A short biography of an outstanding Russian ophthalmologist, Professor Tikhon Ivanovich Eroshevsky is presented to commemorate his 120th anniversary. Professor Eroshevsky made a significant contribution to ophthalmological science and practice. He was the founder of a well-known scientific school.

Purpose. To analyze the cases of ophthalmic hypertension in patients after vitreoretinal surgery with various tamponades of the vitreal cavity.

 Material and methods. We analyzed 344 case histories of patients aged 30 to 80 who underwent vitreoretinal intervention with various tamponades of the vitreal cavity for macular rupture, epiretinal membrane, hemophthalmia, retinal detachment in 2019–2021. To detect ophthalmic hypertension, all patients underwent tonometry before surgery and every month after it during the entire 2-year follow-up period.

Results. Of the 46 patients who were diagnosed with ophthalmic hypertension after vitreoretinal surgery, 18 patients achieved intraocular pressure compensation within the 2 year follow-up and they required no hypotensive therapy. 28 patients, including 4 patients who had glaucoma before vitreoretinal intervention were prescribed hypotensive therapy (carbonic anhydrase inhibitors, 2 adrenomimetics), 2 patients received an implantation of an Express anti-glaucomatous device.

Conclusions. The analysis of ophthalmic hypertension in patients after vitreoretinal surgery showed that post-surgical IOP increase occurs both in cases of applying tamponade with silicon oil and those using sterile air or gasair mixture. Intraocular pressure compensation follows different patterns in every case, so that an individual approach is needed. Using one antihypertensive drug may be insufficient so in some cases a stronger antihypertensive therapy is required and sometimes anti-glaucomatous surgical interventions have to be resorted to.

Purpose. To evaluate the results of glaucoma surgery with Xenoplast drainage and fixation of IOL/capsula bag complex in patients with subluxation and luxation of this complex and secondary pseudophakic glaucoma.

Materials and methods. 35 patients (35 eyes) aged 60 to 92 with secondary pseudophakic previously unoperated glaucoma, pseudophakia, zonula weakness and IOL dislocation or decentration were observed. The patients underwent phacoemulsification 6 to 12 years prior to the follow-up. In all cases IOP exceeded 28 mm Hg under 4–5 hypotensive medications a day. All patients had glaucoma surgery nonpenetrating deep sclerectomy with Xenoplast drainage implantation in the intrascleral space with simultaneous IOL/capsula bag suturing to the sclera. Anterior vitrectomy was performed if proved necessary.

Results. In early post-op period, 94% of cases showed moderate hypertension of 26 to 28 mm Hg, but 2 cases showed 40 mm Hg one day after the operation. During the first month all patients received hypotensive medication: 2–3 instillations of carbonic anhydrase inhibitors. IOP normalized by the 8th week after operation. 1 to 2 months after surgery, all patients received IAG laser goniopuncture. Vision acuity was improving for 8 weeks and reached 0.1–0.8. The observation period varied between 6 months and 4 years.

Conclusions. Non-penetrating deep sclerotomy with Xenoplast implantation combined with IOL/capsula bag complex fixation to the sclera in cases of pseudophakic noncompensated glaucoma normalizes IOP in the long-term post-op period.

Purpose. To compare the thickness of the prelaminar layer of nerve fibers and the depth of the lamina cribrosa in patients with diverse forms of open-angle glaucoma, measured by optical coherence tomography (OCT).

Material and methods. 130 patients aged 71.4 ± 9.7 with stage II (advanced) glaucoma were divided into three groups depending on the form of glaucoma: group 1 of 39 patients with primary openangle glaucoma (POAG); group 2 of 26 patients with normal-tension glaucoma (NTG); group 3 of 22 patients with pseudoexfoliative glaucoma (PEG). The control group consisted of 43 patients without ophthalmic pathology. All patients were scanned for the optic disc and the macular areas in the OCT Disk + Macula 3D regimen and in the Disk Raster regimen (Optopol Revo 60 OCT device (Optopol Technology, Poland). The depth of the lamina cribrosa (LC) and the thickness of the prelaminar layer of nerve fibers (tPLNF) were calculated.

