Purpose: to develop a method for assessing metabolic changes in pedicle skin flaps using spectrofluorimetry in eyelid neoplasm surgery. Material and methods. 14 patients (mean age 74.50 ± 7.14 years) were operated for eyelid neoplasms with tissue defects replaced by pedicle flaps. The area of eyelid lesion achieved 90 %. In 100 % of cases, a histological examination revealed basal cell carcinoma. Metabolic changes of the skin in the transplanted flap and in the symmetrical area of the fellow eye were assessed using the spectrofluorimetric method 3 days and 3 months after the surgery. A number of successive spectra of fluorimetric parameters were taken from each site, whereupon the mean values of the Metabolic Shift Index were calculated. Results. Differences in the spectrofluorimetric parameters of the metabolic shift between the area with the transplanted flap and the symmetrical area were revealed on the third day after surgery (p = 0.00058) and 3 months after it (p = 0.0317). The obtained results indicate a partial preservation of the hypoxic state of the skin on the third postoperative day and the complete restoration of trophism 3 months after the surgery (p = 0.043), as well as the onset of scarring of the transplanted flap by the latter time point. Conclusion. A technique for assessing metabolic changes in eyelid skin has been developed, which enabled the establishment of normal spectrofluorimetric values in this area and helped reveal the changes in the indices of metabolic shift in the transplanted pedicle flaps in the early postoperative periods and throughout the entire follow-up period. 3 months after the surgical treatment, the indices of metabolic changes in the transplanted pedicle flap come close to normal values.

Purpose: to analyze clinico-functional and aberrometric parameters of patients with the neovascular form of age–related macular degeneration (nAMD) treated by the anti-VEGF drug brolucizumab. Material and methods. The study involved 59 patients (59 eyes) aged 55 to 75 years, divided into two groups depending on the type of treatment. Group 1 consisted of 25 patients (25 eyes) who had previously received no anti-VEGF therapy and Group 2 had  34 patients (34 eyes) with an active nAMD form, who had previously been given anti-angiogenic therapy with aflibercept. All patients averagely received 5.48±1.5 brolucizumab injections in the “treat and extend” mode: 3 loading injections with monthly checkups followed by elongated intervals reaching 8 weeks. The treatment effectiveness was estimated by the change in maximum corrected visual acuity (MCVA) as measured by precision visometry, the aberrations parameters of the optical system of the eye, and the thickness of the central retinal zone (CRZ). In addition, the height of retinal pigment epithelium (RPE) detachment, the presence of intraretinal fluid (IRF), subretinal fluid (SRF), and fluid under RPE. Results. In group 1, BCVA whose initial value was 0.37 ± 0.16 reached 0.78 ± 0.25 (p = 0.02) by the end of treatment, while in group 2, the value rose from 0.35 ± 0.18 to 0.62 ± 0.22 (p = 0.02). After the 5^th injection, Group 1 showed a statistically significant decrease in TCZV (ave. by 270.17 ± 92.37 μm, p=0.05), while Group 2 showed a less pronounced morphological result (a decrease from 480.54 ± 174.22 to 320.32 ± 109.53, p < 0.05). Both groups also showed, after the 5^th injection, a decrease in the cumulative frequency of occurrence of various types of fluid (p < 0.02). A decrease in all components of higher order aberrations was also noted after the first 3 injections; this result remained stable until the end of the observation period (p = 0.04). Conclusion. In Group 1 patients, we succeeded in achieving high morphological and functional results and maintaining them at a stable level until the end of the observation period. Group 2, patients with an active nAMD, previously treated with other anti-VEGF preparations, showed a less pronounced, though stable improvement in morphofunctional parameters.

