Purpose: to evaluate the effectiveness of platelet-rich plasma (PRP) lysate in patients with corneal erosion or posttraumatic scarring of eyelid tissues.

Material  and methods. The study involved 30 patients aged 22 to 82 (51.5 ± 19.1 years): 10 with persistent corneal erosions, who were treated in 2 stages (2 weeks of standard keratoprotective therapy, then treatment supplemented  with instillations of PRP lysate) and 20 patients with post-traumatic  scarring of eyelid tissues, who were divided into a clinical group and a comparison group. PRP lysate was produced in the cell transplantation  and immunotyping  laboratory of N.V.  Sklifosovsky Research  Institute  for Emergency Medicine.

Results. In group 1, already on the 3rd day of PRP lysate use, a positive dynamic of the cornea was observed: all patients had fewer complaints of pain, photophobia, and lacrimation. Corneal biomicroscopy, performed daily over the entire epithelization period, revealed a decrease in hyperemia of the tarsal and bulbar conjunctiva and corneal edema, which indicated a weakened inflammatory response. On average, the area of the cornea at the start of traditional therapy was 21.6 [19.6; 30.65] mm2. After two weeks of treatment, at the time of adding PRP lysate, the average area of erosion fell to 15.7 [12; 18.9] mm², after a week of treatment with lysate, it dropped to an average of 2.35 [0.4; 4.3] mm². On day 14, all patients revealed complete epithelialization  of the corneal defect. In patients with post-traumatic  eyelid tissue scars, after a 3-month-long use of PRP lysate (study group), an improvement  was noted in the cosmetic and functional  state of the eyelids, on average by 4 points (M_e = 12 [10; 12] points before and 8.5 [8; 9] points after treatment (on the Manchester scar assessment scale), in contrast to the patients who received no anti-scar  therapy (comparison group), as the latter showed a deterioration in the condition of eyelid scars by 1–2 points (M_e = 11 [10.25; 11.75] points at the beginning and 12 [11; 12] points at the end of the observation period). The acoustic density of scar tissue in the study group approached the normal values, in contrast to the comparison group, in which scar tissue appeared to be hypoechoic.

Conclusion. Using PRP lysate aimed at improving the repair and regeneration processes in patients with corneal erosion or post-traumatic  scarring of eyelid tissues is promising and requires further clinical study.

Purpose: to determine the incidence and clinical course of retinopathy of prematurity (ROP) in modern developmental  care conditions as based by the data of a level III perinatal center.

Material  and methods. A retrospective study of 920 premature infants of the ROP at-risk cohort managed by the Neonatology department of Moscow Regional Perinatal Center over the 2-year period of 2017–2018 was performed. Retinopathy  was graded and treated following the respective Federal clinical guidelines.

Results. Of the 920 infants who met the screening criteria, ROP was detected in 193 (28.5 %) infants; 49 infants (7.2 %) required treatment.  Of all general somatic factors, the duration of artificial ventilation of lungs showed the strongest correlation with the frequency of development and severity of ROP.  In infants with birth weight > 1000 g, the incidence of severe forms of ROP correlated with the presence of necrotizing enterocolitis and intraventricular  hemorrhages, while in children with a lower body weight at birth no such correlation was detected. Bronchopulmonary dysplasia was not found to affect the development of ROP.  In groups of infants with birth weight of 1000–1499 g and 500–999 g, the frequency of transfusions of washed red blood cells with depleted leukocyte and thrombocyte levels was generally higher in children with ROP, both with spontaneous and induced regression, but showed no difference between the two subgroups.

Conclusion. Severe somatic pathology does not always accompany the progression of ROP to the threshold stage. So, in order to optimize ROP screening, it is necessary to search for new more accurate criteria for ROP development and progression risk.

Purpose: statistical evaluation of the diagnostic and differential diagnostic significance of spectral optical coherent tomography (SOCT) and microperimetry methods in patients with (1) optic neuritis (ON) with multiple sclerosis (MS) manifestation; (2) inflammation-related ON and (3) optic nerve atrophy (ONA) caused by MS.

