Purpose: to evaluate the efficiency of brachytherapy treatment in capillary retinal hemangioma and the emerging complications. Material and methods. Between 2005 and 2014, 18 patients with capillary hemangioma of the retina (11 females and 7 males, mean age 29 ± 13.9 years) were treated, 8 patients had monocular and 10 patients had binocular lesion. In 12 cases, capillary hemangioma of the retina was associated with Hippel - Lindau disease, in 6 cases a sporadic tumor appeared. 90Sr and 106Ru ophthalmic applicators were used. In 7 eyes, brachytherapy was preceded by laser coagulation. After local irradiation, the patients were followed up for 1 month to 3 years. Results. The pathological process was stabilized in 13 eyes. 5 eyes, no later than 3 months after the procedure, developed a severe radiation reaction, total retinal detachment, and recurrent hemophthalmos, which later, after 6 months or more, led to the development of neovascular glaucoma. In one case, the eye had to be enucleated due to terminal painful glaucoma. In 3 eyes despite tumor regression, retinal detachment persisted over the follow-up period, although the macular area remained unaffected. Complicated cataract (12 eyes), neuroretinopathy (2 eyes), appearance of new capillary hemangiomas (1 eye), increased epiretinal fibrosis (4 eyes), and secondary central chorioretinal dystrophy (2 eyes) were observed over the period of up to 2 years. Conclusion. In most cases, brachytherapy of retinal capillary brings about a satisfactory anatomical result. However, in order to reduce postoperative complications and improve the functional result, a thorough preoperative selection of patients is needed, which should take into account the initial retinal status. For citation: Neroev V.V., Saakyan S.V., Ilyukhin P.A., Valskiy V.V., Ryabina M.V., Novikova A.Yu. The role of brachytherapy in the treatment of retinal capillary hemangiomas. Russian ophthalmological journal. 2018; 11 (3): 5-10 (In Russian). doi: 10.21516/2072-0076-2018-11-3-5-10

Purpose: to report the first case of the same day use of a single donor cornea tissue for 5 consecutive transplantations in patients with endothelial dystrophy and keratoconus. Material and methods. The Descemet membrane (DM) and the endothelium were fully detached from the stroma of the donor on the endothelial side, using first a circular and then a direct corneal cutter, forming four partial triangle-shaped Descemet grafts (each constituted a 1/4 Descemet graft). The stroma of the donor's cornea was separated by a circular cutter of a preset diameter. One patient with keratoconus underwent deep anterior lamellar keratoplasty (DALK) using the big bubble technique. Then, each of the four Descemet grafts was sequentially transplanted by the Descemet membrane endothelial keratoplasty (DMEK) method to 4 patients with Fuchs dystrophy and pseudophakia. Results. During and after the surgery, there were no complications requiring additional intervention. Six months after DALK, the best corrected visual acuity (BCVA) was 0.66. Six months after four operations each using ¼ DMEK the average BCVA was 0.95 ± 0.1 (from 0.8 to 1.0) and the endothelial cell density was, respectively, 2839 after DALK and 1680 ± 254 cells/mm2 (from 1492 to 2039 cells/mm2) after ¼ DMEK. Conclusion. One donor cornea can be successfully transplanted to at least 5 patients. Despite the fact that the implementation of DALK and several operations using the ¼ DMEK technique within one day is technically difficult, this approach can contribute to a drastic reduction in the deficit of donor tissue. This approach requires a thorough selection of patients and an extensive surgical experience. For citation: Oganesyan O.G., Makarov P.V., Grdikanyan А.А., Getadaryan V.R. A new strategy of keratoplasty: laminating and splitting the donor cornea. Russian ophthalmological journal. 2018; 11 (3): 11-8 (In Russian). doi: 10.21516/2072-0076-2018-11-3-11-18. The full English version is available online at http://roj.igb.ru/eng/issues

