Purpose: the current study was designed to improve drainage options of suprachoroidal space for cilio-choroidal detachment (CCD) prevention and treatment after glaucoma surgeries and to assess their clinical efficacy. Material and methods. A double cross-shaped sclerotomy was proposed to increase the effectiveness of CCD intraoperative prevention and to reduce intervention consequences. It was performed in 49 patients (49 eyes) aged 54-77 years with POAG simultaneously with the main fistulizing surgery within the same area. The control group consisted of 42 patients (45 eyes) who underwent fistulizing surgeries without preventive sclerotomy. For CCD treatment, posterior scleracyclostomy was designed, which was applied to 24 patients (24 eyes) with POAG, aged 52 to 84, who developed CCD aftera fistulizing surgery. The control group of 18 patients (18 eyes) received traditional posterior sclerectomy to treat CCD. Results. Double cross-shaped sclerotomyreduced CCD frequency after fistulizing surgeries by 4.4 times - from 26.7 % to 6.1 %, while the need for surgical treatment of retinal detachment dropped from 50.0 % to 33.3 %. Posterior sclera cyclostomy eliminated CCD in 100 % of cases, in which no relapse occurred, while in the control group the detachment showed a relapse in 16.6 % of cases. Conclusion. The proposed technique of preventive sclerotomy is effective, technically simple, and low traumatic. The designed surgical technique of CCD treatment, posterior sclera cyclostomy, proved to be a more effective way to prevent CCD relapses than conventional posterior sclerectomy // Russian ophthalmological journal. 2017; 10 (2): 5-9. doi: 10.21516/2072-0076-2017-10-2-5-9.

Purpose: to analyze the main pathogenic factors of closing and opening of the anterior chamber angle in patients with acute angle-closure glaucoma before and after hacoemulsification using optical coherence tomography (OCT) data. Material and methods. The study involved 35 patients aged 50-81 (ave. 65 years) with acute angle-closure glaucoma. The control group included 15 healthy individuals (30 eyes) with initial or immature cataract and no disturbed eye pressure and 12 patients with primary open-angle glaucoma aged 55 to 80. All patients underwent phacoemulsification. Results. Increased choroidal thickness, as well as a more pronounced difference between the thickness of the cornea in the center and the periphery, was revealed in angle-closure glaucoma as compared to the control groups. Phacoemulsification of the lens in eyes with acute angle-closure glaucoma reduces the choroidal thickness, decreases IOP, improves visual functions, extends anterior chamber angle, and increases the volume and depth of the anterior chamber of the eye. Conclusion. OCT data may be useful in the evaluation of treatment results, diagnosis and prognosis of acute primary angle closure glaucoma // Russian ophthalmological journal. 2017; 10 (2): 10-6. (in Russian). doi: 10.21516/2072-0076-2017-10-2-10-16.

Purpose: to compare the dynamics of recombinant prourokinase (RPU) in humor of the anterior chamber of the eye with regard to administration technique (instillations vs. subconjunctival injection) using fluorescent spectrophotometry. Material and methods. 62 samples of anterior chamber humor were obtained from 62 patients (62 eyes) who underwent cataract surgery, with rigid pupil due exfoliation syndrome or after an earlier acute iridocyclitis. The patients were divided into two groups. Group 1 received the medication by forced instillations of RPU solution with the concentration of 330 IU per 1 ml of 0.9 % sodium chloride continuously for 10 minutes, the rate being 30 drops per minute. Group 2 (31 patients, 31 eyes) received a subconjunctival injection of 0.5 ml of 0.9 % sodium chloride solution that contained 5,000 IU of RPU. For each sample, the time elapsed from the moment of RPU administration to the moment of humor sampling was noted. RPU concentration in the samples was determined by fluorescent spectrophotometry using the HITACHI 650-60 device (Japan). Results. Inforced instillations, RPU is detected in the humor of the anterior chamber starting from the 5th minute after the instillation, with rapid growth of concentration, which attains the level of 3100 IU/ml in 30 to 60 minutes. Then, however, the concentration drops, with the half-life period being 160 to 180 minutes. In subconjunctival injections RPU is detected after the same time span after the procedure; however, its concentration grows for 120 to 160 minutes, reaching the level of 2500 IU/ml, and only then begins to fall gradually, the half-life period being as long as 320-360 minutes. Conclusions. RPU may be used for the treatment of fibrinoid syndrome with practically the same efficacy by subconjunctival injections or by force instillation. This is explained by the fact that the enzyme is found in anterior chamber humor in sufficient concentrations in either case. The pharmacokinetics of therapeutic concentration of the medicine in the humor of the anterior chamber envisages a single subconjunctival administration and permits two instillations in the 24-hour period Russian ophthalmological journal. 2017; 10 (2): 18-22. (in Russian). doi: 10.21516/2072-0076-2017-10-2-18-22.