Materials  and methods. The results of examination  of the three groups of patients were processed by correlation and multivariate  analysis and binary logistic regression. The threshold of electrical sensitivity (EST) and electrical lability (EL) were determined on a Fosphen-tester using a standard technique. S-OCT was performed on Cirrus HD-OCT (Carl Zeiss Meditec Inc.,  USA) using the RNFL Thickness  Analysis, Ganglion Cell Analysis programs. Computer microperimetry was done on MP-1 (Nidek technologies, Vigonza, Italy)  using the macula 12º 10 dB program.

Results. EST  of the retina was found to have a strong bilateral correlation with the average retinal sensitivity, RNFL thickness and thickness of the upper temporal and upper segments layer of the complex GCL + IPL. Diagnostic parameters significant for visual analyzer disorders caused by MS were revealed and confirmed, including the average retinal sensitivity drop within 6º from the center of the visual field according to microperimetry (p < 0.0005), the thinning of RNFL (p < 0.005) and complex GCL-S + IPL, according to SOCT (p = 0.004). intragroup comparisons revealed the diagnostic significance of SOCT in early diagnosis of ONA due to MS (p < 0.0005).  It was found that if the RNFL was 62 microns or less, the GCL-S + IPL  was 52 microns or less (in the inferior segment it was 50 microns or less, and in the upper segment it was 51 microns or less) then, with a sensitivity of 100 % and a specificity of 87.5–93 %, it is an evidence of the atrophy of the optic nerve.

Conclusion: average retinal photosensitivity within 6º from the center of the visual field, RNFL thickness,  thickness GCL-S + IPL, including that in the superior, superior temporal and inferior segments can be considered as diagnostically significant values in OH inflammatory-related and demyelinating OH and the development of ONA due to MS.

The purpose is to study the shifts in the subpopulation composition of blood lymphocytes in patients with infectious corneal lesions, depending on the number of keratoplasties (KP) undergone by the patient.

Material and methods. We examined 53 patients (aged 18 to 79) with infectious keratitis, divided into three groups, depending on the number of KP: group I (n = 27) with no KP; groups II (n = 12) who underwent one KP; group III (n = 14) who has two or more KPs. The control group consisted of 33 apparently healthy donors. The relative and absolute content of subpopulations of T lymphocytes (CD3+), T helper cells (CD3+CD4+CD8-), T cytotoxic cells (CD3+CD4-CD8+), double positive T lymphocytes (CD3+CD4+CD8+), NK cells (CD16+CD56+), and B lymphocytes (CD19+) was determined using flow cytometry, the CD4+/CD8+ index was calculated.

Results. The analysis of the total population of T lymphocytes and the CD3+CD4+ subpopulation showed a significant increase in the absolute number of T lymphocytes in group II (CD3+: 1.77 ± 0.10 × 10 ⁹/l; T helpers: 1.02 ± 0.09 × 10 ⁹/l) as compared  to group I (1.44  ± 0.06 × 10 ⁹/l and 0.85 ± 0.03 × 10 ⁹/l, respectively).  In group III, there was a substantial  significant increase in the relative amount of CD3+CD4+(50.1 ± 1.9 %) as compared to groups without KP (I: 43.2 ± 1.5 %) and one surgery group (II: 43.3 ± 1.8 %), which led to a significant increase in the ratio of CD4+/CD8+ in group III (2.16 ± 0.19). In the blood of all patients (group I: 0.020 ± 0.003 × 10 ⁹/l; II: 0.030 ± 0.002  10 ⁹/l; III: 0.030 ± 0.001  10 ⁹/l) a significant increase in the absolute number of double positive T lymphocytes (CD3+CD4+CD8+) as compared to the control (0.009 ± 0.007  10 ⁹/l)  was revealed.

Conclusion. The changes revealed in the cellular component of the immune status, common for all patients were characterized exclusively by shifts in the T link of immunity. Individual analysis of the nature of shifts of T helper cells and CD4+/CD8+ going upward from the norm allowed us to qualitatively identify group III (with two or more KPs). The obtained data are important for the development of the criteria for predicting high-risk keratoplasty and confirm that immunosuppression is needed.

