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D. V. Angelova, E. E. Kazaryan, N. Yu. Shkolyarenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-508-512

Abstract:
There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.
A. V. Tereshchenko, I. G. Trifanenkova, E. V. Yerokhina
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-451-458

Abstract:
Purpose: to study the features of the anatomical and topographic relationships of the eye’s anterior segment structures in children with stage 5 ROP in the cicatricial period with the method of ultrasound biomicroscopy and optical coherent tomography of the anterior segment and to evaluate the possibility of using the data to optimize the surgical treatment of ROP.Patients and methods. For the period 2015–2018 in the Kaluga branch of the Fyodorov Eye Microsurgery, 68 children (118 eyes) with 5 cicatricial ROP stages were examined and treated. Gestational age at birth varied from 24 to 31 weeks, body weight at birth — from 630 to 1600 grams. Age at the time of the survey ranged from 5 to 15 months. All children underwent the complex diagnostic examination, which included biometrics, tonometry, ultrasound ophthalmoscanning in B-mode, as well as UBM and OCT of the anterior segment of the eyeball. The extent of fixation of retrolental opacities to the posterior lens capsule, the presence of cystic cavities and retinal folds at the periphery, traction detachment of the ciliary body were determined. OCT of the eye anterior segment was performed in the presence of iridocorneal contact in order to clarify its length. As a result, a comprehensive detailed assessment made it possible to clarify or reject the characteristics identified by UBM, as well as determine the phasing and develop an individual plan of the operation in each case.Conclusion. The use of complex diagnostic examinations, including UBM and OCT of the eye anterior segment in patients with 5 cicatricial PH stages, allows to optimize the tactics of surgical treatment in the advanced stages of the disease.
L. K. Moshetova, O. I. Abramova, K. I. Turkina, M. K. Nurbekov, O. P. Dmitrenko, , S. A. Kochergin
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-330-335

Abstract:
Visual impairment in elderly people is a serious problem that significantly affects the quality of life of millions people around the world. The magnitude of this problem is becoming increasingly apparent as the population ages and the number of older people increases. Age-related macular degeneration (AMD) is the third leading cause of blindness worldwide and the main cause of vision loss in people over 60 years. It is expected that AMD will affect about 288 million people by 2040. AMD is a multifactorial disease with a progressive course. The arised dystrophic changes in the retina cannot be reversed by any of the known treatment methods. A lot of research and effort has already been invested in identifying various biomarkers for predicting the incidence rate, identifying people at risk, finding out the pathogenetic mechanisms of this disease, and finding effective methods of treatment and prevention.Aging is the basis of pathological changes that occur during AMD. Aging biomarkers are measurable vital signs that qualitatively and quantitatively change with the age of the body. DNA methylation is a molecular mechanism that is a potential biomarker of aging. Sirtuins indirectly participate in this process, regulating the activity of the DNMT1 enzyme. The article discusses current knowledge of the mechanisms underlying the action of sirtuins (Sirtuins / SIRT), with an emphasis on SIRT1. Analysis of the pathophysiological action of sirtuins can affect the prevention and treatment of pathological eye changes associated with AMD. The article provides literature sources containing the results of studies of the effect of SIRT1 as a marker of aging in body tissues. SIRT1 is an attractive candidate for developing therapeutic strategies preventing early eye aging, in particular, age-associated diseases such as AMD The impact on the genetic mechanisms of this disease is a promising direction in treatment.
I. A. Gndoyan
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-309-320

Abstract:
The ophthalmologist often raises the issues about using of various vitamins, trace elements and other nutrients for the prevention and treatment of the different ocular diseases at their practice. The significance of this problem is caused by the importance of the vision for the socialization of modern person, as well as the high intensity of the visual analyzer using both in the process of performing professional occupation and in the usual indoor/outdoor activities. The issues of the supplemental support in pediatric ophthalmology are especially important, as today formation of the visual organ in children develops under increased visual stress. For the total population, including children, of the industrialized countries the most typical form of vitamin deficiency is subnormal vitamin supply, which occurs among almost healthy children of different ages. The supplemental support issues should be considered in relation to certain types of ocular pathology in children. The most common problem today among children is myopia with projected high increase of this refraction anomaly magnitude in the future. The oxidative stress is the main pathogenesis factor of many degenerative diseases development, including myopia. It is considered as the oxidative stress is realized due to both endogenous processes and various external factors impact, including ultraviolet radiation. Not only vitamins with antioxidant properties (A, C, E), but the trace elements (zinc and copper), bioflavonoids (anthocyanoides) and xanthophilic pigments (lutein, zeaxanthin) are necessary to stabilize myopia and to prevent the development of degenerative diseases in adulthood. These substances are involved in the most important physiological and biosynthetic processes in the sclera, retina and other eye structures and render an influence on its microvessels and hemodynamics in general. All these substances are not synthesized in the human body, and in order to maintain metabolism and homeostasis the sufficient alimentary intake should be provided beginning with early age. The complex drugs, which include multipotential and synergistic active substances, are of particular interest.
V. G. Likhvantseva, E. V. Korosteleva, T. E. Borisenko, M. M. Skopintseva
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-407-413

Abstract:
Purpose: to study the features of eye hydrodynamics in patients with thyroid dysfunctions.Patients and methods. The material for this study was the results of a survey of 43 patients (86 eyes) with thyroid dysfunctions: 23 people (46 eyes) with primary untreated hypothyroidism (PGT) and 20 people (40 eyes) with primary untreated thyrotoxicosis (PTT). There weren’t ophthalmic hypertension and glaucoma There weren’t signs of ophthalmic hypertension and glaucoma in the patients included in this study at the stage of primary ophthalmologic diagnostics.Results. Correlation analysis revealed a causal relationship between the ratio of T4 / TSH hormones, on the one hand, and indicators of secretion of aqueous humor per unit of time and ease of outflow, on the other hand. In the group of patients with hypothyroidism, a weak linear inverse correlation was found between the ratio of free thyroxine and thyroid stimulating hormone and the minute volume of aqueous humor: according to the regression model, an increase in the ratio of T4 / TSH hormones by 1 was accompanied by a decrease in the minute volume of aqueous humor by 3 units. In patients with thyrotoxicosis, a statistically significant inverse linear correlation was found between the ratio of the T4 / TSH hormones and the coefficient of ease of outflow. According to the regression model, with an increase in the ratio of hormones T4 / TSH by 1, the coefficient of lightness of outflow decreases by 5 units. The presence of thyroid receptors in the cytoplasm and nuclei of the endothelium cells of the trabecular apparatus, the nuclei of fibroblasts forming the stroma of the trabeculae, as well as in the nuclei of the pigment and non-pigment epithelium of the processes of the ciliary body substantiates the molecular basis of the causal connection of thyroid dysfunctions with hydrodynamic disorders The conducted studies confirm the modern concept that the control of regulation of the tissue and organ homeostasis is carried out by the coordinated interaction of 3 systems: nervous, endocrine, and immune. Regression modeling clearly shows a pronounced causal relationship between thyroid dysfunctions and hydrodynamic processes in the eye.Conclusion. The results of clinical studies demonstrate the fact of controlling regulation by hydrodynamic processes at the eye level by the endocrine system, explain the possible mechanism on a morphological basis, and reveal the potential of a new therapeutic strategy.
S. V. Trufanov, E. V. Sukhanova, A. A. Tyurina
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-344-350

Abstract:
Modern corneal refractive surgery provides high efficiency, safety, predictability and stability of the different ametropia kinds correction’s clinically-functional results. However, in overwhelming percentage of cases, having spent some time after surgery patients complain about discomfort, eyes dryness, burning, feel gritty, redness, blurred and vision instability. Complaints mentioned above are caused by the appearance of transitory dry eye syndrome. Main etiology and pathogenesis factors of this disease are presented in this review. The results of dry eye syndrome classical diagnosis methods have been analyzed, as well as modern techniques, characterized by high specificity and sensitivity, which allow to increase the dry eye’s diagnostics accuracy. The study of the dry syndrome after corneal refractive surgery is devoted to a huge number of works of domestic and foreign authors. However, at present time there is no unique algorithm for assessing the damage of the ocular surface before and after corneal refractive surgery, which would include a set of high-precision and specific techniques for quickly and reliably evaluate the severity of dry eye syndrome, allowing to develop preventive measures and pathogenetically oriented treatment and, thereby, accelerate rehabilitation of patients after surgery. Research continuation is needed in this direction.
V. I. Kotelin, M. O. Kirillova, M. V. Zueva, I. V. Tsapenko, A. N. Zhuravleva, O. A. Kiseleva, А. М. Бессмертный
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-398-406

Abstract:
Purpose: To evaluate the possibility of registration of the photopic negative response (PhNR) without pupil dilatation in healthy individuals to determine the dysfunction of neurons of the inner retina.Methods: 12 healthy persons (23 eyes) aged 24 to 40 years were examined. Refraction anomalies did not exceed 0.5 diopters. A PhNR was evaluated in photopic ERGs recorded on a blue background with red flashes of four intensities (0.375, 0.75, 1.5, 3.0 cd·s/m2) using the RETIport/scan21 (Roland Consult). First, ERG was recorded with the natural pupil (3.5 ± 0.2 mm). Then, the recording was repeated after drug mydriasis (average pupil size 8.7 ± 0.1 mm).Results. In eyes with natural pupil width, in comparison with drug mydriasis, PhNR amplitudes in responses to weakest stimuli (0.375 cd·s/m2) were significantly reduced. The effect of pupil size on the PhNR amplitude from a baseline was virtually absent in responses to higher strength flashes. This phenomenon can be associated with an irregular distribution of light over the retina with small pupil size, the effect of which is maximal in responses to weak flashes. For the maximal brightness stimuli (3.0 cd·s/m2), differences were found between groups of non-dilated and dilated pupils in the amplitudes of the b-wave and PhNR from the b-peak, which may reflect a decrease in the number of stimulated photoreceptors during ganzfeld stimulation when the pupil is not dilated.Conclusion. The effect of pupil size on the parameters of the PhNR was most significant in the ERG with minimal flash strength and it decreases in responses to flashes of higher brightness. If it is necessary to record the ERG without drug mydriasis, especially in screening studies, it is recommended to limit the protocol to estimate the PhNR from a baseline in responses to maximal flashes, and use the relative parameter — the amplitude ratio of PhNR/b. Keywords: photopic negative response, electroretinography, pupil width
D. F. Belov, V. P. Nikolaenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-490-494