Purpose: to study the clinical effectiveness of ozone therapy in the treatment of herpetic uveitis. Material and methods.41 patients with herpetic uveitis aged 21 to 69 (40.3 ± 11.5) years were followed. 21 patients (21 eyes) comprised the experimental group, which received traditional treatment in combination with ozone therapy, and 20 patients (20 eyes) comprised the control group who only received conventional drug therapy. Results. The resorption of choroid infiltration took 21.4 ± 0.2 days in the experimental group and 24.8 ± 0.1 days in the control group (p < 0.05). Visual acuity averagely increased from 0.04 ± 0.02 to 0.61 ± 0.09 in the experimental group and from 0.08 ± 0.03 to 0.54 ± 0.08, in the control group (p> 0.05). The total treatment duration was, respectively 22.1 ± 0.1 and 25.9 ± 0.5 days, p < 0.05). The treatment effectiveness can be assessed as follows; in the experimental group, the recovery could be established in 19 patients (90.5 %) and condition improvement in 2 patients (9.5 %). In the control group, the recovery was noted in 14 patients (70 %) and 6 patients (30 %) showed an improvement. Conclusion. To achieve an optimal effect, patients with herpetic uveitis should be treated with ozone therapy in addition to regular antiherpetic treatment // Russian ophthalmological journal. 2017; 10 (2): 23-7. doi: 10.21516/2072-0076-2017-10-2-23-27.

At present, there is no consensus on whether the use of prostaglandin analogues in the perioperative period in patients with the combination of cataract and primary open angle glaucoma (POAG) is safe, because prostaglandins are shown to be inflammatory mediators and may cause an inflammatory response or provoke the development of cystic macular edema after cataract extraction. Purpose: analysis of the impact of prostaglandin analogues in the postoperative period after cataract phacoemulsification in patients with POAG. Material and methods. We observed 58 patients with cataracts complicated by POAG who received prostaglandin analogues as hypotensives. Of these, 14 patients used them as monotherapy, 24 patients had them in combination with β-blockers and 20 patients had a combination of drugs (β-blockers and carbonic anhydrase inhibitors). Before surgery, all patients had normalized intraocular pressure (15.6 ± 0.07 mm Hg). Optical coherence tomography showed normal parameters of retinal thickness in the 1 mm area and of the macular volume in the 6-mm area, which were the same in all groups. The standard instillation pattern used after surgery lasted a week and included antibiotics, steroids, and a nonsteroidal anti-inflammatory drug (NSAID). After that, NSAIDs were administered for another 6-8 weeks, while hypotensive drugs, including prostaglandin analogues, were given throughout the entire period of observation. Results. The early postoperative period was unresponsive. The average visual acuity on the first day was 0.69 ± 0.05, and after 6-8 weeks it increased to achieve to 0.85 ± 0.05. The use of the prostaglandin analogues before and after surgery effectively prevented the development of postoperative hypertension, which was manifested in a slight rise in IOP on the first day to an average of 19.3 ± 1.1 mm Hg (monotherapy group) with an average level of IOP 16.9 ± 0.37 mm Hg in the whole group of patients. After 6-8 weeks, IOP showed no difference from the preoperative level, averaging 15.1 ± 0.28 mm Hg. The use of different groups of prostaglandin analogues did not affect the state of the retina’s macular area in the postoperative period. Conclusion. Uninterrupred use of prostaglandin analogues instillations in the pre- and postoperative period of uncomplicated phacoemulsification in patients with POAG promotes continuity in the treatment of combined pathology, maintain compliance and provide a stable IOP with no pronounced reactive hypertension // Russian ophthalmological journal. 2017; 10 (2): 28-35. (in Russian). doi: 10.21516/2072-0076-2017-10-2-28-35.