Results. No significant differences were found between the LC depth in patients with different forms of glaucoma compared with the control group. LC depth averaged 426.9 ± 98.7 μm (p < 0.164) in patients with POAG, 416.9 ± 161.0 μm (p < 0.818) with NTG and 425.5 ± 88.04 μm, (p < 0.18) with PEG. The thinnest layer of prelaminar nerve fibers was found in patients with NTG (134,0 ± 91.4 μM), where the value was half as much as the control (p < 0.001). There were no differences in the tPNFL parameter in POAG (193.2 ± 114.6 μm) and PEG (190.7 ± 115.3 μm) but both were significantly lower as compared to the control group (p < 0.001, p < 0.002) respectively.

Conclusion. The study of LC parameters contributes to a better understanding of the pathogenesis of optic neuropathy in diverse forms of glaucoma. It opens up new opportunities in the differential diagnosis and prediction of the glaucoma course.

Purpose. To evaluate the clinical and functional results of a combined intervention - one-stage cataract phacoemulsification and a newly developed version of partially fistulizing antiglaucoma surgery (PFS) of patients with primary open-angle glaucoma (POAG) as compared with those of phacoemulsification in combination with penetrating and non-penetrating antiglaucoma intervention.

Material and methods. 61 patients (65 eyes) with a combination of incomplete complicated cataract and previously unoperated stages I–III POAG. were divided into 3 groups: group 1 (control, 17 patients, 17 eyes) with ultrasonic cataract phacoemulsification (PEC) and non-penetrating deep sclerectomy (NPDS); 2 group 2 (control, 25 patients, 28 eyes patients with PEC and trabeculectomy (TE); group 3 (main, 19 patients, 20 eyes) with PEC and the newly developed PFS.

Results. The best long-term results, with approximately equal hypotensive parameters were achieved with combined operations, which included PEC with TE (the absolute effect achieved in 65% of cases) and PFS (in 60%). However, the number of early postoperative complications after PFS turned out to be almost 2 times as small as after a simultaneous intervention with penetrating TE, and was wholly comparable with that after NPDS (15 and 11.8%). At the same time, the best visual results over the relevant period were observed in the main (0.78 ± 0.06) group and the control group 1 (0.64± 0.05).

Conclusion. Combined simultaneous intervention, including cataract phacoemulsification with the newly developed partially fistulizing antiglaucoma surgery, is an effective way to improve visual acuity, normalize intraocular pressure and stabilize glaucomatous optic neuropathy, as well as to reduce the drug load on the patient.

Purpose. Integrated assessment of ophthalmogeriatric changes in patients with the wet form of age-related macular degeneration (AMD) at the time of primary diagnosis.

Material and methods. 200 senior and senile patients aged 60 or more (of which 43.5% were male) with the newly diagnosed wet AMD underwent a standard ophthalmological examination, took a survey aimed at identifying specific risk factors, and tested for Body Mass Index (BMI) and Charlson Comorbidity Index (CCI).

Results. The BMI was 29.46 ± 4.1 kg/m2 and the CCI was 3.3 [2; 4]. The average number of disorders per patient with AMD was 4.0 [2; 6] (ranging from 1 to 7). Polypragmasia took place in 8% of cases. Degenerative changes in the conjunctiva were found in 11%, arcus senilis — in 34.55%, dystrophic changes of the iris — in 68%, pseudoexfoliation syndrome — in 17.5%, senile cataract — in 89.5%, degenerative changes of the vitreous — in 84.5%, primary open-angle glaucoma — in 2% of cases. No gender differences were revealed in these indicators. Among systemic diseases, the most frequent were cardiac and cerebrovascular pathologies (arterial hypertension — 74.5%, ischaemic heart disease — 40.5%, cerebrovascular pathology — 20.5%). Type 2 diabetes mellitus was found in 6.5% of AMD patients.

Conclusion. The wet form of AMD is characterized by a wide range of comorbid disorders that can affect the development and progression of the main disease. Polypragmasia plays its own role in this progression.

Purpose: to analyze eyeball and appendage damages inflicted by criminal injuries of patients who sought assistance by the emergency ophthalmological care unit in Perm.

Materials and methods. The data of the patients’register and medical histories of the ophthalmological department of the State Clinical Hospital No. 2 named after Dr. F. H. Gral of Perm for 2018–2020 were retrospectively analyzed.