Age-related cataract is a major medical and social issue as it is the main cause of reversible blindness in the world. Age-related cataract is frequently accompanied by pseudoexfoliation syndrome (PXFS) - a systemic dystrophic process, clinically manifested in the eyeball. Dystrophic changes in XFS bring about a 5-fold increase of the risk of cataract surgery complications, amounting to 49.4 % of cases. Purpose: to study the clinical characteristics of ocular PXFS manifestations in age-related cataract among residents of the South of Russia. Material and methods. A total of 179 patients (277 eyes) with age-related cataract were tested. Of these, 75 patients (41.9 %, 114 eyes) were found to have PXFS while the remaining 104 patients (58.1 %, 163 eyes) had no PXFS. Testing included visometry, autokeratorefractometry, ophthalmic biomicroscopy, pneumotonometry, perimetry, ophthalmoscopy, ultrasound biometry, determination of electrical sensitivity threshold of the optic nerve, and critical flicker frequency. Results. It was found that age-related cataract patients with PXFS were significantly older than those without PXFS. The former showed a lower initial visual acuity and pronounced trophic changes in the anterior segment of the eye. PXFS patients developed iridodonesis 13 times as often as those without PXFS, while lens subluxation occurred 8 times as often. In more than one third of the cases, PXFS patients had dense or very dense lens nucleus. Conclusion. Age-related cataract of South Russia residents having pseudoexfoliation syndrome was found to be more severe and complication-prone than that of patients without PXFS. For citation: Polapina A.A., Komarovskikh E.N., Sakhnov S.N., Zabolotny A.G. Age-related cataract and pseudoexfoliation syndrome among residents of the south of Russia. Russian ophthalmological journal. 2018; 11(3): 19-24 (In Russian). doi: 10.21516/2072-0076-2018-11-3-19-24.

Purpose: to assess the impact of risk factors and the method of insulin administration on the retina of children with type 1 diabetes. Materials and methods. 221 children with type I diabetes aged 2 to 17 (mean age 11 ± 3.9 years) were followed up retrospectively. They had diabetes for 1 to 15 years (4.4 ± 3.3 years on average). The average level of glycated hemoglobin HbA1c was 7.8 ± 1.9 %. Different groups of patients were formed to assess the impact of the specific factors on the status of the retina. Results. In the group of patients who had type I diabetes for no more than 5 years, 8 cases (6 %) of diabetic retinal lesion were detected. The group with the 5 to 10 years duration of the condition revealed 13 cases (17.8 %), whilst the group of diabetes lasting 10 years or more revealed 3 cases (21.4 %). The distribution of retinal lesions in groups depending to the degree of diabetes compensation was as follows: compensated diabetes yielded 4 cases (4.8 %), subcompensated diabetes, 9 cases (10.1 %), and decompensated diabetes, 11 cases (22.9 %). The group of children who received insulin through the insulin pump yielded a single case (2.6 %), of a diabetic disease of the retina. The group who were given multiple subcutaneous injections of insulin and resorted to regular self-control yielded 12 (9.8 %) cases, while the group who used multiple subcutaneous injections of insulin but resorted to irregular self-control revealed 11 (18.3 %) cases. Conclusion. With the growing duration of diabetes mellitus as the main disease, the incidence of diabetic retinal damage increases (p < 0.05). A statistically significant relationship was found between the degree of compensation for type I diabetes mellitus and the development of retinal complications (p < 0.01). The use of a metering pump and regular self-control of the parameters help avoid the emergence and progression of diabetic retinal lesions in children with type I diabetes (p < 0.05). For citation: Samoylov A.N., Khaibrakhmanov T.R., Fazleeva G.A., Samoylova P.A., Fazleeva M.A. The impact of risk factors and insulin admininstration method on the condition of the retina in children with type I diabetes mellitus. Russian ophthalmological journal. 2018; 11 (3): 25-9 (In Russian). doi: 10.21516/2072-0076-2018-11-3-25-29

Purpose: to study the changes of axial length and distension of the posterior pole retina of the eye in patients with myopia, using two optical methods: contactless biometrics and optical coherence tomography (OCT). Material and methods. We conducted a combined clinical and instrumental examination of 83 patients (166 eyes) with low and moderate myopia aged 10-19 (ave. 13.8 ± 2.5 years). The examination included the measurement of axial length, using a Lenstar contactless laser biometer Lenstar, and retinal nerve fiber layer (RNFL) thickness using optical coherent tomography (OCT Stratus). 32 patients (64 eyes) with emmetropia aged 7 to 18 (ave. 11.7 ± 2.6 years) served as control. Results. The analysis of contactless biometrics and OCT results collected for 1 year helped specify four clinical groups: Myopia progression, Latent myopia progression, Myopic refractogenesis, and Stable myopia. It was also found that RNFL thickness in different retinal sectors is decreasing unevenly in latent myopia progression. To facilitate the evaluation of myopia progression, a structural indicator of progression was proposed. Conclusion. Progressing myopia monitoring by two modern optical methods: biometrics (for AL) and OCT (for RNFL thickness) enables the detection of changes in the fibrous eye capsule and identification of individual features of myopic progression. For citation: Strakhov V.V., Makhova M.V., Klimova O.N. New opportunities of monitoring patients with myopia. Russian ophthalmological journal. 2018; 11 (3): 30-5 (In Russian). doi: 10.21516/2072-0076-2018-11-3-30-35