Myopia is rising as a silent epidemic across the globe with marked ocular morbidity and pathological changes. The retinal nerve fiber layer (RNFL) thinning is indicative of glaucomatous damage; it remains uncertain whether RNFL thickness would vary with the refractive status of the eye. It is therefore important to investigate whether any correlation exists between RNFL measurements and axial length/refractive error in myopia. Purpose. To assess the peripapillary RNFL thickness by spectral domain optical coherence tomography (SD-OCT) and to determine the correlation between axial length and peripapillary RNFL thickness in myopia patients. Material and methods. A total of 100 patients (200 eyes) with low, moderate and high myopia (ave -3.58 ± 2.45 D) aged 15 to 40 years were examined to assess the peripapillary RNFL thickness by SD-OCT and to determine the correlation between axial length (AL) and peripapillary RNFL thickness myopia patients. Results. Average 360-degree RNFL thickness (mean ± SD) was 92.25 ± 10.04 μm. In the low myopic group this parameter was 98.82 ± 6.67 μm, in the moderate myopic group — 89.28±5.23 μm, and in the high myopic group — 78.54 ± 7.32 μm. The average 360-degree mean RNFL thickness in patients with AL < 24 mm was 100.06 ± 5.92 μm, in patients with AL between 24–26 mm — 89.48 ± 4.59 μm, and in patients with AL > 26 mm — 78.2 ± 6.77 μm. There was significant association between thinning of the average 360-degree RNFL thickness with increasing degree of myopia and AL (p < 0.0001). Conclusion. The study shows RNFL thickness decreases with increase in refractive error and increase in axial length of myopic eyes. The degree of myopia may affect the RNFL thickness differently.

Purpose: to evaluate the effect of wearing glasses with Stellest® lenses on the spherical equivalent of refraction (SER) dynamics, the yearly progression gradient (YPG) and the axial length (AL) of the eye in children with progressive myopia 12, 18 and 24 months after the start of use. Material and methods. The main and the control groups of the study included children aged 8 to 13 years with low to moderate myopia at the beginning of observation. Stellest® glasses (the main group) were prescribed to 35 children with myopia 3.15 ± 0.19 D, while single vision (SV) glasses (the control group) were prescribed to 32 children with myopia 2.68 ± 0.18 D. The dynamics of the SER, YPG, and AL of the eye were assessed. Results. In the main (Stellest®) group, after 24 months of observation, SER increased by ave. 0.20 ± 0.06 D. YPG was shown to decrease in 93.5 % of cases by ave. 0.81 ± 0.05 D. The AL increased by an average of 0.15 ± 0.03 mm. In the control group, after 24 months of observation, the SER averaged 0.95 ± 0.08 D. YPG showed a decrease of ave. 0.38 ± 0.05 D in 61.1 % of cases. The AL of the eye increased by an average of 0.48 ± 0.04 mm. Conclusion. Stellest® glasses, if worn constantly, effectively slow myopia progression and axial elongation as compared with SV glasses. By the end of the follow-up period, in the Stelest® group, SER showed an increase by 79 % less than in the control group of SV glasses, and the AL showed increase in the length of the eye which was 69 % less than in the control group. Over the 24 months’ wearing of Stellest® glasses, YPG turned out to be 4.8 times lower than in the control group.

