Purpose:to study the hemodynamics of the bulbar conjunctiva in patients with dyslipidemia and a history of COVID-19 associated pneumonia who received etiopathogenetic therapy. Material and methods. 54 patients (108 eyes) aged 61 ± 14 with a documented diagnosis of COVID-19-associated pneumonia and dyslipidemia were prospectively examined 3 months after the discharge from hospital. Patients were divided into two groups, identical in gender and age, depending on the presence or absence of metabolic syndrome. For 1 month, both groups received etiotropic therapy: statins, antioxidants thioctic acid pills and topical antioxidant instillations (1 % solution of Emoxipine®three times a day, and instillations of NSAID Broxinac®(in the form of 0.09 % Bromfenacum eyedrops) 1 drop 2 times a day. Results.Improvement was achieved in perivascular parameters (of 54 % of patients of group 1 and 50 % of patients of group 2); in the shape of bloodvessels (in 10 and 11 % of cases, respectively); intravascular parameters (in 71 and 78 %, respectively). Conclusion. The proposed etiopathogenetic therapy has a positive effect on the state of damaged bulbar conjunctiva microcirculation.

Purpose:to study morphological and functional relationships in the early and preclinical diagnosis of glaucomatous optical neuropathy based on optical coherence tomography (OCT) of the retina and the data of electrophysiological research. Material and methods. Two clinical groups: (I) 35 patients (60 eyes) aged 49–70 (ave. 58.0 ± 5.3 yrs) with suspected glaucoma and (II) 21 patients (30 eyes) aged 46-68 (ave. 61.0 ± 4.8 yrs) with initial primary open-angle glaucoma (POAG), and a comparison group consisting of 36 relativelyhealthy subjects (41 eyes) aged 54–70 (ave. 62.0 ± 4.5 yrs), were subjected to spectral OCT by OСT Spectralis (Heidelberg Engineering, Germany). The thickness of the peripapillary layer of retinal nerve fibers (pRNFL), the minimum rim width (MRW), and the thickness of theretinal layers in the macular region that make up the ganglion cell complex (GCC) were evaluated. Spearman correlation analysis was used to identify correlations between OCT and electroretinography (ERG) data. Results.In patients with suspected glaucoma, changes in the parameters of transient pattern-ERG correlated with RNFL thinning in the macular region, inner plexiform layer (IPL), and ganglion cell layer(GCL) in the parafoveal area. In patients with initial glaucoma, changes in the retinal GCL were detected for the upper, lower, and temporal quadrants, while the nasal and central quadrants remained intact in all three GCC layers (RNFL, GCL, and IPL). In patients with suspected glaucoma, no statistically significant changes in the thickness of the pRNFL as compared with the norm were detected. Yet the MRW differed significantly from the comparison group. The highest number of correlations was found between the parameters of the ERGs and the thickness of the pRNFL. In patients with the initial stage of POAG, there was a significant increase in the thickness of RNFL in the temporal quadrant of the paramacular region. In our opinion, this phenomenon may be associated with the development of reactive gliosis being thereaction of neuroglia in response to changes in vascular and/or dystrophic homeostasis. Conclusion.Specific combinations of changes in the structural parameters of the retina and optic nerve head and the temporal and amplitude indices of the PERG and phototopic negative response have been found, justifying their use as combined markers of early and preclinical diagnosis of POAG.

Purpose: to assess the prevalence of corneal diseases using the data on the incidence of visits to outpatient facilities in the city of Baku. Material and methods. The data, presented by outpatient facilities for the year 2017, were statistically analyzed. Results. It was revealed that, for every 100 000 people, there were 266.1±3.4 cases of corneal diseases of which 97.9 ± 2.1 were infectious and 166.9 ± 2.7 were noninfectious diseases. Corneal neoplasms were detected in 1.3 ± 0.2 cases. The ratio of non-infectious and infectious diseases ofthe cornea was ca. 1.7. The lowest prevalence rate of both infectious and non-infectious diseases of the cornea was detected in children aged 0 to 9 years. In older age groups, the change of prevalence of corneal diseases was found to be chaotic. The trends of age-related prevalenceof infectious vs. non-infectious diseases of the cornea were basically similar; the highest rate was detected among patients aged 60–69. Conclusion.According to the appealability data, the prevalence rate of corneal diseases is rather high and age-dependent with a prevailing share of non-infectious corneal pathologies. In male population, this rate is notably lower than in female population.

