Almost 50 % of microRNAs (a family of small noncoding RNAs) are associated with the regions of the genome responsible for the development of tumors. These microRNAs play the role of oncogenes or tumor suppressor genes. In 2008, there were reports of the possibility of using microRNA as a predictive biomarker of the metastatic risk of uveal melanoma. Initially, microRNAs were investigated in melanoma samples; later, the possibility of using blood plasma for these purposes was shown.
Purpose: to study the character of expression of miRNA- 146a, miRNA-155, miRNA-223, miRNA-126, miRNA-27b in the blood plasma of patients with choroidal melanoma (CM) and determine their significance in predicting possible hematogenous metastases.

Material and methods. The study included 84 patients with CM aged 35–86 (ave 63.4 ± 1.2 yrs). The thickness of the CM varied in the range of 0.77–17.19 mm (ave 7.21 ± 0.43 mm). The control group consisted of 28 volunteers aged 45-78 (62.90 ± 1.42 yrs). MicroRNA expression levels were determined by quantitative PCR.
Results. An increase in the expression level of miRNA-155, miRNA-146a, miRNA-126, miRNA-223, and miRNA-27b in blood plasma in all 84 patients with CM was revealed.
Conclusion. The study of miRNA levels (miRNA-146, miRNA-155, miRNA-223, miRNA-126 and miRNA-27b) in the blood plasma of patients with CM can be used both to confirm the diagnosis of CM in difficult diagnostic cases and to determine the aggressiveness of the course tumor and prediction of metastasis.

Purpose. To analyze the clinical and functional results of vitreoretinal operations in patients with type II diabetes mellitus and diabetic retinopathy (DR).
Materials and methods. A retrospective analysis of vitreoretinal surgery outcomes in DR was performed in 421 patients (421 eyes), with type II diabetes mellitus and DR, with no previous history of retinal laser coagulation. The follow-up period was at least 4 years. Patients were divided into two groups depending on the postoperative course of the disease. Group I included 338 patients (338 eyes) with a single vitreoretinal intervention followed by stabilization of the pathological changes over the whole follow-up period. Group II consisted of 83 patients (83 eyes), ca. 20 % of the cohort, with repeated vitreoretinal operations required by DR progression. In addition, the groups were analyzed according to the best corrected visual acuity (BCVA).
Results. The initial BCVA of less than 0.1 was noted in 69 % of cases in Group I with a single surgery while that in Group II claimed 80.7 % of cases. By the 6th month, BCVA values revealed an average increase from 0.05 to 0.20 in Group I and an average increase from 0.05 to 0.08 in group II. In Group I, at the end of the follow-up the mean BCVA remained stable and was higher than before the operation, while in Group II it dropped and remained significantly lower than in Group I. Also, by the end of the follow-up the patients given a single vitreoretinal intervention whose BCVA was below 0.1 showed an increase in the mean BCVA value, whilst those with initial BCVA of 0.4–0.6 showed BCVA stabilization. Patients with repeated operations and initial BCVA below 0.1 showed no noticeable BCVA changes but those with BCVA 0.1–0.6 revealed a drop.
Conclusions. Modern technologies of vitreoretinal surgery of severe DR stages ensure a stable anatomical outcome following a single surgery in 80 % of cases, a stable functional result in 59 % of cases. In 20 % of cases, relapses and the need for repeated operations are associated with the initially more pronounced diabetic alterations of the retina, probably due to the patients’ late referral. Timely detection of DR and referral of such patients to a specialized ophthalmology center is a necessary task.

Purpose: to study the clinical signs and effectiveness of laboratory diagnostics of fungal corneal ulcer complicated by endophthalmitis aimed at treatment tactics optimization.
Materials and methods. 15 patients aged 20–55 with severe monocular fungal ulcer complicated by endophthalmitis were examined by microscopy and culture of corneal scraping on Sabouraud Agar; microscopy and culture of intraocular fluid and corneal fragments, obtained during the surgical treatment. Corneal scrapings from the corneal ulcer and corneal fragments removed during keratoplasty were tested in polymerase chain reaction (PCR) for the presence of deoxyribonucleic acid (DNA) of Candida albicans and total Fungi DNA.
Results. Before treatment start, 2.5 hours after the biomaterial was taken, PCR revealed Fungi DNA in all 15 cases. Symptoms of the severe fungal corneal ulcer complicated by endophthalmitis and caused by Aspergillus spp have been identified and described. Conservative therapy and total penetrating keratoplasty (PKP) helped retain the eye in 13 out of 15 patients (86.7 %) and partially restore the visual functions.
Conclusion. Rapid laboratory diagnosis of ophthalmomycosis using PCR offers an advantage over the culturing technique: the results are ready within 2.5 hours instead of 10-14 days (culture method); it is highly sensitive and allows identifying the fungi not only in the tissue of the removed cornea, but also in the сorneal scrapings. The effective treatment tactics of fungal corneal ulcer complicated by endophthalmitis combining PKP with pre-operative and long-term postoperative antifungal therapy was proposed.

