[Effects of systemic drugs on the development of drug-induced retinopathy]. / Vliyanie sistemnykh preparatov na razvitie lekarstvennoi retinopatii.

This article reviews information on possible adverse events occurring in the organ of vision - in particular, the retina - after using systemic drugs, discusses the drugs that lead to drug-induced retinopathy most often, and describes histomorphological changes and modern understanding of the pathogenesis of damage to retinal structures.

[Efficacy of intravitreal dexamethasone implant as a starting monotherapy and when switching from an anti-VEGF drug in diabetic macular edema]. / Effektivnost' intravitreal'nogo implantata s deksametazonom v kachestve startovoi monoterapii i pri pereklyuchenii s anti-VEGF-preparata pri diabeticheskom makulyarnom oteke.

PURPOSE: To conduct a comparative assessment of the effectiveness of an intravitreal dexamethasone implant as a starting monotherapy and when switching from anti-VEGF therapy for macular edema in patients with diabetes mellitus. MATERIAL AND METHODS: The study involved 112 patients (112 eyes) with diabetic macular edema. The 1st group of the study included 58 patients (58 eyes) with newly diagnosed diabetic macular edema, who had not previously received special ophthalmic treatment. Group 2 included 54 patients (54 eyes) resistant to anti-VEGF therapy after 5 intravitreal injections of aflibercept. All patients underwent monthly spectral optical coherence tomography of the macular region, as well as visometry and tonometry during the follow-up period (6 months). RESULTS: The maximum therapeutic effect in both groups was observed 3 months after intravitreal introduction of the dexamethasone implant - in 94.8% and 92.5% of cases, respectively, it contributed to an improvement in the architectonics of the retinal layers, a decrease in retinal edema and an increase in visual acuity. At the same time, the most pronounced increase in BCVA (on average up to 0.66±0.1) was observed in patients of the 1st group. CONCLUSION: This study confirmed that an intravitreal dexamethasone implant can be recommended for newly diagnosed diabetic macular edema, as just one injection leads to resolution of macular edema and high functional outcomes, which persisted in 89.6% of study patients throughout the observation period.

[Intraocular correction of ametropia in patients with keratoconus]. / Intraokulyarnaya korrektsiya ametropii pri keratokonuse.

This review was conducted due to the growing number of patients with keratoconus requiring cataract surgery and the complexity of surgical planning. The article reviews preoperative planning, intraoperative options, and postoperative management, which can help obtain high functional results. Treatment of cataracts in keratoconic eyes requires a multifaceted approach. In some cases, in the preoperative period, interventions such as crosslinking and implantation of intrastromal segments or corneal ring may be required to ensure stable keratometry values for accurate intraocular lens (IOL) calculations. The use of stabilizing procedures prior to optical biometrics can assist in preoperative lens selection and provide predictable surgical outcomes. To achieve targeted refraction and reduce unwanted optical effects, it is necessary to take a critical approach when choosing the type of lens (toric, monofocal). This is due to the appearance of aberrations of different order after preliminary surgical interventions on the cornea. The intraoperative decision plays important role in choosing the position of the corneal incisions, how to use sutures for wound adaptation, choosing scleral approaches to minimize possible postoperative complications. In the postoperative period, the degree of irregular astigmatism and the need for rigid gas-permeable or scleral lenses should be assessed.

[Use of macular lenses in patients with age-related macular degeneration]. / Primenenie «makulyarnykh¼ linz pri vozrastnykh degenerativnykh izmeneniyakh setchatki.

The review presents the characteristics and results of clinical studies on implantation of different types of macular lenses (IOL-VIP system, Lipschitz Macular Implant (LMI), Fresnel Prism Intraocular, IOL AMD) installed in the capsular bag after phacoemulsification in patients with age-related macular degeneration (AMD). The literature review shows that up to now, the data on implantation of these lenses was contradictory and generally based only on short-term results. There are quite strict criteria for the selection of patients to evaluate the maximum possible postoperative visual rehabilitation of patients using special programs, the effectiveness of which largely depends on their commitment to postoperative, sometimes long-term treatment. Additional independent clinical studies with longer follow-up periods for patients with AMD are required to determine the efficacy and safety of macular lenses in order to recommend their use in wide clinical practice.

