The high prevalence of primary open-angle glaucoma, its leading role in the structure of visual disability, and insufficient effectiveness of treatment, prevention and rehabilitation measures require new approaches to providing quality care of patients with glaucoma. It is important to analyze the epidemiological situation, human and technological resources in various regions of the Russian Federation. The paper evaluates the compliance of specialized medical care of patients with glaucoma with the approved clinical guidelines CR 96 “Primary open-angle glaucoma” in the regions of the Russian Federation monitored by the Helmholtz National Research Center for Eye Diseases, based on the material of on-site data collection visits. The epidemiological situation relating to glaucoma, the structure and performance indicators of ophthalmological service departments, preventive measures, human and material resources, and the correctness of statistical accounting and reporting were studied. In most regions, the times of examination and treatment correspond to the regional territorial programs covered by state guarantees. The cases when primary specialized care lags behind is associated with staff shortage at the outpatient level. Practically in all regions of the Russian Federation, diagnostic methods and conservative/surgical treatment techniques with proven high efficiency conform to CR 96/1 “Primary open-angle glaucoma”. Some of the regions, however, are insufficiently equipped for early diagnosis of glaucoma and monitoring its course.

Purpose: To evaluate the efficacy and safety of nonsteroid anti-inflammatory drugs (NSAIDs) in monotherapy and as part of combination therapy with glucocorticosteroids for the prevention of postoperative inflammation after cataract phacoemulsification.

Material and methods. The study included 75 patients who underwent phacoemulsification with implantation of a posterior chamber intraocular lens. Patients were divided into groups depending on anti-inflammatory treatment: A1 — nepafenac (Nepafenac-Optic), A2 — bromfenac (Broxinac), A3 — dexamethasone (Dexamethasone), B1 — Nepafenac-Optic + dexamethasone, B2 — bromfenac + Dexamethasone. Postoperative inflammation was assessed by the severity of conjunctival hyperemia, pain, Tyndall effect and retinal thickness in the macular region.

Results. The severity of the pain symptom was lower in the nepafenac group (A1) as compared to groups A2 and A3 by 49 and 74 %, respectively. A strong direct correlation with the Tyndall effect was revealed, which was more pronounced in group A3 and amounted to 0.73 points. An increase in the thickness of the retina in the macular region in the early stages after surgery was observed in groups A2 and A3, on average by 30 microns. In the groups of Nonpafenac Optic and combined therapy with GCS, the thickness of the retina remained stable. Cystic macular edema in the early postoperative period was observed in groups A2 and A3 and amounted to 2.6 and 1.3 %, respectively. There was a tendency to higher IOP rates in the GCS therapy groups.

Conclusion. After surgical treatment of cataracts, the Nepafenac Optic significantly relieves the pain syndrome, as compared with monotherapy with bromfenac or dexamethasone. Nepafenac-Optic helps to reduce the severity of inflammation in the anterior and posterior segments of the eye, minimizes the changes in the retinal thickness of the macular region in the postoperative period. The severity of these effects is comparable to the combination therapy of NSAIDs + GCS. Nepafenac-Optic does not increase IOP, has a more favorable safety profile than in combinations with glucocorticosteroids, and reduces the risk of postoperative complications.

Purpose: to study the association of the polymorphic marker T786C of the eNOS gene with various stages of primary open-angle glaucoma (POAG).

Materials and methods. Peripheral blood of 90 patients aged 56 to 89 yrs (ave. 71 yrs) with POAG stages I, II, III was tested. DNA was isolated using a set of ribosorbents (Synthol company); subsequently, a real-time PCR reaction was performed on a DT-96 amplifier using the set to determine the polymorphic marker T786C in the eNOS gene.

Results. For all groups of patients, the frequency of occurrence of alleles and genotypes was calculated, and the relationship between the emergence of POAG and the presence of an unfavorable polymorphic marker was determined. The main changes were revealed at POAG stages II and III, whilst at stage I no effect of polymorphism T786C of the eNOS gene was observed.

