The paper analyzes the data of a survey, conducted among the chief ophthalmologists in 34 regions of Russian Federation, on the state of medical care of patients with diabetic retinopathy. The questionnaire of the survey was developed by WHO within the international program "Tool for the Assessment of Diabetic Retinopathy and Diabetes Management System" (TADDS) and adapted to Russia’s conditions. We analyzed the scope of practical use of regulatory documents, the availability of medical care, screening quality, diagnosis, monitoring and treatment of diabetic retinopathy, cooperation of medical facilities, and education of medical staff // Russian Ophthalmological Journal, 2016; 2: 5-10. doi: 10.21516/2072-0076-2016-9-2-5-10.

The paper is a continuation of the previous paper with the same title published in ROJ, 2015; 8 (2): 14-20, which focused on theoretical issues of topometry and dosage/anatomical planning of proton radiation of intraocular targets and presented technical aspects of the development of a special radiation installation for proton therapy of intraocular malignant neoplasms. The present paper discusses positioning issues, i.e. exact placement of the target (tumor) with regard to the dosage distribution field envisaged by the treatment plan. The paper describes the unit supplied with a positioning system aligning the eye with the proton beam: it traces the location of the eye during irradiation and stops the dose delivery if the eye is misplaced // Russian Ophthalmological Journal, 2016; 2: 11-17. doi: 10.21516/2072-0076-2016-9-2-11-17 .

The paper analyzes the results of treatment of 78 children with habitually excessive tension of accommodation combined with low myopia (156 eyes), divided into 3 groups. During one month, daily before going to bed, group 1 (24 children, 48 eyes) received instillations of Mydrimax (tropicamide 0.8 % with phenilephrine 5 %), group 2 (30 children, 60 eyes) received Mydriacyl 1 % (tropicamide 1 %), while group 3 (24 patients, 48 eyes) received Irifrin 2.5 %. Before and after the course of treatment, all groups of patients were given standard ophthalmic examination, which included visual acuity measurement without correction and with maximal correction, refractometry, proxymetry, remotometry, absolute accommodation volume, and accommodography by Righton Speed-K ver. MF-1. Mydrimax therapy proved to be the most effective. The tension of accommodation decreased, the far point of clear vision moved away from the eye, the near point of clear vision moved closer to the eye, and, the absolute accommodation volume showed a statistically significant increase. In 83.3 % of cases, Mydrimax therapy resulted in the normalization and/or improvement of all parameters of the accomodogramme // Russian Ophthalmological Journal, 2016; 2: 18-21 . doi: 10.21516/2072-0076-2016-9-2-18-21 .

The epidemiological situation of glaucoma has been noted to deteriorate throughout Russia and the Amur region in particular. The overall incidence of glaucoma for 1990-2014 (as estimated by referral), increased by 102.6 %: from 3.9 to 7.9 ‰. The primary incidence of glaucoma (by referral) for the same period increased by 75 % - from 0.4 to 0.7 ‰. The overall incidence of glaucoma (by referral) among urban population increased by 162.5 % - from 4.0 to 10.5 ‰. Among rural population, the overall incidence of glaucoma (by referral) increased by 94.4 %, from 1.8 to 3.5 ‰. The primary incidence among urban population of the Amur Region during the period under review increased by 400 % from 0.3 to 1.5 ‰. Among rural population, the primary incidence (by referral) increased by 100%, from 0.3 to 0.6 ‰. Our medium-term forecasts show that by 2019 we can expect further increase of general and primary morbidity of glaucoma in the Amur region, more pronounced among urban population. An increase in glaucoma incidence is probably due, first of all, to an increase in life expectancy and in the rising share of people of elderly and advanced age in the population of the region. However, it should not be disregarded that considerable deterioration in the early diagnosis of glaucoma is associated with the lack of compulsory tonometric examination for patients aged 40 or more who referred to a medical facility for the first time this year // Russian Ophthalmological Journal, 2016; 2: 23-6 . doi: 10.21516/2072-0076-2016-9-2-23-26 .