[Prognostic value of changes in the cornea and conjunctiva in diabetes mellitus]. / Prognosticheskoe znachenie izmenenii kon''iunktivy i rogovitsy pri sakharnom diabete.

Diabetes mellitus (DM) is the most common endocrine disease, and therefore a pressing medical and social problem. In many cases, ocular manifestations of DM are considered the particular cause of patients' disability. The review presents an analysis of morphological, experimental and clinical studies of the cornea in patients with diabetes mellitus - full articles, reviews and monographs of Russian and foreign authors, mostly those published in the recent years. Among the considered topics are modern methods of examining conjunctiva and cornea, clinical and morphological changes in these tissues, and the early diabetic changes in all their structural layers. The review also describes the importance of diabetes-related changes in the conjunctival vessels and corneal nerve fibers and shows the correlation between the densities of corneal nerve fibers and epidermal nerve fibers.

[Effect of internal limiting membrane peeling on morpho-functional state of the retina in patients with proliferative diabetic retinopathy (preliminary report)]. / Vliianie pilinga vnutrennei pogranichnoi membrany na morfofunktsional'nye pokazateli setchatki pri proliferativnoi diabeticheskoi retinopatii (predvaritel'noe soobshchenie).

PURPOSE: To compare morpho-functional parameters of retina during vitrectomy with and without internal limiting membrane (ILM) peeling in patients with proliferative diabetic retinopathy. MATERIAL AND METHODS: The study included 55 patients (55 eyes) that had underwent vitreoretinal surgery in the setting of antivasoproliferative therapy for proliferative diabetic retinopathy. Patients of the 1st group (n=27) underwent vitrectomy with silicone tamponade, 2nd group (n=28) received similar treatment with the addition of ILM peeling. Three months after the treatment, all patients had silicone oil removed. RESULTS: Best Corrected Visual Acuity before treatment was 0.06±0.02 in both groups; after the treatment it improved to 0.1±0.05 (p<0.05) in the 1st group and to 0.25±0.05 (p1-2<0.05) in the 2nd group. Thickness of the 'nerve fiber layer - internal limiting membrane' in the macular area was 28.67±2.21 µm in both groups before the treatment. By 3-month follow-up its thickness increased to 46.44±2.56 µm (p<0.05) in the 1st group due to the formation of epiretinal membrane (ERM). In patients of the 2nd group 'nerve fiber layer' area thickness amounted to 28.41±1.88 µm (p1-2<0.05) and ERM could not be identified in any of them. CONCLUSION: ILM peeling during vitrectomy with following silicone oil tamponade eliminates the risk of ERM formation in patients with proliferative diabetic retinopathy in the follow-up period of up to 6-month and results in better morpho-functional parameters in comparison with patients who received similar treatment but without peeling.

[Results of corneal crosslinking for pellucid marginal corneal degeneration]. / Rezul'taty lecheniia pelliutsidnoi marginal'noi degeneratsii rogovitsy metodom rogovichnogo krosslinkinga.

