis of diabetic retinopathy and macular edema and describes the mechanisms of retinal neoangiogenesis under the influence of these factors. An overview of treatment methods of retinopathy and macular edema is given, with a focus on anti-VEGF therapy. Anti-VEGF drugs are listed and compared, taking account of the results of their clinical trials. For citation: Iskhakova A.G., Zolotarev A.V., Viktorov D.A., Toropovsky A.N., Nikitin A.G. The role of vascular growth factors in diabetic retinopathy and macular edema development. Russian ophthalmological journal. 2018; 11 (2): 62-9. doi: 10.21516/2072-0076-2018-11-2-62-69 (In Russian).

Despite a comprehensive approach to the problem of diabetes mellitus (DM) and diabetic retinopathy (DR) in the Russian Federation, a number of problems persist in medical care for patients with DM. The analysis of statistical data makes it possible to assess the availability and the quality of medical care for diabetic patients in each region of the Russian Federation and to plan the distribution of resources - medicinal and technical support. This paper presents the geographical distribution analysis of DR general incidence, visibility impairment due to DR, the proportion of timely detected DR in the course of primary preventive healthcare, and the medical examination coverage. We propose that certain regional defects exist in the organization of medical care for patients with DR. For citation: Neroev V.V., Zaytseva O.V., Mikhailova L.A. Incidence of diabetic retinopathy in the Russian Federation according to Federal statistics. Russian ophthalmological journal. 2018; 11 (2): 5-9. doi: 10.21516/2072-0076-2018-11-2-5-9 (In Russian).

Purpose: to study the relationship between spherical aberrations of the cornea induced by orthokeratologic (OK) lenses and accommodation stress and to assess the effectiveness of treating accommodation overstrain with Irifrin BK 2.5 % in myopic patients having either unchanged shape of the cornea or changed shape modified by OK lenses. Material and methods. To study the effect of spherical aberration on the accommodation function in patients with unchanged and changed corneal shape, we formed two groups of high school students with myopia. Group 1 included patients with regular contact vision correction (156 eyes), and Group 2 included those with OK correction (196 eyes). To assess the impact of Irifrin BK 2.5 % on the state of accommodation, we examined 142 students (284 eyes) aged 8 to 19 years with myopia from -0.25 to -9.0 D, with changed and unchanged corneal shape, who were divided into three groups. Group 1 consisted of 52 subjects (104 eyes) with regular contact correction (52 children, 104 eyes), received Irifrin BK 2.5 % daily before bedtime for 30 days. Group 2 consisted of 33 subjects (66 eyes), also with normal contact correction (66 eyes) who were given the same quantity of the drug in the same pattern for 60 days. Group 3 (57 subjects, 114 eyes) with OK correction and varied negative spherical aberration received the drug for 30 days. Results. It was found that the character of spherical aberration in the unchanged corneal shape is different from that changed by OK lens. If the shape is unchanged, in 93.5 % of cases a positive spherical aberration is revealed, so that the share of negative spherical aberration accounts for 6.5 % of cases. In contrast, if the shape of the cornea is changed by OK lenses negative spherical aberration claims 86.7 %, leaving only 13.3 % for positive spherical aberration. A 30-day Irifrin BК treatment of patients with accommodation overstrain in cases of both unchanged and changed corneal shape proved to be more effective than the 60-day course of instillations. However, the treatment of overstrain accommodation with Irifrin BK in patients with OK correction was sufficiently effective for low and moderate negative spherical aberration, whereas in high negative spherical aberration it was noticeably less effective. Conclusion. An interrelation between negative spherical aberration induced by OK lenses with the amplitude and degree of accommodation strain and with the degree of myopia was revealed. It was found that a 30-day treatment with Irifrin BK 2.5 % is more effective in all types of correction. For citation: Makhova M.V., Strakhov V.V., Pilikova P.A. Induced spherical aberration of the cornea and stress accommodation in children with myopia. Russian ophthalmological journal. 2018; 11 (2): 10-5. doi: 10.21516/2072-0076-2018-11-2-10-15 (In Russian).

