Purpose. To develop a methodology of surgical treatment of central retinal detachment with macular holes of various diameters in patients with high myopia and scleral staphyloma using autologous conditioned plasma (ACP) as a rupture blocking composite and pneumoretinopexy as the final tamponade, and analyze the results of this treatment.

Material and methods. The surgery included subtotal vitrectomy 25+, 27G, peeling of the inner limiting membrane, pneumoretinopexy, introduction of ACP into the area of scleral staphyloma through the macular hole, and, upon the formation of a plasma seal at the base, applying ACP to the retinal surface in the area of the hole in 2–3 layers until a stable ACP film could be formed. The operation was completed seamlessly, blocking the sclero-conjunctival access by applying 2–3 layers of ACP to the scleral surface and the conjunctiva. Using this technique, we operated 25 patients aged 29–69 with central retinal detachment and macular hole with a width of 700–2200 μm who had high myopia and severe scleral staphyloma.

Results. In the early (on days 2 and 4) and the late postoperative period, the retina was completely attached, and the macular hole was blocked in all patients.

Conclusion. This technique is maximally sparing and highly effective. It allows achieving full anatomical retinal reattachment and closure of the macular hole, eliminates the need for silicone tamponade, minimizes the risk of postoperative complications in patients with central retinal detachment, macular holes of various diameters, high myopia and scleral staphyloma.

Purpose. To evaluate long-term results of anti-VEGF therapy performed in a modified “treat-and-extend” regimen in macular edema secondary to central retinal vein occlusion.

Material and methods. The prospective study included 29 patients (16 men and 13 women) aged 24–81. The median follow-up period was 36 months [24; 60]. 20 patients underwent ranibizumab monotherapy, 3 patients – aflibercept monotherapy, while 6 patients received a combination of the two drugs following the modified regimen, which allowed terminating anti-VEGF treatment when macular edema remission was achieved.

Results. Macular edema completely resolved in 27 out of 29 patients (93.1%) by the end of the second year, while the remaining 2 patients showed the complete resolution during the third year. 18 patients (62.1%) could terminate anti-VEGF therapy during the first 6 months, whereupon they received 3 to 5 monthly injections with no macular edema relapse over the subsequent 21–22 months of the follow-up. 11 patients continued anti-VEGF therapy and averagely received 7.09 ± 1.14, 5.09 ± 2.34 and 2.18 ± 2.36 injections with individually determined intervals at years 1, 2 and 3, respectively. On the whole, 22 patients (75.9%) terminated anti-VEGF therapy and transferred to drugless observation at the end of year 2, while 5 other patients (17.2%) terminated anti-VEGF therapy during year 3. As a result of the treatment, the maximum BCVA improved from 0.15 [0.07; 0.3] to 0.7 [0.4; 0.9] by the end of year 1 (Z = -4.69; p = 0.0000027) and remained stable during the rest of the follow-up.

Conclusion. Anti-VEGF therapy in modified treat-and-extend regimen is effective in macular edema secondary to central retinal vein occlusion. and results in a significant and sustainable visual acuity gain and complete resolution of macular edema with a minimum quantity of injections in most patients.

For a long time, the main parameter of micropulse cyclophotocoagulation (mTS-CPC) operation planning has been the calculated total energy. However, this indicator alone is not enough to determine more accurate correlations between exposure parameters and treatment outcomes.

Purpose: to determine the criteria for choosing energy parameters to be used in mTS-CPC in refractory glaucoma patients.

Material and methods. We propose a more reliable indicator of mTS-CPC clinical results, the energy flow, which is calculated from the speed of the probe movement. We developed and used a new strategy for conducting mTS-CPC: dividing the hemispheres of the ocular surface into 4 quadrants for a better control of the light guide movement while maintaining the selected speed. The standardized protocol for conducting the procedure has been modified so that the calculated energy flow is 121.8 J/cm2.

Results. The evaluation of the treatment results of 140 patients according to the Kaplan Meier criteria showed the success of the treatment. IOP fell by 30 %, as compared with the baseline in the advanced stage, and by 20 % in the terminal stage, causing no complications. 12 months after the follow-up start, IOP compensation was noted in 81.3 % of cases.