The paper is focused on combined burn injuries of the eye, face and other body parts in acute care patients treated in non-ophthalmic hospital departments. Purpose: to develop patterns of actions by ophthalmologists and burn doctors at various stages of multiple burn injuries in patients treated in burn units. Materials and methods. 158 burn patients were given full clinical and instrumental examination. Group 1 included 95 patients hospitalized in the department of eye traumatology and reconstructive surgery after being treated in burn units elsewhere, while group 2 consisted of 63 patients examined and treated simultaneously by ophthalmologists and burn doctors from the start of admission to burn units. Results. The patients in Group 1 developed serious ophthalmic complications, ranging from ulceration or perforation of outer eye coats, swollen cataracts, hypopyon, cicatricial eyelid deformation, lagophthalmos etc. to eye apple atrophy, all caused by the absence of eye surgery assistance at early stages of burn treatment. Conclusion. The proposed patterns and range of surgical assistance including that given in the early stages of treatment, prevented the development of severe complications to the eye and the annexa, reduced the rehabilitation period and improved the functional prognosis of combined burn eye injuries. For citation: Chentsova E.V., Makarov P.V., Verigo Е.N., Petrova A.O., Smirnov S.V. Patterns of treatment of combined burn eye injuries in patients hospitalized in burn units. Russian ophthalmological journal. 2018; 11 (3): 37-42 (In Russian). doi: 10.21516/2072-0076-2018-11-3-37-42

Purpose.To evaluate a 27-gauge aspiration-cutter technique for biopsy of anterior segment neoplasia. Methods. In this retrospective case review, all patients had clinically diagnosed iris or ciliary body tumors. Each underwent surgical iridectomy biopsy utilizing a modification of the Finger Iridectomy Technique (FIT). Specifically, a beveled clear corneal incision was created with a 27-G inked trocar. Sodium hyaluronate 1 % was infused to posteriorly displace the iris and stabilize the chamber. Then a 27-G aspiration-cutter probe was introduced into the anterior chamber, to a position over the tumor. With the aspiration portal abutting the lesion, surgical iridectomy biopsies were obtained using a cut rate of 300 cuts/min and aspiration of 600 mmHg. After each pass, the probe was removed, its tip placed in balanced salt solution and its contents aspirated into a 3-mL syringe. Each syringe was labeled by pass number and tumor location (by clock hour). After obtaining multiple biopsies, the sodium hyaluronate 1 % was removed and the integrity of the wound checked. Main Outcome Measures. Cytologic, tissue histopathology, and immunohistochemical analyses were performed for diagnostic purposes. Visual acuity, intraocular pressure control and procedure-related complications were secondary outcomes measures. Results. Diagnostic specimens were obtained in all 8 cases (100 %). Diagnoses included unifocal melanoma (62 %), diffuse multifocal melanoma (13 %), and melanocytoma (25 %). All 27-gauge corneal wounds were self-sealing. There was no secondary glaucoma, infection, cataract, or vision loss. Two patients had small transient hyphemas which resolved within 10 days. Conclusions. This study reveals that 27-gauge aspiration-cutter assisted surgical iridectomy biopsy was both minimally invasive and effective. It allowed for partial and full thickness iris biopsy. Compared to larger-gauge aspiration cutter assisted biopsy techniques, this 27-G aspiration-cutter probe allowed for even smaller corneal incisions, rapid recovery and tissue for pathology evaluation. For citation: Scripsema N., Finger P.T. A 27-gauge micro incision biopsy technique for tumors of the iris and ciliary body. Russian ophthalmological journal. 2018; 11 (3): 43-8. doi: 10.21516/2072-0076-2018-11-3-43-48

In addition to the classic Coats’ disease characterized by retinal vascular telangiectasias and aneurysmal dilatations surrounded by yellowish intra- and subretinal exudates and developing in somatically healthy children, Coats’-like retinal changes can occur in a number of systemic diseases and complicate the course of other eye pathologies. One of the diseases that occur with Coats’-like exudative vasculopathy is facioscapulohumeral muscular dystrophy, or Landouzy - Dejerine disease. Systemic manifestations of this pathology are the myodystrophic process, which usually affects muscles of the face and arms and distal muscles of the legs, as well as sensorineural hearing loss, respiratory failure, cardiac arrhythmia, in the infantile form - mental retardation and episyndrome. The paper describes two clinical cases involving children with facioscapulohumeral muscular dystrophy, presents the results of treatment, and discusses the importance of a systematic approach in examining patients with Coats’-like retinal changes. For citation: Denisova E.V., Katargina L.A., Kogoleva L.V., Belova M.V., Osipova N.A., Fedoseeva E.V. Eye pathologies in facioscapulohumeral muscular dystrophy (case report and literary analysis). Russian ophthalmological journal. 2018; 11 (3): 50-4 (In Russian). doi: 10.21516/2072-0076-2018-11-3-50-54