Purpose: a year-long study of the accommodative function of the eye in patients with orthokeratologic (OK) correction, and the analysis of the therapeutic effect of the drug Midrimax® on accommodation overstrain in patients with OK lenses.
Material and methods. The study group included 88 patients (176 eyes) with progressive myopia and OK lenses. The control group included 108 patients (216 eyes) who had optical correction with monofocal glasses and soft contact lenses. During the year, the accommodative function of patients of these two groups was studied using a Speedy-I Accommodograph that involved the calculation of accommodative coefficients: the coefficient of accommodative response and the coefficient of accommodative microfluctuations (CMF). The accommodographic examination in the study group was conducted before wearing OK lenses, after 1 month, 6 months and a year of wearing OK lenses. In the control group, the study of accommodation was carried out after 6 and 12 months. To assess the nature of the effect of Mydrimax® on accommodation overstrain, 70 children (140 eyes) with OK correction and varying degrees of accommodation overstrain were examined. A control group and a study group of 35 people (70 eyes) each were formed. In the study group, Mydrimax® was instilled daily before going to bed, 2 drops in each eye for 30 days. The study of accommodation on the Speedy-i accommodograph was conducted before treatment and after 30 days of treatment.
Results. Before wearing OK lenses, 50.5 % had normal accommodative function, 33 % revealed lack of accommodation and only 16.5 % had various degrees of accommodation overstrain. After 6 months of using OK lenses, the accommodation pattern changed: 33.5 % of patients retained normal accommodation function, in 15.5 % of cases accommodation insufficiency decreased, but the number of patients (51.0 %) with accommodation overstrain of varying degrees increased. During the next 6 months of wearing OK lenses, the state of accommodation practically did not change: 39.5 % retained normal accommodative function, 10.5 % had insufficient accommodation and 49.5 % accommodation overstrain. The course of treatment with Mydrimax® for 30 days in patients with OK correction was effective at any degree of accommodation overstrain.
Conclusion. The use of OK lenses stimulates accommodation by reducing the number of patients with accommodation insufficiency and increasing the number of patients with accommodation overstrain. The use of Mydrimax® for a course of 30 days is effective in patients with OK correction at any degree of accommodation overstrain.

Purpose. To study the parameters of visual fixation, photosensitivity of the retina in the macular region, thickness of the central region of the retina and the choroid and their relationship with the best corrected visual acuity (BCVA) and refraction in nystagmus and various types of amblyopia.
Material and methods. 65 patients aged 5 to 44 (mean age 12.61 ± 7.12 years) were divided into 6 groups depending on the type of amblyopia and associated conditions. The control group was composed of subjects of the same age range without eye pathologies. The retinal photosensitivity and fixation parameters were studied using an MP-3 Nidek microperimeter (Japan). Chorioretinal parameters were evaluated using an RS-3000 Advance 2 spectral optical coherence tomograph (Nidek, Japan).
Results. Retinal photosensitivity was lower in the groups with nystagmus and relative amblyopia in congenital myopia compared with the control group. The indices of density and stability of fixation were the lowest in nystagmus and dysbinocular amblyopia. In all groups with nystagmus, a smoother profile of the foveal region was revealed as compared to the control group. The grossest violations of the differentiation of the central fossa were found in nystagmus in combination with congenital myopia. In nystagmus, refractive and dysbinocular amblyopia, a significant correlation was found between the indicators of BCVA and the density of fixation. In the groups associated with congenital myopia, a relationship was found between BCVA, refraction, and foveal photosensitivity.
Conclusion. With nystagmus, violations of both fixation and photosensitivity are revealed. With relative amblyopia due to congenital myopia, the fixation is normal while photosensitivity is impaired. With dysbinocular and refractive amblyopia, the photosensitivity of the retina remains within the normal range, and the fixation parameters are slightly reduced.