Conclusion. The presented modification of mTS-CPC using the energy flow parameters makes it possible to unify the technology of laser treatment, and the results obtained demonstrate a good and uncomplicated hypotensive effect. The availability of standardized energy indicators allows for a selective treatment tactics, depending on the individual characteristics of glaucomatous patients.

Large-scale introduction of automated processes into medical practice, including ophthalmology, can simplify the diagnosis and treatment of patients. Being part of the general biological system of the body, the eye is an exemplary object of mathematical modeling targeted at treatment optimization, — e. g. when choosing a surgical tool for retinal detachment surgery.

Purpose: to develop a software for automatic calculation of the individual length of the circular band to be used in retinal detachment treatment in order to achieve the optimal height of scleral indentation.

Materials and methods. The study had a dual task: 1) to determine the correlation between the axial length (AL) and the equatorial diameter of the eyeball, measured by ultrasonic A- and B-scanning in healthy patients (90 eyes), and 2) to develop formulas for calculating the optimal length of the scleral buckle.

Results. The formulas found to be effective in clinical practice were used to develop a software calculating the required length of the 3-mm wide circular band made of pourous silicon from the patient’s axial length. The software, called Circular Scleral Buckle Length, operates under Windows or Linux, is freely downloadable using a QR-code.

Conclusion. The software greatly facilitates the determination of the optimal length of the buckling material for each patient, simplifies the operation of circular scleral buckling, reduces the time of the operation, minimizes the risk of complications, and ensures favorable anatomical and functional results.

Purpose: to analyze the anatomical and functional results of the differentiated treatment of optic disc pit maculopathy in children.

Material and methods. We examined 23 children aged 5–17 years with an o ptic disc pit maculopathy. 10 children underwent retinal laser coagulation (LC) along the borders of the optic disc pit (1–3 sessions), 13 children underwent pars plana vitrectomy with gas tamponade (C2F6) in combination with retinal LC. In addition to the standard ophthalmological examination, all children underwent optical coherence tomography of the macular area of the retina before treatment and at different times after it.

Results. In the group of children who underwent LC, the initial value of the maximum retina elevation averaged 525 ± 140 μm (from 346 to 882 μm). After laser treatment, all children showed a decrease in retinal elevation by 32 to 602 μm. 3 children had complete resorption of subretinal fluid during follow-up periods from 5 to 13 months. Best corrected visual acuity (BCVA) remained stable in 5 children, increased by 0.04–0.6 in 4 children, and decreased by 0.1 in one child. In the group of surgically treated children, the elevation of the retina before the intervention averaged 919 ± 143 μm (from 614 to 1420 μm) (p < 0.05). After the intervention, this parameter decreased in all children by 91 to 811 μm, complete resorption of subretinal fluid was observed in 4 children during follow-up periods from 4 to 6 months. BCVA remained stable in 5 children, increased in 7 children by 0.1–0.7, and decreased by 0.4 in one child due to the progression of the cataract.

Conclusion. The differentiated approach to the treatment of optic disc pit maculopathy in children proved to be highly efficient, depending on the height of retinal elevation in the macular zone before the start of treatment.

Purpose: to assess the potentials of optical coherence tomography-angiography (OCTA) in the evaluation of anterior segment (AS) uveal vessels in normal and pathological conditions.

Material and methods. 20 healthy volunteers (40 eyes) with no ophthalmic pathology (the control group) and 85 previously untreated patients (85 eyes) with suspected tumors of the irido-ciliary area (the iris, the ciliary body and the peripheral sections of the choroid) were examined. All participants had optical coherence tomography (OCT) and OCTA of AS, with the qualitative assessment of scans (vessels pattern, lumen, tortuosity) and the quantitative assessment (vessel density index, VD%, for the affected zone). In ciliary body or choroid pathologies, VD index was measured for the conjunctiva in the focus projection. VD index included mean and local VD, as well as VD of perifocal tissues. In addition, B-mode ultrasound scanning and ultrasound biomicroscopy were performed.

Results. OCTA scans in 4 sectors of the normal iris showed a predominantly radial pattern of conjunctival vessels positioning, with their lumen remaining the same along their entire visible length. The lowest VD value (38.5%) was registered in the temporal iris segment, while the highest (43.9%) was revealed in the inferior quadrant. In the iris tumors area, intrinsic vascularity molded in various vascular patterns was observed. Melanomas could be suspected because of the vessels oriented along the axis of the tumor and by non-uniform lumen of the vessels.