The purpose of this study is to measure the spherical aberration (SA) of the cornea and the optical system of the eye before and after wearing orthokeratologic (OK) contact lenses. Material and methods. 22 patients (44 eyes) with myopia aged 11 to 18 years were examined. The total SA was determined after medical cycloplegia performed on OPD-Scan III aberrometer, Nidek. To analyze SA values before and after wearing OK lenses, we chose pupil areas from 3 mm to 7.5 mm in 0.5-1 mm increments. Results. In intact eyes with myopia, the total SA is mildly positive and is growing with the increase of the pupil diameter. After OK correction, the SA is changing: from 3 to 6 mm of the pupillary area, the positive SA increases by 50-130 %, in the 6.3 mm area it falls sharply and becomes negative, growing on the way to the periphery of the pupillary area. Conclusions. Corneal topography changes after OK corrections lead to specific changes of the wavefront of myopic eyes, causing increased visual performance and eliminating the hyperopic defocus at retinal periphery. For citation: Tarutta E.P., Harutyunyan S.G. The impact of orthokeratologic contact lenses on spherical aberration of the optical system of the eye. Russian ophthalmological journal. 2018; 11 (2): 17-21. doi: 10.21516/2072-0076-2018-11-2-17-21 (In Russian).

Today, a variety of medications are used in ophthalmology practice to o produce cycloplegia and mydriasis. Purpose: to compare the extent of cycloplegia by residual accommodation response after instillations of various medications. Materials and methods. 54 patients, aged 8 to 23, with varied degrees of myopia were instilled twice, with an interval of 10 minutes, with one of the following medications: Cyclopentolate 1 %, Tropicamide 1 %, Midrimax, and Phenylephrine 2.5 %. The patients were examined before the first instillation and 40 minutes after it using autorefractometry and measurement of objective monocular accommodation response (MAO) with a Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K. The value of MOA, i.e. residual accommodation, was used to assess the completeness of cycloplegia. Results. The difference between manifest and cycloplegic refraction was -0.13 D after Cyclopentolate, -0.2 D after Tropicamide, -0.11 D after Midrimax, and -0.02 D after Phenylephrine. No intergroup differences in this parameter were noted (р > 0.05). MAO fell after Tropicamide and Midrimax but remained sufficiently high: -0.83 D and -0.71 D, respectively. Phenylephrine had no paralyzing action on the ciliary muscle; it even strengthened slightly (by 0.12 D) the objective accommodation response. The only medication to provide true cycloplegia was Cyclopentolate 1%: upon presentation of an accommodation task of 3.0 D, МАО was found to be only -0.1 D. The difference in MAO after Cyclopentolate 1% and all other medications is statistically significant, р < 0.05. Conclusion. For a dynamic observation of patients with no suspicion of elevated tone of the ciliary muscle, Cyclopentolate, Tropicamide and Midrimax are equally effective. In cases of primary examination or if a habitually excessive accommodation strain or accommodation spasm is observed, Cyclopentolate or Atropine must be used. Phenylephrine 2.5 % is a curative medication which normalizes the tone of the ciliary muscle and heightens the accommodation response. It is not advisable to use it for diagnostic purposes as mydriasis is weak and cyloplegia is absent. For citation: Tarasova N.A., Tarutta E.P., Markosian G.A., Maksimova M.V. Objective accommodation response value (completeness of cycloplegia) after diagnostic instillations of diverse medications. Russian ophthalmological journal. 2018; 11 (2): 22-6. doi: 10.21516/2072-0076-2018-11-2-22-26 (In Russian).

The purpose is to develop a combined method of paralytic lagophthalmos treatment using polytetrafluoroethylene (PTFE) implants. Material and methods. The clinical group consisted of 20 patients (8 males, 12 females) aged 31-69 (44.7 ± 5.3 years) with facial nerve paralysis, who were treated within the last 3 years. The onset of paralytic lagophthalmos took place 1-9 years (3.3 ± 2.1 years) before surgical treatment. A typical clinical picture was as follows: lagophthalmos 9-16 mm (13.3 ± 3.1 mm), retraction of the upper eyelid 3-6 mm (4.1 ± 1.1 mm), atony and ectropion of the lower eyelid, epitheliopathy (11 cases), leucoma (9 cases). Visual acuity was 0.01-1.0 (0.3 ± 0.15). All patients had surgery for lagophthalmos with the use of a PTFE implant. In 5 patients, surgery was performed in two stages (separately for the upper and the lower eyelids), in 15 cases it was performed simultaneously, using a combined method The implant was a porous PTFE tape 200-300 μm thick, either solid or with perforations. The follow-up period was 6 months to 3 years (1.9 ± 0.9 years). Results. No complications have been revealed either in the early or late follow-up periods. All patients had positive dynamics of the following parameters: the size of lagophthalmos, the presence of ectropion of the lower eyelid, retraction of the upper eyelid, the condition of the cornea. The evaluation was conducted 6 months after surgery or later. In all cases, lagophthalmos decreased significantly, the residual lagophthalmos was 2-5 mm (3.1 ± 1.3 mm). The condition of the cornea in patients with keratopathy improved, vision increased to reach 0.1 1.0 (0.5 ± 0.25). Conclusion. In the proposed method, the lagophthalmos is eliminated by lower eyelid strengthening and upper eyelid recession. PTFE implants provide a stable effect. For citation: Filatova I.A., Shemetov S.A. Combined method of surgical treatment for paralytic lagophthalmos with polytetrafluoroethylene (PTFE) implants. Russian ophthalmological journal. 2018; 11 (2): 27-34. doi: 10.21516/2072-0076-2018-11-2-27-34 (In Russian).

