[Ophthalmic manifestations of COVID-19]. / Oftal'mologicheskie proyavleniya COVID-19.

In March 2020 the World Health Organization (WHO) declared a pandemic of the novel coronavirus infection (COVID-19) caused by the SARS-CoV-2 respiratory virus. The high spread rate of the virus and the severity of the course of the disease are of great clinical and epidemiological significance, making it relevant for ophthalmologists to study the mechanisms of how SARS-CoV-2 infects ocular structures, as well as possible clinical manifestations of the infection in the organ of vision. This review contains analysis, systematization, and generalization of epidemiological and clinical data on SARS-CoV-2 ocular lesions and was carried out with the data found in scientific abstract databases. The article presents main clinical ophthalmic manifestations of COVID-19, lists the utilized schemes of etiotropic and symptomatic therapy, recommended preventive measures, and considers the possible ophthalmic complications after vaccination against COVID-19.

[Efficacy and safety of a fixed combination drug Brinzolol Duo in the treatment of patients with primary open-angle glaucoma]. / Effektivnost' i bezopasnost' primeneniya novoi fiksirovannoi kombinatsii Brinzolol Duo pri lechenii pervichnoi otkrytougol'noi glaukomy.

PURPOSE: To evaluate the efficacy and safety of a new fixed combination of brinzolamide and timolol in patients with stages I and II of primary open-angle glaucoma (POAG). MATERIAL AND METHODS: Study patients were divided into 2 groups. The patients of the first group were prescribed Brinzolol Duo, the second group received an original drug Azarga. Regimen for both drugs was 1 drop 2 times per day for 84 days. The study included 7 monitoring visits: visit 0 (screening - 124 patients), visit 1 (randomization and treatment initiation - 120 patients), visits 2-4 (therapy), visit 5 (end of therapy - 117 patients), visit 6 (follow-up, study completion). RESULTS: Out of 120 patients included in the study, 117 subjects had completed all study procedures. It was shown that both compared drugs significantly reduce intraocular pressure (IOP). After 3 months, 46.5% of patients in the Brinzolol Duo group and 46.9% of patients in the Azarga group had IOP lowered by more than 30% compared to baseline, with IOP amounting to ≤18 mm Hg in 36.6% and 30.2% of patients, respectively. Hypotensive efficacy and safety of the drugs were comparable between the groups (p>0.05). The drugs were well tolerated, all adverse events (AEs) were mild or moderate in severity. CONCLUSION: The new drug Brinzolol Duo (brinzolamide + timolol) significantly reduces IOP in POAG patients with efficacy comparable to Azarga.

Optical coherence tomographic patterns in patients with retinal vein occlusion and macular edema treated by ranibizumab: a predictive and personalized approach.

PURPOSE: To establish the morphological and functional parameters to predict the effectiveness of intravitreal injections (IVI) of ranibizumab in macular edema due to retinal vein occlusion and to develop a mathematical model for personalized treatment algorithms. MATERIAL AND METHODS: This is a retrospective study of 98 patients (98 eyes) with macular edema, who received IVI of ranibizumab and were followed up for 12 months. Spectral optical coherence tomography scans and best corrected visual acuity (BCVA) assessments were conducted every 3 months. Treatment outcome predictors were calculated based on logistic regression analysis. RESULTS: The most significant prognostic factors for the long-term BCVA were baseline BCVA (OR 11.1, p = 0.001), foveal volume (OR 10.8, p = 0.001), destruction of external limiting membrane (OR 15.8, p = 0.001), photoreceptor inner/outer segments (OR 11.1, p = 0.001) and retinal pigment epithelium (OR 9.1, p = 0.001). It has also been discovered that post-treatment BCVA correlated with the height of serous retinal detachment (SRD) (r = -0.4, p = 0.001), ganglion cell complex thickness (r = + 0.3, p = 0.01) and focal loss of ganglion cells (r =-0.3, p = 0.005). Patients without SRD required fewer ranibizumab injections (3.8 ± 1.1) for macular edema fluid resorption compared to those with SRD (5.7 ± 1.2, p = 0.03). A mathematical model for predicting and personalized approach therapy of ranibizumab has been obtained (accuracy of 89%). CONCLUSION: The effectiveness of IVI of ranibizumab depends on baseline morphological and functional changes. The obtained mathematical model allows for predicting the outcomes of therapy, determining individualized algorithms to increase the treatment effectiveness and to prevent low vision that corresponds to the principles of predictive, preventive, and personalized medicine.