Conclusion. For the first time, a comparative assessment was made of the distribution of alleles and genotypes by the polymorphic marker T786C in the eNOS gene of patients with various POAG stages.

Purpose: to study the relationship between the parameters of reflex and tonic accommodation measured using various objective methods.

Material and methods. A comprehensive parallel study of objective accommodation parameters of 57 children (114 eyes) with low and moderate myopia (average -2.6 ± 1.4 D) aged from 8 to 12 years (average 9.9 ± 1.6 years) was carried out on three devices: Grand Seiko WAM-5500K, Acomoref 2 K-model Righton; TONOREF III, Nidek.

Results. Both coincidences and differences of the indicators obtained by different methods as well as their correlations were revealed: positive - between the values of AR in the open field and in the virtual space (r = 0.23, r = 0.2); between the virtual responses to Righton K-2 and Nidek (r = 0.38); direct correlations of the accommodation response with accommodation tones. A correlation of average strength (r = 0.44) was found between the HAT on the Grand Seiko WR-5100K and the CMF on the Righton K2, which allows us to consider them as synonymous indicators. A negative relationship of CMF with PRA and SE refraction was found. A positive correlation of CMF with the rate of progression of myopia and a negative one with PRA suggests that a high CMF is a bad prognostic sign. However, CMF positively correlates with the magnitude of the accommodative response on all three devices. In this case, it turns out that an increase in CMF accompanies an increase in the amplitude of accommodation and, therefore, is not always a troublesome factor. Perhaps we are dealing with the limits of the norm for this indicator, which still need to be studied.

Conclusion. With the help of objective methods of studying qualitatively different characteristics of one process, it is possible to investigate the actual and prognostic parameters of accommodation, which will allow us to offer an individualized approach to the treatment of patients with myopia using optical and drug instruments.

Retinitis pigmentosa (RP) ranks first in the structure of hereditary retinal diseases. Vasoconstriction is one of the main ophthalmoscopic indications of PR. Laser speckle flowgraphy (LSFG) is a new non-invasive method that allows quantitative assessment of blood flow in the posterior pole of the eye.

Purpose: to evaluate changes in blood flow as determined by the LSFG method in the area of the optic nerve head (ONH) and the macular area in PR patients.

Material and methods. The study included 16 patients with PR aged 25 to 70 years. The control group consisted of 40 healthy volunteers, comparable in gender and age. Blood flow was determined using an LSFG-RetFlow device (Nidek), the main indicator of blood flow determined was MBR (Mean Blur Rate), which was measured for the entire study area, as well as separately for large vessels, and for the microvasculature. A wide range of pulse wave parameters determined by the tool instrument was also analyzed.

Results. This study revealed a significant decrease in blood flow in PR patients compared with healthy individuals in different age groups and at different stages of the disease (p d 0.05). In patients with low visual acuity, the deficit of blood flow in the macular area was found to be more pronounced.

Conclusion. LSFG is an effective method for determining ocular blood flow in PR patients. The data may indicate that a decrease in blood flow is an independent pathogenetic factor in the development of PD. In the future, the method can be used to assess the effectiveness of therapy of patients with PR.

Purpose. To analyze how the clinical and morphological features are associated with vital prognosis of iris melanoma patients.

Material and methods. A retrospective analysis included 84 patients (54 women and 30 men) with iris melanoma treated between 2005 and 2019.

The mean age at the time of treatment was 52.3 ± 14.5 years. All patients underwent standard and special ophthalmological examination, including ultrasound biomicroscopy, and followed up for 32 to 196 months (103.1 ± 44 months) after hospital discharge.

