Objective: to assess the effectiveness of tear substitutes in patients suffering from dry eye syndrome (DES). Material and methods. 100 patients with an established diagnosis of mild to moderate DES, averagely aged 42.0 ± 2.1, were divided into three groups: group 1 involving 33 patients (54 eyes, 13 men and 20 women) aged 42.7 ± 2.13 with mild DES, who were treated by low viscosity eye drops, group 2 involving 33 patients (56 eyes, 13 men and 20 women) aged 41.4 ± 2.07 with moderate DES, who were treated by moderate viscosity eye drops and group 3 involving 34 patients (52 eyes, 14 men and 20 women) aged 41.9 ± 2.1 with moderate DES, who were treated by high viscosity eye drops. Treatment results were evaluated after 1 month on the basis of complaints, objective examination data and indicators of the functional tests Results. The complaints (of discomfort, eye strain, fatigue when working with text, eye redness, lacrimation, burning and cramping in the eyes) became less severe, and so did the objective signs of DES. The functional test indicators showed an improvement, too. The best results of the treatment were noted in group 3, where the tear production indicator (Schirmer’s test) increased by 68.1 %. This indicator increased by 66.7 % and 61.5 % in groups 1 and 2, respectively. The LIPCOF test results dropped 3.9 times in group 1 and only 2,3 times in groups 2 and 3. Conclusion. Tear substitutes must be used in DES as the first line of conservative therapy. The improvement of subjective evaluations of the patients and the data of objective research in all three groups is the result of an adequate selection of tear substitutes drugs of a certain degree of viscosity according to the severity of DES.

Achromatopsia (ACHM) is a rare autosomal recessive disease. Its mutation spectrum is well described in other populations, but the data on ACHM prevalence and features in Russia are insufficient. Purpose. To describe clinically and genetically the Russian cohort of AHCM for the potential use of targeted treatment approaches, including gene therapy. Material and methods. Out of 18 patients with clinical manifestations of ACHM, 10 patients were chosen (6 with no kinship relatedness and 4 with kinship relatedness) aged 12.3 ± 5.8 years. These patients underwent standard ophthalmologic examination: visometry, perimetry, biomicroscopy, ophthalmoscopy, as well as optical coherence tomography, electroretinography, and color test on distinguishing color shades, in order to determine the clinical characteristics of ACHM. Molecular genetic confirmation of the clinical diagnosis was performed by high-performance parallel DNA sequencing. An in silico analysis of pathogenetic pathways of the clinical picture in 10 patients with confirmed ACHM was performed. Results. In the examined Russian patients, previously determined mutations in the CNGA3 and CNGB3 genes were confirmed. The most common mutation was a single nucleotide deletion with a reading frame shift in the 10th exon of the CNGB3 gene; a missense mutation in the 8th exon of the CNGA3 gene was second frequent. One patient had mutations in the CNGA3 and CNGB3 genes. Segregation analysis confirms the autosomal recessive nature of disease inheritance. Mutations in the CNGB3 gene have been observed to lead to more serious clinical manifestations than mutations in CNGA3. Conclusions. The analysis of the Russian ACHM cohort shows that mutations in the CNGA3 and CNGB3 genes are the main cause of the development of the disease. A complete molecular genetic confirmation of the clinical diagnosis has been obtained, which is necessary for prescribing targeted treatment to patients, including gene therapy.

Purpose. A comprehensive assessment of the state of macular retina after phacoemulsification of two eyes performed at different intervals between operations according to optical coherence tomography (OCT) data. Materials and methods. We examined 93 patients (186 eyes) aged 65.7 ± 1.6 years with bilateral age cataract after phacoemulsification of both eyes performed at different intervals between the operations: 1–5 days — 22 patients (44 eyes), 1–3 weeks — 31 patients (62 eyes), 4 or more weeks — 40 patients (80 eyes). Before surgery, visual acuity of the first eye was, on average, 0.38 ± 0.05, while that of the second eye averaged 0.41 ± 0.05. The operations were performed on the «Infiniti Vision System» (Alcon) phacoemulsifier by Ozil technology through a corneal tunnel 2.2 mm long by one and the same surgeon with no complications. The Phaco chop technique was used. All patients underwent retinal examination by Optovue Avante OPT (OPTOVUE, USA) according to the scanning Protocol Raster and, partly, by Retina map (including central retinal thickness and volume of the macula in the 5 mm zone) before the operation, and 1, 2, 4, 12 weeks after surgery, on both eyes. Results. Before surgery, the average central retinal thickness and the volume of the retina in the area of 5 mm, in both operated eyes were almost identical: the first eye revealed 271.0 ± 7.5 μm, and 5.625 ± 0.040 mm³, the second one revealed 270.0 ± 8.5 μm, and 5.628 ± 0.040 mm³. In the postoperative period, the results showed no statistically significant differences (p > 0.05) between the central retinal thickness and volume in the 5 mm zone before and after surgery in both eyes, regardless of the intervals between operations. Conclusion. The absence of a significant difference in the macular retina response to surgery, confirmed by OCT data, indicated the safety of operations on both eyes regardless of the intervals between them.