Reaching a prolonged hypotensive effect in the postoperative period is one of the main tasks of modern glaucoma surgery. The purpose of this work is to develop a new fully biodegradable drainage structure, made of domestically produced materials, and to use modified sinustrabeculectomy (STE) in the surgical treatment of primary open angle glaucoma (POAG) and refractory glaucoma. Materials and methods. The operation was performed in 27 patients (27 eyes) aged 50-70 (averagely 59.5 ± 1.9 years), who had been operated for POAG II (9 patients, 33.3 %) or POAG III (18 patients, 66.7 %) of staged b - c. For drainage, we used polyglycolic thread, which is an absorbable synthetic suture material. Complete absorption of drainage takes 60 to 90 days. The examination included standard methods (visometry, tonometry, computer perimetry, tonography, optic nerve HRT. In the early postoperative period optical coherence tomography of the anterior segment (ASOCT) was used, which was followed by ultrasound biomicroscopy (UBM). The follow-up period was up to 1 year. Results.1-3 months after the surgery, antihypertensive efficacy was noted in 100 % of cases (27 eyes), and 9-12 months after the surgery the figure was 98 % (26 of 27 eyes). Conclusions. The newly developed option of glaucoma surgery using a drainage structure made of domestically produced material provides a long-acting hypertensive effect // Russian ophthalmological journal. 2017; 10 (2): 36-9. doi: 10.21516/2072-0076-2017-10-2-36-39.

The Purpose of this work was to determine microvascular changes in the macular zone with diabetes mellitus (DM) and with different stages of diabetic retinopathy (DR) using optical coherence tomography angiography (OCT-A). Materials and methods. 60 patients were inspected (109 eyes) between the ages 58.20 ± 3.27 with DM (patients without clinical DR and with different stages of DR). The control group consisted of 75 healthy subjects (150 eyes) and was compared by gender and age to the DR group. OCT-A was performed with the help of the instrument RTVue XR Avanti (Optovue Inc, USA) in the Angio Retina settings with the scanning field dimensions 3 x 3 mm and 6 x 6 mm. The density of the top vascular plexus in the capillary network was evaluated in 9 quadrants, in the foveal and parafoveal zones, and in the foveal avascular zone (FAZ). Results. In patients with D, all groups were observed to have a significantly decreased density in blood flow in the top capillary network and a widened FAZ in comparison with the control group. The decrease density of blood flow was more evident in groups with preproliferative diabetic retinopathy (prePDR) and with proliferative DR (PDR), averaging at 16.6 % / 13.6 % and 15.5 % / 7.5 % in scanning fields of 3 x 3 mm / 6 x 6 mm, respectively. The FAZ field with DM and DR was at 38.5 %, with nonproliferated DR - at 26.9 %, with prePDR - at 65.4 %, and with PDR at 30.8 % higher than the control group. Conclusion. OCT-A allowed the identity of microvascular changes within the macular zone with DM in even the most early stages of the disease, when there were no manifestations of DR at the eye’s fundus. Early indicators of changes in the microcirculatory path of the retina with DM were qualitative and quantitative changes. These changes were within the FAZ and in the decreased density of the surfacevascular plexus in the capillary network within the scanning fields of 3 x 3 mm Russian ophthalmological journal. 2017; 10 (2): 40-5. (in Russian). doi: 10.21516/2072-0076-2017-10-2-40-45.

Purpose: to compare clinical, functional and morphological results of treatment of progressing keratoconus by femtosecond, trans-epithelial and standard corneal collagen crosslinking. Material and methods. 114 patients aged 18-35 (148 eyes) with progressing keratoconus of stages I-III and iatrogenic keratectasia were divided into three groups. Group 1 (39 patients, 47 eyes) received femtosecond corneal collagen crosslinking; group 2 (33 patients, 45 eyes) underwent transepithelial crosslinking and group3 underwent crosslinking performed with standard technique. Results. The analysis of data of confocal microscopy performed 1 year after femtosecond and standard corneal collagen crosslinking revealed the effect of cross linkage in the anterior and middle corneal stroma, an increased density of the extracellular matrix, regeneration of subepithelial and stromal nervous fibers, and keratocyte repopulation. 1 year after trans epithelial crosslinking, keratocyte population was restored. Slight folding in the anterior stroma was observed due to the cross linkage effect. Conclusion. The preserved epithelial layer of the cornea reduces the risk of infectious complications on the eroded surface of the cornea, diminishes visual discomfort and sensation of pain in patients in the early postoperative period, and shortens the rehabilitation period. After trans-epithelial corneal collagen crosslinking, no pronounced effect of cross linkage in the stroma was observed. The available weak positive result justifies the recommendation to use this technique in children, patients with thin cornea, those likely to develop complications during reepithelization, and as a preventive measure in cases of slow progression rate // Russian ophthalmological journal. 2017; 10 (2): 47-53. (in Russian). doi: 10.21516/2072-0076-2017-10-2-47-53.

