[Retinal vein occlusion management algorithm. Part 3. Neovascular complications]. / Algoritm vedeniya patsientov s retinal'nymi venoznymi okklyuziyami. Soobshchenie 3. Neovaskulyarnye oslozhneniya.

Neovascular complications severity in central/branch retinal vein occlusion (RVO) correlates with the level of occlusion and the degree of retinal perfusion disturbance. Large areas of retinal non-perfusion (more than half of the total retinal area) are associated with the risk for posterior segment neovascularization as high as 33% and for neovascular glaucoma - 45%. Over the past 30 years there has been an evident declining tendency of neovascular complications rates in the natural course of RVO. In ischemic RVO, anterior segment neovascularization is more aggressive than posterior. Neovascular glaucoma usually develops within the first 6 months of disease and correlates with uncontrolled arterial hypertension. Panretinal photocoagulation (PRP) is a standard treatment for anterior and posterior segment neovascularization in RVO patients. Anti-VEGF agents, if used as monotherapy, lead to rapid, however, short-term remission. Combination therapy, that is anti-VEGF injections and PRP, is the most effective. Intravitreal steroids have demonstrated no effect on ocular neovascularization. If PRP cannot be performed and intraocular pressure levels remain high, one should consider glaucoma drainage implant surgery. Preventive measures for neovascular complications that have proved effective so far include regular follow-ups, individually scheduled intravitreal injections, and PRP for large zones of ischemia.

[Retinal vein occlusion management algorithm. Part 1. Classification, diagnosis, and acute-stage treatment]. / Algoritm vedeniya patsientov s retinal'nymi venoznymi okklyuziyami. Soobshchenie 1. Klassifikatsiya, diagnostika i lechenie patsientov v ostryi period.

Considering an upward global trend in cardiovascular disease rates, retinal vein occlusion (RVO) in particular, development of therapeutic guidelines is a pressing issue in ophthalmology. Risk factors for RVO include hypertension, atherosclerosis, diabetes mellitus, blood disorders, inflammatory disorders, and prescription drug use. Three stages of RVO have been identified. By location, the entity can be divided into three big groups: central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemicentral retinal vein occlusion (HCRVO), each being either ischemic or nonischemic. Functional prognosis is better in nonischemic occlusions. Patient management comprises acute-stage treatment (anticoagulants, fibrinolytic agents, and hemodilution) and struggling with ocular complications (intravitreal injections and laser coagulation). It is essential that primary assessment and follow-up of patients at any stage of RVO include optical coherence tomography and fluorescent angiography.

[Retinal vein occlusion management algorithm. Part 2. Macular edema]. / Algoritm vedeniya patsientov s retinal'nymi venoznymi okklyuziyami. Soobshchenie 2. Makulyarnyi otek.

Macular edema (ME) is the most common complication of both ischemic and nonischemic retinal vein occlusion (RVO). If the main trunk of the central retinal vein is involved, ME occurs in 100% of cases. According to the Central Vein Occlusion Study, in 65% of RVO and ME patients with baseline visual acuity (VA) of at least 0.5 (Golovin-Sivtsev chart) or higher, ME may resolve itself without treatment with subsequent VA improvement. Therefore, we recommend a 3-month treatment-free follow-up of nonischemic central RVO (CRVO) and ME patients with VA of 0.5 or higher. If no improvement is noted within this period, treatment is initiated. Immediate treatment is required in patients with cystic ME revealed by optical coherence tomography (OCT) and VA below 0.5. Ischemic maculopathy is extremely unpromising. Modified grid laser photocoagulation should not be used as monotherapy for macular edema. Repeated corticosteroid (Ozurdex) and/or anti-VEGF (ranibizumab, aflibercept) intravitreal injections are considered the first choice treatment for ME in CRVO patients. Efficiency assessments should include monthly OCT. For persistent ME, intravitreal therapy can be supplemented by laser retinal photocoagulation (panretinal or modified grid). Anti-VEGF treatment schemes should be adjusted in BRVO patients as most of their edemas are self-limiting. Of laser photocoagulation techniques, only modified grid is used.

[Substantiating the mechanism of action of modified laser cyclocoagulation].

The authors studied in an experiment the processes of a limited and controlled inflammatory reaction after modified laser cyclocoagulation (MLCC) and estimated the content of adenosine triphosphate (ATP) and guanosine triphosphate (GTP) in the retina and optic nerve. Hypotensive and trophic MLCC were carried out in 36 grey Shinshilla rabbits (36 eyes) by the standard procedure. Thirty-six pair eyes without MLCC served as a control. Biochemical studies yielded estimates of changes in the content of ATP and GTP in the hypotensive and trophic MLCC and control groups. The experiment showed an increase in the levels of ATP and GTP in nmole. The performed experimental studies proved that ocular exchange processes became activated and the content of ATP and GTP increased.

[Photodynamic therapy in the treatment of diseases of the anterior and posterior eye segments]. / Primenenie fotodinamicheskoi terapii v lechenii zabolevanii perednego i zadnego otrezka glaza.

