Primary or secondary disturbance of blood supply of eye tissues plays a leading role in the pathogenesis of deterioration of visual functions in various ophthalmopathological processes, including primary open angle glaucoma (POAG). For this reason, the study of intraocular hemodynamics can be viewed as a promising direction in clinical ophthalmology. Of particular importance is the evaluation of blood flow in the uveal tract, since it accumulates more than 80 % of blood entering the eye, thus being the primary collector of blood flow and implements the nutritional function in the inner shells of the eye. Rheoophthalmography is one of the main methods of determining the blood supply of the uveal tract. The review presents the evolution of the rheographic method for studying the ocular blood flow since its elaboration in mid-20th century up to the present time // Russian Ophthalmological Journal, 2017; 1: 98-103. doi: 10.21516/2072-0076-2017-10-1-98-103

Hereditary vitreoretinal degenerations are a heterogeneous group of diseases, which are based on the degenerative changes of the retina and the vitreous. The occurrence of intrahemorrhages is different for different hereditary vitreoretinal degenerations. In some diseases (Wagner's disease, Jensen syndrome, Kniest dysplasia, Marfan's, Ehlers -Danlos syndrome, Alport, Bloch -Sulzberger, Walker -Warburg) intraocular hemorrhages almost never occur. In other vitreoretinopathies (X-linked congenital retinoschisis, familial exudative vitreoretinopathy, Norrie disease, Stickler syndrome), intraocular hemorrhages occur more often. The review describes the genetic aspects of the diseases and their clinical pictures. Special attention is given to the incidence and clinical manifestations of intraocular hemorrhage in the above mentioned vitreoretinopathies // Russian Ophthalmological Journal, 2017; 1: 104-10. doi: 10.21516/2072-0076-2017-10-1-104-110.

Purpose: to assess the effectiveness of combined treatment of macular edema (ME) of varied etiology. Materials and methods. The results of combined treatment of 32 patients (38 eyes) aged 55 to 75. Of these, 13 patients (15 eyes) had postocclusion MO, 12 patients (14 eyes) had diabetic MO and 7 patients (9 eyes) had an exudate form of age-related maculardegeneration. Two groups of patients were formed depending on the treatment administered. Group 1 (14 patients) intravitreally received an inhibitor of neoangiogenesis, Ranibizumab, whilst group 2 (18 patients) received combined treatment which included a prolonged corticosteroid (Diprospan) administered into sub-Tenon’s space, laser coagulation and intravitreal administration of Ranibizumab. All patients underwent high-definition optical coherent tomography examinations (HDOCT, OCT 4.000 Cirrus Humphrey - Zeiss, San Leandro, USA) and computer tonometry, performed on a visual field analyzer Peritest 30/50/100 using the Macula software. Results. The combined treatment of patients with ME resulted in a stable improvement of visual acuity (averagely by 0.55 in 88 % of cases), rapid retinal edema reduction (its thinning) in 74 % of cases, reduction of risk of neovascular complications, and stabilization of the results achieved. Conclusion. Due to a number of components involved and pathogenetic emphasis, the combined treatment promotes the effectiveness of functional rehabilitation of patients with ME of varied origin // Russian Ophthalmological Journal, 2017; 1: 5-8. doi: 10.21516/2072-0076-2017-10-1-5-8

The purpose of the study was to estimate the effectiveness of using ranibizumab in combination with medotilin drug in the treatment of neovascular age-related macular degeneration (AMD). Material and methods. 50 patients (65 eyes) aged 41 to 88 (ave. 68.5 ± 0.98 years) with neovascular AMD were followed-up. All patients were assigned treatment consisting of three intravitreal ranibizumab injections with an interval of 1 month between injections. Of these, 25 patients (34 eyes) were additionally given 4 ml of medotilin intramuscularly once a day for 10 days. Results. Combined treatment with ranibizumab and medotilin showed a statistically significant improvement of functional parameters: visual acuity, light sensitivity and flicker ERG as compared to the control group. Conclusion. Medotilin, which has neuroprotective action, enhances the effect of angiogenesis inhibitors drugs in all forms of neovascular AMD and promotes statistically significant increase of the functional condition of the central retina area, which is confirmed by electroretinography data // Russian Ophthalmological Journal, 2017; 1: 9-14. doi: 10.21516/2072-0076-2017-10-1-9-14.