Purpose: assess the effectiveness of anti-VEGF therapy given prior to cataract phacoemulsification in preventing the progression of diabetic macular edema. Material and methods. The retrospective study included 15 patients (15 eyes) with type 2 diabetes who underwent cataract surgery. Group 1 included 8 patients who received anti-VEGF therapy before surgical treatment. The last injection of aflibercept was performed no earlier than 2 weeks before the surgery, regardless of central retinal thickness (CRT) increase. Group 2 included 7 patients who did not receive anti-VEGF therapy before surgery. All patients received standard presurgical preparation. The changes in visual acuity and CRT were assessed on days 5 and 14 after cataract extraction. Results. On day 5, the mean increase of visual acuity was 0.34 ± 0.05 in Group 1 and 0.275 ± 0.07 in Group 2. The mean CRT decrease was 47 μm in group 1, while group 2 showed a mean CRT increase of 135 μm. On day 14, the visual acuity was 0.49 ± 0.1 higher than the initial value in group 1, whilst in group 2 it was 0.21 ± 0.07 lower than on day 5. The mean CRT decrease was 80 μm in group 1, while group 2 revealed a 165 μm increase of CRT. Conclusion. Anti-VEGF therapy prior to cataract surgery of patients with diabetic macular edema should become mandatory if CRT has increased, regardless of visual acuity, since visual acuity measurement is impossible due to cloudy lens environments. The use of aflibercept in patients with clinically insignificant diabetic macular edema 1 month before the planned cataract surgery ensures a positive result of visual acuity increase and improvement of anatomical parameters. For citation: Malysheva N.A. The first experience of using anti-VEGF therapy prior to cataract surgery in patients with diabetic macular edema. Russian ophthalmological journal. 2018; 11 (3): 55-61 (In Russian). doi: 10.21516/2072-0076-2018-11-3-55-61

60 outpatients with weak and moderate dry eye syndrome were followed in order to perform a comparative efficiency evaluation of three tear replacement drugs: Stillavit, Vismed and Tears naturale. Changes in the condition of the eye were estimated using biomicroscopy data and diagnostic tests (including Schirmer test, Norn test, Lipkof test, lacrimal meniscus height, and fluorescein eye stain test). The patients were divided into 3 groups, each consisting of 20 patients, who respectively received instillations of two drops of the three drugs, 3 times a day for 40 days. The last examination was given on the 60th day of observation period since the drugs had been discontinued. As a result of treatment, positive changes were observed in all three observation groups. A pronounced improvement was achieved in the condition of the eyelids, conjunctiva and the cornea, as well as in the parameters of the diagnostic tests. In weak dry eye syndrome, full-scale moisturizing and formation of stable tear film is recommended, which is achievable with Vismed 0.18 %. In dry eye syndrome complicated by keratopathy, the therapeutic effect of the tear replacement drug must be strengthened by adding keratoprotectors, which is best achieved by the three-component eye solution, Stillavit. For citation: Jani Е.V., Seliverstova К.Е. Tear replacement combination drugs in the treatment of dry eye syndrome. Russian ophthalmological journal. 2018; 11 (3): 63-9 (In Russian). doi: 10.21516/2072-0076-2018-11-3-63-69.

Refractory glaucoma is one of the most severe forms of the disease, whose distinctive feature is the resistance to hypotensive treatment, including surgery. The paper assesses the effectiveness of topical application of cytostatics in refractory glaucoma surgery, examines the main methods of their use in the intra- and postoperative period, and presents the main complication types. For citation: Zhigalskaya T.A., Krivosheina O.I. Using cytostatics in refractory glaucoma surgery. Russian ophthalmological journal. 2018; 11 (3): 71-5 (In Russian). doi: 10.21516/2072-0076-2018-11-3-71-75