Uveal melanoma (UM) is an aggressive tumor with a high risk of death due to metastatic disease development. Therefore, it is an important task to find new methods of early diagnosis of metastases in UM patients. Purpose: to assess the method of positron emission tomography combined with computer tomography (PET / CT) used for metastatic UM detection as compare to routine examination techniques. Materials and Methods. The study involved 50 UM patients (18 males and 32 females) aged 26 to 78 (average age 52 ± 13). Of these, 27 patients were examined before treatment start and 23 patients underwent examination 3 to 166 months after being diagnosed with UM (the median was 26 ± 10 months). Metastatic disease screening included liver enzymes level evaluation, ultrasound imaging of the abdominal cavity, chest X-ray, and PET/CT). Results. The liver enzyme level was elevated in one patient with disseminated lesion. In one case, chest X-ray showed fibro-focal changes in the lungs (after previous tuberculosis) were detected. Ultrasound imaging of the abdominal cavity revealed focal liver damages in 13 patients, of which 11 patients had liver formations that were regarded as cysts or hemangiomas and in one case a secondary character of damage was suspected (later, a cyst was diagnosed). Only in one remaining case, multiple focal lesions in the liver (metastases) were revealed reliably. PET/CT imaging showed UM metastases in 6 patients (2 primary and 4 recurrent patients): one case showed multiple metastases to the liver, lungs, bones, peritoneum, retroperitoneal space, intestinal loops) and 5 cases were diagnosed with metastases in the liver. The metastasizing periods were 21 to 160 months (median 74 ± 58 months) from the moment of UM diagnosis. One female patient who was diagnosed with primary uveal melanoma revealed, in addition to a metastatic lesion of the liver, a lesion focus in the sigmoid colon (adenocarcinoma, a synchronous cancer). In 14 patients (22 %), PET/CT revealed small focal changes (less than 5 mm) of uncertain etiology in the lungs. PET/CT also detected concomitant diseases (inflammatory, benign, degenerative dystrophic etc.). Conclusions. PET/CTis the most informative examination method enabling the detection of malignant focal processes and accompanying pathologies which is crucial for choosing the optimal treatment of UM patients and may be able to increase their life expectancy // Russian ophthalmological journal. 2017; 10 (2): 54-61. (in Russian). doi: 10.21516/2072-0076-2017-10-2-54-61.

Purpose: to study the possibilities of laser Doppler flowmetryin assessing the effectiveness of treatment of chronic Demodex blepharitis. Material and methods. The study included 33 patients (66 eyes), divided into the main and the control groups, identical in gender and age structure. The main group consisted of 16 patients (32 eyes) with chronic Demodex blepharitis. The control group included 17 patients (34 eyes) with no signs of changes in the structures of the anterior eye segment. In addition to the standard ophthalmologic examination, the patients underwent an eyelid skin microcirculation examination (using the Analyzer of peripheral blood and lymph flow LASMA MC-1 and laser diagnostic complex LASMA MC, produced by LASMA firm). The patients of the main group used Dexodem Phyto cream gel for 45 days, whereupon, after 1.5 months, an efficacy control examination was performed. Results. In the main group, typical microcirculatory disorders - arterial hyperemia of the upper eyelid and lower eyelid ischemia, and insufficient activity of the lymph of the upper eyelid - were revealed prior to treatment. After treatment, positive changes were clinically observed. Microcirculation parameters, including the perfusion and the amplitude-frequency spectrum of blood flow of both eyelids approached the normal values, and the activity of the lymphatic system improved. Conclusion. The laser Doppler flowmetry enables the examination of blood flow and lymph flow in inflammatory diseases of the eyelids, in particular blepharitis, and may be considered as an objective method of treatment effectiveness evaluation // Russian ophthalmological journal. 2017; 10 (2): 62-6. (in Russian). doi: 10.21516/2072-0076-2017-10-2-62-66.