Purpose: to evaluate the safety and convenience of self-using the intraocular pressure tonometer TVGD-02 at home with no participation of medical professionals. Material and methods. 42 people formed 30 pairs: a patient and an assistant. In 9 pairs, each person played both roles. The participants practiced the technique of transpalpebral measurement of intraocular pressure (IOP) at home, and, as assistants, measured IOP of their partner patients. All subjects were asked to fill in a questionnaire to evaluate the convenience and safety of the tonometer use by a 5-point system. Results. The assistant users, aged 22 to 83 (ave. 59.68 ± 17.20 years) had diverse educational levels. Of the patient users, aged 22 to 82 (ave. 60.64 ± 17.10 years), 82.14 % had ocular pathology, while 35.7 % had glaucoma with concomitant pathology. In 100 % of cases, the participants required no professional assistance to properly prepare the tonometer for operation and perform IOP measurement. The accuracy and reproducibility of measurement results significantly increased with the assistants’ gaining skills of operating the tonometer. On the 1st day, the data obtained in a series of measurements scattered for the control block within 2.07 ± 1.70 [7; 0] mm Hg, while the measured IOP of the patient scattered within 2.89 ± 19.10 [8; 0]. In contrast, on the 5^th day, measurement accuracy increased significantly and the scatter dropped to 1.21 ± 0.72 [2; 0] and 0.85 ± 0.69 [2; 0] mm Hg, respectively. The users rated the ease of using the device at different staged from 4.21 ± 0.67 to 5.0 ± 0.0 points. Conclusion. Assisted transpalpebral tonometry with the TVGD-02 tonometer ensures an adequate assessment of IOP in patients at home. The principles of device operation and the technique can be learned and skills can be gained without the participation of medical personnel.

Purpose:to assess the effect of ultraviolet (UVA) crosslinking of Bioplast plastic material (silicon-dried human cornea) on its biomechanical stability and effectiveness for keratoplasty in corneal ulcers. Material and methods. To determine the maximum rehydration time, 12 Bioplast samples were incubated in physiological solution (NaCl 0.9 %) for 12 hours and monitored for thickness using optical coherence tomography (OCT Spectralis, Heidelberg Engineering). After the epithelium was scarified rehydrated corneas were treated withof 0.1% riboflavin solution for 30 minutes, and after it 8 rehydrated samples (experimental group) were treated with UVA for 30minutes (wavelength 370 nm, power 3 mW/cm²) using a UV-X device system (IROC AG, Switzerland). In the control group (4 rehydrated samples), no UVA crosslinking was performed. The elastic-strength indicators of the experimental and control group samples were assessed by applying uniaxial tension using a deformation machine (Autograph AGS-H, Japan). To examine the patients (presented in clinical examples)before and after keratoplasty with Bioplast subjected to UVA crosslinking, a set of standard ophthalmic tests was used. Results.Rehydration of Bioplast was the most intensive in the first three hours of incubation, during which time tissue thickness increased uniformly by 50–55 μm/hour to 700–710 μm, while further incubation showed no significant additional effect on the fluid content in the cornea. After UVA crosslinking, the strength indices and the elastic modulus of the rehydrated Bioplast samples significantly increased in comparison with the control group. Clinical examples demonstrate the effectiveness of modified Bioplast for organ-preserving penetrating keratoplasty in case of perforatedcorneal ulcer. Conclusion. UVA crosslinking of rehydrated Bioplast increases its biomechanical stability. The data of laboratory studies and the first clinical tests demonstrate that modified Bioplast may be an effective replacement of native donor cornea in urgent keratoplasty of perforated ulcers.

Purpose:to evaluate the clinical efficacy of anti-VEGF therapy of patients with diabetic macular edema (DMO) in T & E regimen for 96 weeks. Materials and methods. The study included 59 patients (101 eyes) with DMO. The average number of intravitreal injections of anti-VEGF agent (IIAVA) — aflibercept given during the whole period was 12.87 ± 3.56, including 7.78 ± 1.20 in the first year, and 4.82 ± 2.66 in the second year. Results.All patients showed an increase in visual functions (+0.33, p < 0.001) with a maximum achieved after 5 injections (+0.24; p = 0.001). Central macular thickness decreased from 397.36 ± 100,00 μm at the initial level to 276.59 ± 52.90 after 5 loading injections (-120.8 μm), to 263.85 ± 45.20 (-133, 91 μm) after 1 year and to 248.6 ± 46.9 (-148.76 μm) after 2 years. A resorption of retinal neuroepithelial detachment was observed in 84.16 % of cases as soon as loading injections were given, and reached 100 % of cases by the 48th week of observation. Strong inverse correlations were revealed between the initial presence of medium and large intraretinal cysts and visual acuity, both initial and final (-0.35 and -0.42, p < 0.01). The disorganization of retina inner layers at the initial level was a predictor of a worse visual outcome at the end of the observation period. By the end of this period, 44 patients (43.5 %) received IIAVA with an interval of 12 weeks, the maximum interval between injections was 16 weeks and was achieved in 19 (28.01 %) eyes. Conclusion.The results of a 2-year retrospective study of the efficacy of aflibercept in DME showed that T&E regimen can be used with highfunctional results. Due to flexible planning of the number of IIAVA in the second year, over-treatment could be avoided without reducing the expected efficacy.