Conclusion. AS-OCTA is an informative method for the visualization of iris vessels in normal conditions and in iris pathology and may be considered a valuable addition to the standard visualization techniques.

Purpose: to assess the functional results of surgical treatment of macular holes (MH) using the authors’ developed technology preserving the internal limiting membrane (ILM) and compare them with the results of traditional surgery technology involving ILM peeling.

Material and methods: 150 MH patients aged 50 to 82 were divided into 2 groups: the main group who underwent surgical MH treatment with ILM preservation and the control group, whose traditional surgical treatment involved ILM peeling. After vitrectomy, the main group patients’ macular areas were treated with a bacterial collagenase solution (1 kU) for three minutes, whereupon it was washed out, the vitreal cavity was dried and treated with platelet-rich plasma. In the control group, ILM was stained and removed, whereupon platelet-rich plasma was applied in the air medium. The anatomical result was assessed by optical coherence tomography data. To assess the functional results, the patients were tested for the best corrected visual acuity (BCVA) and subjected to microperimetry. The observation period was 24 months.

Results: in all cases, a significant increase in BCVA was achieved after surgical treatment. After 6 months, the control group showed a tendency to a BCVA decrease, while in the main group BCVA remained stable. In the main group, not a single case showed a decrease in the total retinal photosensitivity below the threshold level of the norm of 24 dB, whilst in the control group, 35 cases (47 %) revealed a retinal sensitivity decrease below 24 dB. The total retinal sensitivity turned out to be significantly lower in the control group as compared to the main group over the entire observation period (p < 0.05). Postoperative scotomas were significantly more frequent after ILM peeling. Absolute scotomas were detected in 7 control group cases, whilst in the main group they were not noted in any case.

Conclusion. The developed technology makes it possible to practically eliminate the formation of absolute scotomas and to significantly reduce the formation of relative scotomas in the postoperative period, as well as improve functional results against the traditional method of surgical treatment of MH with ILM peeling.

Purpose: to evaluate the results of gene therapy by the recombinant adeno-associated viral vector voretigene neparvovec (VN) in children with follow-up periods of 1, 3, 6, and 12 months.

Material and methods. The study included 6 children (12 eyes) aged 5 to 15 with a confirmed biallelic mutation in the RPE65 gene, treated with VN (Luxturna, USA). Treatment efficacy was assessed by surveying which included questions on spatial orientation under various types of illumination, Goldman perimetry, microperimetry, best corrected visual acuity (BCVA), electroretinogram (ERG), and visual evoked potentials (VEP). To assess the structure of the retina, the central retinal thickness (CRT) was evaluated by optical coherence tomography.

Results. All children showed subjective changes in visual perception, including improved orientation in the dark and twilight, and improved contrast. In one case, the child with initially low visual acuity showed improved visual fixation. In 4 patients out of 6 (8 eyes), an expansion of the visual fields was noted, including 2 cases who displayed significant expansion thereof. In 2 patients (4 eyes), the visual fields were not narrowed and remained so throughout the entire observation period. Mean light sensitivity of the retina in 3 patients and fixation indices in 1 patient improved significantly as shown by microperimetry. BCVA remained stable throughout the study or changed insignificantly. Initially, ERG could not be detected in 8 eyes, but after an VN injection, 6 eyes demonstrated a partial recovery at different times — from 1 to 12 months. An increase in the amplitude of the P1 component to pattern VEP and P2 component to flash VEP was observed in all patients, which indicates an enhanced activity in the projection of the visual cortex after the restoration of the visual cycle. No significant changes were revealed in CRT (p = 0.9). Complications and adverse events were noted in 9 eyes (75 %): chorioretinal dystrophy at the injection site in 3 patients (5 eyes), multifocal nummular dystrophy in 2 patients (4 eyes), local episcleritis in 1 eye, transient increase in intraocular pressure in 2 patients (3 eyes).

Conclusion. The results of a one-year post VN treatment follow-up of Russian patients with RPE65-associated inherited retinal disease demonstrate stabilization and improvement of visual functions, which is especially important for otherwise incurable patients with a progressive course of the disease.

Purpose: a comparative analysis of biometric parameters of the optic nerve obtained by different diagnostic ultrasound sensors.

