[Multimodal topographically oriented approach to the study of full-thickness macular holes]. / Mul'timodal'nyi topograficheski orientirovannyi podkhod k izucheniyu skvoznykh makulyarnykh razryvov.

PURPOSE: This article studies the relationship between structural changes according to the findings of optical coherence tomography (OCT) and OCT angiography (OCTA), microperimetry (MP), multifocal electroretinography (mfERG) parameters in topographically corresponding areas of the macular region in idiopathic full-thickness macular holes (FTMH). MATERIAL AND METHODS: OCT, OCTA, MP and mfERG were performed in 14 eyes with FTMH stages I-IV according to Gass. In 13 points at a distance of 0-2.5°, 2.5-5.0°, and 5.0-10.0° from the fixation point, the light sensitivity (LS), amplitude and latency of the P1 component were compared with the size of the hole, the area of cystic changes (CC) at the level of the inner nuclear layer (INL) and the outer plexiform layer and Henle fiber layer complex (OPL+HFL), vessel density in the superficial and deep capillary plexus (SCP and DCP). RESULTS: LS and P1 component amplitude were significantly reduced at a distance of up to 5.0° from the fixation point. LS correlates with the apical and basal diameter of the hole (R> -0.53), the area of CC in the INL (R> -0.62) and the OPL+HFL complex (R> -0.55), the density of vessels in the SCP at a distance of up to 2.5° from the fixation point (R>0.51) and in the DCP at a distance of up to 5° from the fixation point (R>0.49). The P1 amplitude correlates with the basal diameter of the hole (R= -0.38), the area of CC in the INL and the OPL+HFL complex (R> -0.33) and vessel density in the SCP (R=0.37) at a distance of up to 2.5° from the fixation point, as well as vessel density in the DCP at a distance of up to 5° from the fixation point (R=0.47). Vessel density in the DCP is significantly lower in the presence of CC in the retina (p<0.001). CONCLUSION: In FTMH, there is a relationship between bioelectrical activity and LS, and structural disorders, capillary perfusion in different layers of the retina. A multimodal topographically oriented approach allows studying the relationship between structural and functional parameters in individual points of the retina and can be used in monitoring of FTMH after surgical treatment.

[Factors affecting the hypotensive effect of selective laser trabeculoplasty in primary open-angle glaucoma]. / Faktory, vliyayushchie na gipotenzivnyi effekt selektivnoi lazernoi trabekuloplastiki pri pervichnoi otkrytougol'noi glaukome.

PURPOSE: This study analyzes the influence of various factors on the hypotensive effect of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: A retrospective study of the SLT effect was performed in 582 patients (756 eyes; mean age - 71.9±9.5 years) with POAG stages I-III. The level of intraocular pressure (IOP) decrease was assessed at 1 day, 1, 3, 6, and 12 months after SLT. The relationship between the hypotensive effect and age, gender, glaucoma stage, initial IOP level, number and type of instilled drugs, presence of intraocular lenses, and the surgeon performing the intervention were analyzed. RESULTS: In the entire sample, the hypotensive effect of SLT after 1 day was 4.1±3.4 mm Hg, after 1, 3, 6, and 12 months - 3.7±4.8; 3.5±3.8; 3.1±3.4 and 2.3±3.8 mm Hg, respectively. The hypotensive effect of SLT was most dependent on the preoperative IOP level (R>0.64, p<0.05). No significant correlation was found between the hypotensive effect and the stage of POAG, gender, age, number of hypotensive drugs, phakia/aphakia, and the surgeon. A weaker hypotensive effect of SLT was found in eyes receiving monotherapy with α2-adrenoceptor agonists (p<0.03) and a combination of four drugs (p<0.02). CONCLUSION: SLT is an effective method of additional IOP reduction in POAG at any stage and with any hypotensive regimen. At the same time, the results of its use in real clinical practice indicate the need for more careful IOP control after the procedure, especially in eyes with POAG stage III, as well as in eyes without hypotensive therapy and on the maximum drop regimen.

