[Protocol of intravitreal drug delivery. Consensus of the Expert Counsil of Retina and Optic Nerve Diseases of the All-Russian Public Organasation «Association of Ophthalmologists¼]. / Protokol vypolneniya intravitreal'nogo vvedeniya lekarstvennykh preparatov. Konsensus Ekspertnogo soveta po zabolevaniyam setchatki i zritel'nogo nerva Obshcherossiiskoi obshchestvennoi organizatsii «Assotsiatsiya vrachei-oftal'mologov¼.

Intravitreal drug administration is a procedure that has become widespread in modern ophthalmology. However, there is no global consensus on certain aspects of this manipulation, and practitioners feel the need for guidelines. In the Russian Federation, until now, such a document was not available. The expert council on diseases of the retina and optic nerve of All-Russian public organization «Association of Ophthalmologists¼, with participation of invited specialists, has studied and analyzed the existing foreign guidelines for performing intravitreal injections, as well as the regulatory framework in Russia. As a result, this Protocol was developed and approved for use in the healthcare system of the Russian Federation. The document regulates the requirements for specialists and organizations, the conditions for performing the procedure and the necessary material resources and presents an algorithm for performing intravitreal drug administration, a patient examination check-list for various conditions of the procedure, as well as parameters for evaluating and monitoring the quality of the procedure.

[Isolated lesion of the optic nerve and retina as a relapse of MALT lymphoma transforming into diffuse B-large cell lymphoma]. / Izolirovannoe porazhenie zritel'nogo nerva i setchatki kak proyavlenie retsidiva MALT-limfomy s transformatsiei v diffuznuyu B-krupnokletochnuyu limfomu.

Neuroleukemia is a severe complication of hemoblastosis, which manifests as lymphoblastic lesions of the brain and cranial nerves. Isolated damage to one of the cranial nerves is rare. The diagnosis is based on the results of ophthalmoscopy, magnetic resonance imaging of the orbits, and lumbar puncture. Literature describes isolated cases of retinal and/or optic nerve damage in the absence of blast cells in the spinal fluid. These are the most difficult situations for timely diagnosis of neuroleukemia. The article describes a patient with MALT lymphoma transformed into diffuse B-large cell lymphoma manifesting as leukemic infiltration of the optic nerve and retina without brain damage and absence of blast cytosis in the spinal fluid. The diagnosis of neuroleukemia was established based on the results of cytological examination of the punctate of the infiltrated peripapillary retina and confirmed by regression of changes in the fundus against the background of antitumor treatment. The vital prognosis for patients with neuroleukemia is unfavorable. However, early diagnosis of leukemic infiltration of the optic nerve and/or retina can restore visual acuity of the affected eye and significantly improve the quality of life.

[Combined laser treatment of glaucoma]. / Kombinirovannoe lazernoe lechenie glaukomy.

The main objectives of glaucoma treatment are normalization of IOP and slowing of the progression of glaucomatous optic neuropathy. They are achieved using conservative (medicated), surgical and laser methods. PURPOSE: To study the effectiveness of non-penetrating hypotensive laser sclerotomy (NHLS) in patients with non-stabilized primary open-angle (I-III) b glaucoma with previous laser trabeculoplasty and who are receiving drug therapy. MATERIAL AND METHODS: The study included 54 patients (102 eyes) with initial (38 eyes), developed (46 eyes) and advanced (18 eyes) glaucoma who were examined and operated on. 26 patients (46 eyes) were instilled a combined drug containing brinzolamide and timolol, 28 patients (56 eyes) received prostaglandin F2α analogues (PGA). Intraocular pressure (IOP) levels were 27±2.4 mm Hg. RESULTS: Reduction of IOP was observed in 89% of patients 2 weeks after NHLS with gradual improvement during the first 3 months of the follow-up; in 71% of patients the results preserved by the 6th month. Patients receiving combination of brinzolamide and timolol had more pronounced IOP reduction after NHLS amounting to 2.4±1.8 mm Hg in the first 3 months. By the end of the observation period IOP levels remained within normal range, drug therapy was ceased in 16 patients (21 eyes, 20.6%), 32 patients (67 eyes, 65.7%) achieved normalized intraocular pressure with antihypertensive therapy, and 9 patients (9 eyes, 8.8%) were referred to surgical treatment. CONCLUSION: Non-penetrating hypotensive laser sclerotomy (NHLS) allows measured reduction of IOP in various glaucoma stages achieving controlled and persistent hypotensive effect. In the group of patients receiving combination of brinzolamide and timolol, the effect is statistically significant and clinically superior when compared with patients receiving PGA.

