The article presents a theoretical and clinical justification for optical techniques used for the prevention of myopia. Accommodation, wavefront aberrations, peripheral refraction, and retinal image quality are considered as interrelated factors affecting postnatal refractogenesis. A detailed analysis of myopia correction methods, conditions preceding its development and their impact on the dynamics of refraction and eye growth is given. A strategy of optical correction of myopia was proposed, which includes: 1) constant wearing of defocusing binocular positive spectacle lens or Perifocal-P spectacle lens (in case of exophoria) for children at risk aged 4–7 years; 2) constant alternating weak myopic defocusing in case of myopia from 0.5 to 2.75 D, ortho- or esophoria, positive relative accommodation (PRA), peripheral myopia or emmetropia; progressive addition spectacle lens in case of PRA less than 1.0 D; Perifocal-Msa spectacle lens in the case of a combination of reduced PRA and exophoria; 3) Perifocal-M spectacle lens in case of myopia of any degree with already existing hyperopic peripheral defocus; progressive addition spectacle lens in case of PRA less than 1.0 D in combination with esophoria or Perifocal-Msa spectacle lens in combination with exophoria; 4) contact correction with bifocal soft contact lenses or orthokeratological contact lenses (Ortho-K) in case of refusal from spectacle correction. Ortho-K is preferable with moderate and high myopia; 5) bioptic correction: a combination of monofocal soft contact lenses and Perifocal-M spectacle lens to correct peripheral defocus and residual astigmatism is preferable for myopia over 8.0 D and myopia with astigmatism.

Purpose: to evaluate the effect of inadequately performed laser coagulation (LC) of peripheral vitreochorioretinal dystrophies (PVCRD) on the microcirculation of the macular region in patients with myopia. Material and methods. The state of the microvascular bed was investigated by OCT angiography (OCT-A), Angio Retina mode, scanning area 6 x 6 mm. The density of the surface vascular plexus was evaluated using a 9-quadrant protocol and an ETDRS grid. The parameters of the foveolar avascular zone (FAS) were determined. OCT-A of the retina was performed in 18 patients with PVCRD who had signs of inadequate retinal LC, such as hypercoagulation, an excessive number of coagulates with minimal changes in the retina, or massive LC in normal fundus eyes documented in their case histories. The research results were compared with the data of OCT-A obtained in 10 patients with myopia without signs of PVCRD (controls 1) and in 75 healthy individuals (controls 2). Results. In all patients with myopia (in the main group and controls 1), blood flow density indices were, respectively, 10–20 and 2–14 % lower than those in controls 2. The maximal decrease in blood flow density was found in the foveal zone in cases of hyper LC (p < 0.05). Also, in the eyes with excessive LC a significant expansion of the FAS and thinning of the retina were revealed. Conclusion. The results of the OCT-A study point to a negative effect of hyper LC of the PVCRD on the state of the microvasculature of the retina in the central zone. The obtained data correlate with our results of electrophysiological studies presented in the first part of this paper [ROJ, 2020; 13 (2): 45–52], which indicate functional changes in the fovea zone after inadequate laser coagulation in the peripheral areas of the retina.

Purpose: to analyze the frequency and possible associations of GNAQ and GNA11 oncogenes in peripheral blood ctDNA, as well as the relationship of the ABCB1/MDR1 rs1045642 polymorphic marker gene with the clinical and instrumental characteristics of nevi and initial choroidal melanoma. Material and methods. A prospective study of 81 previously untreated patients (84 eyes, mean age 57.8 ± 13.8 years) included general ophthalmological examinations and special instrumental diagnostics: ultrasound checkups, spectral optical coherent tomography (SOCT), OCT angiography. Depending on the nature of the pathology, the patients were divided into three groups: I — with benign choroidal nevus (23 eyes, 28 %; mean age 61.1 ± 13.6 years); II — with suspicious choroidal nevus (24 eyes, 29 %; mean age 54.8 ± 13.0 years); III — small choroidal melanoma (37 eyes, 43 %; mean age 56.2 ± 14.8 years). Genotyping was performed by melting curve analysis. Results. A significant association was revealed between the presence of ctDNA (GNAQ/GNA11 oncogenes) and the CC genotype of the ABCB1 gene with the risk of developing a small melanoma of the choroid and choroidal nevi. In patients with suspicious choroidal nevus, there is an unfavorable significance of mutations in the GNAQ/GNA11 genes (ctDNA). A relative unfavorable predictive significance of the presence of mutations in the GNAQ/GNA11 genes in peripheral blood ctDNA of patients with a benign choroidal nevus was suggested. No significant associations between GNAQ/GNA11 mutations, ABCB1 gene polymorphism and clinical/instrumental tumor features were found. Conclusion. The revealed features can be used for screening the patients with melanocytic intraocular tumors and for developing modern approaches to predicting the course of UM in the early preclinical period.