Purpose: to evaluate the effectiveness and safety of complex therapy in patients with demodex blepharitis and dry eye. Methods. 25 patients with mixed demodex blepharitis and dry eye (50 eyes; 10 men, 15 women; 61.9 ± 5.6 years) were examined before and after treatment with 0.5 % levofloxacin instillation (5 times a day, 5 days); sulfur and metronidazole gel applications (Blefarogel-forte) as part of therapeutic eyelid hygiene (Blepharogel-cleansing, Blepharolotion; starting from day 6, 2 times a day, 45 days); 0.24 % sodium hyaluronate instillation (3 times a day). Therapy effectiveness criteria were as follows: D. folliculorum mite population reduction; positive dynamics of blepharitis objective signs and meibomian gland dysfunction severity (MGD-S, points). Therapy safety criteria included the absence of negative dynamics of OSDI, tear film breakup time (TBUT, s), inferior tear meniscus height (ITMH, µm) and xerosis index (XI, points). Results. As a result of the therapy, statistically significant changes were noted, including mite population reduction (from 9.23 ± 0.81 to 3.54 ± 0.80 imagos); eyelid margins edema intensity decrease (from 3.18 ± 0.39 to 1.30 ± 0.45 points) and hyperemia decrease (from 2.90 ± 0.29 to 0.9 ± 0.3 points); MGD-S decrease (from 2.1 ± 0.3 to 0.95 ± 0.21 points); OSDI decrease (from 43.23 ± 4.70 to 25.10 ± 2.65 points); TBUT increase (from 4.05 ± 0.50 to 5.55 ± 0.50 s); XI decrease (from 5.36 ± 0.49 to 4.04 ± 0.60 points). Conclusion. The treatment of demodex blepharitis and dry eye treatment, including sulfur and metronidazole gel applications, therapeutic eyelid hygiene and 0.5 % levofloxacin and 0.24 % sodium hyaluronate instillation demonstrated a high efficiency and a good safety profile.

Purpose: to develop a technique for an objective multifactorial assessment of accommodation parameters, including accommodation stability and microfluctuations (MF), and an assessment of the diagnostic value of the technique. Material and methods. The dynamic monocular accommodative response (MAR) was measured using a WAM-5500 device (Grand Seiko, Japan) over a period of 10 to 60 seconds with a recording frequency of at least 6 Hz. The approximating cubic spline was calculated, and the temporal change of signal trend was assessed. The developed technique was used to evaluate the dynamics of MAR for 46 eyes of 23 patients aged 8–12 years with acquired myopia from -0.87 to -5.75 D (ave. -2.96 D). Results. In the examined eyes, the MF frequency varied from 0.4 Hz to 2.3 Hz (ave. 1.4 Hz), and the maximum amplitude ranged from 0.4 D to 2.47 D (ave. 1.2 D). Over the research period, the MAR trend remained constant in 10 eyes, increased from 0.17 to 0.47 (ave. 0.29 D) in 8, and decreased from 0.1 to 1.53 D (ave. 0.35 D) in 28 eyes. MAR varied from 0.79 to 2.63 (ave. 1.8 D). A correlation was found between the minimum MAR and the signal range with the trend level (r= 0.29 and r=0.4, respectively) and a weak correlation was revealed between the MF frequency and the signal range (r=0.2). A set of criteria for accommodation instability was identified: a decreasing trend of more than 0.35 D, a MF frequency of more than 1.4 per second and/or a maximum signal span of more than 1.2 D. Conclusion. The developed technique or objective multifactorial assessment of accommodation parameters, including stability and MF, in real time and space proves to be useful for the diagnosing of accommodation disorders.

Purpose: to identify the intraretinal hyperreflective foci (HRF), their specific characteristics, localization features and correlations with the duration of the disease, type of course and previous episodes of optic neuritis (ON) in multiple sclerosis (MS) patients using a high-resolution OCT scanning protocol. Materials and methods. The study included 160 patients (318 eyes) divided into 8 groups, i.e. Group 1: 44 eyes (13.84 %) — MS onset without a history of ON; Group 2: 30 eyes (9.43 %) — debut of MS with ON; Group 3: 56 eyes (17.61 %) — relapsing-remitting MS (RRMS) lasting ≤ 10 years without ON; Group 4: 38 eyes (11.95 %) — RRMS lasting ≤ 10 years with ON; Group 5: 49 eyes (15.41  %) — RRMS lasting ˃ 10 years without ON; Group 6: 37 eyes (11.63 %) — RRMS lasting ˃ 10 years with ON; Group 7: 34 eyes (10.69 %) — secondary progressive MS (SPMS) without ON; Group 8: 30 eyes (9.43 %) — SPMS with ON. Results. HRF were identified in all groups, at the levels of both the outer nuclear layer (ONL) and the inner nuclear layer (INL). Their number increased depending on the duration, type of course, and the presence of ON history. The thickness of the inner layers of the retina corresponded to the average normative indicators in the group with the onset of MS without ON. In the SPMS group after ON, a decrease in the total thickness of ganglions retinal cells layer (GCL) and the inner plexiform layer (IPL) was noted, showing minimal values of both avGCL + IPL (65.83 ± 8.27 μm) and avRNFL (76.37 ± 6.94 μm). High inverse correlations were revealed between avGCL + IPL and the amount of GRF at the levels of ONL and INL (-0.82 and -0.85, respectively, p = 0.01). Conclusions. The presence and quantity of HRF can be considered as a prognostic non-invasive biomarker associated with the duration of MS and the history of ON, allowing one to visualize the penetration of microglia activated by immune cells into the unmyelinated part of the central nervous system, helpful in elucidating their role in the pathogenesis and progression of the disease.