Results. Pigmented tumors predominated (72.6% of patients), while others showed a slightly pigmented (15.4%) and nonpigmented forms (12.0%). Most of the patients (67.9%) received an organ preserving treatment, while others (32.1%) had to have a liquidating treatment (enucleation) due to anular tumor growth and secondary complications. Uveal melanoma was morphologically verified in all cases: spindle cell type A (14.3%), spindle cell type B (31.0%), mixed cell (42.8%), epithelioid cell (11.9%). The epithelioid cell type of tumor was more common when the tumor spread to the ciliary body rather than in iris melanoma (p = 0,046), but the spindle cell and mixed cell types were more common than the epithelioid cell type in both groups. An anular growth was typical for the epithelioid cell type of tumor (p = 0.006). The presence of vessels in tumor stroma was found to be more frequent in pigmented (p = 0.005) and non-pigmented forms (p = 0.0009). For pigmented tumors, spreading into the ciliary body was characteristic (p = 0.024).

Conclusion. A retrospective analysis of clinical and morphological factors of iris melanoma patients with an iridociliary localization should that the specific survival was 98.8%, and overall survival was 87%. The data obtained indicated the importance of timely diagnosis of iris tumors for an organ preservation treatment.

Purpose: to evaluate the ocular surface changes (OSC) in seasonal and chronic allergic blepharoconjunctivitis (ABC) under dry eye (DE) conditions and to consider therapeutic possibilities.

Materials and methods. 60 patients with seasonal ABC and mild DE syndrome (group 1) and 50 patients with chronic ABC and moderate DE syndrome (group 2) were tested for lipid deficiency (LD; negative lipid-interference test), aqua-deficiency (AD; inferior tear meniscus height < 250 fim), and mucose deficiency (Bijsterveld`s xerosis index > 3 scores; XI, scores), Ocular surface disease index (OSDI), tear film break-up time (TBUT, seconds), meibomian gland dysfunction (MGD) according to Korb, taking into account the proportion of MGD (%) and its severity (MGDS, scores), and the “lid-wiper” symptom (LWS, scores) Statistics: M ± s; Mann — Whitney U-test; differences were statistically significant at p < 0.05.

Results. LD was diagnosed in 65% of the 1st group patients (OSDI 32.3 ± 4.2, TBUT 6.5 ± 0.6, TMH 363.4 ± 43.96, XI 2.1 ± 0.4, MGD

proportion — 41.02 %, LWS 1.1 ± 0.2). LD and MD were detected in 35 % of 1st group patients (OSDI 41.3 ± 5.7, TBUT 5.7 ± 0.5, TMH 332.9 ± 29.9, XI 4.2 ± 0.7, MGD proportion — 61.9 %, LWS 1.24 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD and DE patients with LD and MD were statistically significant. LD and AD were diagnosed in 48 % of 2nd group (OSDI 48.5 ± 6.4, TBUT 5.5 ± 0.6, TMH 192.3 ± 20.8, XI 2.5 ± 0.5, MGDS 1.8 ± 0.4, LWS 1.9 ± 0.3). LD, AD and MD were detected in 52 % of the 2nd group patients (OSDI 57.5 ± 5.8, TBUT 4.6 ± 0.6, TMH 177.7 ± 16.9, XI 5.5 ± 0.6, MGD-S 2.2 ± 0.4, LWS 2.3 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD-AD combination and DE patients with LD-AD-MD were statistically significant.

Conclusion. OSC included lipid deficiency (65 %) and lipid-mucose deficiency (35 %) in S-ABC patients; OSC were represented by lipid-aqua-deficiency (48 %) and lipid-aqua-mucose-deficiency (52 %) in C-ABC patients. In our opinion, the diagnostics of these clinical variants of OSP diagnosis, opens up opportunities for differentiated tear replacement therapy. MGD was diagnosed in one half of S-ABC patients and in all C-ABC patients, which we believe determines another possible therapy direction — eyelid therapeutic hygiene aimed at MGD relieving and lipid deficiency compensation.

Purpose: to assess the functional state of the eyes in age-related macular degeneration depending on the AREDS classification stage.