Purpose: to study the correlation between the acoustic and morphometric parameters of the optic nerve (ON) and anthropometric data in healthy young people.
Material and methods. The research involved 24 healthy volunteers (48 eyes), including 9 men and 15 women, the average age was 25.0 ± 1.9 years. Anthropometry included measurements of height, weight, and body mass index (BMI). Ultrasound examination of the retrobulbar part of the ON included measurement of the thickness of the ON with and without sheath, echodensitometry of the ON, and ocular biometry. Using optical coherence tomography, we measured the intraocular part of the ON, including the registration of Bruch's membrane opening and ovality index.
Results. The average ON thickness with the sheath was 4.6 ± 0.3 mm, and without sheath, 2.6 ± 0.2 mm. In men, ON with the sheath was thicker than in women (p = 0.001). The acoustic density of the parenchyma of the orbital part of ON was 101.2 ± 11.4 r.u. in women, the mean acoustic density of the ON was significantly higher than that in men. Correlation analysis revealed a statistically significant correlation between the height and the thickness of the ON with the sheath (r = 0.480). The strongest reliable correlation was established between the index of the ON thickness and body weight (r = 0.712) and BMI (r = 0.509) (p < 0.05). No statistically significant correlation was found between the morphometric parameters of the optic disc, anthropometry data and acoustic parameters of the ON.
Conclusion. Studying the acoustic and morphometric characteristics of the intraocular and intraorbital parts of the ON in healthy young people, which included anthropometric data and gender characteristics, will contribute to the development more accurate diagnostic criteria of ON state evaluations.

The success of preventing the development and progression of myopia in children depends on establishing compliance between the doctor and the patient (parents).
Purpose: to study the attitude of parents of myopic children towards the issue of myopia and methods of its control.
Materials and methods. 106 doctors from 53 regions of Russia and 2931 parents of myopic children took part in a prospective multicenter epidemiological observational study in the form of a questionnaire.
Results. As preferable interventions to control myopia, parents mention single vision glasses (67.9 %), glasses with perifocal lenses (16.3 %), bifocal or progressive glasses (3.4 %), other types of glasses (1.6 %), soft contact lenses (11.5 %), orthokeratology lenses (5.8 %), while 13.8 % of myopic children do not use any of those. The average time that children spend on visual work amounts to 10 hours a day, while their light-time daily outdoor activities last for 2.12 ± 1.39 hours. Only 27.1 % of the parents surveyed follow all recommendations of the eye doctor. The reasons for not following are lack of time (45.1 %), complexity of implementation (7.3 %), high cost of treatment (8.5 %), other reasons (39.1 %). Parents consider that the most effective interventions to control myopia are eye drops instillation courses (53.4 %), device-assisted therapy (59.6 %), home visual gymnastics (52.4 %), orthokeratology lenses (13.7 %), bifocal soft contact lenses (4.6 %), specialty glasses (22.7 %), vitamins intake (44.4 %), while 10.6 % believe opinion that no effective myopia control methods exist.
Conclusion. Parents choose single vision glasses as the main optical interventi on method. Near visual work significantly reduces physical activity in the children’s daily routine. Parents’ failure to comply with the medical advice is mostly due to lack of time. The most effective methods of myopia control are considered to be pharmacological treatment, device-assisted therapy and home visual gymnastics.

Purpose: to study the nature of changes in morphological parameters of the children’s optic disc and peripapillary retina in cases of congenital pathology.
Material and methods. 45 children aged 5–17 (the median age was 9.5 years) with congenital pathology of the optic disc (optic disc drusen — 15 eyes, myelinated nerve fibers — 10, optic disc coloboma — 10 and hypoplasia — 10 eyes) were tested for morphological parameters of the optic disc — the disc area, the area and volume of the neuroretinal rim and the thickness of retinal nerve fiber layer (RNFL) — using optical coherence tomography (OCT, SOCT Copernicus HR). The control group included 15 healthy children (15 eyes) of the same age group.
Results. The analysis of the mean values of morphometric parameters of the optic disc and peripapillary retina revealed statistically significant changes of morphometric indicators of the optic disc compared to the norm and their specificity for each type of congenital pathology were identified. Children with optic disc drusen showed an increased optic disc area, increased area and volume of the neuroretinal rim, and thicker RNFL. In cases of myelinated nerve fibers, the area of the optic disc and the area and volume of the neuroretinal rim were increased, too: however, the increased thickness of RNFL was observed in only half of the cases. All children with optic disc coloboma showed a reliable increase of optic disc area, reliable drop in neuroretinal rim area and volume, and statistically insignificant increase of RNFL thickness.
Conclusion. Morphometric features of the optic disc revealed for individual pathologies (myelinated fibers, drusen, coloboma, hypoplasia) revealed by OCT allow one to predict the development of clinical and functional disturbances in children with congenital optic nerve abnormalities.