Results. Out of 30428 cases of domestic injuries, 847 (2.8%) were received under criminal circumstances. The victims, predominantly male (77.6%), and of working age (93.7%), were delivered by ambulance in 51.6% of cases. The majority of people sought assistance within 24 hours (90%). The injuries were inflicted by strangers (59.5%) or acquaintances of the patients. 1257 eyes were injured. The prevailing conditions were contusions (46.9%), while the most common traumatizing factor was first punch (79.6%). Combined damages to the eyeball and appendage were more common, claiming 72.6%. Visual acuity fell below 0.1 in 5.6% of cases, 0.1–0.6 in 57.6%, 0.7–1.0 in 36.8% of cases. 45.9% of all cases were represented by eye burns: mainly they were chemical burns (99.5%) of which the overwhelming type was burns caused by gas spray irritants (97.9%). In burn cases, visual acuity was below 0.1 in 1.4% of cases, 0.1–0.6 in 62.6%, 0.7–0.8 in 36% of cases. The wounds inflicted to the eye amounted to 7.2%, the damaging factors being handgun bullet, glass, metallic objects. Injuries of the eyelids and the eyeball were observed. Most of the injuries were mild (91.3%). 5.83% of the victims needed hospitalization in an ophthalmological in-patient facility.

Conclusion. The eye trauma, especially one of a criminal nature, is a social problem, and its analysis is highly relevant. The data obtained illustrates the need to increase the general culture of the population, to improve sanitary and educational work, and optimize medical care for those suffered.

Purpose. To estimate the accuracy of IOP measurement using artificial intelligence (AI) technologies and applanation tonometry with fixed strength. Material and methods. 290 patients (576 eyes) underwent applanation tonometry according to Maklakov with tonometer weights of 5, 10, and 15 g using a modified elastotonometry technique followed by an analysis of impression quality and diameter measurements by three independent ophthalmologist experts. The prints were then fed into a neural network to check the repeatability and reproducibility of the measurements. Results. The comparison of the diameters of the Maklakov tonometer prints determined by AI based on the neural network with the measurements data provided by three experts showed that neural network underestimates the measurement results by an average of 0.27 (-3.81; 4.35) mm Hg. At the same time, the intraclass correlation coefficient for all prints was 98.3%. The accuracy of diameter measurements of prints by neural network differs for tonometers of different weights, e.g. for a 5 g tonometer the difference was 0.06 (-3.38; 3.49) mm Hg, for 10 g and 15 g tonometers was 0.14 (-3.8; 3.51) and 0.95 (-3.84; 5.74) mm Hg, respectively. Conclusion. High accuracy and reproducibility of the measurements by the neural network, was shown to surpass the reproducibility of human-implemented measurements.

Purpose: to study the accommodative function in contemporary schoolchildren using the method of computer accommodography.

Material and methods. 74 children aged 10–16 (54 with different degrees of myopia and the control group of 20 emmetropic children) were tested on a Righton Speedy-K ver. MF-1 computer accommodograph to determine the accommodative response to accommodation stimulus (by calculating the coefficient of the accommodative response, CAR) and the contraction of ciliary muscle fibers (by determining the microfluctuation coefficient, CMF).

Results. In groups of patients with emmetropia and weak myopia, CAR and CMF were found to exceed the normal values. The low myopia group demonstrated especially pronounced changes. In moderate and high myopia, the CAO is significantly lower than in low myopia or emmetropia, while the CMF also exceeds normal values.

Conclusion. The spastic component of accommodation is of great importance in the pathogenesis of progressive myopia of present-day schoolchildren, which is expressed in the strengthening of the accommodation response with regard to the accommodation stimulus and pathological frequency increase of accommodative microfluctuations.

Purpose: to provide clinical and morphological evaluation of the corneal epithelium phenotype in total vascular leukomas of varied etiologies and determine the optimal surgical treatment using impression cytology (IC).

Materials and methods. 44 patients (44 eyes) with corneal vascular leukomas of various etiologies underwent optic keratoplasty preceded by IС. The patients were divided into 2 groups according to IC findings. Group 1 included 30 patients who were shown by IC to have corneal epithelium. These patients received penetrating keratoplasty (PK). Group 2 consisted of 14 patients whose epithelium was determined to be of conjunctival phenotype. Eight of group 2 patients had their corneal epithelium phenotype restored by limbal transplantation followed by PK. The remaining patients of group 2 were not operated for various reasons.