Purpose: Active subretinal visual prostheses require a transchoroidal implantation due to their necessary connection to extraocular parts of the device for energy supply. When starting the program surgically the choroidal access was assumed to be one of the major problems. Material and Methods: 26 legally blind retinal pigmentosa (RP) patients were included in the multicenter study and implanted with a chronic active prosthetic device via a transchoroidal access. 12 out of these 26 patients were operated by one surgeon who developed the transchoroidal procedure and had experience with it. Only this subgroup was analyzed to eliminate the learning curve effects of multiple surgeons. Results: All implantations were carried out successfully in terms of intended position of the implant and stability of the retinal situation. Feared major bleedings were not observed even when accidental perforation of the choroid occurred (1) in the area of the posterior pole. Minor problems concerning surgery were observed when advancing the guide foil or the implant subretinally. The reason were adhesions between retinal pigment epithelium (RPE) and retina. These adhesions seem common in the area of dense pigmentation or scaring in RP patients. Other technical problems during the complex surgical procedure were unintended sub RPE implantation. This occurred twice but could be corrected within the implantation. This pitfall never led to bleedings or other unexpected effects that were harmful for the patient. Conclusion: Problems resulting from the choroid are manageable and seem not to be a limiting factor for this complex surgical procedure. Unintended perforations that occurred did not have a threatening or harmful decisive side effect. One of the reasons may be the rather atrophic choroidal situation in RP. Proper design and geometry of the guide foil and implant are relevant and are under improvement to minimize incidents resulting from this challenge. Thus even difficult retinal situations are no contraindication for chip implantation // Russian Ophthalmological Journal, 2016; 2: 27-32. doi: 10.21516/2072-0076-2016-9-2-27-32 .

The paper studies the efficiency of ranibizumab (Lucentis, Novartis Pharma), a VEGF blocker inhibiting angiogenesis, in patients with wet age macular degeneration (AMD) at different stages of the pathological process. The research included 21 patients (30 eyes), averagely aged 65.1 ± 1.3 years. Intravitreal administration of the medication contributed to a reliable increase of vision acuity and a reliable decrease of pigment epithelium detachment in patients with wet AMD at the stage of prechoroidal neovascularization, pigment epithelium detachment and subretinal neovascular membrane and, in a lesser degree, at the stage of macular fibrosis // Russian Ophthalmological Journal, 2016; 2: 33-37 . doi: 10.21516/2072-0076-2016-9-2-33-37 .

The hypotensive effect of xalatan was analyzed in patients with primary open-angle glaucoma (POAG). This effect was evaluated with respect to involutional changes of the anterior portion of the uveal tract. We examined 50 patients with POAG and dystrophic changes in the iris, namely those newly diagnosed with the disease, those with bilateral process and those who received no hypotensive treatment before. The degree of the glaucomatous process was shown to have the most impact on the development of dystrophic changes in the iris. The visual field changes followed for 6 months turned out to be insignificant. No clear data confirming the dependence of the hypotensive effect of xalatan instillations on the magnitude of dystrophic changes in the iris were revealed // Russian Ophthalmological Journal, 2016; 2: 38-41 . doi: 10.21516/2072-0076-2016-9-2-38-41 .

Biopsy samples of 32 patients with uveal melanoma (10), RBL (11), orbital lymphoma (7), lacrimal gland adenomas (2), rhabdomyosarcoma of conjunctiva (2) were tested by real time polymerase chain reaction (PCR) to detect the DNA of HSV 1, HSV 2, EBV, CMV, HHV-6, HHV-8, Toxoplasma gondii, Mycoplasma hominis, Ureaplasma spp. Totally, 14 of 32 (43.75 %) tumor samples revealed DNA herpesviruses, Chlamydia trachomatis, mycoplasma hominis or ureaplasma spp. Positive PCR results were revealed in orbital lymphoma almost 2 times more frequently than in RBL (6/7 - 85.7 % and 5/11 - 45.5 %; p = 0.15), and 4 times more frequently than in uveal melanoma (6/7 - 85.7 % and 2/10 - 20%; р = 0.015). The spectrum of pathogens in different tumors varied. Only genomes of lymphotropic HHV (EBV, HHV-6, HHV-8) with predominance of EBV are found in orbital lymphoma. In RBL, we could identify DNA of HHV 6, EBV, CMV, and ureaplasma. Infectious DNA were detected the least frequently (2 out of 10 patients) in biopsies of uveal melanoma: in both cases, Chlamydia trachomatis genome was found, in one of them it combined with EBV and CMV DNA. Plasma investigation revealed positive PCR results significantly less frequently than in biopsies (1/28 and 14/32; p = 0.002). Further studies are needed to assess the role of persistent pathogens, primarily human herpesviruses, Chlamydia and ureaplasma in the pathogenesis of orbit and eye tumors // Russian Ophthalmological Journal, 2016; 2: 42-46 . doi: 10.21516/2072-0076-2016-9-2-42-46 .