Malignant neoplasms of conjunctiva (MNC) are characterized by high degree of malignancy and predisposed to invasive growth and generalization of the process, which leads to fatal outcomes. Purpose: to investigate clinical and epidemiological aspects of malignant conjunctival tumors over a 18-year period starting in 2001. Material and methods. We analyzed the epidemiological factors of MNC in 51 patients aged 15 to 97 (average 63.1 ± 17.3), who were treated in the Center of Oncological ophthalmology at the Chelyabinsk regional clinical center of oncology and nuclear medicine. Results. The structure and morbidity changes of MNC are presented, showing the age and gender distribution of patients and revealing the clinical picture for varying types of the pathology. Long-term results were as follows: MNC relapses occurred in 11 patients (22.4 %) 36.0 ± 24.5 months after treatment. Tumor metastases into regional lymph nodes and hematogenous metastases averagely developed after 18.5 ± 6.8 years. Between 2008 and 2015, 9 patients (17.6 %) died. The Cancer Register of the Center was used to calculate the parameters of corrected cumulative survival rate for Chelyabinsk region population after MNC as a whole, as well as separately for melanomas and squamous cell carcinomas of the conjunctiva, and for the stages of the disease. The three-year survival rate for MNC was 80.5 %, for conjunctival melanoma 90.1 %, for squamous cell carcinomas 80.5 %. The 5-year survival rates were, respectively, 71.5, 80.1 and 60.5 %. The 3-year MNC survival rate for stages I and II of MNC was 100 %. For stage III, it was 76.9 %, and for stage IV, 33.3 %. The 5-year survival rates for stages I to IV of MNC were respectively, 100, 88.9, 69.2 % and 33.3 %. Conclusion. The new Center for oncological ophthalmology established within a multidisciplinary oncological treatment and prophylactic institution improved medical assistance and diagnostics of patients with MNP. The results obtained should be taken into account when developing preventive measures for the early detection of conjunctival malignancy.

Purpose. To investigate the effect of resveratrol antioxidant on neurotrophic and structural changes of retina/choroid tissue complex in experimental ischemia/reperfusion (I/R) injury of retina induced by endothelin-1 (ET-1) injection in rats. Material and methods. 60 male Wistar albino rats were divided into 3 groups. 50 rats underwent I/R (Group 1 [n = 20]; Group 2 [n = 30]) while 10 animals served as controls. Retinal I/R was induced in Group 1 and Group 2 by subconjunctival injection of 0.2 mL 4 x 10^-6 М ET-1. The animals in Group 1 received no resveratrol; those in Group 2 received 20 mg/kg resveratrol per os during 1 month before I/R and continued to receive it after I/R up to the moment they were euthanazied. Factors regulating mitochondrial apoptosis (BAX/BCL-2) and external pathways of apoptosis (sFas/FasL), inflammatory marker — monocyte chemoattractant protein-1 (МСР-1) and neurotrophic factors – brain-derived neurotrofic factor (BDNF), nerve growth factor (NGF) were quantified in retinal/choroidal tissue homogenates. In each group, laboratory assessment of retina/choroid complex samples and morphological investigations were performed 3 days (16 eyes), 7 days (16 eyes), 30 days (18 eyes) after ischemia. Results. After 30 days, a statistically significant decrease of apoptotic factors BAX/BCL-2 (p < 0.001) and reduced level of MCP-1 in animals of Group 2 (p < 0.05) as compared to those in Group 1 were noted. The histological examination of the retina on day 3 showed reduced retinal ischemic lesions and signs of inflammation, decrease of the apoptosis of ganglion cells and zones of preserved retina with intact nuclear layers and a layer of photoreceptors in late post-ischemic period (after 30 days). Conclusions. The experimental results demonstrate that resveratrol has neuroprotective properties after retinal I/R injury. This suggests that resveratrol has therapeutic potential in the treatment of diseases of the retina and optic nerve.