[Direct assessment of changes in biomechanical properties of the cornea after ReLEx SMILE and FemtoLASIK surgeries]. / Neposredstvennaya otsenka izmenenii biomekhanicheskikh svoistv rogovitsy posle provedeniya operatsii ReLEx SMILE i FemtoLASIK.

The aim of this study was to evaluate corneal biomechanical properties in myopic patients after ReLEx SMILE and FemtoLASIK surgeries using the Corvis ST analyzer. MATERIAL AND METHODS: The SMILE group comprised 23 patients (46 eyes) with spherical refraction -3.8±1.8 diopters (D), the FemtoLASIK group included 18 patients (36 eyes) with spherical refraction -3.5±1.3 D. Analysis of the biomechanical properties of the cornea was carried out using the CORVIS ST device (Oculus, Germany) before and seven days after corneal refractive surgery. RESULTS: In the SMILE group, with intraoperative decrease in corneal thickness of 91.43±19.43 µm, a significant increase in the following parameters was observed: deformation coefficient (DA ratio; p=0.0001), peak distance (PD; p=0.02) and inverse concave radius (ICR; p=0.003); a decrease in the stiffness parameter at first applanation (SP-A1; p=0.0001), Corvis biomechanical index (CBI; p=0.0001), intraocular pressure (IOP; p=0.001). In the FemtoLASIK group, with intraoperative decrease in corneal thickness of 75.33±32.3 µm, we observed a significant increase in DA ratio (p=0.0002), PD (p=0.04), ICR (p=0.0002), a decrease in SP-A1 (p<0.0001), IOP values (p=0.0003). In comparison with the FemtoLASIK group, the deformation amplitude DA changed significantly less in the SMILE group (p=0.04). In the FemtoLASIK group, in comparison with the SMILE group, the DA ratio (p=0.0009) and SP-A1 (p=0.0003) significantly increased. Intraoperative corneal thickness change correlates with ICR both in SMILE (R=0.52) and in FemtoLASIK (R=0.65). CONCLUSION: Corneal biomechanical properties determined with CORVIS ST in eyes with mild to moderate myopia change to a lesser extent after ReLEx SMILE compared to FemtoLASIK.

[Vortex vein varix (clinical observations)]. / Varikoznoe rasshirenie vortikoznykh ven (klinicheskie nablyudeniya).

Varix of the vortex vein ampulla is a rare benign condition that has clinical similarities to more concerning choroidal lesions that pose a threat to vision, in particular choroidal melanoma. The article describes two clinical cases, one of which is unique due to the combination of bilateral lesion and the presence of multiple varices in one eye. A brief review of the literature on this condition is also provided.

[Comparative assessment of the accuracy of toric intraocular lens calculations]. / Sravnitel'naya otsenka tochnosti rascheta toricheskikh intraokulyarnykh linz.

PURPOSE: To compare the accuracy of toric intraocular lens (IOL) calculations on three modern toric calculators. MATERIAL AND METHODS: The study comprised 35 eyes of 35 patients who underwent phacoemulsification with toric IOL implantation (EnVista Toric). Residual postoperative refractive astigmatism was calculated on three calculators: EnVista Toric Calculator, ASSORT Toric IOL Calculator and the Kane formula. Prediction error for each calculator was determined using vector analysis. RESULTS: The mean absolute deviation of predicted postoperative refractive astigmatism over actual astigmatism in diopters was distributed in the following way: 0.82±0.58, 0.70±0.67 and 0.72±0.76 using EnVista Toric Calculator, ASSORT Toric IOL Calculator and the Kane formula, respectively. Centroid prediction error was 0.08 (EnVista Toric Calculator), 0.06 (ASSORT) and 0.10 (Kane formula). There was a significantly smaller deviation using ASSORT and the Kane formula compared to the online calculator (p<0.05). CONCLUSIONS: Toric calculators ASSORT Toric IOL Calculator and the Kane formula showed higher accuracy of toric IOL calculation than EnVista Toric Calculator.