Material and methods. We examined 20 healthy volunteers with emmetropia aged 20 to 40 years (40 eyes), average age 30.5 ± 5.4 years, who had no complaints or ophthalmic pathologies. Ultrasound scanning was performed on a multifunctional Voluson E8 (GE) scanner (11–18 MHz linear sensor), ophthalmic ultrasound device Ellex Eyecubed (a conventional 10 MHz transducer) and an ophthalmic scanner Absolu «Quantel Medical» (a 20 MHz transducer). All examinations were carried out by one operator who used the same scanning technique and measured the optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) without sheaths in both eyes. Six consequent measurements of the ONSD and the OND parameters were performed to ascertain the reproducibility of the examinations and evaluate the variation coefficient.

Results. The analysis revealed no statistically significant differences in the ONSD and in the OND obtained with 11–18 MHz, 10 MHz and 20 MHz transducers in the B-mode (р > 0.05). The minimum variation coefficient of the optic nerve thickness parameters was registered using a high-frequency 20 MHz transducer on the ophthalmic scanner. The biometry obtained with a high frequency 20 MHz transducer could be considered as the most reproducible.

Conclusion. A high frequency 20 MHz transducer can be recommended for optimal visualization and precise evaluation of biometric parameters of the retrobulbar part of the optic nerve. Transducers of multifunctional scanners with the frequency range from 11 to 20 MHz can be used for measurements of the optic nerve sheath diameter.

Purpose: a comparative study of the efficacy and safety of Latanoprost-Optic, a new composition of excipients and the original latanoprost, in the initial therapy of primary open-angle glaucoma (POAG)

Material and methods. We performed a prospective, randomized, comparative study of 60 previously untreated patients (71 eyes) with early and advanced POAG stages. During the screening visit, patients were randomly divided into the main (Latanoprost-Optic) and the control (original latanoprost) groups. The target points included intraocular pressure (IOP), visual acuity, MD and PSD perimetry indices, RNFL thickness, MRW, NFL, GCL, IPL, tear film break time, OSDI, and adverse events. The observation period was 12 weeks. IOP was measured 4 and 12 weeks from observation start.

Results. The average decrease in IOP in the study group by the end of the observation was 32% and did not show any statistically significant differences from the original drug at any control point. A positive unreliable dynamic of the values of most functional parameters was noted, which may indicate the presence of an indirect neuroprotective effect. In the study group, there was a positive trend in tear film rupture time and OSDI. According to corneal confocal microscopy, no negative changes in dynamics were noted, in contrast to the control group. Reversible discomfort and mild redness of the bulbar conjunctiva were recorded in both groups. No serious or systemic adverse events were noted.

Conclusion. Latanoprost-Optic has a hypotensive efficacy, comparable to the original latanoprost, and a high favorable safety profile.

The article discusses the main etiological factors in the development of binocular diplopia and differential diagnostic signs of diplopia induced by late acquired comitant and incomitant strabismus.

Purpose: to identify the most common causes of binocular diplopia in adults, and to assess typical features of various etiologies of binocular diplopia.

Material and methods. 168 patients with binocular diplopia aged 6.5 to 85 years received a complete ophthalmological examination, which included a qualitative evaluation and characterization of the nature of diplopia, and determination of eye mobility in eight directions of gaze which indicated the affected muscle. A numerical assessment of diplopia was done using a prismatic compensator.

Results. In 66.7% of cases, diplopia was induced by comitant strabismus, predominantly (96.4%) the converging one. A comitant strabismus with a small angle was observed more frequently than one with a larger angle: 5° or less, in 50% of cases, and 10° or less in 25% of cases. In 64.3% of cases, the deviation angle did not conform with the value of the compensating prism, which turned out to be twice as high as the “calculated values”. In 79.5% of cases, diplopia induced by comitant strabismus developed before the age of 45. In 33.3% of cases, diplopia was induced by incomitant strabismus, with the deviation angle varying from 0 to 35°, different directions of eye deviation, and limitation of mobility. In 44.6% of cases, mobility restrictions could not be visually detected. The deflection angle conformed to the strength of the compensating prism. In 58.9% of cases, diplopia induced by incomitant strabismus developed at the age of 45 years and older.

Conclusion. Diplopia frequently develops in young and middle-aged people. The most common cause of the development of diplopia is a late acquired comitant converging strabismus with a small angle (5° or less), which develops in parallel with myopia. A correct identification of strabismus nature (comitant vs. incomitant), which induces diplopia, contributes to optimally choosing a further tactics for diplopia elimination.