[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.

[A model of primary open-angle glaucoma: manifestations and outcomes].

OBJECTIVE: To determine the expected duration of the disease and the age of the patients with different stages ofprimary open-angle glaucoma complicated by pseudoexfoliation syndrome (PES) and/or patients with pseudoexfoliation glaucoma (PEG). METHODS: The study protocol included data from 120 patients (50 males (41.7%), 70 females (58.3%)); 189 eyes; 102 right eyes; 87 left eyes). The first study group (28 patients, 44 eyes) comprised patients with suspected glaucoma. The second group (53 patients, 84 eyes) consisted ofpatients with early glaucoma. The third group (21 patient, 33 eyes) included patients with advanced glaucoma, the forth group (18 patients, 28 eyes) comprised patients with terminal glaucoma. Mean age of the patients at diagnosis was 61.6 (58.4; 66.9) years and 66.9 (63.4; 72.8) years at the endpoint visit in 2013. In all cases, diagnosis was made in accordance with the differential diagnostics system and confirmed by special diagnostic techniques. The database included data from 3 qualified examinations taking account of the results of tonometry and static automated perimetry. RESULTS: The mean expected age of the patients age at the onset of blindness was 75.1 years. The occurrence of the event was limited to a period of 6.1 years. Mean age at the time of possible glaucoma development was 59.58 (56.14; 64.36) years. The disease itself could develop within 3.24 (-5.38; -1.2) years prior to diagnosis. CONCLUSION: Studies for glaucoma diagnosis should be focused on the age group of 55-60 years. The degree of IOP reduction in patients with advanced glaucoma does not agree with the Russian glaucoma society recommendations which accounts for progression of the disease.

[Ophthalmologic electromagnetic stimulator OFTEMAGS]. / Oftal'mologicheskii électromagnitnyi stimuliator OFTEMAGS.

The design of an OFTEMAGS ophthalmological electromagnetic stimulator, its new therapeutical factor (the pulse low-frequency field combined with a static magnetic field), and its brief specifications) are dealt with. A procedure for treating eye diseases and recommendations how to use the therapeutical factor in ophthalmology are given.

[Spatial contrast sensitivity in the differential diagnosis of optic neuritis]. / Prostranstvennaia kontrastnaia chuvstvitelnost v differentsialnoi diagnostike opticheskikh nevritov.

Contrast sensitivity was examined in patients with optic neurites of different etiology. Achromatic and chromatic (red-black, green-black, and blue-black) sinusoidal patterns were presented in succession against the black background at a frequency of 1-22 cycles/degree on the monitor of an IBM computer. Contrast sensitivity was found altered during exacerbation of optic neuritis on both involved and intact eyes, this indicating a possible involvement of the chiasmal region. The authors discuss a new approach to investigation of the mechanisms of impairment of the optic nerve in optic neuritis in the presence of disseminated sclerosis and neuritis of obscure etiology.

[The indices from an electrophysiological study of the eye in herpetic lesion of the cornea]. / Pokazateli élektrofiziologicheskogo issledovaniia glaza pri gerpeticheskom porazhenii rogovitsy.

Electrophysiologic studies were conducted in 34 patients with herpetic lesions of the cornea (35 eyes with the active process and 33 clinically healthy fellow eyes). The control group included 30 healthy persons (60 eyes). In the control group, the threshold of electric sensitivity of the eye was 25.1 mcA, on the average. In the examined groups, it increases to 31.9 mcA (p less than 0.0017) in the group of patients with herpetic keratitis and to 28.7 mcA (p less than 0.05) in the group of patients with clinically healthy fellow eyes. The average value of optic nerve lability was 54.5 Hz in the control group. Reduced lability was recorded in group I--48.6 Hz (p less than 0.001) and in group II--52.6 Hz (p less than 0.02). No statistically significant differences in electrographic values were found. The electrophysiologic studies of eyes with localization of herpetic process in the cornea have shown the involvement of internal layers of the retina and the optic nerve into the pathological process. Similar changes appear in the clinically healthy fellow eyes as well, but to a lesser degree. The determination of the threshold of electric sensitivity and lability of the optic nerve can be used for diagnosing changes in internal layers of the retina and the optic nerve in herpetic keratitis.