[Physical therapy - the main focus of modern ophthalmic rehabilitation]. / Fizioterapiya ­ osnovnoe napravlenie sovremennoi oftal'moreabilitatsii.

Ophthalmic rehabilitation consists of improving or maintaining the functions of the visual analyzer within the possibilities of the "therapeutic window". Ophthalmic rehabilitation involves physiotherapeutic methods, as well as additional ones that improve the condition of the body and indirectly affect the organ of vision. This article presents schematic algorithms of physiotherapeutic ophthalmic stimulation in neurodystrophic diseases of the visual organ and the main results of their multifactorial objective and subjective analysis. It was shown that even with the consistent visual resolution, treatment courses can help get positive changes at the level of nerve structures lasting for three to six months. This allows us to recommend physiotherapeutic ophthalmic stimulation for maintaining the therapeutic effects obtained after the main medical or surgical treatment.

[Choroidal neovascularization in central serous chorioretinopathy]. / Khorioidal'naya neovaskulyarizatsiya pri tsentral'noi seroznoi khorioretinopatii.

The literature review discusses the features of the pathogenesis, differential diagnosis and antiangiogenic therapy of choroidal neovascularization (CNV) associated with central serous chorioretinopathy (CSC), with particular attention given to the choice of antiangiogenic drug and therapy regimen to achieve optimal anatomical and functional outcomes in patients with CSC complicated by CNV.

[The potential of physiotherapy technologies in the rehabilitation of patients with non-exudative form of age-related macular degeneration (drusen)]. / Vozmozhnosti primeneniya fizioterapevticheskikh tekhnologii v oftal'moreabilitatsii patsientov s neekssudativnoi formoi vozrastnoi makulyarnoi degeneratsii (druzy).

Age-related macular degeneration (AMD) is currently the leading cause of vision loss in the elderly population worldwide. Despite the experience of using physiotherapeutic methods of treatment for non-exudative form of age-related macular degeneration, as well as the lack of clear criteria for its indication and evaluation of its effectiveness, the question of its advisability remains open. PURPOSE: Evaluation of the effectiveness of rehabilitation complex involving physiotherapy in the form of infrared and magnetic stimulation of the retina, aerogenation with Heliox21 and dry needling in patients with non-exudative AMD (drusen). MATERIAL AND METHODS: The study included 84 patients (168 eyes), among them 50 men and 74 women with stage 1 non-exudative AMD, aged 60 to 70 years old (average age 60±3.7 years), who were divided into 2 groups with comparable clinical and functional characteristics. Group 1 included 42 patients (84 eyes) who underwent ophthalmic neurostimulation consisting of daily infrared-magnetic stimulation of the retina for 10 days, 10 procedures of daily aerogenation with Heliox21 and 10 daily procedures of acupuncture. Group 2 included 42 patients (84 eyes) who received only basic parenteral therapy (Nutrof forte 1 tablet per day during the entire observation period), which was also the medication background in the main group. Visual acuity (VA), retinal OCT parameters, local photosensitivity and bioelectrical potential indices were assessed with mfERG. The control time points were before therapy, after 2 weeks, 3 months, 6 months and 12 months. RESULTS: After undergoing therapy with the described physiotherapeutic regimen, a positive effect on functional characteristics was noted - the level of light sensitivity of the central zone of the retina and the amplitude of the electrical biopotential have improved. The indicators of maximally corrected visual acuity and the structure of the ellipsoidal zone of the retina and the choroid did not change during the entire observation period. CONCLUSION: In patients with non-exudative form of AMD the developed ophthalmic rehabilitation complex involving infrared-magnetic stimulation of the retina, aerogenation with Heliox21 and dry needling promotes improvement of functional characteristics of the central retina in the form of increased maximal light sensitivity of the central retinal area and increased amplitude of bio-electrical potential.

[Pharmacological and physiotherapeutic methods of treating non-exudative age-related macular degeneration]. / Farmakologicheskie i fizioterapevticheskie metody lecheniya neekssudativnoi formy vozrastnoi makulyarnoi degeneratsii.