Purpose: a covariance analysis of the planned and actually obtained refraction after excimer laser myopia correction surgery in middle-aged patients. Material and methods. 85 patients (170 eyes) aged 35 to 50 underwent excimer laser myopia correction surgery by FemtoLASIK. The patients were divided into 3 groups according to the degree of myopia: group 1 included 13 patients (26 eyes) with myopia from -1.25 to -3.0 D, group 2 had 42 patients (84 myopic eyes) from -3.25 to -6.0 D and group 3 had 30 patients (60 eyes) with myopia of -6.25 D or higher. Results. The patients with low myopia, independently of the age, revealed a postoperative refraction effect closer to that planned than the patients with moderate and high myopia. The difference (delta) between the planned and the obtained results was -0.35 ± 0.08 D (41%) in group 1, -0.58 ± 0.04 D (51.3%) in group 2 and -0.64 ± 0.05 D (46%) in group 3. The divergence between the respective indicators for figures for low and high myopic groups is statistically significant. Conclusion.Patients with low myopia over 35 years old can be recommended a symmetric hypocorrection in binocular format irrespective of the objective data regarding the initial corneal hydration, which affects the ablation volume. To achieve a better agreement between the planned and the actual hypoeffect (and, accordingly, a more precise dosage of the surgery) in patients with moderate and high myopia, it is important to introduce into clinical practice the technology of contactless measurement of corneal hydration.

Rationale.Qualitative rehabilitation of patients with cataracts who had keratorefractive surgeries depends on phacoemulsification technology and correctly calculated optical power of the IOL. Purpose: present the author’s own approaches to the development of surgical tactics for treating patients with cataracts who underwent keratorefractive surgeries. Material and methods. The complicated character of cataract surgery performed after LASIK — deterioration of visualization due to the presence of an optical ablation zone and a transition zone (6–7 mm) — is successfully compensated by instillations of a dispersed viscoelastic (methylcellulose) onto the surface of the cornea. Another factor is the deepening of the anterior chamber in high myopia, which is uncomfortable for manipulation and may require a lowerlevel of irrigation (up to 60 mm Hg). The technology of surgery performed after radial keratotomy (RK) requires utmost attention to the prevention of surgical astigmatism that could emerge due to biomechanical instability of the cornea. To ensure such prevention, paracentesis is performed outside the zone of keratotomy scars, the main 2.2 mm incision is made after capsulorhexis in the sclerolimbal zone, and at theend of the operation, a subconjunctival injection is performed in the conjunctival zone of the knife keratom entrance for the tamponade ofthe outer part of the incision without suturing. These techniques made it possible to successfully perform more than 200 operations and achieve a favorable course of the postoperative period from the first day. Fast adaptation of the incision (1–2 days), uncomplicated course of the postoperative period and the absence of induced astigmatism are important advantages of this technology. Conclusion. The choice of surgical technology, taking into account the initial state of the eye after LASIK and RK surgeries, is an important task. Yet the main problem with which the doctor is faced after keratorefractive surgery is the difficulty of calculating the optical power of the IOL which must take into account the special needs of the patient with a particular refractive history, which will be reported in part 2 of the article.

Purpose: to evaluate the results of spontaneous non-penetrating keratoprosthesis with a Fedorov — Zuev prosthesis in a patient with severe chemical burns in both eyes. Material and methods.Patient K., 38, who had sustained a severe burn injury in the past and numerous reconstructive plastic operations on both eyes (amniotic tissue implantation, allolymbal transplantation, layer-by-layer and penetrative keratoplasty, cataract extraction with IOL implantation, total auto-conjunctival corneal plastic surgery) with no functional effect, was subjected to a multi-stage keratoprosthesis of the left eye according to the method practiced by the Helmholtz National Medical Research Center of Eye Diseases. Results.After one of the stages (implantation of the haptic part of the keratoprosthesis with a temporary cylindrical plug), an aseptic necrosis of the tissue above the cylinder occurred. As a result, an unexpected functional effect was revealed: visual acuity of the operated eye 0.02 sph -20.0 D = 0.2. During a dynamic follow-up that lasts 2.5 years, visual acuity remains stable, and the corneallayers behind the cylinder retain transparency. During this time, all stages of keratoprosthesis were performed on the fellow eye with a functional result of 1.0. Conclusion. The long-term result of spontaneous non-penetrating keratoprosthesis indicates the need to study the prospects and develop a method of non-penetrating keratoprosthesis with a Fedorov — Zuyev prosthesis.

