Habitually excessive tension of accommodation is normally treated by two groups of drugs, cholinolytics and sympathomimetics. While the effect of cholinolytic drops can be fully explained by cholinergic innervation of the ciliary body, the issue of the adrenomimeticmedication target in the ciliary muscle remains debatable. The authors analyze literary data and the results of their own clinical studies to prove the existence of anatomical, physiological, pharmacological and clinical data on sympathetic innervation of the ciliary muscle alongside parasympathetic innervation thereof. Hence, the use of sympathomimetic drops in the treatment of children with habitually excessive tension of accommodation is validated both fundamentally and clinically. Yet, additional research in this area is required in order for an optimal strategy of drug therapy to be developed // Russian Ophthalmological Journal, 2016; 4: 80-9. doi: 10.21516/2072-0076-2016-9-4-80-89.

HHV-8 (Kaposi’s sarcoma associated herpesvirus) is considered as the etiological agent of Kaposi’s sarcoma (KS), primary effusion lymphoma, multicentric Castleman’s disease (MCD), POEMS-syndrome, and HHV-8 inflammatory cytokine syndrome (HHV-8-KICS). Eye diseasesmay be the initial or the only manifestations of KS and MCD or be combined with systemic pathology. We discuss the role of HHV-8 in the pathogenesis of lymphomas of the orbit, the eye, and the conjunctiva. In the pathogenesis of KS and MCD, HHV-8 inflammatory cytokine syndrome plays an important role due to the unique ability of HHV-8 to produce viral cytokine IL-6, homologous to human proinflammatory IL-6 // Russian Ophthalmological Journal, 2016; 4: 91-6. doi: 10.21516/2072-0076-2016-9-4-91-96.

Today, artificial tears containing hyaluronic acid are the first choice remedy in dry eye syndrome treatment. This is due to unique properties of hyaluronan, such as mucoadhesion, high hydrophilia, adaptive viscoelasticity depending on pH level, composition similar to the native tear, an ability to stimulate migration and proliferation of epitheliocytes, to affect cell diffusion, to have a protective and antioxidative effect on the cells, etc. However, while choosing artificial tear drops we have to take account not only of the presence of hyaluronan as the main ingredient, but also ofthe qualitative characteristics of its molecules, type and concentration of the buffer, presence of a preservative agent, and other factors that can weaken hyaluronan beneficial features, cause an allergy, worsen the viscoelastic properties of the solution, etc. // Russian Ophthalmological Journal, 2016; 4: 94-104. doi: 10.21516/2072-0076-2016-9-4-94-104.

The paper gives an overview of recent data concerning the role of pituitary hormone melatonin in the regulation of different physiological processes in the eye under normal and pathological conditions. Melatonin is a key regulator of circadian rhythm in most known species. In addition, it regulates the expression of numerous genes, is a potent antioxidant, has antiinflammatory, antiangiogenic, immunomodulating, anticancer activity and can decrease intraocular pressure. These and other effects of this hormone offer ample opportunities for the use of melatonin in the therapy of eye diseases // Russian Ophthalmological Journal, 2016; 4: 106-11. doi: 10.21516/2072-0076-2016-9-4-106-111.

Purpose. To compare hypotensive efficiency and safety of fixed combinations of drugs treating primary open-angle glaucoma (POAG). Material and methods. We conducted a randomized prospective clinical trial which involved 80 patients (158 eyes) divided into 4 groups) and lasted six months. The patients received timolol 0.5 % + travoprost 0.004 % (group1), timolol 0.5 % + brimonidine 0.2 % (group 2), timolol 0.5 %+brinzolamide 1 % (group 3) and timolol 0.5 % + pilocarpin 2 % (group 4). Results. All fixed drug combinations compared were found to produce a hypotensive effect in the treatment of POAG patients. Over 6 months, IOP dropped by 20.6 % to 33.1 % against the initial level. The best and the longest-lasting effect was achieved when the first combination, timolol+travoprost (jointly called duotrav), was used. Conclusion. The Duotrav combination should be prescribed for long-term treatment of POAG and ocular hypertension. Timolol + brimonidine and timolol + brinzolamide are the most effective in short-term therapy of POAG and ocular hypertension, as well as in the pre-operative period prior to surgeries of glaucoma with high IOP. After normal IOP values have been obtained, the patient should be prescribed Duotrav, which is a more stable combination. Travoprost 0.004 %/timolol with 0.5 % is more effective, stabile and safe combination and recommend for long-term therapy of. Even though the combination of timolol and pilocarpin is not generally recommended for POAG therapy, it can be used for short-term inexpensive POAG and ocular hypertension treatment // Russian Ophthalmological Journal, 2016; 4: 5-10. doi: 10.21516/2072-0076-2016-9-4-5-10.