The purpose is to develop a new technique of eliminating the retraction of the upper eyelid with maximum cosmetic effect duration, retaining eyelid functionality.

Material and methods. The study group included 14 patients (16 eyes), aged 16 to 69 years (45.8 ± 14.4) with upper eyelid retractions. A polytetrafluoroethylene  (PTFE) implant was used as a spacer graft to eliminate the retraction and lengthen the levator. The comparison group was composed of 12 patients (16 eyes) aged 24 to 58 years (41.5 ± 10.4) with upper eyelid retractions, who underwent a surgical intervention consisting of levator mobilization (in some cases, with lateral horns crossing), cutting off the levator from the tarsal plate and refixing with 3–4 sutures with diastasis.

Results. In the study group, the recession value of the upper eyelid corresponded to that calculated prior to surgery. After 1 and 6 months, a positive result was noted, manifesting itself by decreased palpebral fissure and a good cosmetic effect. Lagophthamos  was absent. In the comparison group, the position of the upper lid did not correspond to that expected. Also, hypoeffect progression was observed after 6 months to 2 years after the surgery. A comparative  analysis was conducted  between the elimination of plastic retraction with local tissues and using a PTFE implant.

Conclusion. The proposed method which makes use of PTFE allows obtaining a controlled recession of the levator and achieving a more pronounced and stable effect than in the case when the recession of the levator was achieved by local tissue plastics.

Purpose: to study the structural and microcirculatory changes in the optic nerve and retina in patients with primary open-angle glaucoma (POAG)  in diabetes using OCT  and OCT-A.

Material  and methods. The study involved 156 eyes of 104 patients, divided into 4 groups: group 1 — 47 eyes (26 patients aged 66.96 ± 6.05) with stage I POAG and diabetes, group 2 — 36 eyes (24 patients aged 64.64 ± 7.91) with stage I POAG; group 3 — 36 eyes (28 patients aged 63.03 ± 7.10) with stage III POAG and diabetes; group 4 — 37 eyes (26 patients, aged 69.70 ± 7.44) with stage III POAG. All patients underwent a complete ophthalmologic examination, spectral OCT, OCT-A of the optic disc and the macula.

Results. In groups 1 and 3 (with POAG and diabetes), a decrease in the parameters of best corrected visual acuity and MD was revealed, which became worse as glaucoma progressed. A thinning of retinal nerve fiber layer (RNFL), neuroretinal rim, ganglion cells and inner plexiform layer (GCL  + IPL) was noted, with the lowest values in patients with stage III POAG and diabetes. The analysis of hemodynamics showed a pronounced decrease in perfusion (39.04 ± 3.42 %) as well as vascular density of the optic disc (0.35 ± 0.04 / mm) and the macular area (22.96 ± 5.82 % and 12.19 ± 4.04 / mm) in stage III of POAG and diabetes. This decrease is strongly correlated with functional  and structural changes, the stage of glaucoma and the presence of diabetes.

Conclusion. A comparative  analysis of structural, functional and vascular changes between groups of patients with stage I and III POAG, both accompanied and unaccompanied by diabetes, revealed signs of significant deterioration in perfusion of the optic nerve and retina in patients with diabetes. In combined  glaucoma and diabetes, early diagnosis, monitoring and adequate timely therapy require careful attention of specialists.

Purpose. To study refractive indices in children with a predisposition to myopia and hyperopia after congenital cataract extraction and IOL  implantation.

Material  and methods. 60 children (95 eyes) aged 1 to 12 years were examined  for refraction error 30–36 months after congenital cataract extraction and IOL implantation. The examination  included case history data to find out whether the children were  predisposed to myopia or hyperopia before IOL implantation.