Results. In the remote postoperative period (9–12 months after the operation) corrected visual acuity of group 1 patients ranged from 0.3 to 0.6 (ave. 0.450 ± 0.073). A relapse of corneal leukoma was observed in three patients of group 1 (10%). In group 2, a transparent vascular-free engraftment of keratotransplants was observed in 5 patients after limbal transplantation (the first stage of surgical treatment) and PK, their corrected visual acuity ranged from 0.1 to 0.5 (ave 0.37 ± 0.12), 1 (20%) patient had a relapse of the leukoma. C

onclusions. Impression cytology is an acceptable and low invasive diagnostic technique that allows clinical and morphological evaluation of the epithelium phenotype that covers the vascular leukoma and helps determine validated indications for the choice of a surgical treatment technique for such patients.

Purpose: to develop a software technology based on artificial intelligence methods aimed at analyzing large volumes of optical coherent tomography (OCT) data in order to identify early symptoms of age-related macular degeneration (AMD) and the transition from dry AMD to neovascular AMD (nAMD).

Material and methods. Patients with dry AMD (1125 eyes), wet nAMD (1200 eyes) and subjects without ophthalmic pathology (1205 eyes) underwent a standard ophthalmological examination and macular OCT (Cirrus HD-OCT 4000, Carl Zeiss Meditec AG, Germany) according to the MacularCube scanning protocol with a standard ETDRS macular map. The thickness of the retina from the inner limiting membrane to the retinal pigment epithelium and the presence and location of fovea configuration changes were determined.

Results. Two ultra-precise artificial neural networks (ANN) were created: one intended to identify patients with early signs of dry AMD and the other to identify those with signs of nAMD. By the time when 1000 training images were processed, the image interpretation decision-making accuracy in the first ANN increased to reach 97.6%, in the second ANN, to 96.8%, which shows the high efficiency of this technology. The deep learning processes were run on an Amazon Web Service EC2 GPU. The trained ANN model was also tested on healthy eyes at each estimated probability value. The correspondence between the doctor's diagnosis and the decision taken by the ANN was assessed.

Conclusions. A software technology based on artificial intelligence methods has been developed, which answered the need to process a large amount of OCT data. The technology proved effective in identifying early symptoms of dry and wet forms of AMD and in early diagnosis of the transition of the dry form of AMD into neovascular form, the latter requiring immediate treatment.

Purpose: to develop a clinical and functional rehabilitation system for patients with mild and moderate hyperopia and accommodation disorders before and after FemtoLASIK surgery and to assess its effectiveness.

Material and methods. 234 patients (234 eyes) with the above conditions, aged 25 to 30 (mean age 27.9 ± 1.2 years) were divided into 2 groups. The control group included 114 patients (114 eyes) who received no prevention measures or accommodation disorders treatment, while the main group (120 patients, 120 eyes) received clinical and functional rehabilitation before and after FemtoLASIK.

Results. The “false myopization” syndrome observed in the main group was 14.2% lower than in the control group. A week after FemtoLASIK, the normalization of accommodation parameters was achieved in 57.5% of the main group cases, and combined accommodation disorders occurred 2.37 less frequently than in the control group. Weak accommodation in patients of this group was 30% less than in the control group. Habitually excessive accommodation in the control group was 2.45 times more frequent than in the main group. According to the CISS test questionnaire, the mean values of indices for the main group patients reached the normal level one month after FemtoLASIK whilst the control group required 6 months.

Conclusion. The clinical and functional rehabilitation system in patients with mild and moderate hyperopia and accommodation disorders applied before and after FemtoLASIK helps achieve maximum clinical and functional results 1 month after the operation and yields the best results in accommodation disorders treatment.

Purpose: to compare the corneal power at main meridians, the magnitude and the axis of corneal astigmatism and the reproducibility of measurements taken three times with different types of biometers.

Material and methods. 22 subjects (24 eyes) with regular corneal astigmatism 1.89–8.02 D were given three biometry tests using IOL Master 500, Lenstar LS 900, IOL Master 700, Pentacam and Galilei G6.

Results. The data were divided into groups depending on the principle of mathematical modeling of the corneal surface: group I involved the material processed by IOL Master 500, Lenstar LS 900, IOL Master 700; group II contained maps of the anterior corneal surface; and group III, those of the posterior surface. In group I, Lenstar showed the highest values of keratometry. In group II, the values of K1 , Kave in the 6 mm area were lower than in the pupil diameter area and than any values of K in the 4 mm area; the lowest values of K in this area were obtained on the Pentacam SimK. In group III, in the pupil diameter area (4.0–4.5 mm), all K values obtained with diverse equipment were different whilst in the 6 mm area the values differed only in the flat meridian. Astigmatism within groups I, III showed no difference while in group II the SimK data were different. The astigmatism axes obtained on IOLMaster 500 differed from the respective data provided by other devices. The devices of group I, 6 mm area, were the most stable.