Purpose: to develop a model of the early stage of retinal neurodegeneration via an intravitreal injection of the dopaminergic neurotoxin. Material and methods. The experiment was carried out on 20 Chinchilla rabbits. The experimental groups received intravitreal injection of 0.1 ml of 6-hydroxydopamine (6-OHDA) in NaCl 0.9 % with 0.5 % ascorbate, containing 0.25 or 0.5 mg 6-OHDA. The control group received injections of 0.1 ml of NaCl-ascorbate solution without neurotoxin. On the 7^th and the 14^th days after the injection, intraocular pressure (IOP), pupillary light reaction and ocular blood flow were estimated and the fundus was examined. On the 7^th day after an injection of 0.25 mg 6-OHDA, we used ELISA to measure dopamine concentration in retinal homogenates, while on the 14^th day after an injection of 0.5 mg 6-OHDA, the concentrations of dopamine, norepinephrine, TNF-a and endothelin-1 were measured by the same method. Results. On the 7^th day after a 0,25 mg injection of neurotoxine, we revealed a decrease of dopamine in the retina (0.043 ± 0.130 pg/mg protein compared with 0.10 ± 0,03 pg/mg protein in the controls, р < 0.01). On the 14^th day, dopamine and norepinephrine levels showed a fourfold increase (р < 0.05). An injection of 0.5 mg of 6-OHDA caused a threefold increase of dopamine (р < 0.05) and a fivefold increase of norepinephrine (р < 0.01) concentration in comparison with the controls. On the 14^th day, endotheline-1 level was 65 % higher than in the controls after a 0.25 mg 6-OHDA injection (р < 0.01) and 45 % higher after a 0,5 mg injection (р<0.05). At the same time, TNF-α levels increased by 43 % (р < 0.05) and 20 % (р < 0.05) respectively. We also revealed a dose-dependent change of IOP, a disturbance of pupillary light reaction and decreased ocular blood flow after an injection of neurotoxin. Conclusion. A single intravitreal injection of dopaminergic neurotoxin 6-OHDA in the amount of 0.25 or 0.5 mg per eye leads to a neuroinflammation and vascular disorders, which are the main pathogenetic pathways of neurodegeneration. To model its early phase, the 0.25 mg dose is preferable as it causes less dramatic functional disorders. The latter model can be useful for the investigation of retinal neurodegeneration pathogenesis, the search for early diagnostic and prognostic markers thereof and the estimation of therapy effectiveness.