The treatment of age-related macular degeneration (AMD) with VEGF inhibitors presupposes multiple intravitreal injections (IVI), which requires safety measures and prevention of complications. Purpose: to compare the efficiency of the antibiotic moxifloxacin andthe antiseptic miramistinin the prevention of infectious complications of multiple IVIsof VEGF inhibitor Ranimizumab in AMD patients. Material and methods. 290 patients with wet AMD aged 69.2 ± 3.5 years were followed for 1 year. To prevent infections, group 1 consisting of 154 patients received instillations of 0.5 % solution of moxifloxacin 2 days prior to surgery, while group 2 (136 patients) received 0.01 % solution of miramistin. All instillations lasted one week after the IVI procedure. Results. A comparative analysis of the two groups of wet AMD patients respectively treated with moxifloxacin and miramistin revealed no inflammatory complications of multiple ranimizumab IVIs. It was demonstrated that the aseptic condition (interventionsperformed in a sterile operating room) and the antiseptic condition (use of povidone-iodine) are the decisive factors in the prevention of infectious complications when performing intravitreal injections. An additional measure of preventingsuch complications was the use of antiseptic miramistin, which was successfully tested and shown to provide a high level of antimicrobial protection in the absence of risk of developing resistance. Conclusions. The choice of antimicrobial agents as a means of preventing infectious complications of intravitreal injections should be made with consideration of the fact of their multiple administrationsand the clinical condition of the patient // Russian Ophthalmological Journal, 2016; 4: 11-5. doi: 10.21516/2072-0076-2016-9-4-11-15.

Purpose: to assess the morphometric state of the macula in children with pseudophakia after the removal of unilateral congenital cataract (UCC). Material and methods. 17 children with pseudophakia aged 4.5 to 9 years were examined after UCC extraction removal In addition to traditional techniques, comprehensive ophthalmic examination included optical coherence tomography on Spectralis HRA + OCT (Heidelberg Engineering). OCT data were used to individually analyze the morphometric parameters of the central zone of the eye fundus, including the minimum thickness of the retina in the fovea, the maximum thickness of the retina in parafovea, the thickness of the retina 3.0 mm from the foveola, the width (diameter) of the fovea, and the thickness of the choroid in the subfoveolar area. The parameters were compared with those of the fellow eyes (considered as healthy). Phakoaspiration of UCC with IOL implantation was performed at the age from 5 months to 6.2 years. The optical power of the IOL was determined by the standard formula SRKII. Results. Children with pseudophakia who underwent UCC extraction revealed divergences in morphometric parameters of OCT and its visual image, which testifies to a severe violation inthe differentiation of the macula.The observed correlation between the anatomical and morphological status of the macula as identified from OCT data and the functional status as determined from visual acuity measurements makes it possible to use OCT data in the assessment and prediction of visual functions in children with UCC. Conclusions. The changes of morphological parameters, violated ratios of retinal layers and the neuroretinal architecture, which testify to a delayed physiological formation of the macula in children with UCC are among the main factors that limit the achievement of high visual functions after the surgery // Russian Ophthalmological Journal, 2016; 4: 16-21. doi: 10.21516/2072-0076-2016-9-4-16-21.

Purpose. To study the progress of laboratory diagnostic techniques of the uveal tract of the eye in Omsk region. Material and methods. A retrospective research of medical histories of 8109 in-patients treated in V.P. Vykhodtsevclinical ophthalmological hospital over the last 18 years was performed. Laboratorydiagnostic techniques that addressed the etiology of uveal tract diseases were comparatively analyzed for two separate periods: 2005 to 2012 (group 1 of patients) and 1995 to 2004 (group 2). Results. In group 1, laboratory techniques directed at detecting pathogens of opportunistic infections were applied 2.5 times as frequently as in group 2, while the techniques of etiological categorization of uveitis were applied 3.4 times more frequently in group 1. The increase in the latter technique is explained by the introduction of blood serum testing by Westernblotting into clinical practice. Conclusions. We have determined the methods to etiologically verify isolatedanterior andposterior uveitis, which make use ofa comprehensiveassessment ofthe patient's conditionand theresults of blood serumandtear fluidby Westernblotting. These methods permit us to detect the infectious processquickly and choose adequatedrug therapy // Russian Ophthalmological Journal, 2016; 4: 22-8. doi: 10.21516/2072-0076-2016-9-4-22-28 .