Purpose: to develop a new method of surgical treatment of moderate upper eyelid ptosis.

Material and methods. 88 patients (106 eyes) aged 5–68 years (averagely 24.9 yrs), operated for moderate or severe upper eyelid ptosis, were divided into 3 groups depending on the degree of upper eyelid prolapse and levator function. Group I (43 patients, 47 eyes) had satisfactory mobility of the upper eyelid, its fold being smoothed or absent. Group II (15 patients, 15 eyes) had good mobility of the upper eyelid with a smoothed fold; this group was further divided into subgroups IIa and IIb depending on the technique of the operation. Group III (30 patients, 44 eyes) had low upper lid mobility (less than 4 mm) with no fold. Group I and subgroup IIa underwent a resection of the upper eyelid levator. In subgroup IIb, a new method was used: levatoroplasty with the formation of a levator duplicature. In group III, a suspension operation was performed to the frontalis muscle.

Results. In 10 cases (11 %), the results obtained by the new method of ptosis corrections were significantly better as compared to conventional resection: small edemas were resolved within a week, and the mobility of the upper eyelid levator was restored sooner.

Conclusion. The proposed technique showed good functional and cosmetic results, proved to be more sparing, retains all upper eyelid tissues and can be successfully used for moderate upper eyelid ptosis.

Purpose: to evaluate the effectiveness of silicon-dried cornea, previously subjected to corneal collagen UVA crosslinking, for urgent keratoplasty.

Material and methods. 28 patients (16 males, 12 females), diagnosed with perforating corneal ulcer of various etiologies, underwent penetrating keratoplasty for eye-preserving purposes. 14 patients (the main group) underwent transplantation of a silicon-dried cornea, previously subjected to corneal collagen crosslinking according to the standard (Dresden) protocol while the remaining 14 patients (comparison group) underwent penetrating keratoplasty with not pre-treated silicon-dried cornea. In the postoperative period, we measured the time of primary complete epithelization of the graft and assessed the presence/absence of ulcers and erosions of the corneal graft 1, 3, 6 and 12 months after the discharge from the hospital. For this purpose, all patients underwent corneal biomicroscopy with corneal surface preliminary stained with a 1% sodium fluorescein solution.

Results. Complete epithelization in both the main group and the comparison group was found to take place, on average, at the same time after surgery. However, over the entire observation period, the main group showed fewer relapses of ulcers and corneal graft erosions than the comparison group.

Conclusion. The use of silicon-dried cornea, subjected to corneal collagen cross-linking, increases the effectiveness of perforated corneal ulcer treatment in emergency surgical care.

Purpose: to study significant functional and structural changes in the retina and the intraocular section of the optic nerve in multiple sclerosis (MS) patients and analyze how they are interrelated with electrophysiological changes in the visual analyzer.

Materials and methods. The study included 44 patients (88 eyes): group 1 (26 eyes) with MS duration ≤ 5 years and no history of optic neuritis (ON); group 2 (30 eyes) with MS duration from 6 to15 years and no history of ON; and group 3 (32 eyes) with MS duration ≤ 15 years with a history of ON. All patients underwent a complete ophthalmological examination and optical coherence tomography and had visually evoked potentials (VEP) and static automated perimetry registered.

Results. A decrease in functional and structural parameters progressing with the duration of MS was revealed. In particular, best corrected visual acuity (BCVA) fell to 0.860 ± 0.075, the photosensitivity index MD maximally fell to -3.78 ± 0.95 dB, the strength of the P100 wave amplitude dropped to 7.84 ± 2.98 μV, the latency index of VEP rose to 124.21 ± 1.36 ms, the thickness of GCL + IPL fell to 65.69 ± 7.85 μm, and RNFL thickness averagely fell a low as to 80.25 ± 8.81 μm. When analyzing the topography of GCL + IPL decrease by sectors, the maximum value was revealed in the upper temporal segment (67.63 ± 7.89 μm). Sectoral changes in RNFL arranged in descending order of thickness showed the following sequence: lower upper nasal temporal. As the disease progressed, structural and functional changes were accompanied by an increase in the depth and a decrease in the thickness of the lamina cribrosa, with a maximum value revealed in the group with prior ON (239.00 ± 11.93 μm). Strong correlations were found in all study groups between (1) ave. GCL + IPL and ave. RNFL (r = 0.69; 0.64; 0.88, p < 0.03), (2) ave. GCL+IPL and BCVA (r = 0.86; 0.75; 0.78, p < 0.05), (3) MD and ave GCL + IPL (r = 0.52; 0.69; 0.71, p < 0.03), and (4) MD and ave. RNFL (r = 0.67; 0.61; 0.66, p < 0.05), as well as between the parameters of the lamina cribrosa and the markers under study.