Modeling of Retinal Degeneration.

We developed a model of retinal degeneration in rabbits based on exposure to light with a wavelength of 405 nm. This model allows reproducing structural and functional disorders in the central parts of the retina, including primarily degeneration of the outer layers of the retina (retinal pigment epithelium and layer of photoreceptor cells), and is designed to study the mechanisms of formation, progression and effectiveness of new drugs and methods of treatment of degenerative diseases of the retina.

[Preventive laser treatment of tractional symptomatic retinal flap tears: long-term outcomes]. / Otdalennye rezul'taty profilakticheskogo lazernogo lecheniya traktsionnykh simptomaticheskikh klapannykh razryvov setchatki.

Tractional flap tears are the main cause of the development of regmatogenic retinal detachment (RRD). The main immediate treatment method for it is laser retinal coagulation. PURPOSE: Case monitoring of tractional symptomatic flap tears after laser treatment. MATERIAL AND METHODS: From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti. RESULTS: At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD. CONCLUSION: Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.

[Dome-shaped macula: features of differential diagnostics with clinical examples]. / Fenomen kupoloobraznoi makuly: osobennosti differentsial'noi diagnostiki (klinicheskie nabliudeniia).

The phenomenon of dome-shaped macula (DSM) constitutes protrusion of membranes of the posterior pole of the eye toward the vitreous body due to local thickening of sclera layers. The phenomenon was detected using enhanced depth imaging optical coherence tomography (EDI-OCT). In uncomplicated forms of DSM, all layers of the retina are contiguous, but the setting of DSM can involve a number of pathological conditions causing decrease in vision. One of the most often described concurrent conditions in DSM is serous retinal detachment (SRD). Such complicated forms of DSM are often masked as a non-pigmented neoplasm of the choroid, in particular hemangioma (HC). PURPOSE: To demonstrate the possibilities of differential diagnostics of DSM with HC using modern instrumental diagnostic methods. MATERIAL AND METHODS: The study involved two clinical cases of patients with DSM and HC, who underwent comprehensive ophthalmological examination including EDI-OCT and OCT angiography, fluorescent angiography (FA), indocyanine-green angiography (ICG) and magnetic resonance imaging of brain and orbits (MRI). RESULTS: The most simple and highly informative method for differential diagnostic of DSM with HC is currently EDI-OCT. In difficult differential diagnostic cases, it is recommended to use FA and MRI. Additionally, for identification of the cause of SRD in DSM, OCT-angiography and ICG-angiography can be used. Thus, diagnostics of DSM is difficult today primarily because of the low awareness of ophthalmologists about the presence of such macula pathology. Detection of this anatomical feature by means of ophthalmoscopy alone can be difficult and requires special skills and experience. The use of EDI-OCT, as well as FA and MRI in difficult differential diagnostic cases, and correct interpretation of the obtained data can help avoid diagnostic errors.

[Hyalocytes of the vitreous body and their role in ophthalmic pathology]. / Gialotsity steklovidnogo tela i ikh znachenie v glaznoi patologii.

Hyalocytes of the vitreous body are variety of tissue macrophages that exercise various functions - from ensuring the synthesis of extracellular matrix components and modulating the immune response in the vitreous body to participating in different stages of inflammatory processes. Some aspects of the biology of hyalocytes remain poorly understood and controversial. However, the vitreous cells are starting to be considered a potential point of application in the treatment of diseases of the vitreous body and the retina.

[Effects of urokinase plasminogen activator on cultured human retinal epithelial cells]. / Vliyanie rekombinantnogo aktivatora plazminogena urokinaznogo tipa na kletochnuyu kul'turu pigmentnogo epiteliya setchatki.