Material and methods. A clinical study of 60 patients (120 eyes) with the dry AMD form, aged 55.1 ± 4.2 years, involved 30 patients (60 eyes) aged 52.7 ± 3.9 years with AREDS 2 category (initial AMD stage, group1) and 30 patients (60 eyes) aged 57.9 ± 7.8 years with AREDS 3 category (intermediate AMD stage, group 2). The complex research involved visual acuity measurement, including the assessment of near vision in various illumination conditions according to the authors’ methodology, fluorescein angiography, refractometry, tonometry, optical coherence tomography (OCT), ultrasound duplex scanning of the eye; and an immunological study aimed at determining interleukins and interferons in blood serum.

Results. Visual acuity was found to depend on test illumination in healthy subjects and to substantially drop at all illumination levels in AMD, especially in the 3rd stage. With the development of AMD, the activity of the immune response was recorded.

The patients of groups 1 and 2 showed an increase in the inflammatory response and a depression of the anti-inflammatory response. In group 1, an increase was recorded in IL-I by 23.5% (p < 0.05), in IL5 by 25.4% (p < 0.05), and in IL8 by 19.9% (p < 0.05). In group 2, the value of these parameters exceeded the norm by 32.1, 39.5 and 25.4% (p < 0.05), respectively. The parameters of anti-inflammatory immunity (IL10 and TGF l) were lower than the reference level by 18.3 and 24.6% (p < 0.05) of patients of group 1 and by 24.3 and 30.75 (p < 0.05) of group 2. It was established that the degree of imbalance of the immune system is associated with the stage of AREDS. In group 2 patients with AREDS 3, the content of pro-inflammatory interleukins exceeded those of group 1: IL-I by 12.5% (p < 0.05), IL5 by 11.9% (p < 0.05), IL8 by 11, 2% (p < 0.05). IL10 and TGF l in group 2 were lower than in group 1 by 10.2 and 11.8% (p < 0.05).

Conclusion. Near visual acuity measurement depending on test illumination may be used as a sensitive diagnostic test in AMD in patients. At an early stage of AMD development, a disorder in the immune defense is observed, taking the form of activation of the pro-inflammatory spectrum and depression of the anti-inflammatory component, as well as microcirculatory changes Homeostatic changes of the eye appear at an early stage of the disease and are progressing as the clinical picture is deteriorating. The changes are the greatest at patients with stage 3 of AREDS.

Purpose: A comparative assessment of quality of life (QL) after the use of various vitrectomy (VE) technologies in patients with an advanced stage of proliferative diabetic retinopathy (ASPDR).

Material and methods. We examined 132 patients aged 42 to 76 (average age 62.8 ± 2.4 years) who met the classification criteria of ASPDR: impossibility to estimate the area of neovascularization; the fundus of the eye in the posterior pole cannot be seen or can only partialy be seen using an ophthalmoscope; evidence of preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs and retinoschisis in the macular zone. All patients were divided into two groups, comparable in age, gender and visual status of the “healthy” eye: the main group (69 eyes), in which VE was performed according to the technique developed by the authors, and the control (63 eyes), in which the traditional VE technique was used. QL was assessed before surgery and 3 months after it using the VFQ-25 and QL-20 questionnaires.

Results. QL was found to be higher when the new surgery technique was used: the data of VFA-25 showed a 12.9% increase (p < 0.05) and QL-20 showed a 29.2% increase (p < 0.01), which points to a higher clinical effectiveness of the newly developed surgical treatment technique than that of the traditional technique.

Conclusion. The results obtained are related to the ophthalmological features of the developed surgical treatment of ASPDR: combined (phacoemulsification of cataracts + IOL + vitrectomy) one-stage intervention, lack of drainage of subretinal fluid, etc.), medication support (preliminary intravitreal administration of an angiogenesis inhibitor) and anesthesia (intervention under local anesthesia with intravenous sedation). The differences are most effectively identified using the special QL-20 questionnaire.