Purpose: to create a model of transient eye ischemia in order to study the effectiveness of drugs affecting the intensity of ocular blood flow in ischemic conditions, and to develop a method of quantifying the extent of ischemia. Material and methods. The study involved 72 Chinchilla rabbits. For the first time, the vasoconstrictive drug Phenylephrine 10 mg/ml was used to create an experimental model of ocular ischemia. The degree of ischemia was quantitatively assessed by the method of ophthalmoplethysmography, adapted for animals, while the degree of hypoxia was measured by enzymatic amperometric determination of lactate concentration in the intraocular fluid. Results. The effect of phenylephrine on the development of eye ischemia was found to be dose-dependent. After subconjunctival administration of phenylephrine, the maximum decrease in the minute volume of blood flow occurs in the interval from 60 min to 120 min. The time of permissible repeated injection of phenylephrine for the prolongation of ischemia development period was established at the 90th minute after the first injection, while the period of development of transient ischemia of the rabbit's eye is longer - 240 min. An increased content of lactate in the intraocular fluid after an injection of phenylephrine was noted, which points to the development of hypoxia due to transient ischemia of eye tissues. Conclusion. The proposed experimental model of transient rabbit ischemia developed by us may be used to study the efficiency of drugs affecting the intensity of ocular blood flow. It provides the possibility to control the dose of the ischemic factor and to avoid side effects. For citation: Chesnokova N.B., Grigoryev A.V., Mustafayeva K.N., Beznos O.V. A new model of transient ischemia of rabbit eyes and a quantitative assessment of ischemia degree using ophthalmoplethysmography. Russian ophthalmological journal. 2018; 11 (2): 35-40. doi: 10.21516/2072-0076-2018-11-2-35-40 (In Russian).

Laser refraction surgery is currently one of the most wide-spread surgeries in ophthalmology. It is known that during the process of refraction stabilization and even afterwards the patients are often disturbed by the feeling of eye dryness, discomfort during minimal visual efforts. The purpose of this study is observation of the results tear substitute therapy with medical device Thealoz for patients after LASIK and evaluation of its effectiveness as a preventive mean in the development of dry eye desease (DED). Material and methods. 30 people aged 18-51 years (average age 28 years) undergoing laser in-situ keratomileusis surgery (LASIK) were observed. After a week after the surgery instillation of antibiotic drops, orticosteroids and eye lubricants of medium viscosity stopped. Further treatment included only one medicine - Thealoz, 4 times a day within 30 days. Results. In all cases, the planned visual acuity was achieved, in some cases determined by the initial complexity of refraction anomaly. An increase of the Shirmer test score was registered from the first visit (one week after surgery) by the end of the first month - 9.58 ± 2.71 and 15.47 ± 2.44 respectively. The positive dynamics in BUT-test scores was recorded between the two specified dates: 14.53 ± 3.78 and 21.83 ± 3.55 respectively. Conclusion. The instillation of eye drops Thealoz is effective in preventing the development of DED after LASIK. For citation: Bogush I.V., Burilov K.B., Bratko G.V., Chernykh V.V. The experience of Thealoz eye drops instillation for patients after laser in-situ keratomileusis. Russian ophthalmological journal. 2018; 11 (2): 41-4. doi: 10.21516/2072-0076-2018-11-2-41-44 (In Russian).

The paper is focused on diagnosing eye structure lesions in patients with syphilis. Two clinical cases are described: a case of syphilitic uveitis in early syphilis and optic nerve atrophy in late syphilis. The main purpose is to increase the awareness of ophthalmologists about specific eye diseases in syphilis and the need for early detection of such pathologies. For citation: Bokhonovich D.V., Loseva O.K., Ryabtseva A.A., Kovrizhkina A.A., Yudakova V.M., Chernysheva N.V. Eye lesions in syphilis. Russian ophthalmological journal. 2018; 11 (2): 46-53. doi: 10.21516/2072-0076-2018-11-2-46-53 (In Russian).