Purpose: to evaluate the wave-front and accommodation changes in various stages of keratoconus corrected by scleral contact lenses.
Material and methods. 20 patients (39 eyes) aged 18–37 with keratoconus of various stages (8 eyes with stage I, 3 eyes with stage II, 12 eyes stage II/III and 16 eyes with stage III wore OneFit or OneFitMed scleral lenses, made of hard gas-permeable material Contamac (Great Britain) with Dk 100 and mean thickness of 200–220 μm. All patients were examined using refractometry before and after cycloplegia, tested for uncorrected and best corrected visual acuity, relative accommodation reserve (RAR), binocular and monocular accommodation response (with Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K, Japan) for full spectacle correction and scleral contact lens correction. 17 patients (34 eyes) were tested for corneal aberrations with OPD Scan III aberrometer (Nidek) without correction and with scleral contact lenses.
Results. Patients with keratoconus demonstrated a manifest form of refraction -5.26 ± 0.45 D (by sphere equivalent) and a cycloplegic refraction of -4.75 ± 0.33 D. Uncorrected visual acuity averaged 0.26 ± 0.05, increasing with full spectacled correction to 0.54 ± 0.07 and with scleral contact lenses correction to 0.95 ± 0.08. Keratoconus patients demonstrated binocular accommodative response (BAR) of +4.5 to -6.12 D averaging -1.43 ± 0.34 D with full spectacled correction diopters and of -0.5 to -8.13 D averaging - 2.83 ± 0.23 D with scleral contact lenses, р ≤ 0.01. We could not measure the BAR in 3 patients with keratoconus stage III. Monocular accommodative response (MAR)with a full correction with glasses averaged -0.98 ± 0.33 D (from + 6.0 to -5.0 D) with full spectacled correction and -2.41 ± 0.27 D (from +1.25 to -5.5 D) with scleral contact lenses, р ≤ 0.02. At the same time monocular accommodative response of 4 patients with keratoconus of the third stage of disease was not available to assess. So, accommodative response significant increased with scleral contact lenses. Positive relative accommodation with a full correction with glasses averaged 1.50 ± 0.35 D, with scleral contact lenses – 2.25 ± 0.29 D, р ≤ 0.01. The level of all aberrations, from lower to higher orders was significantly increased. With scleral contact lenses that correct the shape of the anterior surface of the cornea, the level of all corneal aberrations dropped to nearly normal values, while the coefficient of asphericity dropped below normal values, and the point spread function parameter (PSF) increased by fifteen times (to reach 0.06).
Conclusions. Patients with keratoconus demonstrated a generally lower objective accommodative response as compared to normal values, but with the scleral lenses it increases to the normal level. Scleral contact lenses normalize corneal aberrations and increase the quality of vision. All of the above justifies the recommendation to use scleral contact lenses for optical correction of keratoconus to increase the vision, the accommodation response and visual comfort, including that of near-visual work.

Purpose: to evaluate blood flow velocity in the posterior short ciliary arteries during phacoemulsification (PE) at different levels of intraocular pressure (IOP).
Material and methods. The study included 29 patients aged 62–83 (average 71.2 ± 6.0) with initial-stage age-related cataract. PE was performed using the Alcon Centurion vision system at a preset IOP level of 60 mm Hg. Blood flow velocity was determined three times using an expert-class ultrasound scanner (GE Logiq S8): immediately before surgery (before opening the eyeball), intraoperatively at an IOP level of 58.77 ± 8.28 mm Hg, and after surgery and IOP normalization. Additionally, the IOP level was measured three times (by Icare PRO tonometer). The blood pressure level was monitored by the standard method on the brachial artery using the Dr ger Vista 120 system. The measurement results were compared with the control group which included 20 healthy fellow eyes.
Results. A decrease in blood flow velocity was established upon reaching the IOP level of 58.77 ± 8.28 mm Hg. The maximum systolic blood flow velocity in the posterior short ciliary lateral artery decreased from 14.46 ± 2.92 to 11.22 ± 2.55 cm/s, while the final diastolic blood flow fell from 5.11 ± 1.83 to 2.97 ± 1.27 cm/s. The maximum systolic blood flow velocity on the medial side also fell from 12.37 ± 2.74 to 9.50 ± 1.68 cm/s, and the final diastolic velocity fell from 4.54 ± 1.35 to 2.73 ± 0.91 cm/s (p < 0.05).
Conclusion. During PE, the IOP level exceeding certain values leads to a decrease in blood flow velocity in the posterior short ciliary arteries. It is important to realize, however, that autoregulatory mechanisms for maintaining stable hemodynamics are limited if IOP levels are increased.