The paper focuses on the diagnostic value of 3D-CTAG in express testing and dynamic self monitoring of treatment of macular diseases. We examined 165 patients (244 eyes) divided into 5 groups: group 1 - 92 patients with dry AMD; group 2 - 43 patients with wet AMD; group 3 - 28 patients with a fibrous scar; group 4 - 31 patients with diabetic macular edema and group 5 of 50 patients who served as control. The standard examination of all patients were supplemented by 3D-computer threshold Amsler grid test (3D-CTAG), microperimetry, optical coherent tomography (OCT), and fluorescent angiography (upon indication). The treatment depended on the clinical form of the disease: multivitamins with Lutein and Zeaxanthin, metabolic agents, or inhibitors of vascular endothelial growth factor. The study shows that 3D-CTAG with an improved protocol can be effectively used as a rapid method of detecting disorders of the macular area depending on the type and duration of the disease. Clinical and functional parallels revealed between the changes in 3D-CTAG and the size of CNV corresponded to a change in brightness sensitivity seen in microperimetry and were confirmed by OCT and fluorescent angiography. // Russian Ophthalmological Journal, 2016; 2: 48-54 . doi: 10.21516/2072-0076-2016-9-2-48-54 .

The levels of erythropoietin (EPO) in biological fluids were studied on 43 patients with diabetes mellitus type I and II who suffered from a variety of clinical manifestations of heavy proliferative diabetic retinopathy (PDR) which incuded stable PDR, 12 patients with rhegmatogenous retinal detachment and 15 healthy individuals The correlation of EPO levels with the clinical features of heavy PDR was noted only at the local level (intravitreally). The highest intraocular levels of EPO were associated with severe features of the disease, abundant vascularizarion of fibroglial tissue, and intraoperative hemorrhagic complications, which corroborates the theory of active participation of locally secreted EPO in ocular neoangiogenesis, including the progression of PDR // Russian Ophthalmological Journal, 2016; 2: 55-60. doi: 10.21516/2072-0076-2016-9-2-55-60 .

The paper presents the author's observations and the analysis of choked optic disc in patients with penetrating eye injuries and IOP drastically reduced to 6-9 mmHg. The normal tissue pressured of the disk is known to be 10 mmHg. These patients show a significant widening of the vessels of the eye cavity, an active transudation from the microcirculatory bed of the disc area, and the disc’s transudate tissue edema. One day after the surgery sealing the eye cavity, IOP exceeds the level of 10 mmHg, the transudation process terminates, and the congestion level in the disc drops. The author believes that this picture should only be considered as a syndrome of the choked optic disc only in cases of penetrating eye injuries with sharply reduced IOP // Russian Ophthalmological Journal, 2016; 2: 61-63 . doi: 10.21516/2072-0076-2016-9-2-61-63 .

A clinical case involving a severe membrane form of hyperergic adenoviral conjunctivitis in a 63-years-old patient is presented. The dynamics of clinical manifestations was closely followed: it included a repeated formation of conjunctival membranes and symblepharon, and nummular corneal infiltrates. The need for additional reparative and trophic therapy for this form of adenoviral conjunctivitis was justified, and an effective treatment plan was proposed // Russian Ophthalmological Journal, 2016; 2: 64-8 . doi: 10.21516/2072-0076-2016-9-2-64-68 .

The paper presents the results of a seven-year follow-up of 158 patients who originally had early or intermediate AMD in both eyes and regularly received courses of Vitrum Vision Forte, in comparison to the data of 147 patients with a similar initial clinical status who, for various reasons, however failed to receive regular treatment. In the case of early AMD patients receiving regular courses of treatment, the progression rate to the late stage amounted to 0.7 % and to the intermediate stage, to 28.5 %. If no systematic treatment was administered, the progression rate was, respectively, 4 and 38 %. In the case of intermediate AMD patients, the progression rate to the late stage amounted to 18.6 % in patients receiving Vitrum Vision Forte and reached the mark of 30 % in the absence of regular treatment. So, regular courses of Vitrum Vision Forte reduce the progression rate of AMD, promote long-term maintenance of high visual acuity and quality of visual functions in patients with retinal drusen // Russian Ophthalmological Journal, 2016; 2: 70-6 . doi: 10.21516/2072-0076-2016-9-2-70-76 .

Retinal macular edema is the most relevant complication of age-related cataract surgery with a poor prognosis for visual function, manifested in the long-term follow-up. Numerous clinical studies indicate that local forms of various nonsteroidal anti-inflammatory drugs (NSAIDS) are effective for the prevention of macular edema (ME) after phacoemulsification. The paper, based on extensive clinical data involving 140 patients, shows that the use of different NSAIDS (indomethacin, nepafenac, ketorolac and bromfenac) after uncomplicated phacoemulsification of age-related cataract in the absence of underlying risk factors contributes to the effective prevention of increased thickness and volume of the retinal macula, prevents the formation of clinically significant ME, and improves visual acuity (which averagely achieves 0.95-0.97). The expanded range of drugs used for the prevention of postoperative macular edema should positively affect the quality of the rehabilitation of patients after cataract phacoemulsification // Russian Ophthalmological Journal, 2016; 2: 77-82 . doi: 10.21516/2072-0076-2016-9-2-77-82 .