, were measured for 57 patients, including 49 patients aged 51-75 (ave. 66.0 ± 1.7 years) with various stages of POAG and the control group of 8 patients aged 61-68 (ave. 63.7 ± 0.9 years) with no eye pathology (except for age-related cataract). All patients with POAG received hypotensive therapy. Of these, 24 patients received one of prostaglandin analogues (Glauprost) as monotherapy or in combination with beta-blockers and/or carbonic anhydrase inhibitors during no less than 3 months, and 25 patients only received hypotensive therapy beta-blockers and/or carbonic anhydrase inhibitors. The patients’ examination consisted of elastotonometry by Maklakov with three loads having different weights, modified Schiotz differential tonometry using a GlauTest 60 tonograph, measurement of corneal compensated intraocular pressure (IOPcc) and corneal hysteresis (CH) by Ocular Response Analyzer (ORA, Reichert, USA). Results. Coefficient К (2.45 ± 0.15) of patients with stage II POAG (mean age 65.0 ± 1.5 years) who did not use prostaglandin analogues was significantly higher (p < 0.05) than that of patients of the same age group (mean age 66.5 ± 1.8 years) with the same glaucoma stage who received Glauprost (К = 2.09 ± 0.17), which implies a higher risk of glaucoma progression. When prostaglandin analogues were used, CH level proved to be reliably (p < 0.05) higher (9.10 ± 0.4 mm Hg) as compared to patients who received no such therapy (8.14 ± 0.7 mm Hg): this is viewed as a favorable prognostic criterion for the POAG course. A less pronounced decrease of K and increase of CH after prostaglandin analogue instillations than in stage II POAG was also noted in patients with stage III POAG. Conclusion. Prostaglandin analogue Glauprost has a favorable impact on biomechanical parameters of the corneoscleral eye shell, especially in patients with stage II POAG. It lessens glaucoma progression risk induced by disturbed elastic properties of the cornea and the sclera and their ratio // Russian Ophthalmological Journal, 2017; 1: 15-9.

Studying immunological aspects of pathogenesis of retinopathy of prematurity (ROP) helps develop new approaches to prevention, rational diagnosis and increase of the effectiveness of treatment of the disease. Purpose: to analyze the level of growth factors in blood serum of premature infants belonging to the group of ROP risk at the pre-clinical stage and find out how this level is related to further development and course of the disease. Material and methods. 85 prematurely born infants of the ROP risk group were examined. The average gestational age at birth was 27.7 ± 2.2 weeks, the average birth weight - 1086.1 ± 266.1 g. The examination included dynamic ophthalmoscopy and determination of the content of VEGF-A in blood serum (using a flow cytometer BD FACS Canto II) and TGF- β1, IGF-I, IGF-II (by enzyme-linked immunosorbent assay (ELISA) using a c-test system Bender MedSystems, Austria). Results. During the first ophthalmoscopic examination, i.e. before the clinical manifestation of the disease, blood serum of children who later developed ROP that subsequently required laser coagulation of avascular retinal areas, was found to have relatively higher concentrations of VEGF-A (above 1300 pg/ml) and IGF-II (above 140 pg/ml) and lower IGF-I concentrations (below 24 pg/ml) and TGF- β1 (below 8000 pg/ml) as compared with the groups of "safe" children. A dynamic study of VEGF-A content and, simultaneously, TGF- β1 content showed uniform changes in the concentration of these growth factors at all observation times. Conclusion. It was shown for the first time that high IGF-II and low TGF- β1 concentrations revealed before the clinical manifestation of the disease can be viewed as prognostically unfavorable as far as subsequent development of severe ROP is concerned. Uniform changes of TGF- β1 and VEGF-A level in blood serum during ROP development may indicate to the synergistic participation of these growth factors in the pathological vasoproliferation. Further studies are required to determine the details of how this mechanism works // Russian Ophthalmological Journal, 2017; 1: 20-5. doi: 10.21516/2072-0076-2017-10-1-20-25