The non-exudative form of age-related macular degeneration (AMD) is a disease with long-term progression for which effective treatments have not been found. Many studies are being conducted to find effective drugs to prevent the appearance of drusen and increase in RPE atrophy area, which could help avoid this more dangerous form of AMD. The main drugs (nutraceuticals) that are used to treat the dry form of AMD are lutein, zeaxanthin and omega-3 fatty acids. Additionally, treatment may include nanosecond laser therapy for drusen in advanced AMD, panretinal subthreshold micropulse laser exposure for atrophic AMD, as well as microcurrent stimulation. Further research in this area should be aimed at understanding all the pathogenetic mechanisms associated with the development of AMD, and developing new approaches to the treatment of this disease including physiotherapy.

[Structural changes in the ocular anterior segment against elevation of intraocular pressure after repeated intravitreal injections]. / Izmeneniia struktur perednego otrezka glaza na fone povysheniia vnutriglaznogo davleniia posle povtornykh intravitreal'nykh in''ektsii.

Numerous studies have demonstrated the efficacy of anti-VEGF medications for exudative (wet) age-related macular degeneration (AMD). Significant IOP elevation is one of the side effects of anti-VEGF intravitreal injection. PURPOSE: To study the changes in the parameters of anterior segment of the eyeball against acute IOP elevation after repeated intravitreal injections (IVI) of anti-VEGF medication. MATERIAL AND METHODS: The study was conducted on a random sample of 45 patients (45 eyes) diagnosed with exudative (wet) form of AMD. All patients received two 0.05 ml intravitreal injections of ranibizumab with one-month interval. Measurements of IOP were performed with rebound tonometer Icare-Pro (ICare, Finland) before intravitreal injection, then one minute, 30 minutes and 3 hours after. The parameters of the ocular anterior segment, namely thickness and optical density of the cornea, volume and angle of the anterior chamber were evaluated by Scheimpflug imaging (Pentacam HR, Oculus, Germany) before IVI, and 15 minutes after. RESULTS: Statistically significant (p<0.05) elevation of IOP to 40 mm Hg (confidence interval 32-48 mm Hg) was recorded one minute after injecting 0.05 mL of ranibizumab solution into the vitreous cavity with IOP having the tendency for gradual normalization. When measured 15 minutes after IVI, the following parameters of the ocular anterior segment structures had reliably changed in the setting of elevated IOP: corneal thickness had increased to 27 µm (confidence interval 14-38 µm), corneal optical density - to 16.7 (confidence interval 10.4-19.5). No significant changes of either volume or angle of anterior chamber were revealed. Comparative analysis showed no significant changes of parameters after the 1st and the 2nd IVI. CONCLUSION: The revealed changes were transient in nature and did not require any corrections since all parameters returned to baseline after each injection.

[Changes in intraocular pressure after intravitreal injections]. / Izmeneniia urovnia VGD posle intravitreal'nykh in''ektsii.

At present, intravitreal drug injections are used for treatment of various diseases of posterior segment of the eye. Among its side effects is significant rise of intraocular pressure (IOP). PURPOSE: To study the changes in IOP levels after two intravitreal injections. MATERIAL AND METHODS: The study was performed on a random selection of 335 patients (335 eyes) diagnosed with choroidal neovascular membrane (CNVM). All the patients received intravitreal injections of ranibizumab according to medical indications. IOP was measured by rebound tonometer Icare-Pro (Icare, Finland) before intravitreal injection, as well as 1 minute, 30 minutes and 3 hours post-injection. Injection was repeated one months after the initial procedure. RESULTS: Intravitreal injection of additional liquid volume causes significant IOP rise, up to 38 mm Hg in average (confidence interval 30-45 mm Hg, p<0.05), with further tendency for IOP to self-normalize. After 30 minutes, IOP remained slightly higher than the initial level - 18 mm Hg (confidence interval 15-21 mm Hg, p<0.05). After 3 hours, IOP approached baseline level - 14 mm Hg (confidence interval 12-16 mm Hg, p<0.05). After the second injection, IOP was observed to decrease slower, causing more patients (28% compared to 21% after the first injection) to have IOP raised by 6 to 10 mm Hg from the initial level 30 minutes after the procedure. CONCLUSION: The revealed changes can serve as a pathophysiological model for studying changes of biometric parameters of anterior and posterior eye segments and biomechanical properties of fibrous tunic.