Leber’s heredltary optic neuropathy (LHON) is a mitochondrial disease, which leads, in young age, to a gradual bilateral reduction of visual acuity unaccompanied by pain in the eyeballs. At present, no methods of effective prevention and treatment of LHON are known. The paper presents a clinical case of LHON in which visual functions improved following a revascularizing operation (optic nerve revascularization combined with therapeutic retrofilling of sclera) which used Alloplant biomaterial // Russian Ophthalmological Journal, 2016; 2: 84-9 . doi: 10.21516/2072-0076-2016-9-2-84-89 .

The paper’s purpose is to assess visual functions in patients with dry age-related macular degeneration (AMD) who receive antioxidant Nutrof Total supplement. Three groups of patients over 50 were examined. The main group, AMD+, consisted of patients with dry AMD who took 1 capsule of the supplement once a day for 3 months. Control group 1, AMD-, was composed of patients with dry AMD who took no supplement at all and control group 2, Normal, was composed of healthy subjects who took 1 capsule once a day for 3 months. All subjects were subjected to a regular ophthalmologic examination supplemented by evaluation of photostress test recovery time, and measurement of the optical density of macular pigment (MPOD) and achromatic spatial contrast sensitivity (CS): all tests were taken prior to the study and repeated 1 and 3 months after the study’s start. Vision quality was assessed by a VFQ-25, 2000 version questionnaire. Groups AMD+ and Normal revealed a statistically significant improvement in uncorrected distance and near visual acuity and best-corrected distance visual acuity, MPOD increase, improved recovery of visual acuity after a photostress test, and improvement in achromatic CS in all spatial frequency ranges. AMD- patients revealed no positive effects of visual functions. The results of the study thus confirm the efficiency and usefulness of continuous Nutrof Total supplement administration for 3 months by dry AMD patients and all patients over 50 // Russian Ophthalmological Journal, 2016; 2: 90-5. doi: 10.21516/2072-0076-2016-9-2-90-95 .

The review paper presents the results of large-scale international multicenter research of glaucoma. The research has a considerable impact on today’s understanding of strategies of glaucoma diagnosis and treatment. The conclusions made by the authors of this research are heavily cited in ophthalmological literature but its structure, vital for proper interpretation of research details and results, is often disregarded. Randomized clinical studies are extremely important for the selection of correct management of patients with glaucoma or ocular hypertension. The reviewed research showed, for the first time, that IOP reduction definitely slows the progression of glaucoma and reduces the probability that ocular hypertension develops into glaucoma. IOP reduction slows down the progression of glaucoma even if its level is conditionally normal, and the risk of progression is reduced drastically (by some estimates, this risk drops about 10 % per 1 mmHg of IOP reduction). It is noted that various surgical interventions (argon laser trabeculoplasty, trabeculectomy) increase the degree and duration of IOP compensation, but the risk of complications may be different for different operations. The research identifies the major risk factors of glaucoma progression (advanced age, increased IOP, optic disc hemorrhages) and of transition of ocular hypertension to glaucoma (increased IOP, age, lower central corneal thickness and optic disc hemorrhages). The progression rate has been found to depend on the intraocular pressure level as measured at the moment of the detection of the disease, and on the stage of the disease. Besides, the study suggests a differentiated approach to the choice of patient management tactics, including the choice of “wait-and-see” tactics under adequate monitoring of the key parameters of progression, especially of perimeter indices and the condition of the optic nerve. The results of randomized clinical studies permit to achieve a more targeted and effective glaucomatous therapy and to form an evidence-based management of patients in different clinical situations // Russian Ophthalmological Journal, 2016; 2: 96-101 . doi: 10.21516/2072-0076-2016-9-2-96-101 .

Eye wavefront aberrations have a strong impact on the formation of an image on the retina and vision quality. A relationship has also been found between the aberrations and accommodation, which plays a significant role in visual performance and refraction change. It is hypothesized that not only the correction of lower-order aberrations but also that of higher-order ones can affect the quality of the image. Recently, many research papers have reported on wavefront correction by soft contact lenses in a variety of configurations. Contact lenses are available that may induce or, conversely, neutralize the aberrations. The question of how these lenses interact with the eye’s own aberrations, remains unresolved: it is not clear yet if the lenses compensate the aberrations or add up to them // Russian Ophthalmological Journal, 2016; 2: 102-107. doi: 10.21516/2072-0076-2016-9-2-102-107.