Purpose: to compare the effectiveness of corneal ulcer treatment by antibiotic therapy and local ultraviolet crosslinking in a clinical and morphological experimental study using the new Crosscor device. Material and methods. The study was performed on 15 rabbits (30 eyes) with a model of corneal ulceration caused by Staphylococcus aureus. Rabbits were divided into 3 groups of 5 specimens each (10 eyes). Group 1 received local ultraviolet A range (UVA) crosslinking (CL) of the cornea using the Crosscor device (3 procedures lasting 5, 6 and 6 minutes each were given with intervals of three days). In group 2, CL was combined with antibacterial treatment (AB): instillations of tobramycin 0.3 % and ofloxacin ointment 3 mg / g were given 4 times a day for 14 days. In the control group, only AB treatment was given. The dynamics of inflammation, the intensity of turbidity and the size of the corneal ulcer were evaluated using biomicroscopy, fluorescein test, photoregistration of the anterior part of the eye, and according to a point system. Morphological changes in the cornea were determined using light microscopy (Leica with a DFC 420C digital camera). Results. In group 1 (CL) complete healing of the ulcer defect was noted on the 9th day of observation; in group 2 (CL + AB), the diameter of the corneal ulcer was reduced to 1.6 ± 0.5 mm, in the control group (AB) it was reduced to 1.9 ± 0.3 mm (p < 0.05). The total score of inflammatory changes on day 9 in the 1st group was 0.8 ± 1.3, in the 2nd group, 3.6 ± 0.8, and in the control group, 3.7 ± 0.4 (p < 0.05). On day 9, in all cases of the 1st group, a slight clouding of the cornea was formed (0–-1 point); in the 2nd group and in the control group in 90 % of cases a rough clouding of the cornea with vascularization was formed (3 points). Morphological examination of the eyes showed that only in the 1st group avascular scars with an ordered arrangement of fibrous tissue fibrils were formed. Conclusion. The data obtained indicate a significantly higher efficiency of corneal ulcer treatment by local UVA crosslinking using Crosscor as compared with antibiotic therapy.

Purpose: to develop easy-to make and reproducible models of retinal pigment epithelium atrophy (RPE) and retinal degeneration using two types of solution (0.9 % sodium chloride and bevacizumab) and to evaluate these models using clinical instrumental and pathomorphological studies. Material and methods. To create the two models, we used 60 New Zealand albino rabbits divided into 2 groups of 30 animals each (30 eyes). In group 1, 0.01 ml of 0.9 % sodium chloride solution was delivered into the subretinal space at a distance of 1–1.5 mm downwards from the optic disc forming a subretinal bladder, whilst group 2 received 0.01 ml of bevacizumab solution which contained 0.025 mg of the drug. Optical coherence tomography (OCT) and fundus autofluorescence imaging were performed in live rabbits’ eyes before and after the procedure on the 2nd, 7th, 14th, 24th, and 30th day using Heidelberg Spectralis™ SD-OCT (Heidelberg Engineering, Germany). The enucleated eyes were histologically evaluated 14 and 30 days after RPE atrophy modeling. Results. Two easily reproducible experimental models of RPE atrophy have been developed. Clinical and morphological indications of RPE atrophy are described. Histological analysis revealed a more aggressive action of 0.9% sodium chloride solution on the retina and the choroid as compared with the model obtained with a similarly delivered subretinal angiogenesis inhibitor. Conclusion. The obtained experimental models may be useful in investigating various types of RPE atrophy, including those arising from the use of angiogenesis inhibitors.

Causes of macular edema (ME) occurring on the pseudophakic eye after cataract phacoemulsification, and methods of its diagnosis and prevention are analyzed. As follows from the literature and our own data, the term “pseudophakic ME” better reflects the condition that the term “postoperative ME” as it takes into account the diversity of pathogenetic complications. Accordingly, we propose to include this term into the ICD list.

Insufficient effectiveness of laser coagulation of the avascular retinal areas in retinopathy of prematurity (ROP) plus-disease in zone I and aggressive posterior retinopathy of prematurity (APROP) requires new treatment approaches, based on the regulation of retinal angiogenesis and anti-VEGF drugs use. The BEAT-RAP study, which was the first major randomized study of anti-VEGF therapy in ROP, revealed a higher effectiveness of bevacizumab compared to retinal laser coagulation in stage 3 plus-disease of zone I. A prospective randomized trial, RAINBOW, demonstrated the effectiveness of ranibizumab in plus-disease stages 1, 2 and 3 in zone I and stage 3 in zone II and in APROP, so that the drug may be recommended for use in children with ROP. The demonstrated high effect of anti-VEGF therapy in ROP is consistent with our own data. Anti-VEGF therapy opens up new possibilities in the treatment of a particular class of ROP forms. The advantages of anti-VEGF therapy include higher clinical effectiveness of treatment of ROP type I with localization in the posterior pole (I and posterior II zone), absence of "blockage" of the peripheral retina, lower frequency of myopia development and degree, relative fastness of the procedure, the acceptability for patients whose fundus is difficult to visualize, and somatically burdened patients who are contraindicated for prolonged anesthesia used for retinal laser coagulation. When using anti-VEGF drugs in the post-threshold stages of the disease, one should take account of an increased risk of proliferation progression and retinal detachment development. Premature infants with retinopathy regression after anti-VEGF therapy require a longer duration of regular and frequent follow-up (up to 70 weeks of postmenstrual age) due to the risk of relapse and extraretinal proliferation in future.