Abstract:
Purpose: to assess effect of eye drops instillation on the refractive power of the cornea and potential intraocular lens (IOL) power calculation errors appearing related within.Patients and methods. There were 478 patients divided in 3 groups: 1st — patients without glaucoma and topical treatment (n = 325); 2nd — individuals with primary open angle glaucoma (POAG) on treatment (n = 122); 3rd — patients with POAG and previous trabeculectomy (TE) without using eye drops (n = 31). For each patient keratometry was performed by IOL-Master 500. Mean preoperative keratometry and corneal astigmatism were compared within IOL calculation error received by Barrett Universal II formula 1 month after phacoemulsification (PE).Results. Mean keratometry was significantly (p < 0.001) less (0.6 D) at the 1st group (44.00 ± 1.96 D) versus 2nd group (44.6 ± 1.76 D). Cancellation of topical eye drops due to TE leads to insignificant decline of corneal curvature (from 44.6 ± 1.76 D to 44.1 ± 1.59 D). There was no any difference in corneal astigmatism level between study groups (0.92 ± 2.23 D, 0.8 ± 0.59 D and 0.86 ± 0.50 D for groups respectively) as like as no distinction in IOL calculation error in these groups (–0.08 ± 0.57 D, –0.06 ± 0.6 D and 0.003 ± 0.61 D). However, men have more flatter cornea (43.6 ± 1.98 D) than women (44.4 ± 1.80 D) (p < 0.001). Mean keratometry at the age group 60–74 years was less (43.7 ± 2.3 D) than at 75–90 years (44.4 ± 1.54) (p = 0.002).Conclusion. Patients with coexistent cataract and glaucoma on treatment require special attention in IOL calculation. To avoid keratometric errors it is recommended to prescribe lubricants and change hypotensive eye drops to preservative-free analogs to form a stable tear film.
V. V. Brzheskiy, S. Yu. Golubev, O. I. Lebedev, E. S. Milyudin, A. S. Apostolova, A. V. Surov, E. L. Efimova, E. V. Varlashina, I. N. Gorbachevskaya, V. O. Kirichenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-481-489

Abstract:
The purpose: to evaluate the effectiveness of the Delfanto® in the complex therapy of patients with dry eye syndrome of various etiologies and severity of the clinical course.Patients and methods. 114 patients (228 eyes) with dry eye syndrome of various etiologies were examined: 72 patients with chronic meibomian blepharitis and dysfunction of the meibomian glands (xerosis due to increased evaporation of the tear film), 33 women with perimenopause (a mixed form of xerosis with a predominant decrease in the production of components of the tear film) and 9 persons with Syegren syndrome (xerosis due to a pronounced decrease in tear production). All patients received individually selected tear replacement therapy over the past weeks and the drug was not replaced throughout the study. At the same time, patients with mild and moderate clinical course of SSG for 30 days received Delfanto® at a dosage of 60 mg, and with severe course — 120 mg per day.Results. All patients on the background of complex therapy showed a significant decrease in the severity of subjective manifestations of the dry eye syndrome, an increase in the of the tear film stability and indicators of tear production. At the same time, the dynamics of changes in these parameters of the course of the xerotic process increased as the therapy continued, reaching a maximum by the 30th day. The maximum effect of Delfanto® in the complex therapy of patients with dry eye syndrome was observed in patients with chronic meibomian blepharitis. Moreover, patients with a mild clinical course of cornealconjunctival xerosis were the most susceptible to the therapy.Conclusion. The effectiveness of the complex therapy for patients with dry eye syndrome can be significantly increased by prescribing Delfanto® in a daily dose of 60 mg for mild and moderate xerosis and 120 mg — for severe disease. Delfante® can be recommended for widespread clinical use in complex treatment of patients with various clinical and pathogenetic forms of dry eye syndrome.
V. M. Merabishvili, E. N. Merabishvili
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-495-501

Abstract:
Malignant tumors of the eye and its adnexa (C69) relates to rare tumors. Until 2011, this group of tumors was not included to the official cancer report in Russia.Purpose: to investigate the incidence of malignant tumors of eye and its adnexa (C69) in the population of St. Petersburg, to consider the dynamics of a complex of analytical indicators. Standard methods of statistical analysis, state reporting materials and data from the St. Petersburg Population Cancer Register were used. Malignant tumors of the eye and its adnexa (С69) were started to be officially registered only from 2011 onwards, however not in full as only Form 7 that allows to calculate morbidity was filled in. Other information could be obtained from the databases of the Population Cancer Registers (PRR), organized in the country in the late 90’s. Each year, more than 1,000 thousand (e.g.1977–2017 year) cases of malignant tumors of eye and its adnexa (С69) are detected in the whole country. In 2011, 925 cases were diagnosed. In Russia, the crude rate of malignant tumors of the eye and its adnexa (С69) has increased from 2011 to 2017 years from 0.65/100,000 in 2011 to 0.73/100,000 in 2017, respectively, +12.3 % (both sexes), standardized, eliminating the difference in the age composition of the population, remained almost unchanged –0.54 0/0000 and 0.53 0/0000. The standardized incidence rate in men of malignant tumors of eye and its adnexa (С69) in 2017 was 0.58 0/0000, women –0.49 0/0000. The state reporting for malignant tumors of eye and its adnexa (С69) does not provide for the distribution of these patients by age, stage and other parameters. State mortality statistics do not provide for the review of the C-69 heading ICD-10. All of this led us to conduct in-depth analysis of the dynamics of morbidity and mortality of eye cancer on the basis of the PRR database of SaintPetersburg. An insignificant increase in the incidence rate of the Russian population of the eye cancer, completely associated with the aging of the population, has been established. Positive increase in the observed and relative survival of patients has been also revealed.
A. V. Kuroyedov, P. Ch. Zavadski, A. Yu. Brezhnev, V. V. Gorodnichii, I. R. Gazizova, A. V. Seleznev, O. N. Onufriichuk, Yu. I. Razhko, Z. M. Nagornova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-519-526

Abstract:
Purpose. To study the influence of personal protective equipment (PPE) of the respiratory and visual systems on the development and progression of dry eye syndrome (DES) and its relationship with other risk factors for medical workers.Patients and methods. The data of 243 people (male — 22.2 %, female — 77.8 %) were analyzed as part of a multi-center analytical scientific one-step study. Total tear production (Schirmer I test) was studied at the beginning and the end of the working day in persons used PPE of respiratory system (disposable medical face mask, gauze masks or different types of respirators), as well as PPE of the eyes (protective half-closed/closed glasses or protective screens). Risk factors for the development and progression of DES were registered (age, smoking, systemic hormones intake, soft contact lenses), as well as the use of artificial tears.Results. A decrease in the Schirmer I test score at the end of a 7–8 hour work shift was found by an average of 3 mm (from 13 (9; 16) mm to 10 (6; 15) mm, p < 0.001). Statistically significant changes were typical mainly for medical personnel (p < 0.001) with the maximum severity in persons working in outpatient sector. The presence of at least one DES risk factor was found in 30.5 % of patients, two factors — in 3.0 %, and three or more — in 7.0 %. There was no influence of risk factors on the degree of changes in total tear production. Reduced tear production is typical for some PPE of respiratory system (disposable masks and respirators) and the eye (screens and half-closed glasses) (p < 0.001). In people who do not use PPE of the eye, significant changes were detected only in the presence of risk factors.Conclusion. The negative influence of various PPE of the respiratory system and eye on the total tear production was established. The decrease in the results of the Schirmer I test by the end of the working day was 20–25 % of the basic level, regardless of the presence of traditional risk factors for DES. The severity of changes depended on the type of PPE used. The data obtained are particularly relevant during the new COVID-19 coronavirus pandemic and justify the need to establish specific prophylactic measures. One of the possible methods is the preventive use of artificial tears.
I. A. Makarov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-414-421

Abstract:
Purpose. The study of color deficiencies prevalence in young people, students of higher educational university.Materials and methods. The study was carried for the half year — fall semester. A total of 1,609 students were examined, aged 17–21. There were 1191 boys and 418 girls. The survey was conducted to determine the health groups in physical training and in various sports sections. An ophthalmologic examination determined refractive disorders and other ocular pathology, which is important for determining health groups. Rabkin polychromatic tables and Neitz color vision test (Neitz Lab (UW Medicine) were used for determining of color deficiencies. The obtained results of these tests were compared in terms of the time spent on the test, the results of the test effectiveness, the determination of dissimulation, and the assessment of the shift in the color spectrum in individuals with impaired color perception.Results. A total of refractive disorders were detected in 856 students (53.2 %). The high degree of myopia was in 40. Disorders of color deficient were noted in 101 students (8.48 %) of 1191 male subjects when using the Neitz color test. Dichromatic eye changes were observed from 2.1 % students: protanopia and deiteranopia were in 0.67 % and 1.43 %. Most of all there were violations with the perception of shades of light brown and light green colors. A third of healthy students noted the impossibility of distinguishing light brown from light gray. This is regardless of the state of refraction. Simultaneous violations of the perception of shades of red, green, yellow and blue were observed in one subject, it was associated with congenital cataracts. In four young people, acquired eye diseases caused. In two girls, violations of the perception of a pastel shade of light green were noted, with one girl (0.24 %) having a violation in two eyes, and was presumably due to a gene anomaly. The second girl had one eye and was associated with partial atrophy of the optic nerve after the optic neuritis.Conclusions. Neitz color test expands the diagnostic possibilities, since in its design it has pastel shades of light green and light brown colors on a gray background, reduces the likelihood of dissimulation, reduces the time of the survey. Neitz color test allows to expand the possibilities for more accurate and differential diagnosis dichromatic and anormal trichromatic subjects and acquired color vision defects.
S. V. Saakyan, E. B. Myakoshina, M. R. Khlgatyan, N. V. Sklyarova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-465-472

Abstract:
Purpose: To study the features of small choroidal melanoma and choroidal nevi angioarchitectonics using the optical coherence tomography angiography (OCTA).Patients and methods. We examined 128 patients with small choroidal neoplasms: 41 — with small choroidal melanoma (group 1), 42 — with suspicious nevi (group 2) and 45 — with benign nevi (group 3). All patients underwent general ophthalmic examinations and special instrumental diagnostic methods (ultrasound examination (US), fluorescence angiography (FA), spectral optical coherence tomography (SOCT), OCTA).Results. OCTA in all patients with small choroidal melanoma showed neovascular network under retinal pigment epithelium. We found a looped, cranked-twisted, heterogeneous vascular network with uneven clearance and with numerous bends and weaves, located under the vessels of retina. The limiting avascular zone corresponding to the tumor slope was determined in 19 (46.3 %) of 41 cases. There was a rim of dilated hyperreflective choriocapillaries on the periphery of the tumor. We identified hyperreflective homogeneous enlarged choriocapillaries in the focus area with a brighter glow than the surrounding choriocapillaries in 39 (92.9 %) of 42 patients with suspicious choroidal nevus. We detected an avascular zone with surrounding extended hyperreflective choriocapillaries in the center of the nevus in 3 (7.1 %) of 42 cases. We diagnosed homogeneous isoreflective choriocapillaries similar in brightness to the surrounding vessels in all 45 patients with benign nevi.Conclusions. Thus, the complex of clinical and instrumental methods, including OCTA, makes it possible to establish the diagnosis of malignant tumor of the choroid in early stages. At the same time, OCTA: 1) allows to visualize of the tumor vessels in the choroidal layer in 100 % of cases of in small choroidal melanoma; 2) makes it possible to distinguish the newly formed tumor vessels from the choriocapillaries in case of small choroidal melanoma; 3) provides an opportunity to establish the correct diagnosis and provide timely assistance to patients with benign and malignant choroidal tumors.
O. L. Fabrikantov, A. V. Sukhorukova, S. V. Shutova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-459-464