Purpose: to study the interrelation between the biomechanical and the biometric parameters of the eye in different stages of infantile glaucoma. Material and methods. A total of 19 patients (37 eyes) aged from 3 to 10 years with a non-operated primary infantile glaucoma were examined. Of these 6 patients (9 eyes) had initial stage, 7 patients (9 eyes) had advanced stage), 6 patients (9 eyes) had far advanced stage, and 7 patients (10 eyes) had terminal stage, respectively. A combination of different stages of the disease was found in 11 children, while 8 children had the same stage of the disease in both eyes. Examination methods included visometry, ophthalmoscopy, determining the excavation of the optic disc, A-scan recording the anterior-posterior axis (APA) of the eye, Filatov - Kalfa elastotonometry with weights of 5 g, 10 g, 15 g. Results. The gradient of elastic curve rise was noted in all stages, but it was the highest in the terminal stage, where APA was greater according to the severity of the disease. APA and elastic curve raise was found to correlate in the far-advanced and the terminal stages of glaucoma. Conclusion. The changes in the biomechanical properties of the fibrous membrane of the eye in children with infantile glaucoma depend on the severity of the disease, which is manifested in changes in the biometric parameters. Sclera rigidity is reduced in the far-advanced and terminal stages of infantile glaucoma, which can lead to an underestimation of the true level of IOP and the risk of glaucoma development in children // Russian ophthalmological journal. 2017; 10 (2): 68-70. doi: 10.21516/2072-0076-2017-10-2-68-70.

Severe diseases of the anterior eye surface, such as ulcers and erosions of varied genesis, or the consequences of the cornea and conjunctiva burns are important topical issues of ophthalmology. Purpose: to assess the suitability of existing collagen substrates based on types I and II collagen for being used as a matrix for rabbit buccal epithelium cells. Material and methods. The study involved 12 rabbits (24 eyes), on whose intact cornea a contact lens was placed. The lens was covered with a variety of type I collagen which had been obtained from rabbit tendon by acid extraction. For control purposes, a contact lens covered with collagen gel based on type II collagen and designed for healing was placed on the cornea of the fellow eye. Biocompatibility and tolerability of collagen matrixes was assessed. Results. Type I collagen obtained from rabbit tendon had no toxic action on buccal epithelial cells. The types of collagen used were found to be an optimal medium for buccal epithelial cells, which adhere well and can be delivered to the site of corneal damage. Type I collagen, which was produced by acid extraction, had an irritating effect on the rabbit cornea, which is associated with high content of acetic acid. Therefore, the technique of producing type I collagen was modified to achieve an additional reduction of acidity. Conclusion. Type I collagen and collagen gel for corneal healing produced on the basis of type II collagen were shown to be safe and effective when used in bioengineering construction // Russian ophthalmological journal. 2017; 10 (2): 71-7. doi: 10.21516/2072-0076-2017-10-2-71-77.

The article is devoted to the management of children hyperopia, focusing on two principal issues: 1) determining the maximum level of hyperopia (according to age and other factors) below which no correction is required, and above which correction is mandatory; 2) if correction is mandatory, which correction parameters are appropriate. A brief review of modern approaches to the solution of these issues by domestic and foreign schools of ophthalmology and optometry is given. Based on the generalization of the results of clinical studies, a threshold trajectory of the refraction genesis of children with hyperopia is constructed, which determines the probability of a normal course of emmetropization. A therapeutic trajectory of refraction genesis for children with moderate and high hyperopia with no signs of decompensation is theoretically determined. Presumably, managing the patients along the described therapeutic trajectory by means of correction tools may help achieve the maximum acceleration of emmetropization with relatively small risks of development of concomitant complications // Russian ophthalmological journal. 2017; 10 (2): 78-85. doi: 10.21516/2072-0076-2017-10-2-78-85.