AIM: to evaluate the clinical effectiveness of crosslinking in patients with progressive pellucid marginal corneal degeneration (PMCD). MATERIAL AND METHODS: A total of 9 patients (16 eyes) with progressive PMCD were treated by standard crosslinking. The cornea was saturated with Dextralink solution and UV-A irradiated at 3 mW/cm2 for 30 minutes. The follow-up period was 12 months. RESULTS: One month after treatment, there was a slight decrease in uncorrected and best corrected visual acuity (UCVA and BCVA) - from 0.08±0.03 and 0.4±0.15 preoperatively down to 0.06±0.02 and 0.3±0.07, respectively, caused by pseudohaze of the cornea. Keratometric parameters (the average refractive power of the cornea, corneal astigmatism, and corneal thickness) did not change significantly. The demarcation line was identified in 56% of cases. By the 3-month follow-up, UCVA and BCVA improved up to 0.1±0.07 and 0.52±0.1, respectively. The refractive power of the cornea decreased by 2.0 diopters and corneal astigmatism - by 0.7 diopters reaching 46.8±2.7 and 5.1±1.3 diopters, respectively (p≤0.04). Central corneal thickness decreased by an average of 29 microns. The demarcation line remained visible in 25% of cases. At 6 months, BCVA averaged 0.58±0.13, at that, 56% of eyes gained 1 line and 31% - 2 lines. The refractive power of the cornea decreased down to 45.7±1.6 diopters, corneal astigmatism - down to 4.8±1.5 diopters. The demarcation line was not detected. At 1 year, there were no significant changes in the average values of optometric indices as compared to the 6-month period. Сonclusion. Pellucid marginal corneal degeneration should be regarded as a kind of primary ectasia, often bilateral and notable for its characteristic clinical picture and late onset. In progressive disease, photochemical crosslinking of the cornea contributes to the improvement of optometric parameters and stabilization of the process.

[Selective symptomatic therapy of macular edema due to occlusive processes in retinal venous system]. / . Simptomaticheskaia selektivnaia terapiia makuliarnogo oteka pri okkliuzionnykh protsessakh v sisteme retinal'nykh ven.

AIM: to evaluate the effect of dexamethasone intravitreal implant on the functional state of the eye in macular edema associated with central retinal vein occlusion. MATERIAL AND METHODS: The study included two groups of patients: group 1 (control group) - 8 patients (16 eyes) without ocular pathology and group 2 (study group) - 8 patients (8 eyes) with macular edema on the background of newly diagnosed thrombosis of the central retinal vein. All the patients from the study group underwent insertion of an intravitreal dexamethasone implant - Ozurdex. Best corrected visual acuity (BCVA) and retinal light sensitivity of the central visual field were followed up. The maximum follow-up period was 12 months. RESULTS: In group 1 (controls), BCVA averaged 0.93±0.2 and retinal light sensitivity of the central visual field - 19.01±1.18 dB. In group 2, baseline BCVA and retinal light sensitivity were 0.08±0.02 and 4.23±0.2 dB, 1 month after Ozurdex implantation - 0.21±0.04 and 11.77±0.98 dB, at 12 months - 0.23±0.17 and 5.2±0.78 dB, respectively. CONCLUSION: Macular edema associated with central retinal vein thrombosis has a strong deteriorating effect on the functional state of the eye. The dexamethasone intravitreal implant in patients with postthrombotic macular edema contributes to functional improvement, including BCVA and light sensitivity of the central retina, over the first year. At that, different functional parameters show different dynamics after dexamethasone treatment. Light sensitivity values, in contrast to BCVA, change unevenly and significantly during the year. Intravitreal implantation of a dexamethasone implant in patients with postthrombotic macular edema is an effective symptomatic treatment of occlusive processes within the retinal venous system.

[Ahmed valve in glaucoma surgery]. / Klapan Akhmeda v khirurgii glaukomy.

This is a review on Ahmed valve application in glaucoma surgery. It contains, in particular, data on the Ahmed valve efficiency, results of experimental and histological studies of filtering bleb encapsulation, examines the use of antimetabolites and anti-VEGF agents, and discusses implantation techniques. The current appraisal of antimetabolites delivery systems integrated into the Ahmed valve is presented. Various complications encountered in practice and preventive measures are also covered.

[Foveolar effects of dexamethasone intravitreal implant in central retinal vein occlusion].