Purpose: to study the relationship between the clinical and ultrasound characteristics of post-traumatic eyelid scarring at different stages of the post-traumatic period.
Materials and methods. 15 patients aged 13 to 61 (ave. 36.5 ± 12.2 years) with post-traumatic eyelid scarring were examined for the clinical characteristics of the scar by the Manchester scar scale and subjected to ultrasound gray-scale B-scan of tissues in the “Small Part” mode and echodensitometry.
Results. The above measurements of patients who suffered trauma 2–3 months before the study totaled 3–4 points on the Manchester scale, while the acoustic density of scars varied from 21 to 43 conv. units (ave. 30.5 ± 5.9 conv. units). The patients whose eyelid trauma occurred 5–6 months before the study, totaled 4–5 points; and the average scar acoustic density ranged from 30 to 65 conv. units (ave. 43.5 ± 9.8 conv. units). 10–12 months after the trauma, the clinical signs of patients received 5 points whilst a comprehensive ultrasound examination yielded the acoustic density of scars varying from 43 to 84 conv. units (ave. 54.4 ± 17.6 conv. units).
Сonclusion. The study revealed a direct relationship between the changes in the clinical and ultrasound characteristics of the eyelid scar tissue at different post-traumatic period stages. As the post-traumatic period continued, the scar density, its echogenicity and the displacement of the surrounding eyelid tissues was found to increase.

The purpose is to find out the relations of the vascular endothelium dysfunction, atherosclerotic damage to the vessels of the upper and lower limbs, the state of the antioxidant and prooxidant systems, and the lipid profile in patients with different POAG course — carriers of biological clock gene polymorphism.
Materials and methods. 47 patients with advanced POAG underwent an examination that included visometry, biomicroscopy, ophthalmoscopy, perimetry, tonometry, thermometry, as well as determination of lipid metabolism, indicators of oxidative stress and antioxidant system. All patients were also tested for the degree of endothelial dysfunction by reactive hyperemia method, and the elastic properties and vascular wall tone by the volumetric sphygmomanometry method. POAG progression was determined by static automated perimetry and optical coherence tomography. The hospitalized patients were examined for daily melatonin profile and key biological clock genes typed by real-time polymerase chain reaction. The genetic material was taken by buccal scraping. Polymorphic variants were identified for CLOCK rs1801260 3111T/C and MTNR1B genes. 16 patients (S-POAG — 8, A-POAG — 8) were tested for melatonin taken from saliva samples at different times of the day in laboratory conditions with controlled nutrition and lighting using the DLMO protocol.
Results. The predictors of glaucoma progression were found to be pronounced endothelial dysfunction and oxidative stress, which contribute to the acceleration of atherogenesis and a decrease in the elastic properties of the vascular wall of peripheral vessels. Clock 3111t-c circadian gene polymorphism was found to be interrelated with lipid metabolism disorders and increased lipid peroxidation in patients with POAG progression. Carriers of the G allele of the MTNR1B gene tend to have a higher level of triglyceride (TG) which grows in the evening hours if glaucoma is progressing. We showed that the phasal and amplitude characteristics of daily melatonin level, rather than its average level, may affect the state of the vascular wall of peripheral vessels in POAG patients.
Conclusion. POAG progression is associated with pronounced oxidative stress, weakened antioxidant protection and dyslipoproteinemia. Differences in the lipid profile (dyslipidemia) and the indicators of oxidative stress and antioxidant protection in patients with stable and progressing glaucoma course are mutually related with Clock 3111t-c gene polymorphism (CG genotype).