Clinical cases of posterior chamber IOL fixation after phacoemulsification of cataract complicated by violated capsular support of the lens are described. The method developed by the authors, consists in locating the fixing unit in the corneal paracentesis and is shown to be effective and low traumatic. For citation: Kozhukhov A.A., Kapranov D.O., Kazakova M.V. Our practice of fixing a posterior chamber IOL after phacoemulsification of the cataract complicated by damaged lens capsule support. Clinical cases. Russian ophthalmological journal. 2018; 11 (2): 54-7. doi: 10.21516/2072-0076-2018-11-2-54-57 (In Russian).

The review summarizes the results of modern clinical practice of glaucoma treatment, in which diverse combinations of drugs are used. The search for new combinations of treatment of glaucoma patients is directed to the individual characteristics of the disease, but at the same time it should follow a uniform pattern of prescription sequence. Lifelong monitoring of glaucoma patients and prescriptions of medication are faced with a gradual decrease in drug effectiveness. Attention should be given to a falling tolerance to drugs, or reduced reaction to habitual administration of drugs and addiction, which requires increasing doses to achieve the expected effect of the drug. Clinical and organizational aspects of the situation are considered. For citation: Kuroyedov A.V., Nagornova Z.M., Tibieva Z.U., Krinitsyna E.A., Sergeeva V.M. Additive and combined glaucoma therapy: principles and practice. Russian ophthalmological journal. 2018; 11 (2): 71-81. doi: 10.21516/2072-0076-2018-11-2-71-81 (In Russian).

There are two different points of view on the role of ocular microcirculation in glaucoma. According to one of them, ocular hemoperfusion reduction is a consequence of nerve tissue atrophy. Other authors suggest that the retinal microcirculatory bed can already be damaged at early stages of the disease, causing the death of neuronal structures. However, little is known today about retinal microcirculation in glaucoma. The introduction of optical coherence tomography angiography (OCTA) has opened prospects in understanding the connection of microcirculatory and structural damages in glaucoma. The paper provides the data on the anatomy and physiology of microcirculatory bloodstream of the retina and optic disc, which were obtained using OCTA. For citation: Kurysheva N.I. OCT angiography and its role in the study of retinal microcirculation in glaucoma (part one). Russian ophthalmological journal. 2018; 11 (2): 82-6. doi: 10.21516/2072-0076-2018-11-2-82-86 (In Russian).

In recent years, application of night orthokeratological contact lenses (OK lenses) is becoming more and more widespread the world over. Modern orthokeratology makes use of gas-permeable contact lenses of reverse geometry: these are sophisticated structures made from materials with high oxygen permeability. The change of the curvature of the external corneal surface and, as a result, ocular refraction changes caused by OK lenses occurs due to changing architectonics of the corneal epithelium. The safety of orthokeratology is a pressing issue. The percentage of revealed complications in patients wearing OK lenses is comparable to, and in some cases, is even lower than with other means of vision correction. If the choice of OK lenses is adequate and the patient wearing them complies with wearing instructions and maintenance rules, their long use does not entail clinically significant complications. The results of the study emphasize the importance of a careful choice of OK lenses and regular medical checkups of patients. For citation: Levchenko Yu.S. The safety issue of orthokeratology application in clinical practice. Russian ophthalmological journal. 2018; 11 (2): 87-94. doi: 10.21516/2072-0076-2018-11-2-87-94 (In Russian).

The purpose of the review is to analyze the recent clinical research data concerning the efficacy and safety of fixed combinations as a first-choice therapy of patients with all stages of primary open-angle glaucoma. Application results of a fixed combination of Bimatoprost 0.03 % and Timolol 0.5 % are analyzed. The impact of preservative-free fixed combination usage on increasing the compliance, protection of visual functions and improving life quality at different stages of the glaucomatous process. For citation: Loskoutov I.A., Korneeva A.V. Preservative-free fixed combination of Bimatoprost and Timolol in the evolution of compliance and treatment effectiveness in patients with primary open-angle glaucoma. Russian ophthalmological journal. 2018; 11 (2): 95-101. doi: 10.21516/2072-0076-2018-11-2-95-101 (In Russian).

The third part of the paper (the first part see in ROJ, 2017; 10 (4): 105-12; the second - in ROJ, 2018; 11 (1): 103-10) reviews methods of eradication of lens epithelial cells and matrix for their proliferation, as well as the role of postoperative inflammation in posterior capsule opacification. For citation: Toropygin S.G., Glushkova E.V. Secondary cataracts after in-the-bag intraocular lens implantation: risk factors and ways of prevention (Part 3). Russian ophthalmological journal. 2018; 11 (2): 103-12. doi: 10.21516/2072-0076-2018-11-2-103-112 (In Russian).