Purpose: to analyze quantitative indicators and qualitative changes of the choroid in children with anterior uveitis as measured by optical coherence tomography (OCT) and assess the possibility of using the identification of opportunities for their use in evaluation of uveitis activity and the course of disease. Material and methods. 24 children diagnosed with anterior uveitis (38 eyes), aged 6 to 17, underwent standard ophthalmological examination and OCT scanning with an enhanced depth image module (OCT-EDI). The thickness of the choroid was measured manually by one researcher in 5 points: in the subfoveolar zone and at a distance of 3 mm from the fovea nasally, temporally, upwards and downwards. Most of the patients (20 children, 31 eyes) underwent a follow-up OCT to evaluate the choroid at diverse times since the start of the inflammatory process and for diverse degrees of its activity. OCT values were also compared with literature data on normal eyes. Results. For all areas studied, the thickness of the choroid was significantly higher in eyes with active and moderate inflammation than in those with remission of uveitis, and higher than in healthy eyes. The average subfoveal thickness of the choroid in eyes with active, moderate, subactive uveitis and with remission of uveitis was 398.80 ± 85.94, 413.61 ± 73.89, 368.53 ± 68.54 и 338.53 ± 51.50 μm, respectively (in healthy eyes — 341.96 ± 74.70 μm). A moderately strong positive correlation was found between the choroidal thickness and uveitis duration for subfoveal, nasal and suprafoveal points of measuring. Conclusion. A correlation between the choroid thickness and uveitis activity and duration was detected, indicating the involvement of the choroid in the inflammation process. Due to noticeable variability of the data caused by a variety of factors, a dynamic measuring of choroid thickness is recommended for evaluating uveitis activity and course of the disease as well as treatment planning. The OCT method of choroid thickness measurement should be included in the regular examination of children with anterior uveitis.

Purpose: to determine the clinical efficacy of a non-preservative drug based on sodium hyaluronate 0.3 % (Gilan) in the correction of secondary dry eye syndrome (DES) manifestations in patients after cataract phacoemulsification (CPE), based on monitoring clinical and functional characteristics of the ocular surface. Materials and methods. 62 patients with immature cataracts underwent CPE with IOL implantation. Special examination techniques (Schirmer's test, Norn test, assessment of conjunctival hyperemia on the ORA scale (Ocular Redness Analysis)) were performed before the operation, 7 days and 30 days after it. The main group of patients (31 patients) received, in addition to the standard postoperative treatment, a non-preservative drug based on sodium hyaluronate 0.3 % (Gilan), whilst the control group (31 patients) received standard therapy. Results. The parameters studied showed a significant worsening in patients of both groups by the 7 th day after surgery, with no statistically significant difference between the groups. 30 days after CPE, the values of the Schirmer I test in the main group increased from 7.4 ± 2.3 mm (7 days after surgery) to 12.6 ± 1.7 mm, which significantly exceeded the respective values in patients of the control group: from 7.2 ± 2.1 mm (7 days after surgery) to 8.7 ± 2.0 mm (p < 0.001). Norn test scores also increased from 4.3 ± 1.9 s (7 days after surgery) to 7.9 ± 1.3 s in the main group and from 4.1 ± 2.1 s (7 days after the operation) to 5.3 ± 1.2 s in the control group with a statistically significant difference between the groups (p < 0.001). Conclusions. The use of a non-preservative drug based on sodium hyaluronate 0.3 % (Gilan) as part of combined therapy after CPE helps to effectively reduce the main manifestations of dry eye syndrome and improves postoperative rehabilitation.

Purpose. To evaluate the economic and clinical results of the aflibercept and ranibizumab angiogenesis inhibitors in the treat-and-extend regimen in patients with the “wet” form of age-related macular degeneration (wAMD). Materials and methods. We analyzed cost minimization, impact on the budget and “missed opportunities” for the treatment of patients with wAMD using intravitreal injections (IVI) of aflibercept compared to ranibizumab in the “treat-and-extend” regimen (T & E). Costs were calculated with regard to the budget of the system of compulsory health insurance. To calculate the number of IVI, network meta-analysis data (P. Lanzetta, et al., 2019), including a matching-adjusted indirect comparison of aflibercept and ranibizumab in wAMD patients in the T & E regimen, were taken into account. The budget impact analysis involved a cohort of 1,000 wAMD patients. To assess the stability of the results, a one-factor multicomponent sensitivity analysis was used. Results. Network meta-analysis data showed that aflibercept and ranibizumab used in the T & E regimen revealed comparable changes in the maximum corrected visual acuity; however, the use of aflibercept required a significantly lower (by 6 procedures in two years) number of IVI compared to ranibizumab. Analysis of cost minimization showed that the use of aflibercept can reduce costs by 36 % in two years compared to ranibizumab in the T & E regimen. The use of aflibercept in the T & E regimen with wAMD will reduce the cost of compulsory medical insurance by 281 million rubles in two years of therapy per 1,000 patients. The analysis of “missed opportunities” showed that budget savings of the compulsory medical insurance as a result of transferring 1,000 patients from ranibizumab to aflibercept will allow an additional 563 patients to be treated in two years. A sensitivity analysis confirmed the robustness of the study results. Conclusion. Treating wAMD with aflibercept in the T & E regimen saves a significant part of health protection resources compared to using ranibizumab in the same regimen.