Purpose: to assess the effect of the biologically active additive complexes “Doppelherz® active Vitamins for eyes with lutein” and “Doppelherz® active Vitamins for eyes with chromium, zinc and selenium” on the functional state of the eye in patients with chronic ischemic optic neuropathy (ION).
Material and methods. The study involved 60 patients (111 eyes) aged 51–92 (ave. 62.2 ± 1.2 yrs) with chronic ION divided into three groups of 20 patients each. Group I received the first additive, “Doppelherz® active Vitamins for eyes with lutein”; Group II received the second additive, “Doppelherz® active Vitamins for eyes with chromium, zinc and selenium”; and Group III receive no additives at all. The additives were taken according to the standard scheme — 1 tab per os during the first meal for 2 months. All patients were examined before the start and 2 months hereafter.
Results. A positive trend in best corrected visual activity (BCVA) were noted in groups I and II. Group I showed an increase in the critical flicker frequency (CFF) of the red and blue spectra by 1.06 and 1.33 %, respectively, a decrease in the green spectrum by 2.7 % (p < 0.05), and an improvement in the visual fields by 0.61 %. Group II demonstrated an increase in the CFF of the red spectrum by 1.2 %, green — by 2.7 %, blue — by 0.8 %, and an improvement in visual fields by 3.08 %. Group III showed a negative trend in visual functions: BCVA dropped by 1.92 %, and CFF decreased in the green and blue spectra by 3.34 % (p < 0.05) and 0.1 %, respectively. Retinal photosensitivity improved in group I by 0.31 %, in group II by 0.59 % (p < 0.05), in group III it dropped by 0.56 %. A survey showed a decrease in asthenic and asthenopic complaints by patients of groups I and II.
Conclusion. A positive effect of both biologically active additive complexes on the functional state of the eye has been revealed.

Purpose: a comparative study of corneal and total wavefront aberration changes after traditional PRK and FemtoLASIK.
Material and methods. Corneal and total wavefront aberrations were studied on OPD-Scan III aberrometer (Nidek) in 63 patients (126 eyes) with moderate and high myopia before and after FemtoLASIK (Ziemer + Nidek-Quest, Japan) (44 patients, 88 eyes) and PRK (Nidek-Quest, Japan) (19 patients, 38 eyes). Spherical aberration (SA) was considered as the sum Z4 + Z8 + Z12.
Results. The corneal asphericity coefficient Q changed to positive values after both types of intervention. Corneal RMS HOA increased in both Femto and PRK groups. Corneal Tilt 1 increased after FemtoLASIK and moved to negative values after PRK, corneal tilt 2 moved to negative values after Femto and to positive values after PRK. The vertical trefoil showed no significant change in the Femto group and dropped in the PRK group. The vertical and horizontal coma (coma 7, coma 8) changed synchronously. Corneal SA increased after Femtolasic, and became negative after PRK. The total aberrations showed a lesser change and the changes were not synchronized with the corneal ones: in particular, the RMS HOA fell from 0.28 ± 0.05 to 0.19 ± 0.05 in the Femto group, while the corneal RMS increased significantly. In the PRK group, the corneal RMS HOA showed some increase, but it was much less than corneal RMS: from 0.25 ± 0.07 to 0.62 ± 0.02 μm. The total SA increased from 0.11±0.03 to 0.27±0.02 in the Femto group and showed an insignificant drop from 0.09±0.03 to 0.03 ± 0.01, while remaining positive in the PRK group.
Conclusions. The changes of the wavefront after FemtoLASIK and PRK are both significant and different. The revealed differences in the changes of corneal aberrations correspond to different profiles of the anterior surface of the cornea formed after FemtoLASIC and PRK. The internal optics of the eye partially compensates the corneal aberrations induced by excimer laser surgery.

Purpose. Description of a clinical case of a patient with congenital glaucoma and mutations in the CYP1B1 gene, taking into account the analysis of literature data.
Material and methods. The following methods were used to examine the patient: standard ophthalmological examination, EPI (VEP for flash, mERG and rERG) and fundus photoregistration, molecular genetics study of the CYP1B1 gene. DNA research was carried out by the method of direct automatic sequencing according to Sanger (the biomaterial was used — venous blood).
Results. The article describes a clinical case of congenital glaucoma in a child with an early (from birth) manifestation of glaucoma, a distant stage at the time of examination, at the age of 2 years 6 months. Revealed pronounced clinical, functional and structural changes in the eyes, as well as changes in electrophysiological parameters. The previously described pathogenic variants of the nucleotide sequence 1330C> T (p.Arg444 *) and c.1405C> T (Arg469Trp) in heterozygous states were found in the CYP1B1 gene.
Conclusion. The severity of the clinical course of congenital glaucoma in the described clinical case is presumably due to mutations in the CYP1B1 gene. A timely, interdisciplinary approach to diagnosis is key to successful treatment of glaucoma in children.