Purpose: to assess the reaction of multipolar retinal neurons to light irradiation depending on the intensity and duration of exposure. Material and methods. Outbred sexually mature white rats (n = 50, 100 eyes) weighing 180–200 g were exposed to continuous round-the-clock light (200, 3,500 lux; 1, 2, 7, 14, 30 days). The control group consisted of 25 non-irradiated animals (50 eyes). Using semifine sections, colored with toluidine blue, we counted the number of neurons in the ganglionic layer with karyopyknosis, focal and total chromatolysis. In the optic nerve, the percentage of degeneratively altered axons and the number of nerve fibers with deformation of the myelin sheath were calculated. Ultrastructural changes in neurons were studied using a JEM-100 CX-II electron microscope. Results. In the first days of the experiment (1, 2 days), reactive and destructive changes in organelles are observed in the perikaryons of multipolar retinal neurons. The granular endoplasmic reticulum becomes fragmented, loses part of its ribosomes, and vacuoles of varied sizes are formed from its cisterns. With an increase in the duration of exposure (7–30 days), degradation processes are increasing, all the more so after high-intensity (3,500 lux) light irradiation. The photodamage causes changes in all components of the optic nerve and is characterized by a destruction of organelles, a decrease in the number of elements of the cytoskeleton in the axon, and myelin sheath splitting. Conclusion. Changes in multipolar neurons of the retina after photodamage are primarily related to the content and distribution of the chromatophilic substance and depend on the intensity and duration of illumination.

Purpose. Studying clinical and cytological signs of malignant epithelial genesis tumors of eye adnexa. Material and methods. In 2015–2020, 308 patients aged from 23 to 87 (58.0 ± 6.7) years with suspected malignant neoplasms of eyelid skin and conjunctiva were cytologically examined. The material for cytological examination was obtained by scraping (n = 271; 88 %), imprinting (n = 27; 8.8 %), and fine needle aspiration biopsy (n = 10; 3.2 %) if the neoplasm was more than 10 mm thick. Preparations were processed and fixed according to the standard technique using panchromic Pappenheim staining. Results. The cytological analysis confirmed the clinical diagnosis and the epithelial genesis of the malignant neoplasm in 273 (88.7 %) patients. The benign nature of the tumor was confirmed in 17 patients (5.5 %) and the non-tumor nature of the process was confirmed in 11 patients (3.6 %). In the group of malignant tumors, basal cell cancer prevailed, affecting 240 patients (87.9 % of all malignant tumors). 27 patients (9.9% ) had squamous cell cancer, 4 patients had meibomian gland cancer in 4 patients, and 2 patients had undifferentiated cancer. Benign tumors included papillomas (n = 11), while tumor-like lesions included atheromas (n = 3) and granulation polyps (n = 3). Non-tumor lesions involved productive inflammation of the chalazion type (n = 7), or chronic inflammation of a reactive nature (n = 4). 22 patients had histological examination to check the diagnosis, in all cases the histological outcome coincided with the cytological diagnosis. Conclusion. The comprehensive clinical and cytological study allowed us to specify cytomorphological characteristics of epithelial tumors of the eye adnexa: the basal cell cancer and its varieties according to the clinical forms of the tumor, squamous cell cancer and meibomian gland cancer, and papilloma. The complex clinical and cytological method of diagnostics is easily applicable in out-patient conditions, allowing us to specify the diagnosis during the initial visit, which considerably reduces the time required for full patient’s examination.

It is believed that in degenerative diseases of the retina, photostimulation by fractal dynamics signals activates neuroplasticity, thereby increasing the efficiency of visual rehabilitation. Previously, we showed a positive effect of fractal phototherapy (FF) on the electroretinogram (ERG) of healthy rabbits and demonstrated the safety of long-term photostimulation courses for the retina. The purpose of this work is to study the effect of FF on the functional activity and morphology of the retina in rabbits with a model of retinal pathology. Material and methods. We modelled an atrophy of retinal pigment epithelium (RPE) on both eyes of 50 rabbits. 30 days after the administration of bevacizumab, the animals were divided into two groups of 25 animals each. In the main group, photostimulation was performed using a device for FF, while in the control group incandescent lamps were used that create radiation of constant intensity. In both groups, 20-minute binocular light stimulation sessions were performed daily, five times a week. ERG and optical coherence tomography of the retina were performed before and after courses of treatment which lasted 1 week, 1 and 3 months. Results. Long-term courses of FF were shown to be safe for the morphology of the retina of animals with the RPE atrophy model. In all periods of observation, biochemical studies revealed no statistically significant changes in the content of norepinephrine and dopamine in the tear as compared with baseline values. In the main group, a slight positive effect of FF on rod and cone ERG was found after 5 FF sessions, while a significant increase in the amplitude of the transient and steady-state pattern-ERG (PERG), most pronounced after a 1-month FF course, was observed. Conclusions. A positive effect of FF on the functional activity of retinal ganglion cells (RGC) may suggest that prescribing a course of FF lasting up to 1 month (20 sessions) in diseases accompanied by a pathology of RGC is advisable, whereas for patients with a pathology of the macular region, such as AMD, an effective improvement in the activity of photoreceptors and bipolar cells could probably be achieved through a 1-week course of FF, conducted under the control of electroretinography.