[Combination therapy in patients with concomitant macular edema and proliferative diabetic retinopathy]. / Kombinirovannaia terapiia pri sochetanii makuliarnogo oteka i proliferativnoi diabeticheskoi angioretinopatii.

Diabetic macular edema (DME) is a serious complication of diabetic retinopathy. Numerous multicenter studies of the effectiveness of various treatment methods for DME do not give unambiguous recommendations for the treatment of refractory DME, and combinations of various forms of therapy continue to be actively studied. PURPOSE: To study the effectiveness of the combination of intravitreal administration of the drug Ozurdex with subsequent individually selected laser therapy in the treatment of the proliferative stage of diabetic retinopathy in patients with concomitant chronic DME, and its relationship with morphological changes in the retina observed with optical coherence tomography. MATERIAL AND METHODS: This retrospective study included 18 patients with insulin-requiring type II diabetes mellitus complicated by diabetic retinopathy in the proliferative stage and refractory DME. According to morphological changes observed with optical coherence tomography of the retina, the patients were divided into 3 groups: 6 patients with diffuse macular edema, 6 patients with cystic macular edema, and 6 patients with serous detachment of the retinal neuroepithelium. All patients underwent intravitreal injection of 0.7 mg Ozurdex followed by panretinal laser coagulation. The choice of laser applicates with the minimal parameters giving a therapeutic effect was carried out according to the procedure described previously (Patent No. RU2611887C1 d.d. 12/25/2015). RESULTS: The combination of intravitreal administration of Ozurdex followed by individually selected laser coagulation is effective against various morphological types of DME. However, the greatest visual acuity was achieved in patients with diffuse macular edema and retinal neuroepithelial detachment. CONCLUSION: The higher the initial visual acuity, the better the functional outcomes of the treatment. Baseline retinal thickness did not affect the effectiveness of the proposed method of treatment. Cystic macular edema was an unfavorable prognostic factor for improving visual acuity.

Hypoxia as pathogenic factor affecting the eye tissues: The selective apoptotic damage of the conjunctiva and anterior epithelium of the cornea.

The effect of acute hypoxia on the occurrence of apoptosis in eye cells in rats placed in a pressure chamber was studied. Selective primary lesion of cells of the conjunctiva and the anterior corneal epithelium was found. A possible role of the simulated hypoxic conditions in the dry eye syndrome pathogenesis, which is accompanied by primary lesion of cells in the anterior eye surface tissues is discussed.

[Low contrast non-color vision in patients with multiple sclerosis]. / Nizkokontrastnoe cherno-beloe zrenie u bol'nykh rasseiannym sklerozom.

OBJECTIVE: Vision impairment is one of the most typical characteristics of multiple sclerosis (MS). This pathology develops due to the lesions of optic nerves and optic tracts in the brain or eye movement dysfunction. Low contrast vision impairment is very frequent and early detected. We assessed low contrast non-color vision in patients with MS. MATERIAL AND METHODS: We examined 56 MS patients and 33 healthy controls. Computed optometric testing was used (grey-colored digits of the standard size were shown against the background of the different shade of grey on the computer monitor). RESULTS AND CONCLUSION: The results demonstrated low-contrast vision dysfunction while high-contrast vision remained intact. The level of low-contrast vision in MS patients differed significantly from that in the controls. The higher severity of visual disturbances was identified during high illumination. The direct correlation between the degree of low-contrast vision dysfunction and the level of disability on EDSS was found.

[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.