Abstract:
The paper considers the problems of the early glaucoma diagnosis before the development of the marked glaucomatous optic neuropathy. Special attention is paid to the methods of computer perimetry, which are important in diagnosing the presence or progression of glaucoma.Purpose. To create the computer program “perimetric calculator” that performs mutual recalculation of perimeter data of HFA and HEP without additional perimetric studies, as well as calculation of diagnostic information content of perimeter parameters with different “cut-off points” of HFA and HEP parameters.Patients and methods. 56 patients (85 eyes), including 16 men and 40 women aged 55 to 84 years (mean age 64.9 ± 6.4 years). All patients were divided into 2 groups: group I — 23 healthy subjects (40 eyes) without any signs of glaucoma; group II — 33 patients (45 eyes) diagnosed with the initial stage of primary open-angle glaucoma.Results and discussion. The study revealed the comparability of the standard automated perimetry (HFA) results and Heidelberg edge perimetry (HEP), determined the most informative diagnostic criterion (MD/HEP). According to the obtained results, a computer program was created, it included two modules: the first — diagnostic information content of perimeter parameters with different “cut-off points”, the second-mutual recalculation of HFA and HEP parameters.Conclusions. This computer program allows calculating the main indices of diagnostic information content of the perimeter parameters (sensitivity and specificity) at different “cut-off points”, gives the results of calculating the values of sensitivity, specificity and accuracy for at least 150 threshold values, allows performing mutual recalculation of the parameters of the standard automated perimeter (HFA) and Heidelberg perimeter (HEP).
O. V. Kolenko, E. L. Sorokin, N. S. Khodzhaev, N. V. Pomytkina, G. V. Chizhova, Ya. E. Pashentsev, L. E. Kolenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-389-397

Abstract:
Purpose. To study the correlation between pregnancy, complicated by preeclampsia and gestational hypertension (GH), and formation of retinal vascular and optic nerve disorders in the late postpartum period.Patients and methods. 231 women with different previous pregnancy variants of pathology. Exclusion criteria — presence of systemic endocrine, autoimmune, rheumatic pathology before pregnancy; bad habits. Four groups were formed. 1st main group: pregnancy with GH. 2nd main group: pregnancy with preeclampsia. 1st comparison group: pregnancy on the background of pre-existing hypertension, without proteinuria. 2nd comparison group: edema and/or proteinuria during pregnancy, without hypertension. The control group — physiological process of pregnancy. Period of ophthalmological examination after pregnancy is 6–12 years.Results. Development of various vascular and ischemic disorders of posterior eye segment occurred in 70 women (30.3 %). The periods of their formation after previous pregnancy varied from 3 to 11 years. Their frequency in the 1st and 2nd main groups was statistically significantly higher. The most common were retinal vein occlusion and post-thrombotic retinopathy. The negative outcomes of transferred GH and preeclampsia are no eliminated with delivery and can manifest next years and even decades after it.Conclusion. Нigh risk factors for development of vascular and ischemic disorders of posterior eye segment are transferred preeclampsia, especially with its early onset (20–24 weeks), or premature birth (26–28 weeks); pregnancy, complicated by GH. The risk of developing this eye pathology is highest in women aged 38–40 years and over.
S. A. Korotkikh, A. G. Grinev, M. B. Sviridova, A. M. Danilov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-361-367

Abstract:
The method of phacovitrectomy can be used for surgical treatment of patients with cataract and asteroid hyalosis. However, there is still a topical question in the choice of surgical treatment taking into account the completeness of the posterior hyaloid membrane (PHM) detachment.Patients and methods: the study involved 24 patients (24 eyes) with cataract and asteroid hyalosis. The average age of patients was 72.9 years, out of the total number of men — 11, women — 13. Pre-and postoperative diagnosis of all patients included standard methods of investigation, as well as optical coherence tomography performed on the Cirrus HD-OCT 400, Carl Zeiss, Germany. Pre-and postoperative subjective satisfaction was assessed using a validated visual Function Qusetionnaire 14 ophthalmological questionnaire. Patients were divided into 3 groups. In the first group of patients, cataract phacoemulsification with posterior chamber lens implantation and total three-port vitrectomy through a flat part of the ciliary body were performed. In the second patients’ group, cataract phacoemulsification with posterior chamber lens implantation and subtotal vitrectomy through posterior capsulorexis were performed. In the third group of patients, cataract phacoemulsification with posterior chamber lens implantation was performed. All operations were performed with the help of ophthalmic systems Infinity Vision System (Alcon, USA) and Constellation Vision System (Alcon, USA).Results: in the first day after the operation, all patients noted improvement in visual acuity and quality of life, but more significant improvement was noted in patients of the first and second groups.Conclusion: analysis of the results of surgical treatment, questionnaire survey, preoperative diagnosis allowed to develop an algorithm for choosing the method of surgical treatment in patients with cataract and asteroid hyalosis, taking into account the state of PHM.
E. E. Grishina, A. A. Ryabtseva, O. M. Andryukhina, A. A. Kovrizhkina
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-375-381

Abstract:
Neuroleukemia is a severe complication of hemoblastosises characterized by infiltration of blast cells of the meninges, the substance of the brain, cranial and peripheral nerves.The purpose. To analyze the clinical manifestations of leukemia with optic nerve damage in leukemia and malignant lymphomas.Patients and Methods. From January 2016 to January 2020, one center-based non-randomized prospective study was conducted on patients with leukemia and non-Hodgkin’s lymphomas who were treated in the hematology department of MONIKI and made complaints about reduced vision. 26 patients were examined, 4 of them were diagnosed neuroleukosis with leukemic infiltration of the optic nerves: three women aged 41, 44, 46 years and a man aged 50 years.Results. All patients had one common ophthalmological symptom — decreased visual acuity. Complaints of reduced vision in one patient appeared at the onset of the disease, in other patients-during a relapse. The picture of the eye’s fundus in all patients was identical: the optic disk had blurred borders, and elevated above the retina. In the first days, the vascular funnel was viewed, then closed by infiltration. A dense white infiltrate of the peripapillary retina spread over the entire macular area. The retinal veins were sharply dilated of uneven caliber. Along the course of the vessels, there were a large number of different sizes and shapes of hemorrhages. Various types of neuroleukemia with lesion of the optic nerve were described: a combination of focal lesions of the brain and the optic nerve, isolated damage to the optic nerve with blast cytosis in the cerebrospinal fluid (CSF), isolated damage to the intraocular part of the optic nerve without changing the cerebrospinal fluid. In three patients the diagnosis of neuroleukemia exhibited on the basis of changes according to magnetic resonance imaging (MRI) and/or the number of blast cells in punctate liquorologic research. In the fourth patient, in the absence of changes in the liquor and MRI, the diagnosis of leukemic infiltration of the optic nerve was confirmed by data from a cytological examination of a punctate from the peripapillary retina. After the beginning of antitumor treatment, the significant improvement visual acuity and decrease in leukemic infiltrate of the optic disc and retina of the affected eye was noted in all patients.Discussion. Damage of the optic nerve can develop both at the onset of the disease, and relapses of leukemia or aggressive non-Hodgkin’s lymphomas. Leukemic infiltration evolves in all parts of the optic nerve, but more often affects its intraocular portion. The damage to the intraocular part is characterized by the presence of a dense infiltrate both in the area of the papilla and the peripapillary retina.Conclusion. Leukemic infiltration of the optic nerve is manifested by a significant decrease in visual acuity. Careful attention to complaints of reduced vision in patients with leukemia can help to recognize the development of the disease’s debut or its progression. Timely antitumor treatment leads to an improvement in visual acuity and, consequently, an improvement in the quality of life of patients.
S. I. Rychkova, V. G. Likhvantseva
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-435-441

Abstract:
The work is devoted to one of the most actual problems of current strabismology — the development of effective ways to study binocular vision.The purpose — to study the effectiveness of the developed modification of the Bagolini test in the diagnostics of binocular disorders.Patients and methods. 240 patients with non-paralytic strabismus aged from 6 to 17 (on average 10.8 ± 0.24) years were observed. There were 190 patients with converging strabismus and 50 patients with diverging strabismus. The control group consisted of 180 children aged also from 6 to 17 (on average 10.9 ± 0.3) years without ophthalmopathology. All children were examined for the character of vision using a Worth-test, the classic Bagolini test (CTB), and the developed modified Bagolini test (MTB). If the patient has a strabismus angle, the study was performed in two variants: without prismatic deviation compensation (under the subjective angle of strabismus — SU) and under full prismatic compensation (under the objective angle of strabismus — OU). For qualitative assessment of binocular vision with MTB, static presentation of the test image was used, for quantitative assessment — alternating (alternate presentation of details corresponding to the right and left eyes).Results. The qualitative evaluation data obtained with the help of MTB made it possible to differentiate patients with non-permanent regional functional scotoma of suppression (FSP) and patients with stable bifoveal fusion among children with binocular vision by color test, and to distinguish patients with regional stable FSP and total FSP among children with monocular vision by color test. In the study under SU, the sensitivity of the method was 97.8 % and specificity 96.2 %, under OU — 96.6 % and 92.7 %, correspondingly. Using quantitative evaluation, it was found that the minimum duration of monocular phases required to eliminate functional inhibition in children with total FSP is twice as long as in children with regional FSP (z = 6,303, df 52, p < 0.001 according to the Mann — Whitney criterion).Conclusion. Thus, the modified Bagolini test developed by us is an effective way of qualitative and quantitative assessment of the state of binocular vision. The method has a high sensitivity and specificity, combines the capabilities of anaglyphic and phase haploscopy, and can be used for a personalized approach to the selection of conditions and modes of functional correction of binocular disorders, as well as for monitoring binocular vision during treatment.
E. A. Drozdova, O. V. Zhiliaeva
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-382-388

Abstract:
Purpose: to determine the features of myopic choroidal neovascularization (mCNV) using optical coherent tomography-angiography (OCTA) in patients with complicated myopia during anti-VEGF therapy.Patients and methods. A prospective study of 25 people (40 eyes) with complicated myopia was carried out, which consisted in a comparative analysis of the qualitative and quantitative OCTA characteristics of 29 eyes with myopic CNV and 11 paired intact eyes. OCTA was used in the Angio Retina and Angio Analytics modes based on automatic software. The phenotypic features of CNV before treatment, during anti-VEGF therapy (Ranibizumab) and at the end of the observation period were taken into account.Results. The average follow-up period is 26.12 (12.36; 35.02) months. Two mCNV phenotypes were established: glomerular (44.83 %) and flat (55.17 %) as regularized (18.75 %) and tangled (81.25 %) vascular network patterns. Hypointensive peripheral halo during the entire period of the neovascular complex activity was visualized regardless of the phenotype. Significant differences in the flat phenotype were revealed: neuroepithelial detachment (87.50 %) was more common, the Select Area and Flow Area of the neovascular complex was significantly greater both before treatment and at the end of the observation period, the mCNV course of continued growth after injection of anti-VEGF did not occur, recurrence rate is much higher. The area and perimeter of the foveal avascular zone (FAZ) in the eyes with mCNV increased significantly by the end of the observation. The acirculatory index (AI) was determined to be significantly higher, and the Retinal capillary flow density in the fovea region 300 μm wide around the FAZ (FD) was lower in the eyes with mCNV compared to the control group. The nonactive neovascular complex were characterized by depletion of the vascular network with a predominance of intervascular space, vessels in the form of a residual skeleton, blindly end, dim, small capillaries and end loops are missing. Halo with nonactive CNV is not found.Conclusion. OCTA identifies the features of the course of myopic CNV depending on the phenotype, allows to evaluate the effectiveness of anti-VEGF therapy and the degree of progression of degenerative changes in the macular region.
I. G. Ovechkin, I. S. Gadzhiev, A. A. Kozhukhov, E. I. Belikova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-422-428