Purpose: to determine the concentration of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in the tear of patients with cornea melting and to assess whether these factors can be used as prognostically significant biomarkers of keratolysis. Material and methods. 20 patients who underwent urgent penetrating keratoplasty were tested for cornea perforation (melting) before and after the procedure. For control, 12 healthy adults (24 eyes) were tested. The tear fluid was collected before the surgery and on the 7^th day after it with the help of filtering paper. MMP-9 and TIMP-1 concentrations were determined by ELISA. The course of the early postoperative period was assessed according to the area of keratotransplant epithelization on the 7^th day after surgery. Results. MMP-9 and TIMP-1 concentrations in the tears of all patients before the surgery were significantly higher than the ones of healthy controls. The patients who were supposed to have re-keratoplasty had a significantly higher MMP-9 concentration than the ones who expected the first keratoplasty. An uncomplicated early postoperative period showed a statistically significant decrease of MMP-9 and TIMP-1 concentrations, whilst the complicated one demonstrated a significant increase of both markers. The highest increase of both markers was shown by the patients who underwent re-keratoplasty. Conclusion. MMP-9 concentration in the tears is a valid marker of the clinical course of the early post-keratoplasty period. To ensure a successful donor cornea engraftment, the levels of MMP-9 and TIMP-1 in the tear must be high enough before the surgery and the concentration of the ferment should decrease timely after its main functions have been completed. A 2-fold (or greater) decrease of MMP-9 concentration in the tear on the 7^th day after keratoplasty can be considered a marker of the favorable prognosis for engraftment.

A clinical case of ocular surface xerosis in a patient with previously undiagnosed skin ichthyosis is presented. Clinical manifestations of change occurring in the eyes of the patient disease are outlined, and a complex of therapeutic measures to maintain the eye surface in ichthyosis is proposed.

A clinical case of bilateral descending optic neuritis in a 63-year-old patient is presented. The patient, whose age is beyond the normal limit for this pathology, was previously treated for neuritis of the right eye, which had no effect and led to a complete atrophy of the optic nerve (ON). A timely correct diagnostics of the left eye, which revealed structural disorders of the optic nerve accompanied by inflammatory viral changes of brain tissue, was a key factor in choosing an adequate treatment, which helped retain visual functions. The clinical observation illustrates the polyetiological nature of inflammation of the ON, the viral agent playing a leading role. Importantly, ophthalmic manifestations of the herpesvirus infection may remain the only sign of this pathology for a long time, so the ophthalmologist must always be on the alert regarding the viral genesis of the disease.

The article presents a variety of ways to increase the efficiency of glaucoma filtering surgery. Special attention is given to maintaining the ocular surface healthy through optimal glaucoma therapy. The duration of the disease should be taken into account when choosing the type of hypotensive surgery and designing an algorithm for its pharmacological support: preoperative preparation, prolonged postoperative anti-inflammatory treatment and cornea protection.