Purpose: to assess the possibility of using thioctic acid and indomethacin tin eyedrops for the therapy of early stages of retinal neurodegeneration.

Material and methods. The study was performed on 20 Chinchilla rabbits, including 16 rabbits in whom the neurodegenerative process in the retina was produced by intravitreal installation of 6-hydroxydopamine (6-OHDA), 0.25 mg per eye, and 4 rabbits (8 eyes) served as control. Thioctic acid 0.5% and Indocollir 0.1% were instilled separately and in combination 5 times daily for 7 days after the injection of 6-OHDA. Pupillary light reaction was estimated and eye fundus condition analyzed. Alpha2-macroglobuline ( 2-MG) and SOD activity, dopamine and protein concentrations were measured in retinal homogenates.

Results. Instillations of thioctic acid reduced the retinal damage area almost by half as compared to the untreated group (p d 0.005). Indomethacin was less effective, but the combination of the two drugs brought about a maximal reduction of the damage area (p d 0.05 against the untreated group). Both preparations normalized the disturbed pupillary light reaction. The injection of 6-OHDA caused a decrease of dopamine concentration in the retina (0.050 ± 0.009 pg/mg as against 0.095 ± 0.031 pg/mg in healthy controls, р d 0,05). After instillations of indomethacin and thioctic acid, the concentration tended to increase, and it increased significantly after treatment with their combination (0.141 ± 0.037 pg/mg, p d 0.01 as against untreated animals). The activity of 2-MG in retina decreased after a 6-OHDA injection (2.93 ± 0.42 pg/mg as against 5.5 ± 1.2 pg/mg in healthy controls, р < 0 005) just as they increased the decreased SOD (13.30 ± 5.68 U/mg in healthy controls, 5.41 ± 1.50 U/mg in untreated animals, р < 0.05). Both preparations applied separately or in combination caused a significant increase of 2-MG activity (thioctic acid — 4.19 ± 0.91 pg/mg, indomethacin — 6.95 ± 1.09 pg/mg, combination — 7.25 ± 0.63 pg/mg, р < 0.05 as against the untreated animals) and SOD activity (thioctic acid — 8.25 ± 1.27 U/mg, indomethacin — 29.84 ± 6.63 U/mg, combination — 23.99 ± 3.78 U/mg, р < 0.01 as against the untreated animals).

Conclusion. The combination of indomethacin and thioctic acid in eyedrops is the most effective for the prevention of eye damage caused by 6-OHDA, which makes this method promising for the treatment of eye diseases accompanied by neurodegeneration.

Purpose: to determine the content of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases — 1 (TIMP-1) in the tear and blood serum (BS) and to analyze how these parameters correlate with the clinical course of endogenous uveitis in children.

Materials and methods. 131 eyes with uveitis of 74 patients aged 3 to 17 (mean age 10.57 ± 3.29 years) were examined. The content of MMP-9 was found in 281 samples of the tear and 48 samples of BS. The dynamics of MMP-9 in the tear was studied in 55 patients (100 eyes), in BS — in 9 children. The content of TIMP-1 was studied in 173 tear samples and 25 BS samples. The dynamics of TIMP-1 was studied in the tear of 31 patients (56 eyes). The concentration of MMP-9 and TIMP-1 was determined by enzyme immunoassay (ELISA) using the kits ELISA for MMP-9/ELISA for tissue metalloproteinase inhibitor 1 (Cloud clone corporation, USA).

Results. The content of MMP-9 in the tear dropped compared to the control group (p = 0.09). The highest content of MMP-9 in panuveitis was found in the tear as compared to the anterior and intermediate uveitis (p = 0.01). The highest MMP-9 concentration was found in cases of 3rd degree of proliferation, in contrast to the 1st and 2nd degrees (p = 0.16). An increased content of TIMP-1 was found in the tear in subactive/intermediate uveitis in contrast to inactive uveitis (p=0.08). An imbalance of MMP-9 was revealed in relation to TIMP-1 in the tears. In the early postoperative period, an increase in the content of MMP-9 and a decrease in TIMP-1 in the tear returning to the initial level was noted, which corresponds to normal wound healing.