Abstract:
Optical-reflex treatment of patients with myopia and computer visual syndrome with a concomitant asthenic form of accommodation asthenopia seems relevant and not fully developed. The basic provisions that determine the tactics of treatment are monocular exposure in order to increase the absolute accommodation rate and staging (outpatient room, home conditions) of training. Measures aimed at improving the effectiveness of optical reflex treatment at home include the development of alternative instrumentation with reasonable (in accordance with the clinical and physiological characteristics of the functioning of the ciliary muscle of the eye) optical, amplitude and temporal parameters of the training process.
N. M. Kislitsyna, S. V. Novikov, N. V. Perova, S. V. Kolesnik, A. I. Kolesnik, M. P. Veselkova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-3-473-480

Abstract:
Intravitreal use of vital dyes in combination with the action of endoillumination can induce a cyto- and phototoxic effect on posterior eye segment structures. The search for a staining agent with a maximum safety profile to retinal structures, intensively and selectively coloring vitreous body and vitreoretinal interface structure, remains relevant.Objective: to determine comparative viability of NIH / 3T3 mouse fibroblast cell culture with traditional agents for chromovitrectomy and “Vitreocontrast” suspension with and without endovitreal illumination.Materials and methods. NIH / 3T3 mouse fibroblast cultures contacted with agents for chromovitrectomy (MembraneBlue® Dual, Triamcinolone acetonide, “Vitreocontrast” suspension) and the corresponding controls in a volume of 50 μl / well. The test plate was irradiated with a Photon II illuminator (Synergetics, USA), working distance of 5 mm. The control tablet with the introduced preparations was not exposed to light. Next, the cells were washed and incubated, after which the morphology and lysis of the cells, as well as the number of proliferating relatively negative control of fibroblasts, were evaluated using the vital dye PrestoBlue Cell Viability Reagent. Negative control was the complete growth medium for the cultivation of mouse fibroblasts of the NIH / 3T3 line. The results of the cytotoxic reaction of a culture of mouse fibroblasts of the NIH / 3T3 line were interpreted using the table “The degree of cell response”.Results. Studies have shown that exposure to a source of endovitual illumination does not affect the cytotoxic effect of TA suspension and MembraneBlue® Dual dye. The TA suspension, both after light source and without it, has a moderate cytotoxic effect, and MembraneBlue® Dual has no cytotoxic effect on the culture of mouse fibroblasts of the NIH / 3T3 strain. Without light, “Vitreocontrast” suspension does not have cytotoxic effect on mouse fibroblasts culture NIH / 3T3 line. Light irradiation for 1 h increases the cytotoxicity of “Vitreocontrast” suspension to the level of unsharp cytotoxicity allowed by ISO Standard 10993-5-2011.Conclusion. The safety profile of MembraneBlue® Dual and “Vitreocontrast” suspension allows them to be recommended for use in endovitreal surgery. The cyto- and phototoxicity demonstrated in the experiment with TA suspension can reduce the functional outcomes of retinal surgery.
Е. P. Gurmizov, К. B. Pershin, N. F. Pashinova,
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-209-215

Abstract:
Purpose. Evaluation of the visual and refractive results of additional correction using LASIK and PRK methods in patients with residual refractive error after previous cataract surgery. Patients and methods. The prospective open study included 57 patients (79 eyes) who previously underwent cataract phacoemulsification (n = 37) or refractive lensectomy (n = 42) with various IOL models implantation (2012–2017). The average age of patients was 50.8 ± 13.9 (19–79) years. Operations LASIK (91.1 %) and PRK (8.9 %) were carried out according to standard methods. In 6 cases, femtosecond laser supported by laser correction. The target refraction ranged from –0.25 to 0.25 D in most (97.5 %) cases. The follow-up period ranged from 6 to 9 months. Results. The patients were divided into groups according to the type of residual refractive error (Group 1 — myopia, group II — emmetropia and group III — hyperopia). Statistically significant differences were determined for the species of previously implanted IOLs — in group II, the frequency of monofocal IOLs was significantly higher (p < 0.05). In group II, the values of the cylindrical component of refraction were significantly higher compared with groups I and III (p < 0.05). In group I, a significant (p < 0.05) decrease in the spherical component of refraction from –1.36 ± 0.92 to –0.2 ± 0.8 D was observed. In patients of group II, there was a slight increase in the spherical component of refraction from 0 ± 0.20 to 0.25 ± 0.29 D (p > 0.05). In group III, a significant (p < 0.05) decrease was observed in the spherical component of refraction from 1.27 ± 0.69 to 0.43 ± 0.49 D. When analyzing the cylindrical component of refraction in group I, its decline was noted from –0.69 ± 0.5 to –0.38 ± 0.46 D (p > 0.05). In group II, the largest decrease in the cylindrical component was observed from –1.6 ± 1.0 to 0.03 ± 1.10 Dptr (p < 0.01). In all the studied groups, a statistically significant (p < 0.05) increase in UCFVA was revealed in the postoperative period. Indicators K1 and K2 did not significantly change. Conclusion. The high efficiency of the correction using the LASIK, PRK and femtoLASIK methods on pseudophakic eyes with the achievement of the target refraction in most of the studied cases was shown. This method can be used as an alternative to spectacle and contact correction in patients with residual refractive error after cataract phacoemulsification and refractive lensectomy with IOL implantation.
A. N. Pashtaev, B. E. Malyugin, S. B. Izmailova, N. P. Pashtaev, K. N. Kuzmichev, S. S. Alieva, K. I. Katmakov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-216-222

Abstract:
Purpose. To evaluate the quality of the surface of an ultra-thin donor transplant prepared from the endothelial surface of the cornea using a femtosecond laser and to demonstrate the preliminary clinical results. Patients and Methods. 4 eyes were operated: 3 with Fuch`s endothelial dystrophy and 1 with pseudophakic bullous keratopathy. All patients were treated with DSEK with an ultrathin graft prepared by Alcon Wavelight FS 200 femtosecond laser (Germany). Before and after surgery UCVA, BSCVA, astigmatism, ECD were measured. EC death, graft thickness and CCT were evaluated at 12 months` observation. Atomic force microscopy was used for examination of 10 samples. Control group was 5 corneal flaps obtained by mechanical microkeratome (Moria SLK-2, France). Main group — 5 corneal flaps, obtained by femtosecond laser. Nonparametric Mann-Whitney test was used for statistical analysis. Coefficient of reliability p < 0.05 was considered to be significant. Results. RMS value of femto-laser group samples was 18.6 ± 7.8 um. RMS of microkeratome group samples was 22.3 ± 18.3 um. Statistical analysis did not reveal significant differences between the values of the studied parameter in these groups (p > 0.05). Transparent engraftment was observed in all cases, no corneal edema was identified. BSCVA ranged from 0.2 to 0.6, which was associated with the presence of concomitant pathology. Astigmatism was 1.35 ± 1.0 D. ECD = 1526 ± 434 cells/mm2. EC loss = 48.0 ± 12.8 %. Graft thickness in the central zone was 78.0 ± 18.1 µm. Center-Edge Index — 0.84 ± 0.12. CCT = 600 ± 31 um. No postoperative complications were found. Conclusion. The developed settings allowed to obtain high-quality ultra-thin graft with a sufficiently uniform surface without a risk of perforation. Preliminary clinical results showed the method potential for restoration of corneal transparency. ECD loss corresponded to the one achievable by DSAEK.
M. M. Sitka, S. G. Bodrova, O. I. Tikhonova, N. P. Pashtaev, N. A. Pozdeyeva, T. N. Okhotina
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-263-268

Abstract:
Purpose. To evaluate changes of anatomical and functional parameters of the eye in children with initial emmetropia and to assess their impact on the occurrence of myopia. Patients and methods. 189 children: 85 boys (44.97 %) and 104 girls (55.03 %) aged 7–11 years (mean 8.5 ± 1.01 years) with emmetropia were examined. Ophthalmic examination consisted of refractometry, keratometry with registration of the radius of corneal curvature (CR) on the RC-5000 autorefractometer (Tomey), visual acuity testing with and without correction, positive relative accommodation (PRA), optical biometry with axial length (AL) measurement were performed with a IOL-master biometer (Carl Zeiss). Results. 87 schoolchildren (56 girls (64.4 %) and 31 boys (35.6 %)) of the 189 healthy children had myopia (p = 0.017) by the end of 5-year observation period. Myopia was more prevalent in girls (53.8 %) than boys (36.5 %). There was a statistically significant difference in the values of the ratio of the axial length to the CR in children with stable emmetropia and developing myopia: 2.9 ± 0.06 and 2.95 ± 0.07 (p < 0.001). PRA at the beginning of the study was lower in children with subsequent myopia in comparison with children with stable emmetropia (3.76 ± 0.72 diopters and 4.1 ± 0.7 diopters, p = 0.002). Change of AL was 0.58 ± 0.39 mm in healthy young children (7–8 years old) and 0.44 ± 0.29 mm — the oldest (9–10 years old) (p = 0.021). Increase of AL in case of myopia was 1.55 ± 0.67 mm in children of the younger age group and 1.13 ± 0.32 mm in the older one (p = 0.011). Conclusion. Higher ratio of the axial length to the radius of curvature of the anterior corneal surface was noted in children with developing myopia compared with stable emmetropia. Decline in positive relative accommodation before clinical manifestation of myopia was revealed. A greater increase of axial length was noted in children of 7–8 years of age compared with children of 9–10 years of age in groups with stable emmetropia and with developing myopia.
N. M. Kislitsyna, S. V. Novikov, S. V. Kolesnik, A. I. Kolesnik, M. P. Veselkova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-249-257

Abstract:
The role of the vitreous body and vitreomacular interface (VMI) is key in many processes including proliferative diabetic retinopathy (PDR). In PDR patients, the VMI changes can significantly influence the emergence and progression of the disease. There are multiple factors at work in the VMI including taut posterior cortical layers, vitreoschisis, posterior vitreous detachment (PVD), and vitreous adhesions. But there is no general consensus about their role in proliferative complications. Further understanding the VMI relationship in a case of PDR is warranted in order to design better treatments, to arrest and possibly even reverse progression of PDR. Today there is no imaging techniques to determine normal vitreous and VMI interactions in different PDR stages intraoperatively. Purpose: to analyze intraoperative vitreous and vitreoretinal interface features during chromovitrectomy in patients with A-C stages of PDR. Patients and methods. Seventy-four diabetic patients (74 eyes) were included. We performed standard 25 Gauge pars plana vitrectomy using Vitreocontrast for vitreous and vitreoretinal interface (VRI) visualization. Intravitreal “Vitreocontrast” suspension is the most favored agent of those studied and it is increasingly used as an adjunct during surgery to delaminate fine tissue planes and pockets of formed vitreous and VRI structures that may not be visible with routine operative illumination systems, or using modern vital dyes. Results. “Vitreocontrast” suspension allows to visualize posterior cortex changes during different stages of PDR. We investigated vitreous and VRI anatomy, topography and structure and determined safety of retrociliary and equatorial cisterns walls in 97 % in stage A of PDR, 95 % in stage B and in 82 % of stage C. In 3–5–18 % cases, correspondently, we determined disorganization of some vitreous cisterns. In 94 % cases of PDR A and 96 % cases of PDR B we visualized preretinal vitreous layer in a central macular zone, within the boundaries of vascular arcades. It has specific topography and strong adhesion to the internal retinal membrane. It’s the first time when this new vitreous cortex layer was revealed. The presence of this layer is the result of a strong vitreomacular adhesion that causes the posterior vitreous cortex split as it attempts to detach from the inner retinal surface. Such outermost layer remains attached to the macula and can induce further proliferation process. On a stage B of PDR this area correspond with multiple vitreoschisis, on a stage C of PDR — with fibrovascular membrane. The complete PVD was revealed in 61 cases. Conclusion. In this article we analyze the results of surgical treatment in 74 patients with A-C stages of proliferative diabetic retinopathy. Newer imaging technique with new dye — suspension “Vitreocontrast” allows to detect sensitive relationships of vitreous and VRI in each stage of the disease. The role of vitreous body in this process gives us a reason to consider it as an important object for further research. Moreover, the understanding of their relations in different stages of PDR enables to develop optimal surgical approach on each stage of PDR.
V. V. Volkov, I. L. Simakova, I. A. Tikhonovskaya
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-229-237