Purpose: to study the morphological structures of the eyes of patients with primary open-angle glaucoma (POAG) and to identify the changes characteristic of this disease.
Material and methods. We examined 90 patients with various stages of POAG and compensated ophthalmic tonus and 50 patients without glaucoma with ophthalmic pathology not associated with eye hydrodynamic disorders (control group), aged 40 to 81 years and older. In addition to the standard ophthalmological examination, all patients were examined for the curvature of the anterior surface of the cornea and its thickness, the depth of the anterior chamber and the thickness of the lens, the length of the eye axis, the thickness of the retinal nerve fiber layer (RNFL) and the condition of the optic nerve head (ONH), using ophthalmometry, keratotopography, anterior segment analyzer (Pentacam, OCULUS, USA), ultrasound biometry (UD-6000 Tomey, Japan), and optical coherence tomography (OCT).
Results. No significant differences in the parameters of ultrasound biometry and pachymetry were revealed between the control group and POAG patients. The only types of data characterizing the glaucoma process were altered parameters of the optic disc and the peripapillary zone of the retina, namely, the thickness of the RNFL. In 81.1 % of glaucoma eyes, temporal excavation was detected, the average RNFL thickness in the temporal segment of the ONH was 44.2 ± 3.0 μm.
Conclusion. Ophthalmoscopy and OCT of the ONH and RNFL are the main diagnostic methods that allow obtaining indisputable data on the morphological changes characteristic of POAG. These studies should become mandatory in the diagnosis of glaucoma and monitoring of patients with POAG..

Inherited retinal dystrophies (IRD) include a wide range of genetically and phenotypically heterogeneous diseases that lead to progressive loss of vision. With the development of gene therapy, it has become possible to treat two forms of IRD caused by biallelic mutations in the RPE65 gene: isolated retinitis pigmentosa (IRP) type 20 and Leber's congenital amaurosis (LCA) type 2. These nosologies are included in the list of orphan diseases of the Russian Ministry of Health. The success factor for the use of IRD gene therapy is the early stage of the disease, when the viability of retinal cells is preserved. An interdisciplinary approach to diagnostics makes it possible to timely establish the clinical and genetic variant of IRD and refer the patient to targeted therapy. Therefore, at a joint meeting of the Council of Experts of the North-Western Federal District of the Russian Federation, which included ophthalmologists and medical geneticists, a scheme for managing patients with IRD was accepted, including the stages of clinical and functional ophthalmological examination and molecular genetic testing. In addition, regional centers of expertise for IRD were approved in two federal medical institutions in St. Petersburg, whose task is to optimize the quality of diagnosing patients with IRP and LCA.

Infectious crystalline keratopathy (ICK) is a rare cornea disease, manifested by gray-and-white tree-like or needle-like stromal opacities with minimal signs of inflammation. The disease is caused by the colonization of microorganisms on the corneal stroma and their formation of biofilms, making them extremely resistant to treatment with antibiotics and to the immune response of the patient. Typically, the most important risk factor for ICK development is the presence of an immunodeficiency cornea condition with long-term topical steroid therapy, which is normally prescribed after keratoplasty. Two clinical cases of ICK are discussed in which the reduction of topical glucocorticoids and the intensive use of antibiotics did not result in positive clinical changes. Only after an accelerated crosslinking procedure (PACK-CXL), needlelike opacities disappeared in the area of microbial invasion and signs of infiltration appeared, indicating the restoration of the local immune response. This phenomenon is likely due to the destruction of the biofilm and the microbial agents themselves, which afterwards contributed to a more effective impact of the antibacterial drug. This combined treatment led to resorption of the inflammatory focus with the formation of local opacification. The effectiveness of PACK-CXL in infectious processes is explained by the effects of both riboflavin and ultraviolet radiation. No literature references on the use of cross-linking in the treatment of ICK are available. In our opinion, cross-linking in early ICK patients after keratoplasty is justified by the inability, in some cases, to completely discontinue glucocorticosteroid therapy, as this will greatly increase the chances of rejection and graft jailure. PACK-CXL can be an effective way of destroying the biofilm in the corneal stroma.