Dry eye disease (DED) is an ocular condition with a high prevalence globally. The survey was conducted to understand factors that influence the treatment of DED in Kazakhstan and Uzbekistan and the properties of artificial tears required in its treatment. Purpose. The survey aimed to understand the prevalence of DED in the population of Kazakhstan and Uzbekistan, whether associated ocular diseases and patient lifestyle affected DED treatment, the properties of artificial tears required in the treatment of DED, and the use of artificial tears in conditions other than DED. Material and methods.A total of 457 ophthalmologists participated in the survey that was conducted between June–July 2019 in selected cities of Kazakhstan and Uzbekistan. The questionnaire assessed the number of patients with DEs, associated ocular diseases, contributing factors to poor adherence to DED treatment, major concerns in DED and properties of artificial tears required in the treatment of DED. Results.About 73 % of the doctors in Kazakhstan and all the doctors in Uzbekistan reported that DE-associated ocular diseases and lifestyle of a patient contribute to poor adherence to DED therapy. Doctors in Kazakhstan and Uzbekistan ranked hydration at 1.613 and 1.928, respectively, while considering the properties of artificial tears required for the treatment of DED. Conclusion.A majority of the doctors in Kazakhstan and Uzbekistan considered DE-associated ocular diseases and patient lifestyle as major contributing factors to poor adherence to DED treatment. Doctors from both countries considered hydrating property of artificial tears to be the most important ones for the management of DE.

With multimodal visualization of the chorioretinal complex structures using modern research methods, it was possible to isolatea mixed, or combined, phenotype of the late stage of age-related macular degeneration (AMD). Early detection of this AMD form is of vital importance not only for accurate diagnosis, but for choosing optimal management tactics for patients. The paper presents two clinical cases with different variants of the development of the mixed phenotype of the late AMD stage. In one case, the long-lasting “geographic atrophy” (GA) was complicated by the development of choroidal neovascularization, while in the other case GA appeared during the treatment of wetAMD.

A clinical and morphological description of a case of pilocytic astrocytoma (astrocytic hamartoma) of the retina and optic nerve in an 11-year old girl is presented. The clinical and instrumental characteristics of the tumor are determined by ultrasound and MRI tests. Detailed cytological and pathomorphological description of the tumor, which is rarely observed, is given. The tumor poses a threat to the eye and requires that the eyeball be removed.

Optical coherence tomography (OCT) is widely used in ophthalmological practice. The review presents the results of OCT in patients with somatotropin-producing pituitary adenoma, or somatotropinoma, which is a hormone-active tumor of the adenohypophysis, characterized by excessive production of somatotropic hormone (STH). It stimulates the secretion of type I insulin-like growth factor (IGF-I). The mechanisms of STH action (pro-angiogenic action, stimulation endothelial cell proliferation and migration, development of endothelial dysfunction and retinal edema) requires much attention to the results of examination of patients with somatotropinomas using modern diagnostic methods, such as OCT.

Prostaglandin analogues are a class of antihypertensive drugs for glaucoma treatment which are systematically safe but have a sufficiently large number of local side effects. These effects may worsen the quality of life of patients with glaucoma and reducetheir adherence to treatment routines due to physical and psychological discomfort. The review presents literature data and clinical cases fromthe author’s own medical practice.

The review discusses the development of optical coherence tomography with the function of angiography, focusing on its advantages, features, and prospects for the diagnosis of fundus pathologies.

Drug treatment optimization in primary open-angle glaucoma (POAG) is a topical issue of ophthalmology in recent decades. The review focuses on the choice of local hypotensive therapy and the effectiveness of a fixed combination (FC) of dorzolamide / timolol in glaucoma treatment. Since decreased perfusion eye pressure and disturbed regulation of local hemodynamics affect the development and progression of glaucomatous optical neuropathy, the use of anti-glaucomatous drugs or other hypotensive agents requires taking account of their effect on intraocular pressure (IOP), visual functions, and ocular blood flow. Most studies show that the hypotensive and hemodynamic effects of dorzolamide/timolol FC contribute to the preservation of visual fields in POAG patients by reducing significant risk factors for POAG progression, such as increased IOP and blood flow deficiency in the retinal and choroidal vessels. Improved hemodynamic parametersdue to local hypotensive treatment can be considered as basis for visual function stabilization, especially in long-term chronic courses of the disease.

The third part of the review (for the first part, see ROJ 2020; 13 (2): 99–104, for the second part — ROJ 2020; 13 (4): 105–110) discusses the structure of the outer and inner layers of normal macula in optical coherence tomography, their pathomorphology as well as its impact on the state of visual functions in epimacular membranes (EMM).