Conclusion. An increase in the content of TIMP-1 in the tear is associated with subactive/intermediate uveitis. The content of MMP-9 in the tear correlates with the proliferative process stage. A higher MMP-9 content in the tear in panuveitis, in contrast to the anterior and intermediate uveitis is associated with the involvement of all sections of the choroid of the eye into the inflammatory process. The decrease in the content of MMP-9 in the tears is probably explained by the inhibitory effect of glucocorticosteroid (GCS) therapy.

A previously unknown technique of observation one’s macula is presented. Depending on the illumination of the room where the observer is present, the macula is visible in whitish-gray, yellowish, blue or green.

During large-scale vaccination against coronavirus infection, studying possible side effects after the introduction of the vaccine is of great practical value. We present a rare clinical case of a complication of COVID-19 vaccine prophylaxis. A 40-year-old female patient was diagnosed with a bilateral adenoviral keratoconjunctivitis complicated by corneal erosion and iritis after a LASIK refractive intervention and a subsequent (after 5 days) immunoprophylaxis with the Gam-COVID-Vac vaccine followed by a displacement of the corneal flap due to involuntary friction of the left eye. The corneal flap was urgently repositioned; its adhesion and stabilization were achieved usinga bandage soft contact lens. The timely local and systemic anti-inflammatory and antiviral therapy allowed achieving a successful visual result (1.0). Ophthalmologists need to remain vigilant about possible adverse effects after immunoprophylaxis on the part of the eye, specifically the conjunctiva and cornea. A timely diagnosis and treatment are important to prevent complications such as persistent corneal opacities that reduce visual acuity, especially in patients who have undergone refractive surgery aimed at achieving the highest possible vision. In our opinion, it is advisable to perform vaccination at least 1 month after the refractive surgery.

Scleral rigid contact lenses efficiently correct the vision of patients with irregular corneas. Purpose. To study the features of contact correction and visual rehabilitation of patients with irregular corneal surface using individual scleral rigid contact lenses. Results. Three clinical cases of successfully selected rigid individual scleral lenses for patients with an irregular corneal surface that appeared after a penetrating keratoplasty, implantation of intrastromal corneal segments, and eye injury. The expected refractive result was achieved; high tolerance and good adaptation to lenses was revealed. Conclusion. Scleral RCL can be successfully used in patients with irregular cornea to improve visual acuity, reduce the number of aberrations, restore binocular vision and social adaptation.

Optic disc drusen (ODD) is a bilateral anomaly of the optic nerve, in which hyaline calcified intercellular inclusions appear in the optic disc head area in front of the cribriform plate. As a rule, in the early stages, ODD patients have no complaints, central vision does not suffer, while perimetry data may show an expansion of the blind spot and narrowed visual field. As complications are developing and the optic nerve atrophy is progressing, visual acuity may decrease. The visual functions are deteriorating gradually. In the clinical case discussed, a patient with optic disc drusen was examined for a second time after a prolonged interval (27 years).The ophthalmoscopic picture and functional parameters obtained during this examination clearly confirmed the unfavorable course of optic disc drusen and the need for such patents to be regularly examined for changes in visual functions (visual field), the state of the retina and the optic nerve.

We present a case of carotid-cavernous fistula (CCF) in a 52-year-old female patient who was urgently referred for surgical treatment of a left-sided orbital phlegmon. On the 62nd day after a traumatic brain injury, the patient revealed a visual impairment of the left eye, which was noticeably red and showed a moderate protrusion. The patient’s left orbit was urgently opened and drained.