The purpose of this study was to develop reconstructive techniques for post-injury lower eyelid ectropion repair using allogenic transplants manufactured according to Alloplant technique. Material and methods. We managed and followed up 110 patients with unilateral lower eyelid ectropion that occurred post-traumatically 1 to 6 years ago. All patients underwent ectropion grading and measured for palpebral rim length and widt hand lagophthalmos degree. Surgical interventions were performed using Alloplant biomaterial, for eyelid plastic surgery and allogenic tendon fibers. The efficiency of surgical operation was assessed by the absence/presence of ectropion and lagophthalmos, change in palpebral rim width as compared to the healthy fellow eye in early and long-term post-surgery period. Results. For 99 patients (90 %), ectropion and lagophthalmos were fully eliminated. In 11 patients, insufficient eyelid closure within 1-3 mm was observed, which was corrected with additional operations. Conclusions. We developed an effective method of post-traumatic lower eyelid ectropion repair using Alloplant for eyelid plastics and allogenic tendon fibers, which contributes to normal eyelid position recovery and palpebral rim symmetry of the affected and the healthy fellow eye // Russian Ophthalmological Journal, 2016; 4: 30-6 . doi: 10.21516/2072-0076-2016-9-4-30-36.

In cases of severe endocrine ophthalmopathy, conservative therapy often fails to produce satisfactory results. Therefore, surgical treatment is used, in particular orbit decompression, which triggers controversial opinions in the literature. Purpose: to present the authors’ own method of orbital decompression, clinical observations, and the results achieved over 30 years of experience. Material and methods. 119 patients aged 17-73 with severe endocrine ophthalmopathy were operated in accordance with the authors’ technique of orbital decompression. In the course of these operations, three walls of the orbit are partially resected, periorbital, intraorbital and retrobulbar fat is removed, eyelids are simultaneously corrected for deformities and retracted. Results. After the operation, all patients showed a significant reduction of exophthalmos (by 5-11 mm, averagely 7 mm), and IOP, a marked improvement in extraocular muscle functions, and considerable reduction or disappearance of subjective symptoms. Vision acuity improved in 68 % patients. Mild relapse of exophtalmos was noted in three cases only, and only one patient required a repeated unilateral operation. Strabismus surgery had to be performed in 6 patients (5 %) due to correction of residual double vision. Conclusion. It can thus be concluded that our method or orbital decompression gives very good functional and aesthetic long-term results // Russian Ophthalmological Journal, 2016; 4: 37-45 . doi: 10.21516/2072-0076-2016-9-4-37-45.

Purpose: to analyze indications for enucleation in uveal melanoma (UM) patients after brachytherapy (BT). Material and methods. 52 patients with UM (31 females and 21 males) aged 25 to 74 years (mean age 53.2 ± 12.3) underwent an enucleation after a previously administered BT. Tumor sizes before BT were 6.1 ± 2.1 (1.2-11) mm in thickness and 13.0 ±2.9 (6-19) mm in diameter. Immediately before enucleation, they were 5.3 ± 3.4 (1-17) mm and 12.4 ± 3.6 (5-20) mm respectively. The time span between BT and enucleation varied from 2 to 103 months (median, 25 months). 40 patients (77 %) had choroidal localization of UM (of these,16 had juxtapapillary localization), 10 patients (19.2 %) had ciliochoroidal localization, and 2 patients (3.8 %) had UM in the anterior areas of the eye (iris and ciliary body). Results. In more than a half of the patients (30 patients, or 58 %) tumor regrowth was detected 5-96 months after BT. The second frequent cause for enucleation was neovascular glaucoma found in 21 patients (40 %). Extraocular extension of UM, identified in 12 patients (23 %), took place 3-82 months after BT and turned out to be the third complication as far as frequency of occurrence is concerned. Conclusion. Tumor regrowth remained to be the main cause for secondary enucleation in UM patients after BT. As a matter of fact, complications that can require immediate enucleationmay develop at any time after BT (although the peak falls upon the first 2 years after BT. This fact confirms the need of lifelong follow-up of such patients. Hence, unfounded extension of indications for BT may result in ineffective prolongation of local treatment, a number of radiation complications requiring immediate secondary surgical treatment // Russian Ophthalmological Journal, 2016; 4: 46-51. doi: 10.21516/2072-0076-2016-9-4-46-51.