AIM: to study the effects of urokinase plasminogen activator (UPA) on the human retinal pigment epithelium (hRPE) cell culture. MATERIAL AND METHODS: The toxicity of 50 U/ml UPA was studied with the trypan blue exclusion test. Cell migration was assessed by the wound healing and modified Boyden chamber assays. Additionally, cell morphology, trypsin resistance, and Ki67 expression were investigated. RESULTS: Trypan exclusion test did not reveal any cytotoxicity of 50 U/ml UPA against hRPE cells. The agent appeared able to induce cellular cluster formation and increase the number of spindle-shaped cells (6.4±2.4 cells/field and 67.3±3.2 cells/field in the controls and in the presence of 50 U/ml UPA, respectively, p<0.001). Cell migration in the Boyden chamber also showed a statistically significant increase (1.75-fold, p=0.012). Monolayer wounds were found to heal at an accelerated rate (p<0.05). This effect was dose-dependent, just like the increase in Ki67-positive cells (from 2.5 to 50 U/ml). Moreover, there was a reduction in trypsin resistance of the hRPE cells (the number of resistant cells in the control and 50 U/ml UPA cultures was 5.2±1.7 cells/field and 0.46±0.32 cells/field, respectively, p<0.001). CONCLUSION: UPA, at concentrations of 50 U/ml or less, demonstrates no cytotoxicity against the hRPE cells. The effects of UPA on hRPE include stimulation of epithelial-mesenchymal transition, migration, proliferation, and intercellular interaction. At that, changes in migratory and proliferative activity are dose-dependent.

[Role of Chlamydia trachomatis intraocular infection in the development of proliferative vitreoretinopathy (experimental study)].

OBJECTIVE: To study the influence of C. trachomatis infection on proliferative vitreoretinopathy (PVR) stimulation and development in an experimental model. MATERIAL AND METHODS: Intravitreal C. trachomatis injection was performed in 17 rabbits (right eyes) out of which 8 developed minimal chlamydial damage (1 was further subjected to histopathological examination with pathogen detection in ocular structures and other 7 were included in the study group). The control group consisted of 7 rabbits with no laboratory evidence of chlamydial infection. PVR was induced by 4 peripheral retinal punctures with a 19 G needle. Follow-up methods included ophthalmoscopy, ultrasonography, and PVR grading according to the Fastenberg classification. Histopathological examination, supplemented with pathogen detection by direct immunofluorescence in the study group, was performed at weeks 7 and 20. RESULTS: PVR rate and severity were higher in the study group as compared with the controls (5 out of 7 rabbits, grade 2-4 vs. 2 out of 7 rabbits, grade 0-1, p<0.01). In the study group, histopathological examination performed before and after the induction of PVR revealed a pronounced lymphocyte and macrophage infiltration, characteristic of infectious inflammation. Similarly, extra- and intracellular chlamydial inclusions could be found in the retina and/or zones of proliferation throughout the whole study period. Inflammation signs (including those of proliferation) were reliably less significant in the controls. CONCLUSION: C. trachomatis infection of the posterior segment contributes to PVR development due to associated chronic inflammation.

[The organization of emergency actions for ocular burns in conditions of military unit (of the ship)].

Prehospital services for ocular burns are delivered by servicemen as self or mutual management and also by paramedic. Every case of ocular burn should be considered as severe one. The patient, shortly after the first aid, should be transported to the medical company or medical unit. Under conditions of medical unit military doctor has to organize an ophthalmological working space (ophthalmological comer) with the necessary equipment. Eye irrigation has to be made for chemical ocular burns. Military doctor should consider any previous irrigation as insufficient. For severe ocular burns during evacuation to the hospital it is necessary to perform a simple blepharorrhaphy or (if the condition of lids allows) to make a hermetic seal with aid of aid-band. Doctor's obligations should also include prophylaxis of ocular burns.

[Lattice degeneration of the retina].