Results. Refraction increase in pseudophakia is observed both in and beyond the risk group. Myopia and emmetropia disproportionate to age were manifested in most children with a predisposition to myopia (70.2 %). The authors believe that abnormal refractive changes may be a result of inadequate selection of IOL  optical power, explained by the fact that it is calculated by a universal formula irrespective of the risk of abnormal refraction changes in children and specific biometry in the risk group. The high frequency of unplanned refraction in case of pseudophakia  in children predisposed to abnormal refractive changes is probably due to either obscuration and refractive amblyopia.

Conclusion. In children at risk of abnormal refractive changes, it is advisable to determine an individual  correction coefficient for the formula calculating IOL  power prior to IOL  implantation, to correct residual refraction and to treat amblyopia.

The purpose of this study was a comparative assessment of the refraction and the axial length (AL)  changes occurring in the operated and unoperated  eyes of patients with anisometropic  myopia who underwent  unilateral  excimer laser correction.

Material  and methods. We observed 13 patients (8 women and 5 men) aged 21 to 53 years (34.2 ± 8.6) with anisometropic myopia (averagely, with spherical equivalent of refraction -3.87 ± 1.77 D in one eye and 0.71 ± 0.71 D in the other), who underwent unilateral LASIK. The observation period was 3-5 years (averagely 3.5 ± 1.1 years). The observation included autorefractometry on a Nidek ARK-530A apparatus, ultrasound biometry on a Nidek US-1800 Echosсan (Japan), and pachymetry on a GALILEI G6 (Ziemer, Switzerland).

Results. No significant changes in refraction or axial length were observed either in operated or fellow eyes. Changes in the axial length were controversial: 7 operated and 7 fellow eyes showed an increasing tendency while another 6 operated and 6 fellow eyes showed a decreasing tendency (p > 0.05).

Conclusion. The data obtained fail to support the assumption that excimer laser reshaping of the cornea produces an inhibitory effect on the development of myopia.

Purpose: to conduct a clinical and morphological study of the role of corticosteroids in the healing of the ulcerative defect on an experimental model of the bacterial corneal ulcer.

Material  and methods. The developed model of the bacterial corneal ulcer was used. Rabbits with bacterial corneal ulcer were divided into 4 groups of 10 animals (10 eyes) each. Group 1 received local antibacterial treatment. Groups 2 and 3 additionally  received injections of 0.2–0.3 ml of Dexamethasone 0.1 % solution once per day (parabulbarly  or under the skin of the back,  respectively). Group 4 received no treatment but was checked  clinically after ulcer modeling. Structural changes in eye tissues were assessed by histopathological examination  using an examination  on a Leica microscope system with a magnification of 100 to 600.

Results. Addition of corticosteroids in the early period of bacteria ulcer treatment contributes to an inhibition of the inflammatory process, reduces the action of collagenolysis processes and the size of the ulcer defect, and suppresses angiogenesis, which leads to an improvement in scar tissue quality.

The etiology of Abrikossoff granular cell tumor remains uncertain. No clinical data on the growth of the intraocular granular cell tumor could be found in Russian literature available to the authors.

Purpose: to describe the growth and particularities of the Abrikossoff tumor and to offer plausible ideas concerning its etiology.

Material and methods. For a year, we observed a clinical case of the growing tumor in a female patient who had refused to have her eyeball enucleated.  Every 3 months the patient was subjected to biomicroscopic examination, В-scan, and optical coherence tomography.

Results. After the hemophthalmus treatment,  the patient revealed a dark brown neoplasm with a slight prominence from the optic disk to the macular area with no distinct boundaries. A year later, enucleation was performed and, an intraocular granular Abrikosoff cell tumor was diagnosed by the results of an immunohistochemical test. A low expression of vimentin was detected, accompanied  by a strong and stable S-100 expression. Melan A, OLA or Ki-67  were not expressed.

Conclusion. Since the tumor does not respond to chemotherapy or radiation therapy, the only treatment method is enucleation or complete removal in case of any other localization.