Anomalies of refraction belong to the most important issues of pediatric ophthalmology. Purpose. To assess the impact of timely detection of ametropia on clinical and economic aspects of its treatment. Material and methods. A retrospective study of the quality of medical eye care of 260 children with refractive errorsor strabismus aged 5 to 7 years consisted in the analysis of primary medical documentation. Results. Timely medical check-ups which detect ametropias in an early age are shown to be a good preventive measure against the onset of amblyopia, binocular vision disorders, or strabismus. Uncorrected refractive errors in children are characterized by high levels of economic and social burden of the disease (the older the age of the detection of refractive errors, the greater the cost of treatment). Conclusions. The best age at which children should be screened for refractive errors must not exceed 1 year, both from the standpoint of clinical effect and cost effectiveness. Mid-term analysis of the budget impact of early detection of refractive error and strabismus shows that such detection may reduce the costs ofthe treatment of complications // Russian Ophthalmological Journal, 2017; 1: 26-30. doi: 10.21516/2072-0076-2017-10-1-26-30.

A variety of factors that change the topography of the cornea may also induce changes in peripheral refraction. Purpose. The paper is aimed at assessing the peripheral refraction and retinal contour of myopic eyes after FS-LASIK and orthokeratological (Ortho-k) correction. Materials and methods. We examined a total of 30 patients (60 eyes) aging from 28.86 ±2.83 years which included 12 patients (24 eyes) with myopia of -5.11 ± 0.5 D and with an axial length (AL) of 25.04 ±0.33 mm before and 1 month after FS-LASIK surgery, and also included 18 patients (36 eyes) with myopia of -5.4 ± 0.24 D and AL of 25.78 ± 0.2 mm who wore ESA-DL Ortho-k lenses. The peripheral refraction of all the patients was measured using the Grand Seiko Open-field binocular autoref/keratometer and the peripheral eye length was measured using the IOL Master 500 (Carl Zeiss) at 15° and 30º nasally (N) and temporally (T), respectively, from the center of fovea. Results. The peripheral eye length measured before and after FS-LASIK as well as after Ortho-k correction was less in all peripheral zones than in the center, which corresponds to characteristics observed in hyperopic peripheral defocus. Refraction measured after FS-LASIK showed the formation of myopic defocus with a maximum at 30° from the following results: -2.49 D at T15°, -2.5 D at N15°, -6.73 D at T30°, and -7.8 D at N30°. The maximal myopic defocus after Ortho-k correction was detected in the middle periphery from these following results: -4.89 D at T15°, -5.51 D at N15°, -2.92 D at T30° and -2.4 D at N30°. Conclusions. Both procedures induced a significant peripheral myopic defocus. In the first case, the maximum values of defocus were detected in the peripheral zone (30° from the center of the fovea); in the second case, the maximal effect on the middle periphery was identified 15° from the center. Such patterns of peripheral refraction fully coincided with the specific changes in corneal topography after the two procedures. The retinal contour within 30° from the center retained the relative hyperopic defocus characteristic of intact myopic eyes // Russian Ophthalmological Journal, 2017; 1: 31-5. doi: 10.21516/2072-0076-2017-10-1-31-35.

Purpose: to study the possibility of the correction of post-traumatic cicatricial corneal astigmatism (PССA) by implanting intrastromal corneal segments (ICS) with a femtosecond laser. Materials and methods. We operated 28 patients (28 eyes) aged 18 to 70 (averagely 37.5 ± 13.2 years) with astigmatism from 2.5 to 10.0 D. Prior to ICS implantation, astigmatism as measured by autokeratorefractometry was 5.7 ± 2.8 D, by keratotopography 6.0 ± 2.6 D, and by visometry - 6.1 ± 2.1 D. In all cases the spherical equivalent of refraction (SER) was negative, averaging 4.5 ± 2.1 D. Results. The major refractive changes in the cornea were manifested in the first month after ICS implantation. The cylindrical component of clinical refraction and SER decreased significantly 6 months after the operation. Post-surgical uncorrected visual acuity proved to average 0.29 ± 0.09, which was significantly (by 0.19 ± 0.08) higher than before surgery (0.10 ± 0.06). Conclusion. The effectiveness and safety of PCCA correction by ICS implantation of ICS could be confirmed. The procedure was found to have a hyperopic effect. The intrastromal corneal tunnel formed for ICS was found to be precise, as shown by optical coherence tomography. It must however be borne in mind that residual astigmatism and residual SER require additional correction in all patients who underwent ICS implantation // Russian Ophthalmological Journal, 2017; 1: 36-42. doi: 10.21516/2072-0076-2017-10-1-36-42.