Conclusion. Significant functional and structural changes in the retina and the optic nerve were detected, correlating with the duration of the disease and with the clinical features of the course of multiple sclerosis. The presence of ON in history was accompanied by more pronounced changes, which can be considered as an important additional aggravating factor of the disease.

Purpose: to analyze the mutation frequency of the GNAQ/GNA11 gene in circulating tumor DNA and genotypes of the polymorphic marker C3435T of the ABCB1 gene in a large sample of patients with intraocular melanocytic neoplasms (IMN).

Material and methods. In an open prospective study performed in 2015–2022, 272 IMN patients with intraocular melanocytic neoplasms aged 28 to 87 (ave. 58.3 ± 12.6), including 187 females (68.8 %) and 85 males (31.2 %), were divided into three groups depending on the nature of the tumor focus: Group I, n = 141, progressing choroidal melanomas; Group II, n = 67, stationary melanomas, and Group III, n = 64, choroidal nevi.

Results. In Group I, at least one mutation in the GNAQ/GNA11 gene was detected in 134 patients (95.0 %). Of these, 35 patients (24.8 %) revealed two mutations, and 16 patients (11.3 %) had 3 mutations. In Group II, one mutation was detected in 49 patients (73.1 %), of which three patients (4.5 %) had two mutations. In Group III, one mutation in the GNAQ/GNA11 gene was detected in 13 patients (20.3 %). When comparing the overall frequency of mutations in the GNAQ/GNA11 genes in Groups I and II, significant differences were obtained (OR = 7.03 (2.77 to 17.86), F = 0.000015, ξ2 = 20.6), with Group I having mutations identified in 95 % of cases and Group II, in 73.1 %. Significant differences were also obtained when comparing the frequency of the studied mutations in Groups I and III (OR = 75.1 (28.36 to 198.86), F = 0.0000001, ξ2 = 121.15) with a frequency of 20.3 % in Group III. The frequency of mutations in the GNAQ/GNA11 genes was significantly higher in Group II than in Group III (OR = 10.68 (4.73 to 24.1), F = 0.0000001, ξ2 = 36.64). The frequencies of heterozygous mutations in all 4 exons were significantly higher in Group I than in Groups II and III, except for the GNAQ183 gene when comparing Groups I and II. Heterozygous mutations in all 4 exons were significantly more frequent in Group II than in Group III. Homozygous mutations were found only in Group I patients, but, in spite of this, no significant differences were detected when comparing them with other groups. The frequency of genotype CC of the polymorphic marker C3435T of ABCB1 gene was significantly lower in Group I as compared to Group II, whilst the frequency of genotype CT was significantly higher than in group II.

Conclusion. The general analysis of molecular genetic studies of 272 patients with intraocular melanocytic neoplasms showed a direct correlation between the frequency of detection of mutations in genes and the size and source of the tumor. The obtained results substantiate both screening of patients from risk groups and differentiation of patients depending on the size and source of the tumor.

Purpose: to study the regenerative potential of immobilized hyaluronidase and subtilisin enzymes preparations in experimental models of chemical and mechanical corneal trauma.

Material and methods. The study involved 28 mongrel rabbits weighing 3.5 to 4 kg, divided into 4 groups for separate studies of repair models according to different types of injury (chemical vs. mechanical), and different drugs and the methods of administration thereof. Hyaluronidase (PEG-hyaluronidase) and subtilisin (PEG-subtilisin) pegylated by electron beam synthesis technology were used. The condition of the cornea was assessed 24 hours after the injury had been inflicted, whereupon the eyes were enucleated and histologically examined.