In recent years, the range of combined narcotic drugs has widened. New chemical modifications  have emerged, including so-called designer drugs, whose action on the body and in particular on the state of vision is increasingly difficult to determine. While the problem of drug abuse is growing drastically, timely detection of a possible toxic damage to the eye induced by drugs and reliable diagnosis differentiating such damage from other etiologies becomes a topical practical issue. The paper presents a clinical case of poppers maculopathy  (poppers being a slang name of aromatic volatile alkyl nitrite compounds). Ophthalmological  manifestations and differential diagnostic criteria of the damage are described. The mechanisms of action and possible treatment methods are discussed.

Purpose: to study the changes of visual function in patients with combined pathology involving multiple sclerosis and pituitary adenoma.

Material  and methods. Four female patients (8 eyes) aged 18 to 41 were subject to standard and special eye examinations, which revealed decreased visual acuity (0.01 to 0.1) and central visual field defects. IOP was normal. To identify the cause of reduced visual acuity,  the patients were subjected to optical coherence tomography, microperimetry, magnetic resonance imaging (MRI) of the brain and the orbits and tested for blood serum hormones. They were also consulted by a neurologist, neurosurgeon, and endocrinologist.

Results. Three of the patients were diagnosed with optic neuritis while the fourth patient had optic disk atrophy. All patients showed changes in the visual field and in the  electrophysiological parameters, as well as altered thickness of the nervous fibers of the peripaillary retina, signs of hyperemia and swelling, blurring of the disc margin, while one patient had temporal optic disk pallor. MRI  of the orbits showed niduses of demyelination in the optic nerve of three patients. In all cases, MRI  of the brain revealed pituitary microadenomas. Hormonal activity of pituitary microadenomas  in the blood serum (cortisol and prolactin) was found to be normal.

Conclusions. Visual impairment  was mainly caused by a demyelinating process, which was confirmed by special examination  techniques and opinions of non-ophthalmology specialists. Combined pathology of the type specified requires a change in the tactics of patient management, as it is still not known for sure how the pituitary adenoma  affects the course of multiple sclerosis.

Purpose: to analyze posterior polar cataract (PPC) phacoemulsification results with regard to surgery technique.

Materials and methods. 14 PPC patients (26 eyes) were examined; 8 of them under 50 years and 6, over 50. Before surgery, visual acuity was 0.3–0.6. The operations were performed by one and the same surgeon on an Infiniti Vision System phacoemulsifier (Alcon). In all cases, posterior chamber IOLs were implanted (in 24 cases, complete intracapsular fixation was achieved, in 2 cases, mixed fixation). The follow-up was 1 to 10 years. The main features of the proposed surgery technique: 1) to ensure a stable position of the anterior/posterior chamber, the introduction of solutions and  capsulorhexis are carried out through paracentesis before the main incision is made, 2) complete rejection of hydrodissection, hydrodelineation at the stage of preparation for the emulsification  of the core itself, as well as rejection of additional  hydrodissection of residual epinucleus before its aspiration, 3) the choice of constant torsion ultrasound mode to reduce the oscillatory movements of nuclear fragments, 4) reduction of hydrodynamic parameters (irrigation bottle height no more than 70 mm, aspiration no more than 30 cc/min, vacuum no more than 250 mmHg on the Infiniti  Vision System), 5) technique of sequential segmental stepwise fracture of the nucleus during emulsification  with minimal  rotation of fragments while reducing the ultrasonic power (up to 30%),  6) selection of a separate bimanual  irrigation / aspiration technique for a more predictable anterior chamber depth, in particular when extracting tips that can be carried out separately, 7) rejection of polishing the posterior capsule for the prevention of mechanical  contact and damage to the posterior capsule.

Results. The postoperative period was uneventful. Best corrected visual acuity improved in all patients: to 0.4–0.5 (4), 0.6–0.8 (16), 0.9–1.0 (6). In the late postoperative period, 4 patients required a laser dissection of secondary opacities in the posterior lens capsule.

Conclusion. The obtained functional results demonstrate the possibility of successful phacoemulsification with the minimum incidence of complications in patients with PPC. In the reported practice, the known surgical techniques aimed at reducing pressure fluctuations in the capsule bag as well as in the anterior chamber as a whole, were used.

Purpose: to describe a clinical case of ocular complications of gastric stromal tumor treatment with imatinib mesylate.