She was undergoing an anti-inflammatory therapy and showed a positive dynamic of the disease, whilst on the 5th day after the procedure, the patient started feeling pain in the left eye and noise in the head. The data of ultrasound examination of the orbit and duplex scanning were largely consistent with a severe massive inflammatory infiltration of the retrobulbar tissue with hypervascularization (the orbital phlegmon could not be excluded). Only a selective computed tomography with angiography helped establish the final diagnosis: arteriovenous malformation in the projection of the supra-sphenoid section of the left internal carotid artery, with post-traumatic CCF on the left. After surgery (endovascular embolization of the CCF), a positive result was observed: with a positive result — no injection or pain in the left eye, exophthalmos gradually regressed. Yet the visual acuity of the left eye was 0.03 due to an atrophy of the optic nerve.

Conclusion. The ophthalmologists must be on the alert in cases of unilateral exophthalmos with a history of blunt head trauma, since neuro-ophthalmic symptoms are crucial in clarifying the indications for a prompt implementation of the only surgical treatment effective for this pathology, i.e. endovascular embolization.

The outcomes and complications of the coronavirus infection are of interest to specialists in many fields of medicine, including ophthalmologists.

Purpose: to analyze the clinical features of ophthalmic complications in patients with coronavirus infection COVID-19.

Materials and methods. Four patients aged 37 to 70 years with ophthalmic inflammatory complications with coronavirus infection were examined and treated.

Results. In 2 cases, eye damage was observed in the acute phase of COVID infection. It included deep keratitis, iridocyclitis, and exacerbation of rhinosinusitis complicated by osteomyelitis, orbital phlegmon with loss of vision. In the remaining 2 cases, in the post-COVID period (2 and 5 months after the disease, respectively), acute dacryoadenitis with the dry eye syndrome and subacute episcleritis was observed. In addition to anti-COVID therapy, all patients underwent specific ophthalmic therapy, which in 1 case included surgical intervention.

Conclusion. The cases presented demonstrate eye damage against the background of coronavirus infection with the involvement of various eye structures into the inflammatory process. The ophthalmological manifestations were severe, with complications in the acute phase of COVID and in the early post-COVID period. Clinical observations indicate the need for additional specific therapy of coronavirus infection complications, along with the basic anti-COVID treatment.

Chorioretinal folds are a wave-like change of the form of the choroid and outer retinal layers resulting from changes in the surface area ratio of the sclera, the choroid, and the retina. The range of etiological factors for this condition includes eyeball hypotonia, posterior scleritis, intracranial hypertension, tumor and inflammatory diseases of the orbit. The pathogenesis of chorioretinal folds is determined by mechanical displacement or thickening of the vasculature, sclera thickening and changes in its contour, as well as edema of the optic nerve coats. We present a clinical case of a 45-year-old female patient with acute hyperopia and chorioretinal folds, focusing on the clinical and instrumental algorithm of differential diagnostics of the causes of this condition.

The review presents literature data about the anatomical structure, morphology and structural features of the optic nerve (ON). Four ON regions are detailed: intraocular, intraorbital, intracanalicular and intracranial. Specifically, the features of the intraocular region are outlined. It is divided into three zones: the surface nerve fiber layer, the prelaminar part and the lamina cribrosa of the sclera, which differ in histological structure and blood supply. The data on the coats of the intraorbital part include the details of the hard (dura mater), arachnoid and the soft (pia mater) coats. Other data represent the morphological structures of the intracanalicular and the intracranial parts of the ON. The distinctive features of blood supply in different ON regions are discussed.

The information about the anatomical characteristics and structural features of the ON is important for studying the pathogenesis of the optic nerve´s damage.

In nearly all Russian regions, glaucoma ranks first among the causes of disability due to ophthalmic pathology, which is in line with global trends of glaucoma incidence growth and its leading position among the causes of irreversible blindness. Treatment of glaucoma is aimed at lowering intraocular pressure (IOP). This review presents the main current trends in the treatment of glaucoma: drug therapy, laser surgery, fistulizing, drainage and non-penetrating surgery, as well as the latest micro-invasive glaucoma surgery (MIGS).