The literary review presents an analysis of modern views of the biomechanical properties of lamina cribrosa (LC) in glaucoma. It is shown that LC deformations in glaucomatous eyes are connected with their morphological and structural disorders at macro- and micro levels even in the early stages of glaucoma development. New visualization technologies of ocular structures, in particular, optical coherent tomography with enhanced depth imaging (EDI) enable in vivo evaluation of biomechanical characteristics of LC and its stress-strain from the data on the changing shape of its anterior surface (curvature index), thickness and deepness, pore dimensions, presence and severity of LC tissue defects. LC changes inherent to glaucoma are significant criteria for the estimation of the risk of glaucoma emergence and its early diagnostics, determination of the stage of the pathological process, and prediction of its progression rate. For citation: Kiseleva O.A., Iomdina E.N., Yakubova L.V., Khoziev D.D. Lamina cribrosa in glaucoma: biomechanical properties and possibilities of their clinical control. Russian ophthalmological journal. 2018; 11 (3):76-83 (In Russian). doi: 10.21516/2072-0076-2018-11-3-76-83

The literary review presents the results of domestic and foreign studies of blood flow in the arteries and veins of the eye and orbit using color Doppler Imaging (CDI) and pulsed dopplerography. These methods are used to obtain the data on linear blood flow velocity and vascular resistance in different areas of the ocular vascular system and detect the correlation thereof with the severity of vascular disorders. CDI demonstrates the possibilities of multiple application in order to obtain reliable results in the diagnosis and evaluation of the effectiveness of treatment of the vascular pathology of the eye. For citation: Kiseleva T.N., Zaitsev M.S., Ramazanova K.A., Lugovkina K.V. Possibilities of color Duplex Imaging in the diagnosis of ocular vascular pathology. Russian ophthalmological journal. 2018; 11 (3): 84-94 (In Russian). doi: 10.21516/2072-0076-2018-11-3-84-94

A new diagnostic method of ocular microcirculatory bloodstream - optical coherence tomography angiography (OCTA) has helped obtain new information on the anatomy and physiology of microcirculatory bloodstream of the retina and the optic disc. The review provides literary data on the reduction in peripapillary and macular blood flow in various glaucoma stages. These changes are shown to correlate with structural and functional disorders. It is emphasized that OCTA is a prospective method for early detection of glaucoma and for glaucoma monitoring. For citation: Kurysheva N.I. OCT angiography and its role in the study of retinal microcirculation in glaucoma (part two). Russian ophthalmological journal. 2018; 11 (3): 95-100 (In Russian). doi: 10.21516/2072-0076-2018-11-3-95-100

The literary review focuses on the dysfunction of endoplasmic reticulum (EPR), the role of EPR stress and oxidative stress in the pathogenesis of optic nerve damage. The data on the molecular mechanisms of optic nerve damage are given: these include the expression of genes and molecular chaperones, which are related to EPR stress and antioxidant protection. The studies into oral administration of bilberry extract anthocyanosides showed elevated levels of molecular chaperones in retinal ganglion cells (RGC). The chaperones suppress EPR stress and produce a positive effect on the metabolic activity of the cells. Thus, bilberry extract anthocyanosides may be considered as neuroprotectors in combined treatment of retinal pathology and glaucoma. For citation: Neroev V.V., Kiseleva T.N., Zaitsev М.S. Molecular mechanisms of optic nerve damage: the role of anthocyanozides in the prevention of retinal ganglion cell death. Russian ophthalmological journal. 2018; 11 (3): 101-6 (In Russian). doi: 10.21516/2072-0076-2018-11-3-101-106

The review gives a detailed account of research data on myopia predictors. The most reliable predictors include cycloplegic sphere equivalent of axial refraction less than +0.75 D in children under 6 years, the axial length of more than 23.5 mm with the refractive error ≤ +1.0 D, myopic parents, axial length / corneal radius ratio (AL/CR) of less than 3, AC/A ratio over 4 Δ/D, pseudomyopia, heterophoria of more than 4 Δ, peripheral refraction of the nasal half of the eye at 20-30° higher than the temporal refraction in both eyes more than 0.5 D, reduced outdoor activity and high visual activity. Measures of prevention of myopia development are presented: adhering to the regiment of visual activity load, ergonomic stereotypes of near visual work, creation of binocular central and peripheral myopic defocus - positive spectacles or spectacles with Perifocal-P lenses with a central refraction of +0.25 D for permanent wear, home accommodative training exercises, physical exercises and sports, outdoor activity at least 90 minutes a day during daylight hours. For citation: Tarutta E.P., Proskurina O.V., Tarasova N.A., Ibatulin R.A., Kovychev A.S. Myopia predictors as a starting point for active prevention of myopia development. Russian ophthalmological journal. 2018; 11 (3): 107-12 (In Russian). doi: 10.21516/2072-0076-2018-11-3-107-112