Purpose: To analyze the results of scleroplastic operations aimed at eliminating radiation necrosis of the sclera in patients who underwent brachytherapy (BT) of uveal melanoma (UM) using a variety of plastic materials. Material and methods. The paper presents the results of treatment of 19 patients aged 32 to 67 years with radiation necrosis of the sclera after BT of UM. Scleroplasty was carried out 3 to 33 months (the median being 15 months) after brachytherapy using cadaveric sclera (13 patients), alloplant from the dura mater (3 patients) and synthetic ophthalmic material (4 patients). Results. On the whole, the materials and methods used for scleroplasty are effective and most cases save the patient’s eye (17 of 19 eyes have been saved)., However, they are imperfect, which requires that new materials and new methods of eliminating post-radiation defects of the sclera be elaborated and introduced into clinical practice. Conclusion. When planning and performing sclero plasty, strict individual approachs required. The operations have to be performed only in specialized ophthalmic hospitals in cases, of clear indications to uveal melanoma radiotherapy. Preventive measures should always be taken with regard to patients with a risk of necrosis, which will help reduce the frequency and severity of radiation sclera necrosis // Russian Ophthalmological Journal, 2017; 1: 43-8. doi: 10.21516/2072-0076-2017-10-1-43-48.

Purpose. This paper presents the results of objective accommodation measurements taken from patients with concomitant strabismus. Materials and methods. The experiment was performed on 32 patients (64 eyes) ranging from 5-26 years of age (in average 13.5 ± 1.43 years old): 26 patients with esotropia (52 eyes), 2 patients with exotropia (4 eyes), and 4 patients with secondary strabismus (8 eyes). 8 of the patients (10 eyes) identified amblyopia of various degrees. 51 of the eyes exhibited hyperopia from 0.5 to 9.5 D according to spherical equivalent refraction, and 16 eyes exhibited myopia from 0.25 to 10 D. The control group consisted of 30 children with hyperopia (16 eyes), emmetropia (10 eyes), and myopia of various degrees (34 eyes) without strabismus. To determine specific indicators of objective accommodation - Binocular (BAR) and Monocular Accommodative Response (MAR), the options of consensual accommodation, as well as the resting state of accommodation (RSA) in concomitant strabismus - the open field autorefkeratometer Grand Seiko WR - 5100K was used. The degree of deviation was determined using the Hirschberg test and a handheld ophthalmoscope. Results. The MAR ranged between normal and drastically lower values averaging at -1.85 ± 0.1 D. The BAR averaged at 2.23 ± 0.1 D and was greater than the MAR in half of the measured cases (61.3 %). The interocular difference in the BAR reached 2.95 D, averaging at 0.87±0.14 D. The interocular difference in MAR reached 0.85 D, averaging at 0.34 ± 0.07 D. In the control group, BAR values were lower than MAR; the interocular differences consisted of 0.13 ± 0.01 and 0.08 ± 0.01 D, respectively. Highly amblyopic eyes had equal and drastically decreased BAR and MAR (average of -0.16 ± 0.07 D); in the fellow eyes, BAR and MAR were higher -1.08 ± 0.14 and -1.0 ± 0.14 D, respectively. In esotropic eyes, RSA was higher in the misaligned eye, and in exotropic eyes, RSA was lower in the misaligned eye. The straight and concomitant responses were decreased: until -1.43 ± 0.1 and -1.32 ± 0.15 D respectively. In the control group, the straight and concomitant accommodative response was similar (average of -1.77 ± 0.17 D in both cases). Conclusion. The results showed the characteristic changes in accommodative parameters as a result of heterotropia, not typical for orthotropic patients with various types of refraction // Russian Ophthalmological Journal, 2017; 1: 49-54. doi: 10.21516/2072-0076-2017-10-1-49-54.