AIM: To evaluate functional and morphometric parameters of the central retina in patients with postocclusive macular edema treated with dexamethasone intravitreal implant injection. MATERIAL AND METHODS: We examined 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema, including 4 men and 1 woman aged 55.8±3.65 years (experimental group). All the patients received a single injection of dexamethasone intravitreal implant. The maximum follow-up period was 12 months. The control group consisted of 5 presbiopic patients (10 eyes) aged 59.14±3.14 years. RESULTS: One month after injection, the best corrected visual acuity (BCVA) and central retinal light sensitivity improved (from 0.09±0.03 to 0.19±0.05 and from 3.18±0.19 to 11.07±0.97 dB, correspondingly), while foveolar thickness decreased from 425.36±57.87 to 273.75±36.65 µm. One year after the treatment, BCVA remained high and averaged 0.21±0.14. The total light sensitivity also remained higher than that at baseline, however, decreased down to 4.8±0.76 dB. Optical coherence tomography showed some flatness of the fovea. Foveolar thickness appeared 1.5 times higher than that in the control group and 1.2 times higher than that at the 1-month follow-up after dexamethasone intravitreal implant injection. Over the whole follow-up period, IOP has never significantly exceeded the baseline, optical media remained clear. CONCLUSION: 1. Dexamethasone intravitreal implant has been shown effective in resolving postocclusive macular edema, improving visual functions, and increasing central retinal light sensitivity within the first month after injection. 2. Positive changes in morphometric parameters of the central retina induced by the injection involve inner segments of photoreceptors as well as the outer nuclear, outer plexiform and inner nuclear layers. The morphofunctional effect persists for no less than 12 months after injection. 3. Over the 1-year follow-up period, there has been no negative influence of the implant on either intraocular pressure level, or lens transparency.

[Dynamics of riboflavin level in aqueous humour of anterior chamber of experimental animals under standard stroma saturation by ultraviolet corneal cross-linking solutions]. / Dinamika urovnya riboflavina vo vlage perednei kamery glaza eksperimental'nykh zhivotnykh pri standartnom nasyshchenii stromy rastvorami dlya ul'trafioletovogo krosslinkinga rogovitsy.

AIM: To evaluate the dynamics of riboflavin changes in the aqueous humour of the anterior chamber (AHAC) of rabbits' eyes during standard ultraviolet (UV) cross-linking with account to the area of corneal debridement. MATERIAL AND METHODS: Forty two rabbits were studied sequentially. The following solutions of riboflavin were used for cornea saturation: IR - 0.1% isosmotic riboflavin, D - Dextralink (0.1% riboflavin with 20% dextran), R - 0.1% riboflavin with 1.0% hydroxypropylmethylcellulose (HPMC). Each solution was evaluated in 3 groups that differed in the diameter of corneal debridement: group 1 - Epi-Off 3 mm (IR-3, D-3, P-3), group 2 - Epi-Off 6 mm (IR-6, D-6, R-6), and group 3 - Epi-Off 9 mm (IR-9, D-9, R-9). Aqueous humour sampling (252 samples in total) was performed in 10-minute intervals within a 60 minute period. Riboflavin levels were measured by enzyme-linked immunoassay (ID-Vit microbiological test system; Immundiagnostik, Germany). RESULTS: Stable growth rates of riboflavin level in the AHAC (with maximum values reached at 30-40 min) were observed for solutions D and R, regardless of the variant of corneal debridement. Moreover, throughout the whole follow-up period and regardless of the area of corneal debridement, the solution D provided a relatively lower concentration of riboflavin in the AHAC as compared to the two other solutions. At 30 minutes, when the cornea was considered ready for UV irradiation, the riboflavin level in the AHAC ranged from 385±26.1 µg/l (D-9) to 665±28 µg/l (R-9). In groups IR-9, IR-6, P-6, IR-3, and P-3 riboflavin levels were found to be in the same range starting at 20 minutes. However, even a sufficient concentration of riboflavin in the cornea or AHAC cannot guarantee safe and effective UV cross-linking, since the removed epithelium limits the area of the stroma that can be saturated with riboflavin, while the area of UV exposure is 8-10 mm. CONCLUSION: Safe and efficient standard UV cross-linking may be performed only under sufficient saturation of the stroma with riboflavin, which in turn depends greatly on the area of corneal debridement (should be at least 8-9 mm). A solution of 0.1% riboflavin and 1.0% HPMC enables quick and pronounced saturation of the stroma and, thus, can be used in the UV cross-linking procedure, including cases of insufficient corneal thickness.