Abstract:
Purpose: To evaluate the effectiveness of a new modification of the vacuum-perimeter test (VPT) by V.V. Volkov in the early diagnosis of glaucoma in comparison with the results of the original test and its known modification — vacuum-compression automated test (VCAT) in an open comparative clinical research. Patients and Methods. The study involved 26 patients (47 eyes) (average age 52.9 ± 8.5 years) with suspected open-angle glaucoma (OAG). Patients were divided into three groups: 1-st — 19 eyes with preglaucoma, 2-nd — 18 eyes with the early stage of OAG, 3-rd — 10 eyes of five patients with unconfirmed glaucoma. The control group (4-th) included 20 eyes of 10 healthy people (average age 56.4 ± 4.4 years). Along with the standard ophthalmological examination, all patients underwent perimetry on Humphrey Visual Field Analyzer II 745i (Germany-USA), our modification of Frequency Doubling Technology (FDT) perimetry, evaluation of the optic nerve head (ONH) on Heidelberg Retina Tomograph (HRT 3, Germany) and three stress tests: VPT, VCAT and our modification — vacuum-contrast-frequency test (VCFT). VCFT was created on the base of FDT perimetry with the aim of increasing the sensitivity of the original test (VPT) for detection of preglaucoma through the use of non-standard stimulus and increasing the number of investigated points of central visual field. Results. According to the National classification (1975) the diagnosis of preglaucoma was determined on the basis of a positive result of at least one of three stress tests, taking into account the risk factors for the development of glaucoma in patients. The early stage of OAG was established on the base of International standards for structural and functional assessment of the ONH (2003). The specificity of all three compared stress tests was 100 %, which confirmed their negative results in all patients (10 eyes) from the 3-rd group. However, the sensitivity of VCFT (75 %) was significantly higher than VPT (21.05 %) and VCAT (21.05 %), which is due, we believe, to the specific nature of VCFT stimulus. Conclusion. According to the obtained data, the developed new modification of VPT — VCFT on the specificity of the results was not worse, and the sensitivity was better than the original VPT and VCAT in the diagnosis of preglaucoma. VCFT is quickly performed and comfortable for patients.
I. E. Panova, A. V. Titov, D. R. Mirsaitova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-274-280

Abstract:
Purpose — to analyze the effectiveness of artificial tear drops HYLOPARIN-COMOD® in the complex medical support of the FemtoLASIK operation based on monitoring of clinical, functional and morphometric indicators of the eye surface’s condition. Patients and methods. The study included 25 patients (50 eyes) who underwent a keratorefractive surgery (Femto-LASIK) and were prescribed instillations of artificial tear drops HILOPARIN-COMOD®. To analyze the effectiveness of artificial tear drops HYLOPARIN-COMOD® in the complex medical support of the Femto-LASIK operation based on monitoring of clinical, functional and morphometric indicators of the eye surface’s condition: UCVA, BCVA, Schirmer’s II test, tear break-up time (Norn’s test), OCT pachymetry of the cornea and corneal flap. The treatment effectiveness was evaluated at 1 day, 1 week, 1 and 3 months after the surgery. Results. As a result of the treatment, the following refractive data were obtained: UCVA increased from 0.09 ± 0.02 to 0.94 ± 0.07 on the first day after surgery and to 0.96 ± 0.04 and 0.99 ± 0.07 to 1 and 3 months of follow-up, BCVA respectively, from 0.97 ± 0.04 to 0.94 ± 0.07, 0.97 ± 0.07 and 0.99 ± 0.07 after surgery. A faster restoration of the cornea and corneal valve was revealed, as evidenced by a decrease in their thickness already in the 1st week after surgery in comparison with the control group, where were more pronounced changes occur only by the 1st and 3rd month of observation (p ≤ 0.05). There was a significant increase in the basal secretion of the lacrimal gland (Schirmer’s II test) from 10.16 ± 1.33 to 11.66 ± 1.13 and 12.88 ± 0.96 µm by 1 and 3 months after surgical treatment, respectively (p ≤ 0.05). The Norn’s test increased from 10.89 ± 1.94 to 12.78 ± 1.59 and 13.83 ± 0.5 s to 1 and 3 months of treatment, respectively (p ≤ 0.05). Conclusion. The effectiveness of the HILOPARIN-COMOD® use in the correction of the dry eye syndrome after keratorefractive operations has been proven. The obtained results clearly demonstrate that the HILOPARIN-COMOD® preparation enhances not only the stability of the tear film, but also the restoration of the OCT morphometric parameters of the thickness of the cornea and corneal flap.
S. N. Sakhnov, S. V. Yanchenko, A. V. Malyshev, V. V. Dashina, A. R. Ceeva, L. M. Petrosyan
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-281-289

Abstract:
Purpose. To evaluate the prevalence, clinical and pathogenetic variants and statistically significant risk factors of dry eye (DE) in patients before cataract surgery. Patients and Methods. 600 age-related and complicated cataract patients (70.6 ± 7.8 years old; 269 men, 331 women) were examined. Visometry and biomicroscopy with photographic recording of the lens state and assessment of its opacities according to the LOCS III classification were used to cataract revealing. OSDI testing, lipid interferential test, TBUT, Shirmer-1, -2 tests, visual and OCT meniscometry, evaluation of epitheliopaty and microerosion (with vital staining), compression Norn test in Korb modification, visual and OCT LIPCOF assessment, lid viper epitheliopathy evaluation, anterior segment of the eye photoregistration with computer morphometry were performed to assess the ocular surface condition. The structure of the DE risk factors, was studied both in DE patients and non-DE subjects with calculation of the Pearson xi-square test. To estimate the strength of the connection between the etiological condition and the DE, the normalized value of the Pearson coefficient (C´) was used. Results. The dry eye prevalence was 53.2 % (of them, 25.5 % was mild, 27.7 % — moderate, by Brzhesky). Subclinical DE prevalence was 27 %. Clinical and pathogenetic variants of mild DE included: isolated lipid deficiency (71.9 %), lipid-mucin deficiency (28.1 %). In patients with moderate DE were identified: aqueous-lipid-mucin deficiency (54.8 %), aqueous-lipid deficiency (37.95 %), isolated aqueous deficiency (7.2 %). The most significant systemic-organ DE risk factors were: diabetes mellitus (C´ = 0.302; in 18.8 % DE patients), female sex (C´ = 0.240; in 62.1 % de patients), allergy (С´ = 0.233; in 23.2 % DE patients). Local risk factors most significantly associated with DE were: meibomian glands dysfunction (С´ = 0.58; in 77.7 % DE patients), chronic blepharitis (С´ = 0.233; in 23.2 % DE patients), pterygium (С´ = 0.276; in 13.2 % DE patients), allergic conjunctivitis (С´ = 0.21; in 21.3 % DE patients). Among the exogenous risk factors, the most significant were: the use of medication affecting tear production or tear film stability (С´ = 0.485; in 89.03 % DE patients), preservative eye drops instillation (С´ = 0.2975; in 56.1 % DE patients). Conclusion. In our opinion, data on the high DE prevalence in cataract patients (53.2 %) should be taken into account when planning cataract surgery, since perioperative correction of the ocular surface condition can increase the surgical treatment efficiency, predictability and safety. The data on the structure of significant risk factors and clinical and pathogenetic DE variants in cataract patients can be the basis for the development of measures to ensure timely DE detection and implementation of reasonable therapy. The risk factor most significantly associated with DE in cataract patients was the meibomian gland dysfunction (MGD) (Pearson xi-square test = 88.542, p < 0.001, С´ = 0.58; “relatively strong” strength). Considering the modifiability of this risk factor (MGD), as well as its high prevalence (77.7 %), it can be considered that eye lids hygiene may be a reasonable therapy in most DE and cataract patients before phacoemulsification.
N. V. Maychuk, I. A. Mushkova, A. M. Mayorova,
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-295-299

Abstract:
Introduction. Reduced corneal transparency leads to dissipation of energy of the femtosecond laser (FSL), which may complicate the formation of the intrastromal incision and limits the use of FSL in eyes with corneal opacities and scars. The purpose of this work is to demonstrate the possibility of successful ReLEx SMILE in a patient with superficial corneal opacity located in the paracentral zone. Case report. Patient R., 29 years old, complained of decreased vision in both eyes since childhood. Visual acuity OD = 0.1 sph –2.75D = 1.0; OS = 0.1 sph –3.50 D cyl –0.75D ax 165° = 1.0. Biomicroscopy of the right eye visualized a superficial semi-transparent corneal opacity of 5 x 3 mm located at 5.30–6 hours at a distance of 1.3 mm from the optical center. According to the anterior segment optical coherence tomography (AS-OCT) the depth of the opacity was 73–78 microns and was limited by the Bowman’s membrane. ReLEx SMILE for myopia correction was performed on both eyes with 6.7 mm lenticule diameter at a depth of 120 µm, which covered the opacity area by 1.1 mm. The surgery was standard and uncomplicated. Seven days postoperatively the patient did not complain. Uncorrected visual acuity (UCVA) was 1.0 for both eyes (and binocularly it was 1.2). According to the AS-OCT data, a hyperreflective line of the interface zone was visualized on the right eye at the depth of 141–147 µm; the opacified superficial corneal layers were detected in the lower paracental zone over the interface line. In one month after the surgery the visual acuity did not change: UCVA = 1.0 in both eyes (binocularly 1.2). Conclusion. ReLEx SMILE technology can be considered as one of the options for myopia correction in patients with superficial corneal opacity located in the paracental zone. More observations are required to evaluate the effectiveness of this technology on corneas with paracentral opacities different in sizes and located at different depths.
E. A. Sozurakova, E. V. Gromakina, V. G. Mozes
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-181-187

Abstract:
Eye injury is one of the actual problems in modern ophthalmology. Penetrating wounds of the cornea are the most significant among all eye injuries. New data on the course of inflammation in corneal injury will allow us to predict the course of the post-traumatic period and improve treatment outcomes. The corneal immune privilege is a unique system of protecting one’s own tissues from damage caused by systemic immunity reactions, which is realized through several mechanisms. Modern research shows that healing from corneal injury is a complex cascade of cellular reactions, the understanding of which is still far from consummation. It was described the regenerative potential of cell populations of the cornea when it was damaged. Contravention of barrier properties in injuries of the cornea deprives the organ of vision of immune privilege. This violation initiates the launch of the messenger pools of angiogenesis, remodeling and inflammation. Besides studying the interaction of cellular messengers in cornea trauma and inflammation, researchers pay great attention to cellular reactions. Recruitment of immune cells during corneal injury is mediated by pro-inflammatory cytokines released during damage from epithelial cells and keratocytes.
, I. E. Panova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-172-180