Multimodal visualization data of inherited retinal degeneration (IRD) on a Mirante platform (Nidek, Japan), used in a number of clinical cases, is compared with the data obtained by electrophysiological diagnostic methods. 4 patients with varying IRD were examined: adult-onset foveomacular vitelliform dystrophy, Stargardt disease, including those with fundus flavimaculatus, and retinitis pigmentosa. Multimodal imaging includes: colour fundus imaging, fundus autofluorescence, retro mode, and optical coherence tomography. Electroretinography was performed using an MBN electroretinograph (Russia), and electrooculography was performed using a RETIscan Science system (Roland Consult, Germany). Using non-invasive retinal imaging methods, specific patterns of inherited dystrophies were shown, which correlated well with the data of electrophysiological research methods. The combination of multimodal imaging on the Mirante platform (Nidek, Japan) in combination with electrophysiological diagnostic methods can be successfully used in complex diagnostics, monitoring of the progression, and evaluation of the results of IRD treatment.

Rehabilitation treatment of a patient with symptoms of computer visual syndrome and concomitant asthenic form of accommodative asthenopia in an asthenic-neurotic state of psychosomatic genesis is discussed. The treatment was based on an integrated approach that takes into account diagnostic criteria (the volume of absolute accommodation, indicators of objective accommodation, the severity of asthenopia, the state of psychological adaptation) and the basic principles of medical and rehabilitation measures, including, along with traditional methods of correcting asthenic-neurotic states, sequential and staged physiotherapeutic and optical-reflex effects on the accommodative system of the eye.

In recent publications, positive results have been reported with the use of glasses with red protective filters in prematurely born infants with low body weight, which were presumably associated with a decrease in the levels of illumination of the environment of the child. However, to date, it has not been proven that a decrease in the amount of light reaching the retina of the newborn affects the frequency and severity of retinopathy of prematurity (RP). The analysis of the literature on the therapeutic effect of various modes of red and near infrared radiation on the retina is presented, which allowed a different look at the protective mechanisms of glasses-filters in premature babies. It has been suggested and substantiated that the observed effect may relate to the phenomenon of pre-conditioning photostimulation, which reduces the risk of developing RP and reduces the severity of the disease due to the induction of adaptive plastic reactions in the retina.

The third part of literature review (see first part in ROJ 2019; 12 (4): 99–108, second part in ROJ 2020; 13 (2): 88–98) discusses the features characteristic of small uveal melanoma and pseudomelanomas (choroidal nevus, circumscribed choroidal hemangioma, melanocytoma, choroidal metastatic carcinoma, congenital hypertrophy of retinal pigment epithelium, late-stage age-related macular degeneration, focal retinochoroiditis, organized subretinal hemorrhage, retinal hemangioma) which were revealed by optical coherence tomography and optical coherence tomography-angiography. The need for further comparative studies aimed at defining differential diagnostic is emphasized.

Coronaviruses (CoV) are a large group of RNA viruses that are pathogenic to animals and humans. Until the end of the 20th century, human CoV were known as pathogens of seasonal mild respiratory diseases. In the last 20 years new CoVs caused three outbreaks of severe acute respiratory diseases with a predominant lesion of the lower respiratory tract: SARS-CoV — the causative agent of the severe acute respiratory syndrome (SARS) in 2002–2003; MERS-CoV that induced Middle East respiratory syndrome (MERS) in 2012 and SARS-CoV-2 the causative agent of the coronavirus disease-19 (COVID-19), a pandemic of which began in China in late 2019 and is ongoing. The review presents current data on SARS-CoV-2, ways of contagion, transmission routes, detection time in the body, the role of asymptomatic virus carriers in the epidemic process. Advantages and disadvantages of the main laboratory methods of COVID-19 diagnosis are described: polymerase chain reaction (detection of viral RNA) and serological tests (detecting IgG-and IgM-specific antibodies). The data on conjunctivitis, the main currently known ocular symptom of COVID-19, are summarized. The role of the tear and eye discharge as a possible source of infection is discussed, as well as the role of the eye as the entrance gate of the virus with the subsequent development of respiratory infection. The high professional risk of ophthalmologists being infected through close contact with the patient during the examination is outlined. A system of complex protection of ophthalmologists against contagion during examination of patients, proposed in some countries, is presented.

The second part of the review (for the first part, see ROJ 2020; 13 (2): 99–104), discusses the dynamics of cystoid macular edema (CME) resorption, macular profile changes after the removal of idiopathic epimacular membranes (EMM), the impact of CME and the macular profile on visual functions of eyes with EMM, and issues of CME management after EMM removal.