The aim of the work is to find out how the ABCB1 C3435T polymorphism gene is associated with the risk of early choroid melanoma (ECM) and to study the genotypes distribution frequency of the ABCB1 polymorphic gene in ECM patients. Material and methods. The prospective study included 26 previously untreated ECM patients (7 men and 19 women) aged 32 to 80 (mean age 59.0 ± 14.3 years). All patients underwent general ophthalmological examinations and special instrumental diagnostics (ultrasound examination, spectral optical coherence tomography, OCT angiography). Monolateral ECM was diagnosed in 25 patients (96 %), bilateral ECM in 1 patient (4 %). In all, 27 eyes were affected. The material for the study was genomic DNA taken from peripheral blood leukocytes from patients with ECM. Genotyping was carried out using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Results. Significant associations were found between (1) the CC genotype and the risk of ECM and (2) between the TT genotype and a low risk of tumor development. A reliable association of the CT genotype of the ABCB1 C3435T polymorphism gene with the presence of orange pigment on the tumoral surface and the familial cancer history of ECM patients was revealed. Conclusion. In the future, the obtained results can be used in the development of innovative approaches predicting the course of melanoma, and in patient screening.

Purpose: to estimate the cumulative effect of different preoperative predictors on the functional results of the removal of idiopathic epimacular membranes (EMMs) 12 months after the surgery. Material and methods. 62 patients (63 eyes) with idiopathic EMMs aged 49 to 85 were operated according to the standard procedure and followed up for 12 months. The monitoring included, in addition to standard methods, Amsler grid test and optical coherence tomography of the macula. Results. Throughout the postoperative period, significant improvement in visual acuity, reduction of metamorphopsias, and restoration of both inner and outer fovea layers as well as macular thickness were observed. Twelve months after surgery, visual acuity strongly correlated with baseline visual acuity (R = 0.571, p < 0.05), the span of the defects of the external limiting membrane (ELM) (R = -0.359, p < 0.05), and interdigitation zone (IZ) defects (R = -0.394, p < 0.05). At the end of the follow-up period, metamorphopsia value correlated the most strongly with the duration of the disease (R = 0.380, p < 0.05), baseline visual acuity (R = -0.398, p < 0.05), initial metamorphopsias intensity (R = 0.271, p < 0.05), central retinal thickness (R=0.318, p<0.05) and the ectopic inner macular layers (R = 0.358, p < 0.05). A trend was observed toward the correlation between the final visual acuity and presurgical metamorphopsias severity (R = 0.248, p = 0.113), thickness of EMM (R = -0.246; p = 0.111), central retinal thickness (R = -0.203, p = 0.198) and the presence of a cystoid macular edema (CME) (p = 0.181). A correlation was also observed between metamorphopsias severity noted 1 year after surgery and the length of ELM (R = 0.222, p = 0.159) and IZ (R = 0.211, p = 0.201) defects before surgery. Regression with a 0,597-determination coefficient showed that the baseline visual acuity and central retinal thickness had the biggest impact on the visual acuity measured 1 year after surgery (p < 0.001 and p = 0.002, respectively). Conclusions. The surgery for idiopathic EMMs leads to a significant improvement in the quality of visual functions and anatomical characteristics of the macula. Restoration of outer macular layers may indicate the ability of photoreceptors to repair. The most significant preoperative predictors which determine the quality of visual functions after EMMs removal are thickness of the membrane, central retinal thickness, deformation degree of the inner foveal layers, state of photoreceptors, CME, visual acuity and metamorphopsias severity. At the same time, the baseline visual acuity and central retinal thickness had the biggest impact on the visual acuity achieved by surgery. Early surgery is reasonable, while the evaluation of both anatomical and functional results is advisable not earlier than 12 months after surgery.