Abstract:
Choroidal melanoma is the most common and life-threatening intraocular malignant neoplasm affecting the eye choroid in about 90 % of cases. The incidence varies from 0.7 to 1.1 per 100,000 of the population. This category of malignant neoplasms is highly aggressive in terms of local distribution, the occurrence of loco-regional and distant metastases. According to various authors, the frequency of metastasis reaches up to 50 %, the risks of metastatic disease depend on the size of the tumor, the duration of observation, clinical and pathomorphological characteristics of the choroidal melanoma and genetic factors. This article provides a detailed literature review on the developmental aspects and growth dynamics of choroidal melanoma from the point of view of neoangiogenesis and the phenomenon of vasculogenic mimicry, and the possibilities of instrumental diagnostics for determining the malignant vasculature of a tumor. The relevance of studying this issue is determined by the peculiarities of the origin of choroidal melanoma, which can occur both de novo and due to malignant transformation from nevus cells and the critical point for it is a tumor thickness of more than 2 mm, at in which the the process of neoangiogenesis starts. This review details the role of various methods of instrumental diagnostics, such as doppler ultrasound imaging to determine the presence or absence of blood flow in the tumor and its blood flow characteristics, angiography using contrasts: fluorescein and indocyanine green angiography, and optical coherent tomography—angiography to identify the malignant vasculature and evaluation of tumor angioarchitectonics. It has been shown that in the diagnosis of especially small choroid melanomas, which are of significant diagnostic complexity, a multimodal approach using the above research methods is important. There is no doubt that these instrumental technologies aimed to identify the malignant vasculature of choroidal melanoma play a large role not only in diagnosis, but also are of considerable practical interest in planning treatment, in assessing its effectiveness, and also in predicting the risks of metastatic process development.
G. I. Krichevskaya, E. S. Vakhova, S. V. Saakyan, E. B. Myakoshina, A. E. Andryushin, A. M. Maybogin, O. V. Proskurina, A. V. Trukhina
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-290-294

Abstract:
Conjunctival lymphomas are predominantly extranodal B-cell non-Hodgkin’s lymphomas (NHL), most of them are MALT-lymphomas originating from the mucosa-associated lymphoid tissue. Manifestations of the conjunctival NHL are very diverse, and often imitate the appearance of other ocular diseases, which makes their clinical diagnosis difficult and significantly lengthens the time from the first visit to the ophthalmologist until the diagnosis is verified. The article presents the case histories of two young patients who were treated for a long time at the place of residence as acute chlamydial conjunctivitis (in one case — 3, in the other — almost 5 months). A comprehensive laboratory study to detect specific blood antibodies, DNA of the pathogen in conjunctival scrapings and the cytological picture of the conjunctiva did not confirm the chlamydial etiology of the process. A pronounced lymphoid reaction mainly due to small lymphoid cells was found in both patients in scrapings from the conjunctiva of the eyelid, which was the basis for referring patients for consultation to oncologist. Histological examination of conjunctival biopsy specimens also revealed proliferation of lymphoid tissue: patients with suspected MALT lymphoma were referred to onco-hematologists. A PCR analysis of the biopsy material revealed HHV-8 DNA in one patient and Epstein-Barr (EBV) DNA in another, although no pathogen genomes were detected in the conjunctiva scrapings. Immunohistochemical analysis in one patient confirmed the conjunctival MALT-lymphoma, in another one diagnosed hyperplasia of the conjunctival mucous-associated lymphoid tissue, caused by prolonged antigenic stimulation (EBV DNA was detected in the biopsy). The follicular appearance of the lymphocyte hyperplasia in conjunctiva may imitate the clinical picture of infectious diseases. For differential diagnosis of chlamydial conjunctivitis and MALTlymphoma, especially in young patients with refractory follicular conjunctivitis, it is advisable to include a set of serological, molecular biology and cytological methods.
S. I. Makogon, A. P. Momot
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-258-262

Abstract:
Purpose: study of the effect of dosed pneumatic vasocompression (DPVС) as part of complex therapy on functional indicators in patients with primary open-angle glaucoma (POAG) depending on the characteristics of the individual profibrinolytic response of the vascular wall. Patients and methods. An additional analysis of data that was obtained earlier in 20 patients of the main group with stage II POAG was performed. Patients of this group, along with conservative drug therapy at the inpatient stage, underwent a course of DPVС, including 4 sessions of pneumocompression of the upper extremities (see previously submitted to print work — Non-pharmacological enhancement of fibrinolysis in the treatment of primary open-angle glaucoma. Part 2). According to the results of assessing the severity of the profibrinolytic response to pneumocompression, patients were conditionally divided into two groups: 1st group — with a high response to a single external mechanical effect, documented by an increase (∆) of t-PA / PAI 1 ≥1.00 (Me 1.57; 95 % CI 1.12–3.83); 10 patients, and the 2nd group — with a low response with ∆t-PA / PAI 1 –0.37); also 10 patients. In the both groups, a comparative analysis of the hemostasis and fibrinolysis system indicators, as well as the functional parameters of the organ of vision, hydrodynamics and retinal sensitivity, was carried out. Results. It was revealed that in patients with a high response after external mechanical exposure there is an increase in t-PA level after 1 hour 1.88 times and after 24 hours 2.08 times from baseline (median). In contrast, in patients with low response, there was only a tendency for this indicator to increase after 1 hour (1.43 times, median) and return to baseline after 24 hours, which was not statistically significant. In patients with a high response to pneumocompression after the end of the course of complex therapy, the best results were observed, reflecting the indicators of hydrodynamics and photosensitivity of the retina. Conclusion. When selecting patients with POAG that require vasocompression, it is advisable, at the treatment course beginning, to evaluate the individual reaction of the wall of the blood vessels of the upper limb by changing the ratio of t-PA / PAI-1 before and 1 hour after the session. It is proposed to include DPVС in the composition of complex drug therapy for POAG in those cases when the ∆ ratio indicator t-PA / PAI-1 is equal to or more than 1.0.
A. N. Pashtaev, N. P. Pashtaev, N. A. Pozdeyeva, I. V. Mukhina, S. B. Izmailova, S. A. Korotchenko, K. I. Katmakov, S. S. Alieva, K. N. Kuzmichev, B. E. Malyugin
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-202-208

Abstract:
Purpose. To rationale experimentally the use of an excimer laser for forming an ultrathin transplant for posterior lamellar keratoplasty. Materials and methods. Atomic force microscopy was used for examination of 10 samples. Control group was 5 corneal flaps obtained by mechanical microkeratome (Moria SLK-2, France). Main group — 5 corneal flaps, obtained by microkeratome and underwent photoablation by “Microscan 500” (Optosystems, Troick, RF) excimer laser at 50 um depth. For quantification of endothelial loss 10 donor corneas (5 pairs) with viable endothelium, preserved in Borzenok—Moroz media, were used. Two groups were formed: main — 5 ultrathin transplants obtained by consistent application of microkeratome and excimer laser, control (from the paired eyes of same donors) — ultrathin transplants prepared by two cuts of microkeratome. Detection of live and dead endothelial cells (EC) was provided by Calcein Violet 450 and Propidium Iodide “vital” fluorescent dyes. Nonparametric Mann—Whitney test was used for statistical analysis. Coefficient of reliability (p < 0.05) was considered to be significant. Results. RMS (roughnessmean square) of the transplant, prepared by excimer laser was — 24.17 ± 12.4 um, and RMS of the transplant prepared by microkeratome — 22.3 ± 18.3 um. Statistical analysis did not reveal significant differences in RMS values in the mentioned groups (p > 0.05). EC death in excimer laser group was 10.35 ± 5.84 %. EC death in microkeratome group — 8.06 ± 1.31 %. No statistically reliable difference of EC death was revealed in the 2 groups (p > 0.05). Conclusions. The investigation has showed identical RMS values in the examined groups, representing high optical qualities of the transplant prepared by excimer laser. EC loss was also comparable in 2 groups. The received results indicate considerable potential of excimer laser transplants for posterior lamellar keratoplasty.
M. H. Durzhinskaya, M. V. Budzinskaya
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-165-171

Abstract:
Oxidative stress due to the imbalance in the production and detoxification of reactive oxygen species in antioxidant defence system of the body, as well as subsequent chronic inflammation, is believed to be associated with age-related eye diseases. Prevention of chronic degenerative diseases such as age-related macular degeneration (AMD) and primary open-angle glaucoma are of particular interest. In the last decade, tremendous success has been achieved in the treatment of age-related retinal pathology. However, these treatments are expensive and require frequent monitoring and, in some cases, injections, which place a huge burden on both the healthcare system and patients. Consequently, considerable interest remains in preventing or slowing the progression of these diseases. Epidemiological studies have shown that diet is a modifiable risk factor for AMD, and nutritional modification with food antioxidant supplements is a particularly attractive method of prevention because of its potential benefits and relatively low cost. A large number of experimental studies, including clinical studies in animals and humans, have provided supporting evidence that antioxidant food additives inhibit the oxidation of macromolecules, as well as an inflammatory response that occurs in the pathogenesis of involutional retinal pathology, which ultimately inhibits its development and progression. This review discusses the role of antioxidant dietary supplements in the prevention of age-related retinal pathology.
D. A. Borisov, , Z. A. Dautova, N. V. Fomina, S. V. Buynovskaya
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-223-228

Abstract:
The purpose: to study to evaluate the effect of ortokeratology lenses (OK-lenses) on the state of the ocular surface, depending on the duration of their wearing by adolescents with myopia. Patients and methods. Under control were 212 patients with myopia aged 12 to 16 years, who used OK-lenses “Paragon CRT100” (USA) for a long time (3–5 years). Examination, in addition to standard ophthalmological methods, included evaluation of complaints using the OSDI questionnaire/scale, Schirmer, Norn tests and biomicroscopy with staining of the cornea with fluorescein before and during wearing OK-lenses. Patients with keratopathy additionally underwent scanning confocal microscopy of the cornea using ConfoSkan-4 (Nidek, Japan); bacteriological examination of scraping from the cornea. Results. Clinical and functional signs of dry eye syndrome (SDE) in patients before and after prolonged use of OK therapy are not diagnosed. In 12 (5.6 %) teenagers with non-standard values of corneal curvature, signs of late epitheliopathy were revealed against the background of the absence of complaints. Patients were divided into 2 subgroups depending on the choice of antimicrobial eye drops in addition to keratoprotectors. The results of treatment in both subgroups were the same, but the use of fluoroquinolones was accompanied by an adverse development of SDE. Conclusion. In general, long-term OK therapy of myopia in adolescents is safe. The compulsory condition is an adequate prescription and observance of the wearing and lens care rules. It does not have a significant adverse effect on the clinical and functional state of the ocular surface, including the cornea. The frequency of late epitheliopathies with long-term (3–5 years) wearing OK lenses is 5.6 %, and the severity of the manifestation is characterized mainly by a mild degree. Patients with extreme corneal curvature are in a high-risk group for the development of late corneal complications during the use of OK therapy. If late epitheliopathies are detected while wearing OK lenses, it is necessary to cancel their use and to prevent the development of infectious keratitis, in addition to keratoprotectors, you can add the modern antimicrobial drug with antiseptic effect, for example, Vitabact, as the original, without a preservative, approved medicine for use in children. The use of fluoroquinolone drugs with virtually aseptic inflammation of the cornea is unjustified.
M. A. Frolov, N. A. Sakhovskaya, A. M. Frolov, A. D. Pryamikov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-188-194