Conclusions. The highest values of keratometry are obtained when only the anterior surface of the cornea is taken into account, the lowest values are characteristic of the posterior surface. The stability of the parameter registered grew with the increase of the measured zone diameters. The biometers of group 1 showed the highest values of astigmatism with the maximum repeatability of the measurements

Purpose: to study iris perfusion in patients with primary open-angle glaucoma (POAG) after selective laser trabeculoplasty (SLT) using optical coherence tomography angiography (OCTA).

Material and methods. 12 patients aged 68.3 ± 8.4 with stage I to III POAG underwent a standard ophthalmic examination as well as OCTA examination of the iris, which was performed through the center of the pupil under photopic conditions using RTVue-XR with Angio Retina 3-mm protocol. All patients received examination before SLT, one day, seven days, and 30 days after SLT. Vascularity was determined with ImageJ as the total length of binarized and skeletonized vessels over the full thickness of the iris slab.

Results. A statistically significant correlation was found between the values of intraocular pressure (IOP) measured one month after SLT and iris vascularity before SLT, one day after SLT, and their difference. The strongest correlation (r = 0.60, p = 0.001) was found between iris vascularity one day after SLT and IOP one month after the procedure.

Conclusions. SLT is accompanied by an increase in iris vascularity, which fact may probably be used in the prediction of the final IOP in these patients.

Purpose. To analyze the clinical and functional results of refractive lenticular extraction using ReLEx SMILE® and CLEAR® technologies in patients with moderate and high myopia.

Materials and methods. 160 patients (160 eyes) aged 18 to 36 years diagnosed with moderate or high myopia, who had binocular vision, average keratometry parameters (43.0–45.0 D), and no contraindications to laser vision correction were operated according to the technology of refractive extraction of lenticula followed up 1 and 3 months after surgery. The patients were divided into 2 groups: (1) SMILE, which included 80 eyes of patients operated with the femtosecond laser VisuMax 500; and (2) CLEAR, including 80 eyes of patients operated using the femtosecond laser FEMTO LDV Z8. Both types of surgery were performed according to standard protocols.

Results. No intraoperative complications were recorded. The analysis of clinical and functional parameters in the correction of myopia using the technology of refractive lenticular extraction performed with VisuMax and LDV Z8 femtosecond lasers demonstrated high and comparable efficiency, safety, predictability and stability.

Conclusion. Both technologies of refractive lenticular extraction can be recommended for wide clinical use in the correction of moderate and high myopia.

Purpose. To present various techniques of surgical treatment with the dislocation of the IOL — fibrosed capsular bag complex, and to analyze their clinical and functional results.

Material and methods. 50 patients (mean age 75.7 ± 1.3 years) who received surgery with IOL-capsular bag complex (ICBC) were divided into 2 groups according to the applied treatment tactics. Tactics 1 consisted in suturing ICBC to the iris on the support needle without manipulations with the capsular bag (26 eyes). Tactic 2 involved IOL suturing to the iris in combination with various manipulations on the capsular bag, aimed at partial or complete removal of fibrous tissue (24 eyes). The follow-up period ranged from 4 to 6 years.

Results. The criteria affecting the choice of the treatment technique were determined: integrity of the Zinn ligament, manifestation of capsular bag fibrosis (phimosis of the anterior capsulorhexis, fibrosis of the posterior capsule); impact of changes in the capsular bag structure on the correct position of the IOL (frontal inclination of the IOL, inversion of haptic elements to the optic zone); presence of a prolapse of the vitreous body; Semmering's ring with a high risk of the release of lens masses. A frequency occurrence analysis of the proposed criteria showed their importance in the choice of surgical treatment technique in patients with mixed type ICBC dislocation. Remote functional results of the operations are presented.

Conclusion. The proposed low invasive methods of surgical treatment of patients with the dislocation of the IOL — fibrosed capsular bag complex are reliable and technically simple. Relative indications to choosing the treatment method with dislocation of the IOL-fibrosed capsular bag complex have been determined for various combinations of the proposed criteria.