Purpose. To conduct a comparative study of cellular and subcellular components of tear fluid of healthy persons (HP), those suffering from primary open-angle glaucoma (POAG), and patients with diabetic retinopathy (DR). Material and methods. Electron microscopy of ultrathin sections was used to test tear samples of 16 patients with initial POAG, 9 patients with developed POAG, and 6 with an advanced stage of POAG. Besides, 12 patients with proliferative DR (PD) and 6 patients with nonproliferative DR (NPD) were tested. Tear samples of 29 subjects with no ophthalmic pathology served as control. Results. All the examined samples contained cells, cellular fragments and debris, mucous granules and lipid structures. The occurrence of all these structures was found to be different in the tears of diabetic and glaucomatous patients as compared to that of HP. The share of epithelial cells in the tear of patients with the initial stage of POAG was twice as high as in the control group; then it drops gradually so that in the advanced stage, epithelial cells are not detected. The tear of NPD patients shows an increase of the content of mucin and lipids against the control, while in PD it is lower than in HP. Leukocytes were observed in the tear of a quarter of HP, while in diabetic patients leukocytes show a significant increase, which reflect a higher permeability of blood vessels as the disease develops. There were no leukocytes in tear samples of all patients with POAG, which may be associated with damaged functions of the blood vessel wall. We found “hairy” vesicles in the tear which had not been noted previously; the amount of these vesicles was growing at early stages of POAG and DR. Conclusion. Electron microscopy of tear deposits evaluates the state of the cornea and the conjunctiva, as well as goblet cells and the meibomian glands. It reveals signs of permeability change in tissue vessels adjacent to the anterior area of the eye. For the first timechanges in tear components in glaucomatous and diabetic patients, were found: theses changes may in future be used to achieve early diagnosis of these diseases // Russian Ophthalmological Journal, 2017; 1: 56-62. doi: 10.21516/2072-0076-2017-10-1-56-62.

The results of a 35-year long study of mechanism underlying the pathogenesis of the chocked optic disc under increased intracranial pressure are presented. The study is based on the theory of structural and functional histohematic regulating protective blood-ocular barrier. Different pressure levels of cerebrospinal fluid moving from the cranial cavity to the optic disc nerve were found to be regulated by histohematic and histocytic structures of the blood-ocular barrier. The obtained results validate the opinion that choked optic disc pathogenesis under increased intracranial pressure has a liquor tissue nature// Russian Ophthalmological Journal, 2017; 1: 63-8. doi: 10.21516/2072-0076-2017-10-1-63-68.

Purpose: to improve the clinical and functional results of the treatment of dacryocystitis of newborns (DN) and to validate local antibiotic therapy of children with DN in laboratory conditions. Materials and methods. The study involved two groups of children with DN. Group 1 (275 eyes) consisted of children treated as outpatients without taking account of the microbial spectrum of pathogens and their sensitivity to antibiotics. They had been prescribed the following medications: tobramycin (70.0 %), chloramphenicol (31.3 %) and tetracycline (17.2 %). Group 2 (118 eyes) consisted of children who received treatment based on the microbial spectrum of pathogens and their sensitivity to antibiotics. In this case, the treatment included picloxydine (Vitabact). In both groups, the children’s age was similar: 3.12 ± 0.18 months and 3.63 ±0.19 months, respectively (р > 0.05). Results. The microbial spectrum of DN pathogens is represented by 24 species of microorganisms and microbial associations (5.6 %). The major pathogens were: S. epidermidis (27.6 %), S. aureus (19.3 %) and S. pneumonia (8.0 %). The best sensitivity (94.1 %) was revealed to picloxydine (Vitabact). The treatment resulted in the recovery without probing the lacrimal tract in 6.1 % of group 1 patients and in 31.8 % of group 2 patients. Relapses requiring a re-probing of the lacrimal tract affected 12.3 % in group 1 and no patients in group 2. Conclusion. A two-stage DN treatment plan was developed and tested using etiologically validated antibacterial medications. The treatment resulted in the recovery of 31.8 % of children without probing the lacrimal tract, and prevention of DN relapses requiring re-probing // Russian Ophthalmological Journal, 2017; 1: 69-72. doi: 10.21516/2072-0076-2017-10-1-69-72.