Results. The chemical trauma groups treated by PEG-hyaluronidase revealed a decrease in the wound area by an average of 36.6 mm2, while those given a subconjunctival injection showed a 36.08 mm2 decrease. If PEG-subtilisin was applied, the area of the corneal defect revealed an average increase of 11.63 mm2 (with a case of perforation registered). In subconjunctival injection of PEG-subtilisin, the wound area decreased by 27.42 mm2. In the mechanical trauma groups, a similar pattern was observed: with the instillation of PEG-subtilisin, the wound area averaged 53.63 mm2 and 1 case of perforation was registered, whilst with subconjunctival administration, the wound area decreased to 28.76 mm2. With PEG-hyaluronidase instillations, a significant wound area decrease of 36 mm2 was noted, and with subconjunctival administration, the wound area decreased by 70.3%. A higher corneal transparency in the optical zone and a weaker inflammatory reaction with the use of PEG hyaluronidase were revealed by histological testing.

Conclusion. A positive effect of PEG-hyaluronidase, specifically concerning the enhancement of regenerative processes in the wound in chemical and mechanical wounds could be seen. PEG-subtilisin showed no positive effects, which may be associated with high fibrinolytic activity.

Enzyme-linked immunosorbent assay (ELISA) has traditionally been used to diagnose infectious diseases, including ophthalmic ones. As a rule, however, investigators are only focused on differentiated detection of specific immunoglobulins (Ig) of varied classes, despite the fact that ELISA is able to register a wider range of emerging immune responses.

Our purpose is to assess the effectiveness of the solid-phase version of ELISA for the etiological diagnosis of endogenous uveitis.

Material and methods. 107 patients (114 eyes) aged 19 to 83 (ave. 45.2 ± 2.8 yrs) with various clinical forms of endogenous uveitis were examined by the traditional ELISA method. Along with the detection of specific Ig, the avidity of IgG and “paired” sera were studied.

Results. In the primary serological examination, specific IgG were found in almost all patients (to herpes simplex viruses in 100 %, and to cytomegaloviruses in 96,3 %). Specific IgM were revealed in 3.7 % of cases. Specific IgG to T. gondii were found in 44.9 % of the patients and in 2 people, IgM. Specific IgG to C. trachomatis were found in 23 patients, and in two cases, IgM. By studying the avidity of antibodies, etiology was additionally deciphered in 1.9 % of patients. The study of “paired” sera helped determine the etiology of the disease in another 16 people.

Conclusion. An integral approach using all diagnostic capabilities of ELISA, in particular the differentiated definition of specific Ig of various classes and the avidity of specific IgG, as well as the study of “paired” sera, made it possible to significantly increase the diagnostic capabilities of ELISA. As a result, the etiology was deciphered in 26 patients (24,3 %).

The main source of intraocular lens (IOL) power calculation errors in phacoemulsification (PE) is axial length (AL) measurement inaccuracy in cases if optical biometry cannot be used.

bto describe an original double-step method of IOL power calculation in lens opacities which exclude AL measurement with optical biometry.

Material and methods. Patient S. (male, 71) with a bilateral immature cataract underwent right eye phacoemulsification (PE) with no IOL implantation. After that, AL was measured in the aphakic state with transparent optical media and used in combination with preoperative anterior segment biometry data to calculate the IOL power. In the second stage, a selected lens with an extended focus range was implanted.

Results. The patient was examined and discharged on the second day after surgery with visual acuity OD 0.3 sph +0.25 cyl -0.75 ax150 = 0.5 and signs of moderate postoperative keratopathy. After 2 weeks, uncorrected visual acuity was as high as 0.9 and could not be further corrected by spectacle lenses. The patient was admitted for surgical treatment of the left eye cataract and also operated in two stages. The AL measured by the optical method in the aphakic state, was 0.31 mm less than that measured before the operation. Six months after PE with IOL implantation, distance visual acuity in both eyes was 1.2, the patient could use binocular vision for reading and PC work with no difficulty.

Conclusion. The double-step approach to IOL power calculation is justified in cases of strong decrease of crystalline lens transparency, especially in complicated cases, for example, in high myopia or “premium” lens implantation, in which patients are especially sensitive to correct target refraction, even though this approach requires a delayed IOL implantation, which should take place after a precise calculation of AL taken in the aphakic state.

In recent years, the literature has been discussing the issues of diagnosis and managing damaged eye patients who suffer from syphilis/HIV coinfection. We present a clinical case of syphilitic uveitis in the patient’s third reinfection of syphilis, which occurred during a long-term HIV infection. The causes for insufficient treatment effectiveness are analyzed.