The article presents a clinical example of intraocular presbyopia correction in a patient who previously underwent laser vision correction by LASIK for mild myopia. Before the surgery, the distance VA mono- and binocular was 1.0, ADD for reading distance 40 cm +2.0 D, objective refraction sph +0.5 D cyl -0.25 D ax 980, left eye sph +0.75 D cyl -0.25 D ax 660.  The patient was given a simultaneous bilateral refractive lens exchange with an implantation of a trifocal aspheric intraocular lens in the right eye and a trifocal toric aspheric intraocular lens in the left eye. We used the following IOL calculation formulas: ASCRS mean IOL power, Shammas formula, Barrett true K formula, Masket formula, Modified Masket formula, Haigis-L formula. 1 week postop: UDVA OU = 1.0, UNVA 40 cm = 1.0, UVA 70 cm = 0.7. The objective refraction OD was sph +0.0, D cyl -0.75 D ax 163, OS sph +0.25 D, cyl -0.0 D. The compliance with the modified algorithms of pre-and intraoperative behavior of the operating team, thorough preparation of the patient, careful calculation of the IOL allowed us to obtain the predictive refractive result with a high level of visual satisfaction and absence of undesirable postoperative phenomena. The patient underwent the examination with Salzburg reading desk before and after the surgery, to confirm the excellent functional results of the treatment. Despite the fact that simultaneous same day IOL implantation in both eyes, especially in eyes with previously operated corneas, is still disputable, the above case confirms that with modern equipment, precise multi formula calculation, and ample experience help achieve excellent functional and refractive results.

COVID-19 causes an immunosuppressive condition and increases the risk of secondary infections, including fungal diseases such as mucormycosis (MM), so doctors should be aware of the possibility of MM development in COVID-19 patients. Since no specific complaints or clinical symptoms exist and the disease is rare, especially in developed countries with a moderate climate, it is often impossible to diagnose MM at the initial examination. Therefore, the detection of the pathogen (mycelium zygomycetes) plays a key role in the diagnosis. Over 70 % of MM patients experience eye damages. According to the literature, the most common manifestations thereof are blepharoptosis, ophthalmoplegia, exophthalmos, injection and conjunctival chemosis. Quite often, the patients have eye pains, orbital cellulitis or phlegmon of the orbit, accompanied by a decrease in vision. For the effective treatment of this severe infectious COVID-19 complication, which takes the form of deep and aggressive mycosis, an interdisciplinary approach is necessary. The complex treatment should make use of antimycotic agents and symptomatic therapy, and, essentially, surgical rehabilitation of infection foci by removing the affected necrotic tissues. The prognosis is always very serious.

The review is focused on the adherence of glaucoma patients to the immediate start of treatment after the condition has been diagnosed. A personalized strategy, which includes the assessment of the patient's clinical and socio-economic status and the use of medications with proven efficacy, contributes to the formation of long-term adherence to therapy. In particular, the strategy combines preventive and diagnostic measures depending on the patient’s individual characteristics and involves their direct participation. Over 250 risk factors are known to reduce a patient’s adherence to treatment, whereas insufficient adherence can itself be considered as a risk factor for glaucoma progression. The asymptomatic course of the disease or the lack of a noticeable effect of drops instilled often cause the regimen to be violated, whilst the long-term therapy requires determination and self-control of the patient. Combined measures to improve the adherence are based on the specific needs of the patients and are consistent with their lifestyle. As a rule, the patients need special instruction, good means of communication with the doctor, simplified treatment regimens, and an adequate interaction with the public health facilities. Importantly, the therapy start depends not only on the level of intraocular pressure, but also on the stage of the glaucomatous process at which it was first diagnosed.

The review presents recent research works on new technologies of scleral collagen crosslinking, a promising approach to sclerastrengthening treatment of progressive myopia. We assess the advantages and limitations of a number of experimental techniques of photochemical and medicinal crosslinking of the sclera, as well as donor tissue crosslinking aimed at optimizing the plastic material for sclera-strengthening surgery. Successful experiments and effective first clinical implementation results of the approach can be viewed as the basis for its further improvement and wider introduction of the technology into ophthalmological practice.