[Ultraviolet Corneal Crosslinking].

This review presents basic information on UV corneal crosslinking. The method is widely used in ophthalmology to treat various types of ectasia, which are characterized by progressive degenerative changes in the cornea, associated with its thinning , hazing and scarring, which leads to a significant reduction in visual acuity. Crosslinking is based on ultraviolet (UV) irradiation of the cornea wavelength 370 nm in the presence of riboflavin, leading to photochemical intracorneal interactions. As a result of crosslinking of collagen treatments, an increase of strength and mechanical properties of the cornea, stops the progression of the disease. The article displays the steps of the method development and the ways of its implementation are described especially occurring biomechanical, biochemical, morphological and ultrastructural changes, as well as the main areas of clinical application of riboflavin-UV-A-induced crosslinking of cornea.

[Central retinal changes after ranibizumab injection for wet age-related macular degeneration].

AIM: to assess the dynamics of macular morphofunctional parameters in wet age-related macular degeneration after three injections of ranibizumab. MATERIAL AND METHODS: A total of 76 patients with classic choroidal neovascular membrane were examined. The latter could be seen on optical coherence tomography scans before the treatment as an optically heterogeneous formation beneath the neurosensory epithelium. The point of fixation was located 2-10 degrees from the fovea according to microperimetry testing. Wedge-like reduction of light sensitivity down to 0-2 dB corresponded to the area of neovascularization. RESULTS: Macular sensitivity improved from 7.24 ± 2.73 dB to 13.88 ± 1.94 dB (p < 0.05) after a course of three ranibizumab injections, the most significant changes taking place after the third one. The point of fixation moved somewhat back to the fovea after each injection. Morphological parameters of neovascular membranes gradually decreased: after the first injection the height went down to 20.29 ± 17.84 µm and the width--down to 1200 ± 300 µm on average, after the second one the height was 14.39 ± 9.83 µm, width--1000 ± 175 µm, after the third one the height and the width were 13.31 ± 8.13 µm and 900 ± 100 µm correspondingly (p < 0.05). CONCLUSION: Antivascular therapy reduces the pathological effect of neovascular membrane throughout the whole treatment period. The dynamics of studied parameters are characterized by an apparent response to the first injection, which indicates the advisability of further treatment.

[Results of fistulizing and Ahmed valve surgery for treatment of refractory glaucoma].

Surgical results of 76 patients (76 eyes) aged 25-79 years with secondary refractory glaucoma were analyzed. The best hypotensive effect and visual functions integrity were achieved with Ahmed valve implantation (86.7% and 83.3% of cases respectively); after conventional fistulizing surgery the hypotensive effect was observed in 45.5%, noncompromised vision--in 54.5% of cases. Tunnel trabeculectomy with iridocycloretraction led to normalization of intraocular pressure and stabilization of visual functions in 81.3% and 68.8% of cases respectively and thus can be considered as an alternative to fistulizing surgery in patients with secondary refractory glaucoma. Uveal glaucoma is a relative contraindication to Ahmed valve implantation, while neovascular glaucoma is that to tunnel trabeculectomy with iridocycloretraction.

[Morphometric assessment of the macula in spongiform macular edema treated with antivasoproliferative therapy].