Purpose: to evaluate the effect of a new antiallergic drug epinastine in the treatment of seasonal conjunctivitis as manifested in clinical cases.

Materials and methods. 37 people (22 men and 15 women) were observed during spring exacerbation of the allergic conjunctivitis, from mid-March to the end of June. Indicators of the dynamics of subjective complaints, duration of treatment, clinical effectiveness, were thoroughly recorded; we also assessed how easy it was to stop using the treatment when the condition of the ocular surface returned to normal.

Results. We identified four groups of patients depending on the course of the disease, clinical manifestations, and response to epinastine therapy. For each group, we analyze a most informative clinical case.

Conclusions. In all of the cases, epinastine instillations brought about a quick and stable reduction of itching and eye discomfort, as well as normalization of the clinical condition of the conjunctiva.

The results of present-day research into the pathogenesis of glaucoma as a neurodegenerative disease, leave no doubt that neuroprotective therapy of the condition is needed. It has been proven that achieving the target intraocular pressure does not always lead to the stabilization of the glaucoma process, as evidenced by a further decrease in visual functions and the death of retinal ganglion cells. Currently, research is focused on finding new drugs that can slow down the damage to the nerve fibers of the optic nerve and prevent apoptotic neuronal death. This literature review presents the results of recent experimental and clinical studies of the most promising neuroprotective drugs.

Damage of the retinal pigment epithelium (RPE) underlies the pathogenesis of degenerative-dystrophic diseases of the retina, in particular, age-related macular degeneration (AMD) — one of the leading causes of irreversible loss of central vision, blindness and elderly population disability. Advanced AMD treatment options are limited to angiogenesis inhibitors in the wet form of the disease; there is no effective treatment for geographic atrophy, since RPE cells are unable to regenerate. The advances of biomedicine and the progress of vitreoretinal surgery gave rise to searching new high-technology methods of degenerative retinal disease treatment, aimed at restoring RPE. Replacement transplantation with induced pluripotent stem cells (iPSCs) specifically oriented at RPE seems to be the most promising approach for replacing damaged retinal elements and improving visual acuity, while, as some researchers believe, the fact that the eye is an immune-privileged organ ensures relatively safe conditions for subretinal administration of iPSC-RPE. The review systematizes the literature data on immune privilege in the posterior eye segment, as well as the results of studies in the field of subretinal stem cells transplantation. The conditions and possible mechanisms that trigger graft rejection, methods aimed at preventing tissue incompatibility reactions are also discussed.

Retinal detachment with a macular hole is a severe pathology leading to vision loss and disability of the patient. It is most frequently observed in myopes and causes severe damage of functional parameters of the retina. The pathogenesis of the disease is associated with tangential tractions of the inner limiting membrane and the posterior layers of the vitreous that affect the retina of the myopic eye. Modern ophthalmology uses a variety of approaches to the surgical treatment of the pathology. The final functional result primarily depends on how successful the macular hole closure and retinal reattachment are. To achieve this success, various techniques of subretinal fluid drainage can be used. The present literature review was conducted using the Pubmed search engine. We analyzed the articles published from 2000 to 2021. The analysis of research results showed the advantage of the peripheral method of drainage using a perfluoroorganic compound. This technique is relevant both in cases of the peripheral retinal tear and in subretinal fluid aspiration through the retinotomy. The peripheral method of drainage using a perfluoroorganic compound ensures a better functional outcome, which, in case of retinal detachment with a macular hole, mainly depends on the safety of the neuroreceptors of the central zone and the closure of the macular hole.

The review presents differences in the nosological structure of ophthalmic pathology leading to childhood blindness and low vision in different countries. Worldwide, 1.4 million children are blind, about three quarters of whom live in the poorest regions of Africa or Asia. In lowincome countries, the congenital cataract is one of the leading causes of visual impairment in children, while retinopathy of prematurity is more common in middle-income countries. Uncorrected refractive errors both in children and adults, remain a major cause of visual impairment in all countries. The development of new technologies and quality medical care impacts the structure of blindness and low vision causes, as well as their geographical specificities. The analysis showed that much effort is required from large-scale state programs of prevention, early diagnosis, treatment and rehabilitation of children with socially significant eye diseases.