The medical industry is undergoing an active digital transformation, including the creation of electronic databases, cloud security systems, mobile health monitoring devices, and telemedicine tools. Artificial intelligence (AI), one of the most important technological achievements of the last decade, is gradually gaining momentum in various areas of practical medicine. The cutting edge of AI, neural networks, offers promising approaches to the improvement of clinical examination quality. The review presents data of studies focusing on the use of AI tools in the diagnosis of the most common ophthalmic diseases: diabetic retinopathy, macular degeneration, retinopathy of prematurity, glaucoma, cataracts, and ophthalmic oncology. We discuss both the advantages of neural networks in the diagnosis and monitoring of eye diseases, and outline the difficulties of their implementation, including ethical and legal conflicts.

Vitrectomy followed by endotamponade of the vitreal cavity with silicone oil (SO) is one of the main techniques of treating severe forms of regmatogenic retinal detachment (RRD). Endotamponade with SO, having numerous advantages and a huge potential, carries the risk of a number of complications arising at various times of application. The literature review analyzes the published data on the effect of tamponade SO on the retina and the function of central vision in RRD surgery: visual acuity, indicators of light and color sensitivity, data of electrophysiological test results. Possible causes of deteriorated central vision functions directly or indirectly related to tamponade with SO are discussed: changes in the thickness and structure of the retina or its individual layers as shown by optical coherence tomography (OCT) data, microcirculation disorders according to OCT angiography, fluorescein angiography, Doppler laser scanning, as well as pathohistological findings related to SO migration into the fundus of eye tissues.

Nowadays, glaucoma is viewed as a multifactorial neurodegenerative condition that involves many factors affecting different cell types in a human body. As is known, increased intraocular pressure (IOP) is not the only threatening factor of ganglion cell apoptosis and glaucomatous optic neuropathy development; IOP can be associated with other factors, such as vascular, metabolic, neurotrophic, immune, inflammatory, etc. However, the treatment of glaucoma remains largely symptomatic, aimed almost exclusively at reducing IOP. Microbiotic dysbiosis is a newly developing research direction of the glaucomatous progress, showing that this mechanism may turn out to be an important factor of glaucoma development. There are reasons to believe that treatment strategies aimed at microbiota damage correction may contribute to a better efficiency of glaucoma management. 

Glaucoma is one of the world’s primary causes of blindness. Russia is following the global increasing trends of glaucoma and its leading position among ophthalmic pathologies that cause irreversible loss of vision. Elevated intraocular pressure (IOP) is the only modifiable risk factor of glaucoma, so treatment strategies specifically focus on reducing IOP by suppressing the production of intraocular fluid and boosting its outflow. The current review presents new medications aimed at glaucoma and high IOP control that have recently appeared at the international market as well as the drugs under the different stages of development, from experimental to clinical studies. These include both the developments of agents belonging to the existing classes and of entirely new drugs intended to control IOP. In an attempt to reduce the side effects of locally administered drugs and prolong their action, in parallel with the development of new drugs, there is also evidence of alternative methods of drug delivery: intraocular implants, injectable forms and obturators, combinations of polymers and colloidal systems.

The review presents methods for performing endothelial keratoplasty (EK) in patients with endothelial corneal dysfunction, combined with discontinuities of the iridolenticular diaphragm as reflected in the PubMed, Scopus and eLibrary reference databases for the period ending in 2022. EK performed according to a variety of techniques allows achieving good clinical and functional results and reducing the risk of complications at different stages of treatment of patients with endothelial insufficiency. Another important advantage of EK as compared to penetrating keratoplasty is the fact that it can be repeated multiple times, which is relevant for patients with severe combined pathologies. Considering the plethora of modifications of posterior lamellar keratoplasty and transplantation of the Descemet's membrane and endothelium for cases with combined damages of the integrity of the iridolenticular diaphragm, the number of affected patients may be even more numerous than presented in the publications reviewed. The variety of literature data shows that the search for a universal technique of EK to be performed on patients with various disorders of the iridolenticular diaphragm is likely to continue.