Purpose. To study the basic transport characteristics of human and pig corneal endothelial cells, including osmotic water permeability, activation of sodium transport from the cell after conservation, and the ability of the cells to restore their volume when transport mechanisms of the endothelial cells are activated at 37°C.

Material and methods. The experiments were held on the primary cell culture of human and pig cornea endothelia. Changes in cell volume were determined by a method based on quenching of Calcein fluorescence probe by the cytosol proteins. Changes in intracellular sodium ion concentration were studied using Sodium Green as a fluorescent probe. Restoration dynamics of cell volume and intracellular sodium concentration were studied under medium temperature changes from 20 to 37°C. Osmotic water permeability was calculated from the rate of cell volume changes under medium osmolality decreasing from 560 to 280 mOsm/kg H2 O.

Results. It was established that human endothelial cells plasma membrane has a significantly higher osmotic water permeability than pig endothelial cells (Pf = 1.90E-01 ± 4.66E-02 and 1.31E-01 ± 1.16E-02 cm/s, respectively; p < 0.01, n = 17). Human cells after the temperature restored to 37°C, sodium ions removal from human cells occurs more intensely than from pig cells (-3.2E-3 ± 3.1E-4 с-1 и -6.5E-4 ± 1.2E-5 s-1, respectively; p < 0.01, n = 6). The study of cell volume drop has shown that heat activation of cellular transport restores the endothelial cell volume in humans more slowly (-1,7E-4 ± 5,5E-5 с-1, n = 9) than that of pig cells (-1.7E-3 ± 4E-4 s-1, n = 4, p < 0.05).

Conclusion. When using the endothelium of pig cornea as an experimental model of human endothelium, we need to take into account the significant difference in parameters that determine cell volume regulation.

Purpose: to study the structural organization of the vascular bed of human retina in the terminal stage of primary open-angle glaucoma (POAG).

Material and methods. We performed a comparative immunohistochemical analysis of the content of vessels in the retina of 13 eyes of patients in the terminal stage of POAG, enucleated for medical reasons, and 17 eyes with uveal melanoma, using the markers of blood vessels endothelium CD34. The ultrastructural organization of the interstitium and endothelial cells of retinal microvessels was studied by electron microscopy and morphometry.

Results. A significant increase in the volume density of the interstitium and a decrease in the volume density of CD34+-blood vessels in the retina of patients in the terminal stage of POAG, as compared with uveal melanoma, were revealed. An increased volume density of luminal and basal caveolae and the formation of transendothelial channels in the cytoplasm of endotheliocytes of retinal blood capillaries in the terminal stage of POAG were noted.

Conclusion. In the terminal stage of POAG, the interstitial spaces of the retina are increased and the volume density of blood vessels is dropping. The increased volume density of luminal and basal caveolae and the formation of transendothelial channels in the cytoplasm of blood capillary endotheliocytes indicate the growth of transcytosis and the permeability of the blood-retinal barrier.

The article presents three clinical cases of severe pathologies of the anterior segment of the eye, which developed in patients with serious concomitant somatic diseases and COVID-19 under the pandemic. Our observations show that the SARS-CoV-2 virus can contribute to the onset of severe keratitis and keratouveitis, characterized by a long torpid course, relapses, and a poorly predicted outcome. In patients with coronavirus and severe somatic pathology, these diseases have atypical symptoms that complicate the diagnosis, are resistant to treatment, and require an extended period of convalescence. This can be explained by pronounced vascular inflammatory reactions, a possible invasion of eye tissue by viral particles, disruption of tear production, a decrease in local immune defense factors of the eye and systemic immunity, and a violation of the hemato-ophthalmic barrier. Local and general drug treatment brought weakly positive changes. The course of the disease took an undulating character. The description of the clinical cases reflects the polymorphism of symptoms and the multiorganic character of damages associated with COVID-19.

In this case study, a bilateral acute angle closure due to choroidal effusion was the initial manifestation of a previously undiagnosed hantavirus infection (hemorrhagic fever with renal syndrome). The diagnostic and treatment algorithms are described. Advanced diagnostic technologies and a systematic approach to the analysis of atypical angle closure allowed not only to identify the cause of clinical presentations — choroidal effusion and anterior displacement of the lens–iris complex, but also to reveal the underlying systemic disease. The clinicians’ awareness of acute angle closure mechanisms is important in preserving the patient’s vision and timely diagnosing potentially life-threatening conditions.