Purpose. To describe two ipsilateral, metachronous, ocular choroidal melanoma metastases.
Material and methods. A 64-year-old choroidal melanoma patient was initially treated with palladium-103 ophthalmic plaque brachytherapy which induced local control of the primary cancer. Seven years later, ophthalmic findings of a second, ipsilateral, discrete choroidal melanoma prompted restaging which revealed new hepatic and nodal metastases. Systemic immunotherapy (ipilimumab 3 mg/kg with nivolumab 1 mg/kg IV every 3 weeks 4 doses) resulted in intraocular tumor regression and was followed by maintenance nivolumab 480 mg IV every 4 weeks with follow-up ophthalmic examinations.
Results. Three years after initiation of systemic immunotherapy, the patient was found to have a second ipsilateral local recurrence of choroidal melanoma. It presented with retinal detachment, uveitis, and optic neuritis. Then, due to its anterior uveal location, extrascleral tumor extension was amenable to a diagnostic biopsy. Overall, 3 years after onset of metastatic uveal melanoma and 2 months after her second ocular metastasis, the patient died. This was 10 years after the initial diagnosis of choroidal melanoma.
Conclusions. Metastatic choroidal melanoma can present twice in the same eye as the primary tumor. Ophthalmic and systemic examinations allowed for immunotherapy to affect initial systemic regression, vision sparing, and globe salvage.

The density of macular pigment in the central retina is the total concentration of lutein, zeaxanthin and meso-zeaxanthin. Normally, the average value of the optical density of macular pigment can vary significantly as it depends on the person's lifestyle, the total amount of pigment in the body, nutrition, gender, age, as well as concomitant diseases such as diabetes, obesity, arterial hypertension. Differences in the level of optical density of macular pigment between different countries were revealed and it was showed that this parameter drops in cases of retinal pathology, cataract, glaucoma, myopia, macular degeneration, or diabetic macular edema. The level of macular pigment may be considered as a significant diagnostic criterion in many ophthalmic pathologies, so any changes of this parameter require attentive consideration.

The issue of surgical treatment of cataracts in patients with age-related macular degeneration (AMD) is important due to a high incidence of the comorbid course of the two diseases. The effectiveness of phacoemulsification of cataract (FEC) in patients with AMD, its influence on the course of AMD, the characteristics of visual functions, and the quality of life of these patients are still controversial. The study of risk factors for the development of choroidal neovascularization, the influence of the characteristics of surgical treatment and the number of injections on the incidence of intraoperative complications seems to be quite relevant for understanding the possible mechanisms of AMD progression after FEC. This study is instrumental in the development of measures preventing the reactivation of the pathological process, improving visual functions and the quality of life of patients after surgical treatment of cataracts. The range of contraindications for FEC in patients with neovascular AMD is rather limited , and continuation of anti-VEGF therapy stops active exudation and increases visual acuity in patients with neovascular AMD. Maintaining functional parameters, improving peripheral vision, contrast sensitivity, improving the quality of OCT imaging provides both significant benefits for the patient and boosts the control of the disease, increasing the accuracy of monitoring.

The review presents data on the effect of program hemodialysis on the state of intraocular pressure in patients with terminal chronic renal failure. Treatment with hemodialysis is accompanied by various effects: from intraocular pressure drop to the development of ophthalmic hypertension with pain syndrome. The state of the iris-corneal angle, neovascularization of the structures of the eye drainage system and the presence of glaucoma are significant, but not indisputable, risk factors for pain-related dialysis ophthalmic hypertension. Their combination with the effect on the osmolar balance of dialysis therapy increases the possibility of the formation of ocular hypertension syndrome formation. The need to eliminate dialysis eye pains and the chance of glaucoma progression due to dialysis-affected fluctuations of intraocular pressure remains relevant.

The review discusses the treatment methods based on physical phenomena in clinical ophthalmology. The physical nature and treatment techniques using electric current and electromagnetic field, light and laser radiation, mechanical energy and sound waves, high and low temperature in various ocular pathologies are considered. It is noted that reliable evaluation of the effectiveness of physical treatment methods for the different diseases and pathological conditions requires the implementation of protocols that include objective testing methods of the structure and functioning of the visual system. Once the clinical effectiveness of the particular physical treatment methods and techniques is confirmed, further development and improvement of the most efficient ones becomes possible.

The review presents an analysis of traditional and promising approaches to assessing the quality of life (QoL) in cataract surgery. Literature data indicate statistically significant correlations between QoL and objective indicators of the visual system both during the initial examination of the patient and, more importantly, in the course of therapy. Traditional approaches to the study of QoL in cataract surgery reveal a trend towards the development of targeted questionnaires featuring optimized psychometric testing of questions and the procedure for scaling answers. New QoL questionnaires are developed in order to improve the collection and evaluation of information by taking into account the quantitative assessment of patient complaints made by an expert ophthalmologist, who can reliably evaluate their impact on QoL. It also seems appropriate to use the "International Classification of Functioning, Disabilities and Health", develop more targeted questionnaires aimed at assessing modern aspects of cataract surgery, and optimize the study itself.