Abstract:
Vascular pathology of the vision organ is one of the leading causes of irreversible vision loss. Ocular ischemic syndrome is a serious condition that requires special attention to prevent adverse effects and outcomes. Today, this syndrome mainly occurs in the form of ischemic optic neuropathy and chronic ischemic retinopathy, which are based on damage caused by impaired perfusion in the pool of the ophthalmic artery. According to the data presented in foreign and domestic literature, there is an correlation between the ocular ischemic syndrome and the pathology of the cardiovascular system. Often, this pathology is accompanied by such diseases as: coronary heart disease, atherosclerosis, arterial hypertension, and diabetes mellitus. A number of studies have shown that an important risk factor for the development of vascular eye’s pathology is the combination of coronary heart disease with elevated total blood cholesterol and atherosclerosis in combination with arterial hypertension. Also, there are data indicating the association of the risk of ischemic opticopathy with the presence of cardiovascular diseases in patients, and vice versa, previously transferred opticopathy can be considered as predictors of cardiovascular pathology. Thus, prevention and treatment of this pathology is an interdisciplinary problem. The classical approach in the treatment of ocular ischemic syndrome today remains conservative therapy, which aims to reduce local ischemia and the effects of hypoxia. However, conservative treatment does not eliminate the main reason for the development of this condition; therefore, the search continues for new, more effective methods of preventing and treating this pathology. In recent years, data on high clinical efficacy in the treatment and prevention of ocular ischemic syndrome manifestations have appeared in the literature after surgery to restore the main blood flow at the level of the brachiocephalic arteries. A variety of cardiovascular diseases and various levels of its damage determine the approach to the treatment of this pathology. This literature review is devoted to the analysis of the causes of ocular ischemic syndrome, depending on the level of localization of the lesion of the cardiovascular system.
E. S. Milyudin, O. Yu. Smorodinova, K. E. Kuchuk
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-269-273

Abstract:
The purpose of our study was to substantiate and evaluate the effectiveness of the conservative method of treating keratoconus in the early stages of the development of the disease. Patients and methods. The study of the effectiveness of the proposed method for the conservative treatment of keratoconus was performed on clinical material obtained by monitoring 39 patients (75 eyes) with a diagnosis of keratoconus stage I–III for at least 10 years. Every 4–6 months, all patients underwent an ophthalmological examination — visometry, autorefractometry, keratometry, keratotopography, pachymetry, biomicroscopy. Along with the study of the ophthalmic status of the patients, cardiointervalography was performed before starting conservative treatment. The assessment of vegetative homeostasis was performed using the Mustang-Diagnost device of the Technika company (Russia). Results. All patients observed by us were matched with corneal or corneoscleral gas-permeable contact lenses of various models and manufacturers. According to cardiointervalography, in 97 % of our patients vegetative dysfunction was determined, while in 85 % and all examined, a significant predominance of sympatheticotonic neurotrophic regulatory processes was determined. At the first stage of the conservative treatment of keratoconus pharmacological agents were selected. They potentiate cholinergic neurotrophic regulatory effects and activate aerobic processes in the tissues of the eyeball. The next step was the potentiation of sympathicotonic (ergotropic) neurotrophic regulatory processes. Treatment was carried out during the entire observation period, alternating complexes of preparations for 60 days. An increase in diopter strength along the steep meridian was noted in patients with keratoconus of all stages. In the group of patients with stage I keratoconus in 4 eyes out of 16, in patients with stage II disease in 7 eyes out of 35, in stage III patients in 7 eyes out of 24. Opposite, a study of the KISA % index in all observed patients showed a decrease in the coefficient values. Conclusions. The combination of therapeutic factors into tonic (trophotropic, anabolic) and phase (ergotropic, catabolic) regulatory blocks, taking into account their mutual neurodynamic synergism and in accordance with the phase nature of biorhythmogenesis of reparative processes, makes it possible to prevent the progression of keratoconus. The use of the treatment complex developed by us, which includes therapeutic treatment and correction with rigid gas-permeable contact lenses, corrects metabolic disorders and stabilizes collagen synthesis, which makes it possible to lay off the surgical treatment of patients with keratoconus.
V. V. Neroev, S. V. Saakyan, А. G. Amiryan, В. В. Вальский, А. Iu. Tsygankov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-195-201

Abstract:
Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.
N. A. Gavrilova, E. E. Ioyleva, N. S. Gadzhieva, O. E. Tishchenko, N. Yu. Kutrovskaya, A. V. Zinov’Eva
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-2-238-248

Abstract:
The literature review presents the results of a static perimetry for the study of the visual field in patients with compression in the chiasm-sellar region on the Humphrey Visual Field Analyzer (HFA) and Octopus. These models of perimeters are recognized as the “gold standard” and are most widely used in the global ophthalmic practice. The analysis of research results using traditional and function-specific perimetry with selective stimulation of the magnocellular and koniocellular (frequency-doubling technology perimetry, FDT; short-wavelength automated perimetry, SWAP) visual pathways was performed. The literature data analysis allows us to conclude that the static perimetry for the study of the visual field in patients with chiasmatic compression is carried out quite widely and is informative. But despite this, there are no generally accepted recommendations on the use of certain testing strategies and programs for the diagnosis and further dynamic observation of changes in the visual field in patients with this pathology. In this regard, it is advisable to conduct further studies that will allow the formation of standard perimetric protocols for diagnosing and monitoring visual field defects in patients with compression in the chiasm-sellar region based on a comparative analysis of the diagnostic informativity of various strategies and programs.
, A. E. Vasilyeva, O. Yu. Kolosova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-105-110

Abstract:
Uncontrolled administration and prolonged use of antihypertensive drugs with preservatives often leads not only to subjectively poor tolerance of treatment, but also to a deterioration in the results of subsequent surgery, if required. The manifestations of dry eye syndrome and its aggravation as a result of such drops use can lead the patients to refuse therapy and worsening the prognosis. The manifestations of dry syndrome are often detected before any hypotensive therapy begins, since the functions of secretory cells change with age and there is always the influence of adverse environmental factors. It is necessary to examine the condition of the anterior surface of the eye to resolve the issue of the need to prescribe drugs without preservatives for all patients before the appointment of antihypertensive therapy. However, sometimes it is not possible due to lack of time or equipment. Therefore, it is important to study the condition of the anterior eye surface in patients with newly diagnosed glaucoma before and during treatment with nonpreservative forms of antihypertensive drugs in order to determine the necessity of the first prescription of non-preservative forms of antihypertensive drops to further interpolate its results into practical recommendations. This study revealed that drug treatment of patients with newly diagnosed glaucoma with the drug Timolol-POS® β-blocker on a non-preservative basis along with IOP compensation improves both subjective and objective indicators of the condition of the anterior surface of the eye with maximum effect after 3 months of treatment. This conclusion suggests the importance of the primary appointment for such patients with instillation drops on a preservative basis.
T. G. Kamenskikh, I. O. Kolbenev, Ю. А. Мельникова, O. A. Andreychenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-70-75

Abstract:
Micro incision vitrectomy surgery with removal of epiretinal and internal limiting membranes is used for treating various forms of vitreomacular traction syndrome.Objective: to study the condition of retinal microcirculation using the OCTA method in the patients with traction maculopathy and macular ruptures before and after vitrectomy.Patients and Methods. The study included 160 patients, of which 55 had epiretinal fibrosis (Treatment 1), 60 had macular ruptures (Treatment 2), and 45 with no ophthalmic pathology (Control). Treatment 2 group included two subgroups: 2a — patients with large-diameter ruptures (over 800 μm) subject to inverted internal limiting membrane flap technique (n = 12), and 2b — patients with 430–800 μm ruptures subject to rapprochement of the rupture edges with a platelet mass technique. All patients underwent conventional ophthalmology examinations and optical coherence tomography angiography (OCTA) using Sirrus HD-OCT 5000, Carl Zeiss, Germany.Results. In the postoperative period, there was an improvement in retinal microcirculation in the Treatment 1 patients, and the values of both perfusion and vascular densities increased. A month later, an additional improvement of these indicators was recorded against the background of a decrease in retinal thickness and restoration of the vitreoretinal interface configuration. In the early postoperative period, Treatment 2 patients showed significant difference in the capillary density of the superficial vascular complex from the control group. A month later, the density of blood vessels in the Treatment 2 patients achieved control group values. Despite an immediate increase in perfusion measurements after surgical treatment, their values in a month were still lower than in the control group.Conclusions. In the patients with epiretinal membrane and macular ruptures, a statistically significant decrease in both vascular and perfusion densities of the surface capillary complex was revealed by OCTA. The effects of vitreoretinal surgery performed on Treatment 1 and 2 patients with macula traction pathology included increased visual acuity, decreased retinal thickness, and restoration of the proper vitreoretinal profile. Based on OCTA results, we discovered a gradual increase in vascular density of the macula in Treatment 1 and 2 patients after surgical treatment of VMT syndrome. Retinal perfusion in the macular region of Treatment 1 patients achieved the values of the control group within a month, while in Treatment 2 patients they increased, but remained lower than in control group. OCTA is a highly informative method for the diagnostics and monitoring of the eye posterior segment condition in the patients with VMT syndrome.
E. E. Ioyleva, A. V. Zinov’Eva
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-152-157

Abstract:
Drug dependence is one of important social problems in modern society. It became more actual because of the high morbidity in young working-age patients. The central nervous system is the main target for psychoactive substances. Long-term drug intoxication results in functional and structural brain alterations, it leads to cognitive impairment and disturbances of higher mental functions rendering patients’ disadapted in their work and daily life activities. Eye disorders due to drug abuse are multifaceted and can vary from conjunctival damage to severe endogenous endophthalmitis. Opioid dependence can result not only from intentional self-administration of narcotic drugs, but also from long-term prescribed use of these medicinal products owing to their potent analgesic effect exhibited in somatically ill patients with severe chronic pain. Opioid derivatives act as partial or full agonists of three types of opioid receptors (δ, κ, and µ) extensively expressed by the neurons of the central and, to a lesser extent, peripheral nervous system. The most dangerous complication of intoxication with this group narcotic drugs is opioid induced-respiratory depression resulting in hypoxaemia and hypercapnia. The paper presents a case report of bilateral optic nerve atrophy that developed in a young female patient after a long period of intravenous heroin use. There are practically no reports of optic nerve damage due to heroin intoxication in the current literature. Possible optic nerve atrophy mechanisms under discussion include generalized hypoxia developing against a background of chronic heroin intoxication and direct toxicity of admixtures used to dilute home-made narcotic drugs. In view of the growing use of these substances, physicians have to consider their effects in the differential diagnosis in patients with atypical eye disorders.
I. L. Kulikova, N. S. Timofeeva
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-13-19