Currently, the pharmaceutical market offers many antihypertensive drops. Fixed-dose combinations of drugs have been proposed to increase treatment adherence, and effective drug delivery methods are being developed, which lower IOP with minimal side effects. Further development of laser surgery makes it both a method of choice for the initial treatment (selective laser trabeculoplasty) and expands its capabilities for various stages of glaucoma (micropulse cyclophotocoagulation). All this significantly reduces the frequency of classical macroinvasive antiglaucoma operations. The previously existing gap between conservative medical therapy and antiglaucoma surgery is filled by the newest MIHG procedures. In recent years, at all stages of primary open-angle glaucoma therapy, the emergence of new pharmaceuticals, methods and implants has been noted. These constitute the purpose of this publication.

The microflora of the ocular surface serves an important role in the protective mechanisms, since it significantly affects the regulation of immunological activity and the barrier effect against pathogen invasion. The presence of a healthy ocular microbiome causes no eye diseases, and ophthalmic pathologies develop only when anatomical barrier functions and immune status are violated. A healthy eye surface is characterized by a relatively stable and small microbiome diversity. The environment, diet, gender, age and some other factors, such as potential contamination, affect the composition of the microbial flora, complicate its analysis and may affect the results of the latter. Moreover, potentially pathogenic organisms various disorders, including inflammation and methods of treating ocular surface can also affect the composition of eye microbioma. Traditional microbiological studies based on cultivation often reveal a rather low diversity of microorganisms in a particular region. New research methods, e.g. genetic analysis based on rRNA sequencing, indicate a much greater diversity than previously assumed. It has been shown that changes in the microbiota composition occur in blepharitis, conjunctivitis, keratitis, uveitis, dry eye syndrome, age-related macular degeneration, diabetic retinopathy, glaucoma, myopia, etc.

Currently, there are no clear criteria for describing norms of the ocular microbiome (including fluctuations which should be considered normal during life). The features and impact of the microflora composition on immunity and human body as a whole, in particular, those associated with the intestinal microbiome and their dependence on gender, age, place of residence, etc have not been studied in full.

Further studies of eye microbiome can give answers to all these questions.

Rhegmatogenous retinal detachment (RRD) is one of the leading causes of primary vision disability, while the majority of RRD patients with RRD are people of active working age. Over the past 50 years, retinal detachment surgery has been progressing rapidly, the rate of success increasing up to 90% or higher. However, the reduction of reoperation risks of reoperations, improvement of functional outcomes and increase of postoperative visual acuity remain topical issues. The main reason for repeated surgical interventions is the proliferative vitreoretinopathy progression, which can lead to epiretinal fibrosis, macular oedema, or retinal detachment recurrence. The review is focused on current literature studies that report the results of internal limiting membrane peeling in cases of RRD surgeries and other optional techniques aimed at reducing the risk of the above mentioned postoperative complications.

Diabetes mellitus (DM) is a major public health problem, with approximately one third having signs of diabetic retinopathy (DR). In such patients, cataracts develop at an earlier age and 2–5 times more frequently. The incidence of macular edema (ME) after phacoemulsification of cataracts (FEC) in patients with diabetes has been shown to increase by 1.80 times and, in the presence of DR by 6.23. The critical period for retinal deterioration is 2 months after FEC, which requires an active therapy and monitoring. For patients with pre-existing diabetic macular edema (DME), If the cataract does not affect daily activities of patients with a pre-existing DME and the optical clarity is adequate, it is preferable to postpone surgical treatment in order to maximize retinal stabilization on OCT at two consecutive visits with a month’s interval between. In the case of severe impairment of lens transparency, FEC with an intravitreal injection of anti-VEGF 28 days or steroids 1 month before surgery under strict monitoring of the retinal condition using OCT is recommended. If macular changes are absent and there is a risk of developing DME, the use of nonsteroid anti-inflammatory drugs is necessary. Prophylactic intravitreal therapy is unacceptable in the absence of MO.