Lattice degeneration of the retina is a clinically important type of peripheral retinal dystrophies due to its participation in the pathogenesis of rhegmatogenous retinal detachment. In spite of extensive epidemiological, morphological, and clinical data, the question on causes of this particular type of retinal dystrophies currently remains debatable. Existing hypotheses on pathogenesis of retinal structural changes in lattice degeneration explain it to a certain extent. In clinical ophthalmology it is necessary to pay close attention to this kind of degenerations and distinguish between cases requiring preventive treatment and those requiring monitoring.

[Evaluating the effectiveness and safety of diode laser trans-scleral thermotherapy of the ciliary body as a treatment for refractory glaucoma].

OBJECTIVE: To evaluate the effectiveness and safety of diode laser trans-scleral thermotherapy (TSTT) in cyclodestruction for refractory glaucoma (RG). MATERIAL AND METHODS: The proposed cyclodestructive procedure was performed on 87 patients with severe and terminal RG (stages III and IV) at power levels of 0.4-0.5 W with exposure times of 15-25 seconds. RESULTS: The incidence of severe inflammatory response was less than that after well-known cyclodestructive procedures. The average reduction of intraocular pressure at the first day after surgery (considering all observations) was 10.45 +/- 7.23 mmHg. In all cases after TSTT of the ciliary body the pain resolved within the first day. CONCLUSION: The effectiveness of the new method is comparable to that of other methods of cyclodestruction, however, the proposed TSTT technique is much safer than the conventional trans-scleral cyclophotocoagulation.

[Molecular genetic aspects of glaucoma pathogenesis].

To improve our understanding of glaucoma pathophysiology it is important to investigate endophenotypes which are determined by heritable quantitative traits, such as intraocular pressure, vertical cup-to-disc ratio, optic disc area, and central corneal thickness. Glaucoma is associated with increased intraocular pressure and defects of trabecular meshwork and anterior chamber which lead to derangement of intraocular fluid outflow, progressive optic nerve degeneration, loss of nerve cells, and blindness. Factors that are not affected by intraocular pressure also contribute to glaucoma degeneration. In progressive degenerative diseases, such as glaucoma, chronic astrocyte activation exacerbates the damage to neurons and impairs the regeneration of their axons. This review considers the polymorphism of predisposition factors to glaucoma-associated endophenotypes, optic nerve degeneration, and side effects of antiglaucomatous drugs.

[Molecular genetic basis of age-related macular degeneration].

Visual loss due to age-related macular degeneration (AMD) is caused by one or both forms of advanced disease: "wet" (neovascular) or "dry" (geographic atrophy). Immune system plays a central role in pathogenesis and progression of both AMD forms. Main genetic polymorphisms associated with risk of AMD development and progression were found to be genes that regulate inflammation especially in complement factor H gen (1q31 locus) and 10q26 locus (PLEKHAI/ARMS2/HTRA1). Association of response to treatment and genotype was shown in patients with AMD. Complete characterization of both common and rare alleles that influence AMD risk is necessary for accurate determination of individual genetic risk as well as identification of new targets for therapeutic intervention.

[Rendering of primary health care to patients with trauma of visual organ].

This article is devoted to the actual problem of modern ophthalmology--primary health care in cases of mechanical ocular trauma. The article presents the information about the most common ocular trauma and secondary organs of eye, which can occur in the practice of the military doctor. The article includes epidemiological analysis of eye injuries in peacetime and wartime. The authors propose an algorithm for examining patients with damages of visual organs. They also suggest the most informative diagnostic techniques and manipulations that can be performed in a medical center of a military unit with the help of provided resources to the correct formulation of preliminary diagnosis and choice of evacuation destination of a wounded person. These diagnostic manipulations do not require special skills and can be carried out in a medical center of a military unit. In their article, the authors propose an approximate algorithm of therapeutic measures carried out using medicines of primary health care that can be performed in a medical centre of a military unit with a help of provided resources, with an indication of drugs, dosage and ways of injection. Performing the described list of simple treatment measures for eye care allows a high degree of probability to achieve the prevention of infectious and inflammatory complications of eye injuries and subsidiary organs. This article is intended to military doctors and paramedics.