Purpose: to assess the results of treatment of patients with computer visual syndrome (CVS) accompanied by low and mild myopia. Material and methods. 52 CVS patients aged 17 to 34 years (mean age 22.3 ± 2.72 years) were divided into 2 groups. For 4 weeks, patients in group 1 received Irifrin 2.5 % and patients in group 2 received preservative-free Irifrin-BK 2.5 % daily before going to bed. Before and after the course of treatment, all patients were examined to see how Irifrin 2.5 % and Irifrin-BK 2.5 % affect the main accommodation parameters: tear production, tear film stability and ocular surface epithelium. Results. The effectiveness of Irifrin 2.5 % medication was established for both pathogenetic links of CVS: disorders of accommodation and accommodative asthenopia related with it and the secondary “dry eye” syndrome. All patients demonstrated a decrease in the frequency and severity of asthenopia manifestations, increased uncorrected visual acuity, the absolute accommodation volume, as well as positive and negative parts of volume relative accommodation volume, which can be associated with the effect produced by phenylephrine hydrochloride. Besides, a reduction of the subjective discomfort is noted. Corneal epithelial staining with sodium fluorescein and conjunctiva staining with rose Bengal solution becomes less pronounced. Precorneal tear film demonstrates increased stability. These effects are apparently due to the presence of hydroxypropylmethyl cellulose in both drugs and the absence of preservative in Irifrin-BK 2.5 % // Russian Ophthalmological Journal, 2017; 1: 74-9. doi: 10.21516/2072-0076-2017-10-1-74-79.

A clinical case is presented of a patient with a corneal puncture wound. The clinical course and treatment tactics are discussed. 1.5 months after primary surgical care during which the wound was sutured, the damaged area of the cornea was covered by an amniotic membrane abd a soft contact lens, the patient developed sharp thinning of the forming scar, threatening perforation: this was caused by incomplete sealing of the wound in the anterior chamber area. The patient was re-hosipitalized and given an additional through-and-through suture; autologous blood was infused into the anterior chamber, which resulted in stromal defect elimination. In cases when punctured wounds with corneal tissue deficit are accompanied by lysis and stromal thinning, through-and-through suturing and infusion of autologous blood into the anterior chamber is the operation of choice // Russian Ophthalmological Journal, 2017; 1: 81-4. doi: 10.21516/2072-0076-2017-10-1-81-84.

Congenital analgesia is characterized by insensitivity to pain. Children with this syndrome feel no physical pain when biting their tongues, lips, cheeks or fingers, which often results in significant bleeding. Burns and traumas leave numerous scars on the body. Clinical cases are presented of children with insensitivity to pain who have similar symptoms: the cerebral cranium dominates the facial skeleton, facial expressions are reduced. Ocular manifestations involve absence of blinking reflex and corneal sensitivity. These features lead to the erosion of the cornea in the followed-up patients which were later complicated by corneal ulcers. The patients underwent autoconjunctival covering of the cornea and blepharorrhaphy. Therapeutic contact lenses were prescribed // Russian Ophthalmological Journal, 2017; 1: 85-9. doi: 10.21516/2072-0076-2017-10-1-85-89.

This article presents modern aspects of clinical manifestations, laboratory diagnostics and treatment of herpetic keratitis (HK). A total of 68 patients participated in the study. In 75 percent of patients high relapse rates of Herpes Simplex skin infection were revealed in the period before HK onset (one-six times per year). Trigger factors for keratitis were thoroughly analyzed. Among them we discovered a number of new ones: the instillation of prostaglandin analogues, paranasal sinus surgery, septoplasty and blepharoplasty. 51 out of 68 patients had active herpetic keratitis, whereas 17 people were in the remission phase. Polymerase chain reaction (PCR) test results for the herpes viruses (HSV, VZV, CMV, EBV, HHV-6) in various body fluids (tears, saliva, blood and urine) from patients with HK are discussed. Herpesvirus DNA was determined in 96 percent of cases (49 out of 51 patients with active HK). Among these 49 patients a monoinfection was detected in 47 percent of cases and mixed infection - in 53 percent. According to the obtained results, we proposed some optimized treatment solutions // Russian Ophthalmological Journal, 2017; 1: 90-7. doi: 10.21516/2072-0076-2017-10-1-90-97.