Antivasoproliferative therapy is a pathogenetic treatment for diabetic macular edema. The objective of the study was to investigate the effect of ranibizumab on foveolar parameters in spongiform macular edema. A total of 37 patients (38 eyes) with spongiform macular edema were assessed and given antivasoproliferative therapy with ranibizumab. Optical coherence tomography showed a reduction of the total retinal thickness by 44 microm (from 306 +/- 77 microm to 262 +/- 30 microm, p < 0.05). The pigment epithelium thickness within the central area changed from 21 +/- 4 microm to 40 +/- 9 microm. The maximum decrease of the outer nuclear layer thickness was noted in 400 +/- 100 microm from foveola and averaged from 72 +/- 19 microm to 29 +/- 6 microm with its gradual increase to the periphery to 100 +/- 8 microm.

[Anti-VEGF-agents in treatment of neovascular glaucoma].

Neovascular glaucoma (NVG) is one of the most severe form of refractory glaucoma. Vascular endothelial growth factor (VEGF) is one of the strongest promoters of angiogenesis and was found to be the main neovascularization regulator. The use of anti-VEGF-agents is a rational option because in the majority of cases it allows to reach disappearance or reduction of neovascularization, that significantly reduces the risk of complications in following surgery or laser treatment of NVG.

[Conservative treatment of amblyopia].

Methods of conservative treatment of amblyopia are presented in the review. The paper includes information about pleoptics, physiotherapy, pharmacotherapy and examples of combined treatment of the amblyopic eye. Analysis of literature shows that this problem is an issue of concern and further research is needed.

[Corneal collagen cross-linking in keratoconus management].

Functional results of collagen UV cross-linking in keratoconus management are evaluated. 77 patients (87 eyes) with keratoconus stage I-II (Amsler classification) were under observation. All the patients received UV radiation (370 3m, 3mW/sm2) for 30 min with simultaneous instillation of "Dextralink" solution. Besides routine ophthalmological examination confocal biomicroscopy (HRT III, Heidelberg, Germany) and optical coherent tomography (Vizante-OCT, Carl Zeis, Germany) were performed before, in 1, 3, 6 and 12 months, 2 and 3 years after the procedure. By the 6th month the best corrected visual acuity showed improvement from 0.41 + 0.12 (M+m) till 0.52 + 0.01. Corneal refractive power decreased to 49.41 + 1.69 dpt by the last examination. UV cross-linking is a minimally invasive and effective option for management of keratoconus at the early stages, that let achieve biomechanical stabilization of the cornea and reduce progression rate.

[Endovitreal surgery in children].

As new technics in vitreoretinal surgery develop performance of miniinvasive procedures has become possible in children with ocular diseases associated with cataract (persistent hyperplastic primary vitreous, retinal detachment, vitreous synechia), retinopathy of prematurity, retinoblastoma, retinal detachment of different ethiology as well as for prevention of proliferative syndrome. Analysis of endovitreous surgical procedures in children allows to estimate advantages and falls of each technique, helps to find new techniques aimed to improve functional outcome and decrease unfavorable results of vitreoretinal surgery.

[Immunomodulatory role of perfluorane in the preoperative preparation of patients with rhegmatogenous retinal detachment].

The paper presents the results of studying the effect of 10% perfluorane (PF) emulsion intravenously injected 1-2 days before surgical treatment for rhegmatogenous retinal detachment on the levels of the cytokines IL-1beta, TNF-alpha, IL-6, and IL-4 in the serum and subretinal fluid of patients. PF infusion was found to exert an immunomodulatory effect that favored a short-term increase in the serum level of proinflammatory cytokines (IL- 1beta and IL-6) at week 1 and TNF-alpha on day 1) with their gradual normalization. The subretinal fluid showed recovery of the mechanisms for local immunological reactions; eye inflammation reduced due to the decreased production of proinflammatory cytokines and simultaneously the elevated level of the anti-inflammatory cytokine IL-4.