Today, the problem of multiple resistance of pathogens to antibacterial drugs used in the treatment of pyoinflammatory diseases gains importance. At the same time much fewer new antibacterial drugs are registered now, as their investment prospects have become very poor. Hence, we need to maximally enhance the effectiveness of the drugs available on the market. Purpose: to determine the concentration of Ciprofloxacin and Ofloxacin in the tear after regular quantities of eye drops or ointments containing these antibacterial drugs have been instilled into the conjunctival sac, and to compare it with the minimum inhibitory concentration (MIC) for the major pathogens of pyoinflammatory diseases of the anterior segment and the adnexa of children eyes. Material and methods. A randomized study was conducted, which involved 89 patients (100 eyes) aged 1 to 14 years with ocular pyoinflammatory diseases of the anterior segment and the adnexa. The leading pathogens of inflammation and their sensitivity to antibacterial drugs have been identified. A dynamic monitoring of Ciprofloxacin and Ofloxacin concentration in the tear was performed after eye ointment with these antibiotics had been placed into the conjunctival sac. Results. The leading pathogens of inflammatory diseases of the anterior segment and the adnexa in children turned out to be H. influensae (34 %), S. pneumonia (24 %), S. aureus (10 %). With the same sensitivity of the pathogens the eye ointment containing Ciprofloxacin (Oftocipro) shows better results of maintaining the concentration of the drug in the tear exceeding MIC for the leading inflammatory pathogens (H. influensae и S. aureus) of the anterior segment and the adnexa in children for 4 hours after the instillation, as compared to an Ofloxacin-containing ophthalmic ointment (Floxal) and eye drops containing Ciprofloxacin. Conclusion. Oftocipro eye ointment containing Ciprofloxacin is the preferable drug to be prescribed to children in need of the treatment of inflammatory diseases of the anterior segment and the adnexa of the eye // Russian ophthalmological journal. 2017; 10 (2): 87-90. (in Russian). doi: 10.21516/2072-0076-2017-10-2-87-90.

Сlinical cases of rigid gas permeable lenses prescribed to the patients after radial keratotomy in the remote period are presented. The efficacy of optical correction of induced ametropias by scleral lenses is shown. Comfort sensation and high visual acuity make scleral lenses the main optical correction method for patients with irregular corneas // Russian ophthalmological journal. 2017; 10 (2): 92-6. (in Russian). doi: 10.21516/2072-0076-2017-10-2-92-96.

The review presents new insights into the mechanisms of development of amblyopia. There is objective evidence that amblyopia develops simultaneously as the monocular and as the binocular deficit of visual processing and that decrease in monocular visual acuity and disorders of binocular and stereoscopic vision take place. Given the ever-increasing evidence of fundamental and clinical studies, it is most likely that the binocular dysfunction is primary, and the decrease of monocular visual acuity is secondary in this disease. Amblyopia is a binocular pathology, and binocular interaction plays a critical role in the pathogenesis of strabismic, anisometropic and combined amblyopia. Accordingly, it seems appropriate to start the treatment with the restoration of binocular vision, which also leads to the recovery of the amblyopic eye. Visual dysfunction in amblyopia is often associated with the emergence of powerful suppression while watching with both eyes. Suppression converts the structurally binocular system into a functionally monocular one. Therefore, the elimination of suppression should be considered the first and the most necessary step to restore binocular vision. Quantification of suppression is a critically significant step for the development of new methods of treatment of amblyopia, including those based on the perception of global motion, associated with the function of the extrastriate dorsal visual cortex. The new understanding of amblyopia becomes the basis for a large amount of diverse research targeted to the development of more effective treatment methods, which will focus primarily on the elimination of suppression and restoration of binocular vision // Russian ophthalmological journal. 2017; 10 (2): 97-102. (in Russian). doi: 10.21516/2072-0076-2017-10-2-97-102.

Aflibercept is a hybrid protein-imitation of VEGF receptor with a prolonged activity. The review describes the structural properties of the Aflibercept molecule, the impact of the medication on the pathogenesis of retinal diseases, and the results of clinical studies into the safety and effectiveness of Aflibercept in the therapy of age related macular degeneration (VIEW1, VIEW2), diabetic macular oedema (VISTA, VIVID), macular oedema caused by the occlusion of the central retinal vein (GALILEO, COPERNICUS) or its branches (VIBRANT), and myopic choroidal neovascularization (MYRROR) Russian ophthalmological journal. 2017; 10 (2): 103-11. (in Russian). doi: 10.21516/2072-0076-2017-10-2-103-111.