Abstract:
The presence of concomitant corneal astigmatism is the most common cause of low visual functions in patients with surgical treatment of cataracts. The implantation of toric intraocular lenses is procedure of choice in the correction of corneal astigmatism from 1.0 DPT and more in patients with cataracts. Successful results depend on several factors, the most important of which: the correct and stable position of the intraocular lens (IOL) in the capsule bag, the absence of residual astigmatism, the choice of the implanted IOL’s model, taking into account material and design of lens elements. Deviation of the cylindrical component by 10 degrees reduces visual acuity up to 35 %. Repeated intervention for the purpose of toric lens reposition, according to the literature, varies from 0,65 to 9 % and is carried out with the rotation of IOL more than 10°. Femtolaser-assisted phacoemulsification allows partially automate the surgical process, making it more efficient and safe, creating a theoretical advantage over manual techniques of surgery. In practice, the capsulorexis formed by the femtolaser is characterized by a regular rounded shape with a given diameter and provides a coating of optical part of IOL for 360°, which, according to various sources, contributes to a lesser degree of decentralization and tilt of the lens in the capsule bag and can be considered as one of the reasons for obtaining a more accurate refractive result and, as a consequence, higher visual functions. The review presents the results of clinical studies of corneal astigmatism correction during standard and femtolaser-assisted phacoemulsification with implantation of various models of toric IOLs: visual acuity, rotational stability, residual astigmatism percentage, wave front change. Researchers continue to discuss the advantages and disadvantages of modern technologies. However, the problem of increasing the predictability of the surgical outcome in order to obtain a higher refractive result both in the early and in the long-term postoperative period remains unquestionable.
V. N. Kazaykin, V. O. Ponomarev, O. P. Ponomarev, A. G. Dudorov, K. T. Israfilov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-63-69

Abstract:
Purpose: Mathematical modeling of the eyeball vitreous cavity and analysis of the vitreous cavity volume vs. eyeball length correlation dependence; software for automatic calculation of individual doses of antibiotics for intravitreal injection in treating bacterial endophthalmitis.Materials and methods: The study included three sequential stages: 1st stage — mathematical modeling of the vitreous cavity of human eye based on data of 77 phakic eyes, by the least square method. The data were obtained by Tomey UD-8000 ultrasonography (Japan) and VuMax Sonomed ultrasound biomicroscopy (USA). 2nd stage — study of the vitreous cavity residual volume, free from silicon oil, by measuring a volume of vitreous body substitute injected to 64 pseudophakic patients who underwent a vitrectomy on account of detached retina. 3d stage — development of a computer program based on the data of the vitreous cavity volume vs. eyeball length dependence, vitreous cavity residual volume, and anterior chamber volume, and description of an algorithm for diluting antibiotics for intravitreal injection, based on a required concentration.Results. Vitreous cavity of eyeball was approximated by ellipsoid. Statistical analysis has shown a linear dependence of eyeball length vs. vitreous cavity volume; vitreous cavity calculation accuracy does not depend on the cavity size, and a relative error of volume calculations that were performed from the resulting data of a single determination of the cavity surface point coordinates, with a probability of 0.866, does not exceed 1 %. Average residual volume of the vitreous cavity subjected to silicon oil tamponade was 332.36 ± 0.02 mm3, and average anterior chamber volume, 246.36 ± 0.06 mm3. The resulting data were exported to the computer program kernel.Conclusion. The developed original mathematical model of the eyeball made it possible to calculate a vitreous cavity volume vs. eyeball length dependence and whereby to plot calibration nomograms that allow individual doses of antibiotics for intravitreal injection to be precisely calculated, thus providing a desired concentration thereof to suppress bacterial microflora and preventing toxic effect on retinae.
S. I. Makogon, A. P. Momot, A. S. Makogon, T. D. Shaternikova, Y. A. Bryukhanova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-96-104

Abstract:
Purpose: to study the effect of dosed pneumatic vasocompression (DPVK) on the functional parameters of the organ of vision in patients with primary open-angle gluacoma in the complex therapy of this form of pathology.Patients and Methods. The study included 39 patients with stage II POAG, which were randomized into two groups: main and control. All patients received a conservative complex drug therapy. Patients of the main group were additionally conducted DPVK sessions — twice a week (only 4 procedures during the entire course of treatment). All patients underwent standard ophthalmologic examination, hemostasis and fibrinolysis.Results. In the main group of patients, 1 hour after the end of compression, an increase (from baseline) in t-PA level (by median — 1.4 times) was observed while reducing the content of PAI-1 (by median — 2.7 times); improvement of hydrodynamic indicators (improvement of the outflow lightness coefficient, by 19.04 % in OD and 20.0 % in OS, decrease in KB by 24.7 % in OD and by 22.3 % in OS from the initial level) and retinal sensitivity (decrease the number of cattle type 1 in both eyes: 1.70 times on OD and 2.14 times on OS, decrease in type 2 cattle by 2.70 (OD) and 2.30 times (OS). In this regard, an increase sites of normal retina’s photosensitivity in 1.14 times on the OD and 1.19 times on the OS, in contrast to patients in the control group, where no significant changes were found.Conclusion. The obtained preliminary results of the study indicate the prospects for non-pharmacological stimulation of fibrinolysis in the inpatient stage of the addition of conservative therapy in patients with POAG, achieved with a course of dosed pneumatic vasocompression.
O. V. Shilovskih, A. N. Ulyanov, I. S. Rebrikov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-56-62

Abstract:
Lens material can be detected behind posterior capsule in case of infusion misdirection syndrome development during phacoemulsification. This condition is associated with Wieger ligament damage. There is no accepted management options for this issue. Authors offer original technique of small diameter (2–3 mm) posterior capsulorhexis performed before IOL implantation for evacuation of infusion fluidics and lens material from Berger space. Safety of new technique was evaluated by OCT images analyzing central foveal thickness in 1 day, 3 weeks and 6 weeks after cataract surgery. There were 3 patients groups: I — uneventful phacoemulsification (10 eyes) (control group); II — phacoemulsification with development of infusion misdirection syndrome and lens material behind posterior capsule without performing posterior capsulorhexis (10 eyes); III — phacoemulsification with development of infusion misdirection syndrome performing posterior capsulorhexis for draining Berger space. There was no significant difference in central foveal thickness between patients groups. There was trend of central foveal thickness increase in 3 weeks after surgery in all groups. Central foveal thickness returns to initial values in 6 weeks after surgery in all patients groups. There was no cases of cystoid macular edema in study. In conclusion, small diameter posterior capsulorhexis technique is useful in clinical practice for evacuation of infusion fluidics and lens material from Berger space before IOL implantation.
V. V. Tuzlaev, V. V. Egorov, I. Z. Kravchenko, G. P. Smoliakova
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-133-141

Abstract:
Purpose: to study the effect of differentiated treatment approach in patients with varying degrees of severity chronic ocular ischemic syndrome (OIS) on clinical course of disease and hemodynamics of eyes in prospective research.Patients and methods. The research included 20 patients with chronic OIS. Patients were divided into 4 groups due to severity of chronic OIS and type of treatment. 1st group — 7 patients with moderate severity chronic OIS and hemodynamically significant of internal carotid artery stenosis (ICAS); only carotid endarterectomy (CE) of ICAS was performed. 2nd group — 6 patients with severe degree chronic OIS and hemodynamically significant stenosis of ICAS; 2 weeks before CE, panretinal photocoagulation (PRP) of retinal capillary non-perfusion areas was performed. 3rd group — 4 patients with severe degree chronic OIS, complicated by rubeosis iris and increased IOP on hypotensive regimen, on the background of hemodynamically insignificant ICAS; PRP of retina was performed. 4th group — 3 patients with moderate severity chronic OIS with hemodynamically insignificant ICAS; course of neuroprotective therapy was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, eye vessels was performed by ultrasound scan, spiral computed tomography, OCT-angiography with the AngioVue.Results. Monitoring of patients’ groups for 1 year after chronic OIS treatment allowed us to determine tactics of patient management depending on degree of ICAS and severity of chronic OIS. Reconstructive surgery at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of BCVA in 71 % of patients. Preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of chronic OIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment. Neuroprotective pharmacotherapy in early stages of chronic OIS, in absence of indications for reconstructive surgery and PRP of retina, improved the prognosis for patients’ vision.Conclusion. Differentiated treatment approach in patients with chronic OIS, due to changes of hemodynamics of internal carotid artery, has improved indexes of hemodynamic and visual acuity.
D. D. Garri, S. V. Saakyan, I. P. Khoroshilova-Maslova, A. Yu. Tsygankov, O. I. Nikitin, G. Yu. Tarasov
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-20-31

Abstract:
Machine learning is applied in every field of human activity using digital data. In recent years, many papers have been published concerning artificial intelligence use in classification, regression and segmentation purposes in medicine and in ophthalmology, in particular. Artificial intelligence is a subsection of computer science and its principles, and concepts are often incomprehensible or used and interpreted by doctors incorrectly. Diagnostics of ophthalmology patients is associated with a significant amount of medical data that can be used for further software processing. By using of machine learning methods, it’s possible to find out, identify and count almost any pathological signs of diseases by analyzing medical images, clinical and laboratory data. Machine learning includes models and algorithms that mimic the architecture of biological neural networks. The greatest interest in the field is represented by artificial neural networks, in particular, networks based on deep learning due to the ability of the latter to work effectively with complex and multidimensional databases, coupled with the increasing availability of databases and performance of graphics processors. Artificial neural networks have the potential to be used in automated screening, determining the stage of diseases, predicting the therapeutic effect of treatment and the diseases outcome in the analysis of clinical data in patients with diabetic retinopathy, age-related macular degeneration, glaucoma, cataracts, ocular tumors and concomitant pathology. The main characteristics were the size of the training and validation datasets, accuracy, sensitivity, specificity, AUROC (Area Under Receiver Operating Characteristic Curve). A number of studies investigate the comparative characteristics of algorithms. Many of the articles presented in the review have shown the results in accuracy, sensitivity, specificity, AUROC, error values that exceed the corresponding indicators of an average ophthalmologist. Their introduction into routine clinical practice will increase the diagnostic, therapeutic and professional capabilities of a clinicians, which is especially important in the field of ophthalmic oncology, where there is a patient survival matter.
V. S. Kulybysheva, I. A. Ronzina, A. A. Gamidov, V. G. Motalov, V. N. Nikolenko
Ophthalmology in Russia, Volume 17; doi:10.18008/1816-5095-2020-1-88-95

Abstract:
Purpose. Determining the functional state of the outer and inner retina’s layers in patients with diabetes mellitus (DM) type 1 and 2 before the clinical manifestations and in the early stages of diabetic retinopathy (DR) using the methods of multifocal electroretinography (mfERG) and microperimetry (MP).Patients and methods. 91 patients were examined (182 eyes). The patients were divided into 4 groups: 1st — 23 people (46 eyes) with diabetes without DR (the duration of the disease is up to 2 years); 2nd — 22 people (44 eyes) with diabetes without DR (diabetes from 2 to 8 years); 3rd — 24 people (48 eyes) with NPDR on the background of diabetes; 4th — 22 people (44 eyes) of the control group (healthy eyes). In addition to the standard ophthalmologic examination, all patients were registered mfERG (FOK1) on the diagnostic equipment EP-1000 Multifocal (Tomey, Germany) and carried out MP using the device “MAIA” (CenterVue, Italy).Results. According to mfERG, it has been established that the components of mfERG, the biopotential density and the amplitude of P1, are most sensitive to diabetic changes. In groups with type 1 and type 2 diabetes, there is a significant decrease in the density of P1 in comparison with the control group (p < 0.005, Mann-Whitney test), as well as a decrease in the amplitude of P1 on almost all tested rings (p < 0.005). In all groups, there is an increase in the latency of P1 in the central ring (0–2.3°). According to MP data, it was found that patients with type 1 and type 2 diabetes showed a decrease in the average light sensitivity in comparison with the control group, however, our data are within the reference values, regardless of the presence or absence of clinical manifestations of PD.Conclusion. As a result of the study, early functional and morphological disorders of the neurosensory apparatus of the eye in diabetes were identified. It is proved that mfER and MP allow to detect violations at the preclinical stage of DR and are necessary studies for the dynamic control of the progression of DR.
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