Purpose. To evaluate the efficacy of lubricating cationic emulsion in the combined treatment of superficial punctate keratitis (SPK) of glaucoma patients. Material and methods. The clinical study involved an experimental group 1 of 28 patients (30 eyes) aged 50 to 84 (mean age 67.1 ± 7.2 years) with symptoms of SPK who received long-term (averagely 9.5 ± 6.6 years) topical hypotensive anti-glaucoma medication. The control group 2 consisted of 26 patients (mean age 67.6 ± 7.1 years) belonging to the experimental group: in this case, the contralateral eyes with topical anti glaucoma medication but no signs of keratitis were examined. The basic therapy for group 1 consisted of topical antihistamine, corneoprotector (dexpanthenol) and a new generation lubricant, Cationorm. Group 2 was also treated with Cationorm. The testing procedures and efficiency monitoring included biomicroscopy, Schirmer test, Norn test and evaluation of tear film osmolarity. Results. Dry eye symptoms with disturbed tear film osmolarity and decreased values of Norn and Schirmer tests were detected in all patients both in the eyes with SPK manifestations and without them. Patients with concomitant dry eye syndrome who received complex therapy, including Cationorm, showed increased tear film stability: Norn sample values increased from 5.5 ± 1.8 to 8.5 ± 2.1 seconds and from 7.7 ± 1.4 to 8.8 ± 2.2 seconds in groups 1 and 2, respectively, p < 0.05). Besides, the values of the Schirmer test improved from 6.3 ± 2.1 to 8.3 ± 3.7 mm and 8.7 ± 3.7 to 9.1 ± 3.8 mm in groups 1 and 2, respectively, p < 0.05), and osmolarityrate decreased in both groups, p < 0.05. Subjective symptoms in group 1 changed from 3.4 to 0.6 points after 3 months of treatment. The average severity of SPK, which amounted to 4.2 ± 2.3 points before treatment, dropped to 1.2 ± 0.9, 0.23 ± 0.5 and 0.1 ± 0.3 points respectively after 1, 2 and 3 months. Conclusion. The study shows that Cationorm can be considered as a tear replacement lubricant of choice in the complex therapy of superficial punctate keratitis and dry eye symptoms in chronically medicated glaucoma patients // Russian Ophthalmological Journal, 2016; 4: 52-7. doi: 10.21516/2072-0076-2016-9-4-52-57.

Proliferative vitreoretinopathy (PVR) is a pathological process based on proliferation of retinal pigment epithelium (RPE) cells and glia on the interior surface of the retina accompanied by epiretinal membrane formation. The condition’s pathogenesis remains unclear. The best-founded hypothesis is that PVR pathogenesis involves growth factors and cytokines with the key role of platelet-derived growth factor (PDGF). The purpose of this work is an experimental morphologic study of changes in eye tissues after they were treated by recombinant PDGF administered intravitreally. Material and methods. 6 Chinchilla rabbits (12 eyes) were given intravitreal injections of 0.1 ml of PDGF through the flat part of the ciliary body. The concentrations were 2000 mg/ml (4 eyes), 5000 mg/ml (4 eyes), and 20000 mg/ml (4 eyes). Microscopic observation of the eyes, enucleated one month after the procedure was performed with a Leica microscopic system supplied with a digital camera with a x200-x600 magnification. Results. RPE was found to be the main target of PDGF. The impact was revealed to be dose-related. With doses of 2000 mg/ml and 5000 mg/ml retinal epithelial cells are dissociated, rounded, they form processes, fall out of the sheet and migrate to the surrounding area. With big doses (20000 mg/ml), death of photoreceptor cells in the retina occurs along with extensive migration of cells and Bruch's membrane denudement. The mechanism underlying migration processes, associated with the influence of PDGF on the system of counter-adhesive proteins is discussed. Conclusion. The role of migration of RPE cells induced by PDGF in the formation of the early stage of PVR was demonstrated // Russian Ophthalmological Journal, 2016; 4: 59-63. doi: 10.21516/2072-0076-2016-9-4-59-63.