Material  and methods. A patient aged 78 was examined  by general ophthalmologic and instrumental  methods,  including ultrasound  and spectral optical coherence tomography (SOCT).

Results. Ophthalmoscopy  helped diagnose a blunted foveal reflex of the right eye. In the left eye, fuzzy boundaries of the optic disc edema and the macular reflex, the presence of gray-yellow foci of an irregular shape with even distinct boundaries in the paramacular zone were revealed. In the lower part of the left eye fundus, a weakly pigmented gray-yellow focus with uneven indistinct boundaries and an uneven  surface was to be seen. SOCT showed in the right eye a retinal edema in the macula  and paramacular  zones and an epiretinal membrane.  In the left eye, SOCT showed vitreoretinal tractions and retinal edema on the edges of the optic nerve; in the paramacular  zone and in the inner parts of the fundus,  vitreoretinal tractions, epiretinal fibrosis, retinal edema was observed whilst in the lower parts of the fundus complete destruction of all retinal layers due to the hyperreflective focus with a small-shaped inner contour, an even choroidal profile with thinning of the choroid, vitreoretinal tractions, and epiretinal membrane  in the left eye could be seen.

Conclusions. The clinical case of eye complications of imatinib mesylate in the treatment of gastric stromal tumor necessitates an interdisciplinary integrated approach (involving an oncologist and an ocular oncologist) in the diagnosis and treatment of eye tumors. A complex of instrumental methods of diagnostics of eye fundus diseases involving additional refinement methods (SOCT) ensures differential diagnosis of retinopathy during the chemotherapy, secondary metastatic involvement, and vitreoretinal pathology of a different pathogenetic etiology. Early diagnosis facilitates providing adequate treatment aimed at preserving the patient’s vision, the eye, and life.

Modern multicenter studies of psychological features proper to glaucoma patients reveal the presence of physiological and psychological issues associated with the condition. A high level of anxiety causes a clinically significant increase of intraocular pressure. The incidence of depression and anxiety in older people with visual impairments is twice as high as in older people in general. Damaged visual field has an even more adverse effect on the quality of life than deterioration in visual acuity,  especially when the visual field defect is localized in the lower hemisphere. The failure to comply with the prescribed antihypertensive regimen may be due to patients' disbelief in a successful outcome of the disease, a low level of trust towards the doctor, poor education,  low monthly income, side effects of local antihypertensive  therapy, the type of drugs used and their amount. 

The diagnostics of the optic nerve (ON) pathology relies on the results of clinical and instrumental examinations, electrophysiological tests, computer tomography and magnetic resonance imaging. The potentials of these techniques are often limited, and the costs high. Ultrasound examination  is noninvasive, informative and relatively inexpensive. The literature review is focused on the role of echography in the diagnosis and diagnostic differentiation of optic nerve pathologies. The data on the techniques of measurements  of the optic nerve sheath diameter (ONSD) and its normal parameters are presented. In addition to eye pathology, B-scanning of the optic nerve is a very useful diagnostic method in cerebral pathology and systemic diseases. In clinical practice, the measurement  of the main acoustic and biometric characteristics of ON plays a crucial role in the assessment of severity of damage and treatment effectiveness of ON pathology. The comparability of measurements of intraocular and retrobulbar ON parts using the different imaging techniques will require further studies.

As life expectancy  increases, the incidence  of glaucoma is expected to rise worldwide. The  review presents data on the comorbidity and polypharmacy of old and senile patients with glaucoma. Such patients also often have polypathia: on average, they have 6.3±0.6 concomitant somatic diseases. Approximately  one in five glaucoma patients receives both a systemic and local beta-blocker (ВВ).  Parallel use of local and systemic drugs in glaucoma patients is likely to cause drug interaction, increase side effects and contribute to an earlier onset of the tachyphylaxis. The selectivity of oral and local ВВ is one of the factors contributing to the prediction of their additive effect. The data on the expediency  of prescribing brimonidine  as the first-choice drug for glaucoma and hypertension  patients who were previously prescribed systemic ВВ are presented.