[Role of Chlamydia trachomatis and Chlamydophila pneumoniae in damage of eye posterior segment structures].

AIM: Study the ability of Chlamydia trachomatis and Chlamydophila pneumoniae to damage structures of eye posterior segment, features of development of such infectious process, its morphological and clinical characteristics. MATERIALS AND METHODS: 6 rabbits with confirmed absence of C. trachomatis, C. pneumoniae were used in the study. 3 animals were infected with C. trachomatis culture and 3 animals--with C. pneumoniae culture. Subconjunctival and intravitreal mode of infectious agent introduction were used, as well as instillation of its culture into conjunctival sac. Microbiological diagnostics included microscopy with direct immunofluorescence, culture method and determination of antibody titers. Infectious process was studied by using ophthalmologic methods and histological examination. Observation period was 4 months. RESULTS: In all the animals a development of infectious process at early stages after the infection was confirmed. Conjunctivitis symptoms, inflammatory exudation into vitreous humor, chorioretinal inflammation loci, disorders in transparency of optical media and detachment of retina were clinical manifestations. In 2 animals infected with C. trachomatis severe panuveitis was noted. In 4 animals infectious process assumed subclinical characteristics (infection with both C. trachomatis or C. pneumoniae). In pathomorphologic studies data on the ability of C. trachomatis and C. pneumoniae to cause damage to cells of retina, pigment epithelium and choroid were obtained. CONCLUSION: C. trachomatis and C. pneumoniae may play a significant role in pathology of vitreous humor, retina, pigment epithelium and choroid.

[Comparative estimation of rehabilitative abilities after organ preserving operations for severe eye damages].

Postoperative analysis of rehabilitative potentialities in 59 patients operated on occasion of severe eye trauma with the use of various methods of ophthalmosurgery has been presented. It has been demonstrated that the method of organ preserving complex vitreoretinal surgery provided evading enucleation and retaining the damaged eyeball in 96.4% of cases. In 82.1% of cases it has been succeeded in retaining some vision functions and raising considerably the indices of life quality. It has been determined that properly made silicone tamponade provides the support of the necessary ophthalmotone and prevention of progressive growing of posttraumatic eyeball subatrothy--the most frequent outcome of a severe eye trauma.

[Comparative evaluation of therapeutic efficacy of early amnion covering the cornea, temporary blepharorrhaphy and its combination in severe alkali burns of the eye in the experiment].

In four groups of rabbits on model of a heavy alkaline burn of a cornea and a limbus of various extent character and outcomes of healing of an eye surface as a result of early (it is direct after a burn) applications is investigated: only conservative treatment - group I, conservative treatment + time blepharorrhaphy - group II, conservative treatment + covering of a cornea and a limbus of amnionic membrane - group III, and also combinations of conservative treatment, temporary of blepharorrhaphy and coverings of a cornea and a limbus amnionic membrane - group IV. In all groups conservative treatment included: an instillation of maxitrol within 14 days with transition to a mortgaging of Unguentum Tetracyclini of 1% 3 times a day. Depending on width of sector of the burn measured in circular degrees, each group included 4 subgroups: 60° - a subgroup "A", 120° " " - 180° - "B", 270° "Γ" - (on 4 eyes in a subgroup). Results estimated daily within the first 10 days, and further every 5 days (during 3 months) after a burn with photoregistration at colouring of an eye surface of 1% a solution fluorescein-natrium. On the basis of the received results it is established that the early fortnight time blepharorrhaphy (as addition to conservative treatment) is the most effective and accessible method (from considered) optimisation of healing of an eye surface at heavy burns of eyes with capture to 75% of the area of a cornea and a limbus.