Extramedullary leukemic foci in acute leukemia attract special attention. They reflect the diversity of clinical manifestations of the disease, affect the severity of the patient’s condition and may influence the choice of treatment strategy. Purpose: to present a rare clinical case of leukemic optical neuropathy in a patient with acute lymphoblast leukemia. Results. Decreased visual acuity of both eyes related to the involvement of the optic nerve was one of the main complaints of the female patient during the onset of the diseases. A loose greyish tumor with blurred contours was identified on the optic nerve disc, with a large number of hemorrhages in various layers of the peripapillary retina. During ophthalmoscopy, the central vessels in the optic disc funnel could not be distinctly differentiated. Brain and orbit MRI showed intraocular masses in the area of the projection of the optic nerve disc and a lesion in the left frontal lobe. There were no signs of high intracranial pressure. After the first chemotherapy course for acute leukemia, visual acuity of both eyes increased, along with a substantial regression of tumor infiltration of the optic disc, which made it possible to visualize the border of the optic disc and the central retinal vessels. Follow-up images showed a full regression of the mass in both eyeballs. The left frontal lesion, whose origin was unclear, remained unchanged. Conclusion. An isolated lesion of the optic nerve could be a potential first sign of neuroleukemia, so it should be on the list for differential diagnosis of optic nerve disorders. First of all, leukemic optic neuropathy should be differentiated from optic nerve edema. Early diagnosis of neuroleukemia and adequate anti-tumor treatment allow for significant improvement of visual acuity and hence, for better quality of life of patients with leukemia // Russian Ophthalmological Journal, 2016; 4: 64-8. doi: 10.21516/2072-0076-2016-9-4-64-68. .

According to the definition of the Expert council on accommodation and refraction, asthenopia is a functional disorder of vision with typical symptoms manifested in the fact that visual work becomes difficult or impossible. The paper suggests a classification of asthenopias which generalizes literary data and takes account of the authors’ own research results. The classification distinguishes among four forms of asthenopia, depending on the causes inducing the condition: accommodative (or refractive-accommodative), muscular (motoric), sensory (neuroreceptive) and psycho-emotional asthenopia. We also propose to distinguish three stages of asthenopia with regard to the severity of the symptoms: compensation, subcompensation, and decompensation stages // Russian Ophthalmological Journal, 2016; 4: 69-73. doi: 10.21516/2072-0076-2016-9-4-69-73 .

Up to 2.4 % of primary patients seeking ophthalmological care are cases of canaliculitis. Purpose: to systematize the methods of diagnosing, treatment and relapse prevention of fungal canaliculitis on the basis of the authors’ experience. Material and methods. The results of diagnosing, treatment and relapse prevention are systematized based on the analysis of examination of 57 patients aged 46 to 89 with tear duct disorders of micotic origin. Results. Canaliculitises of fungal etiology are characterized by chronic course of the disease and complications caused by late diagnosis and prolonged inadequate treatment. Practical ophthalmologists should be aware of the fact that this pathology develops primarily in senior females suffering from chronic conjunctivitis and inflammatory disorders of ocular adnexa within the tear duct area that are resistant to antibiotics. A plan of diagnostic examination is recommended based on the analysis of the clinical picture, determination of patency of lacrimal passages during washing and probing, and canalicular and nasolacrimal assays. We also used bacteriological methods of study and X-ray contrasting of tear ducts. The main technique of treatment of fungal canaliculitis is surgical dissection of lacrimal canaliculi, removal of their content with subsequent instillations and washing of tear ducts with antiseptics and antifugal preparations. In the follow-up period spanning 2 months to 5 years no relapses of the process were observed. Conclusion. The use of special diagnostic methods based on the analysis of clinical picture and surgical treatment combined with antimicotic preparations is necessary for relapse prevention and rehabilitation of patients with fungal diseases of lacrimal canaliculi // Russian Ophthalmological Journal, 2016; 4: 74-9. doi: 10.21516/2072-0076-2016-9-4-74-79.