Purpose. To evaluate antihypertensive efficiency and safeness of Xenoplast, Glautex, and Ex-PRESS drainage during glaucoma surgery. Material and methods. 249 patients with primary open angle glaucoma (253 eyes) underwent antihypertensive operations with Xenoplast (group I, 121 patients aged 68.6 ± 7.7 yrs), Glautex (group II, 49 patients aged 66.8 ± 7.7 yrs) and Ex-PRESS (group III, 79 patients aged 67.9 ± 8.3 yrs). In groups I and II, drainages were implanted during penetrating and non-penetrating surgery. Long-term results were traced for 2 years. Results. In the early postoperative period, all groups had complications typical for antiglaucoma surgery without drainage: I — 14.8 %, II — 16.8 %, III — 16.8 %. An absolute success of the operation (normalization of IOP without additional antihypertensive therapy) was achieved as follows. In group I for patients with non-penetrating deep sclerectomy it was achieved in 98.4 % of cases at the moment of discharge from hospital, whereupon the figure fell to 15.4 % in 18 months. In group I patients, with trabeculectomy the success was achieved in 96.7 %, dropping to 6.7 %. In group II for patients with non-penetrating deep sclerectomy the success claimed 96.3 %, but after 12 months it vanished completely. In group II with trabeculectomy the success reached 95.7 %, but dropped to 16.7 % after 24 months. In group III the success rate at the moment of discharge was 96.3 % but it dropped to 16.7 % after 24 months. In cases if target pressure could not be achieved the surgery was repeated. Conclusion. The absolute success originally achieved in all groups (96.3–98.4 %) was not persistent and after a 2-year observation, tended to disappear. The effect lasted longer in eyes after trabeculectomy with Glautex and Ex-PRESS. The hypotensive effect of primary antiglaucoma surgery was higher in penetrating operations.

In premature babies, plastic changes develop in the neural retina, which, depending on the severity of retinopathy of prematurity (ROP), are a manifestation of adaptive or non-adaptive plasticity. In various experimental studies on animal ROP models, the conditioning effects of intermittent white light stimulation and various mechanisms of the positive effect of red and ultraviolet radiation on the plasticity of the retina have been demonstrated, which allows phototherapy to be considered as a promising modifying treatment for ROP supplementing the main therapy. Taking into account that light-dependent processes are involved in the pathogenesis of ROP, we also hypothesize that fractal phototherapy with complex-structured optical stimuli, as a method of activating adaptive neuroplasticity, can be most effective in the complex of methods for preventing and treating ROP.

The first part of the review was focused on modern methods of instrumental diagnostics of primary open-angle glaucoma [1]. Diagnostic possibilities and informativeness of objective measurable parameters were discussed with regard to special criteria, called clinical endpoints. The second part of the review is dedicated to finding methods of early diagnosis and criteria of the progression of glaucomatous optic neuropathy.

The review presents the main clinical forms of eye allergy. The modern classification of conjunctival allergic diseases (CAD) divides them into several types according to the presence or absence of proliferative changes complicated by atopic dermatitis or mechanical artifactual irritation. These include: 1) allergic conjunctivitis (AC) without proliferative changes, including seasonal allergic conjunctivitis and chronic allergic conjunctivitis, in which the symptoms persist the whole year; 2) atopic keratoconjunctivitis, a chronic allergic conjunctival disease affecting patients with atopic dermatitis, 3) spring keratoconjunctivitis with conjunctival and proliferative changes — papillary conjunctival hyperplasia with the involvement of the cornea (superficial punctate keratitis, erosion, persistent epithelial defect, sterile corneal ulceration), 4) giant papillary conjunctivitis (GPC) accompanied by proliferative changes in the upper lid and the arch of the conjunctiva of the eyeball, caused by mechanical irritation factors (contact lenses, eye prostheses, or surgical sutures). To treat these conditions, the following groups of medications are used: artificial tears; topical antihistamine drugs; mast cell membrane stabilizers; dualaction drugs, preferably without preservatives, nonsteroid anti-inflammatory medications and vasoconstrictors having side effects. Olopatadin 1 mg/1 ml, preservative free (Olofadin -ECO), has certain advantages due to the fact that it combines antihistamine and membrane stabilizing action. Due to the presence of an antihistamine component in the composition, an acute reaction is stopped, while the effect of the drug is accumulated due to the presence of a membrane-stabilizing component. It is safe for long-term therapy.

The review presents the data on the use of hybrid contact lenses (HCL), a modern method of contact correction of ametropias of diverse origins. A HCL has a central rigid optical zone made of highly gas-permeable material and a flexible peripheral part made of hydrophilic material. These lenses combine the optical effect of gas-permeable corneal lens with the comfort and stable fitting of soft contact lenses. Compared with the corneal (RGP) lenses, HCLs are more comfortable, often are better centrated and more stably fit on the eye. HCLs are successfully used in various refractive disorders: ametropias (with regular cornea), irregular astigmatism, presbyopia, including that combined with astigmatism. This type of lens is a good option of contact correction for patients who have high requirements to the quality of vision.