The article deals with the use of photodynamic therapy with regard for the modern choice of photosensitizing preparations and with regard for new-generation lasers, which reveal, to a full extent, the possibilities of the above treatment method. Examples of using the photodynamic therapy in the treatment of some oncology pathologies of various localizations, including the ocular pathologies, are depicted in the article. The use of photodynamic therapy at retinal diseases, caused by the onset of new-vascular membranes due to the age-related degeneration of the macular, is under discussion. The application of photodynamic therapy in the treatment of cystic filtration cushions, involving the technique offered by the authors, is described.

[Treatment of inflammatory conditions of the iris and ciliary body, accompanying fibrin exudation]. / Lechenie vospalitel'nykh sostoianii raduzhki i tsiliarnogo tela, soprovozhdaiushchikhsia fibrinoidnoi ékssudatsiei.

The paper presents a description of a new method for treatment of iris and ciliary body inflammation accompanied with fibrin exudation. We used low-level blue laser destroying a fibrin clot in its initial stage of formation. We also used herapin and ascorbic acid. In the absence of the greatest impact urokinase was additionally administered.

[Effects of trans-scleral laser cyclo-coagulation on intraocular pressure and visual function in patients with far advanced open-angle glaucoma]. / Vliianie transskleral'noi lazernoi tsiklokoaguliatsii na vnutriglaznoe davlenie i zritel'nye funktsii u bol'nykh otkrytougol'noi dalekozashedshei glaukomoi.

Transscleral diode laser cyclocoagulation was modified so that laser coagulants (20-25 applications) were applied not only to the ciliary crown, but to the flat part of the ciliary body as well. Inflammation modulators forming after coagulation thus enter aqueous humor and the vitreous body and penetrate into the retina and optic disc, causing dilatation of capillaries and stimulating the blood stream in them. Forty patients (40 eyes) with far advanced glaucoma and pronounced concentrical narrowing of the visual field were operated on and observed for 6-12 months postoperation. One month after the intervention intraocular pressure decreased by 9-21 mm Hg and was below 22 mm Hg in 38 eyes; visual acuity increased by 0.1-0.3 in 11 cases; visual field widened in all patients. These results did not appreciably change till the end of the period of observation.

[Efficacy of pilocarpine and timolol maleate combination in therapy of glaucoma]. / Effektivnoct sochetaniia pilokarpina i timolola maleata v lechenii glaukomi.

The authors assessed the effects of a single instillation and prolonged use of pilocarpine, thymolol maleate, fotyl, and fotyl-forte on the ophthalmic tone and some ocular functions in 118 patients (202 eyes) with glaucoma. The duration of pilocarpine effect is 6-8 h, that of thymolol maleate, fotyl, and fotyl-forte more than 24 h. The most expressed reduction of intraocular pressure was observed after fotyl and fotyl-forte (32-40% of initial level). Moreover, these agents showed the highest hypotensive activity upon prolonged (up to 6 months) use. Intraocular pressure normalized in about 70% patients. The hypotensive effect of fotyl-forte is somewhat higher than that of fotyl, but patients complain of pain after instillation of fotyl-forte 2-3 times more frequently than after fotyl.

[The hypotensive action and side effects of the carboanhydrase inhibitor dorzolamide hydrochloride]. / Izuchenie gipotenzivnogo deistviia i pobochnykh éffektov ingibitora karboangidrazy dorzolamida gidrokhlorida.

Effects of a carboanhydrase inhibitor 2% dorsolamine hydrochloride solution (Trusopt) on intraocular pressure and some ocular functions have been studied in patients with primary open-angle glaucoma (POAG): 10 patients aged 56 to 72 (16 eyes) with POAG and 5 patients aged 60 to 68 (8 eyes) with normal ophthalmic tone administered a single instillation of Trusopt and 15 subjects aged 63 to 82 (21 eyes) with POAG to whom Trusopt was administered three times daily for 14 days. A single instillation of the drug resulted in a reliable decrease of intraocular pressure both in glaucoma patients and subjects with normal ophthalmic tone. Maximal lowering of intraocular pressure was recorded 2 hours after instillation, by 21.4% of initial, on average. The hypotensive effect persisted for 12 hours (8.9% reduction of intraocular pressure). 80% of examinees complained of a sensation of short-term burning in the eye directly after instillation. Prolonged use of Trusopt was associated with a tendency to boosting the hypotensive effect: after 12 hours intraocular pressure was 15.4% lower than initially. Tonography showed a reliable (18.5%) reduction of aqueous humor production.

[The phasic structure of early disorders of functional capacity following irradiation in rats]. / Fazovaia struktura rannikh narushenii deesposobnosti posle oblucheniia krys.

In experiments with rats it was shown that an early decrease in physical efficiency after irradiation involves some partially mutually superimposed phases. Phases of excitation, hypokinesia and neurological disorders are identified in early transient inefficiency followed by phases of an early transient diminution of efficiency and a reversible disturbance of the accomplishment of the known operations. Simultaneously, there is a phase of an irreversible decrease of the informational capacity of CNS as well as the tolerance to early transient in efficiency upon repeated exposure.