[Terson syndrome and acute myeloid leukemia (case report)]. / Sindrom Tersona na fone ostrogo mieloidnogo leikoza (klinicheskoe nablyudenie).

The article presents a clinical case of bilateral Terson syndrome caused by the manifestation of acute myeloid leukemia. A 32-year-old man complained of a sharp decrease in vision in both eyes. Spontaneous subarachnoid hemorrhage occurred secondary to acute myeloid leukemia. Uncorrected visual acuity (UCVA) amounted to OD=0.01, OS=0.005. The anterior segment was normal in both eyes, voluminous immobile white-gray mass measuring 7-9 DD that completely covered the macula (intense hyperechoic cell suspension with a volume of about 1/2 of the vitreous cavity, ultrasound B-scan) were visualized in the posterior pole of the vitreous body of both eyes under conditions of maximum drug-induced mydriasis. Diagnosis: vitreous hemorrhage due to subarachnoid hemorrhage in both eyes secondary to acute myeloid leukemia. Vitrectomy was performed in both eyes. UCVA increased to 0.05 in both eyes. Vitrectomy contributed to improvement of visual functions and patient quality of life.

[Investigation of diabetic retinopathy progression in women with diabetes mellitus during pregnancy]. / Issledovanie osobennostei progressirovaniya diabeticheskoi retinopatii u zhenshchin, stradayushchikh sakharnym diabetom, v period beremennosti.

PURPOSE: The study evaluates the transient and stationary diabetic retinal changes in pregnant women with diabetes mellitus (DM) based on the analysis of individual clinical cases of diabetic retinopathy (DR) progression. MATERIAL AND METHODS: The study examined 24 pregnant women with DM. The examination was carried out in each trimester of pregnancy and 6 months after delivery. In 10 pregnant women DR was not detected, and 14 (58%) were diagnosed with DR. RESULTS: Progression of DR during pregnancy was observed in 9 patients with pre-proliferative and proliferative DR (PPDR and PDR) and uncompensated glycemia, 3 patients developed macular edema (ME) in both eyes. Panretinal laser coagulation (PRLC) was performed in patients with ongoing DR progression. In the postpartum period, the manifestations of DR did not regress. ME turned out to be transient in one patient with PPDR. Three clinical cases of DR manifesting in the first trimester of pregnancy are presented: PPDR with transient ME, PDR with ME, non-proliferative DR with a stable course. CONCLUSION: 1. DR detected at the beginning of gestation in women with decompensated glycemic status progressed in 64% of cases. 2. Progression of DR during pregnancy was noted in patients with PPDR and PDR. 3. Progression of DR during pregnancy is more often true than transient. 4. Detection of PPDR and PDR during pregnancy is a direct indication for laser coagulation of the retina.

[Bilateral uveitis associated with protein kinase inhibitor-based treatment of skin melanoma (case study)]. / Dvustoronnii uveit, obuslovlennyi priemom ingibitora proteinkinazy pri lechenii melanomy kozhi (klinicheskoe nablyudenie).

The article presents a clinical case of bilateral uveitis with macular edema that developed during long-term administration of vemurafenib. Methods of conservative treatment of malignant tumors are presently available and reasonably effective. However, at the same time drugs can have toxic effect on normal cells in various tissues of the body. According to our data, the use of corticosteroids can ameliorate the clinical signs of macular edema associated with uveitis, but with a tendency to recur. Only complete cancellation of vemurafenib provided remission of sufficient duration, which is fully consistent with clinical observations made by colleagues. Therefore, when prescribing long-term therapy with vemurafenib, in addition to periodic observation by an oncologist, it is also mandatory to continue follow-up observation by an ophthalmologist. Partnership between health care specialists could help avoid severe ocular complications.

[Occurrence of myopic maculopathy in eyes with staphylomas of various localization]. / Chastota formirovaniya miopicheskoi makulopatii pri stafilomakh razlichnoi lokalizatsii.

Complicated myopia develops in young people of working age, of which about 30% subsequently become visually impaired. Formation of ocular staphyloma affects the macula causing myopic maculopathy, which leads to significant and irreversible decrease in visual functions. PURPOSE: To study the occurrence frequency of various forms of myopic maculopathy in scleral staphylomas of different localization in patients with pathologic myopia. MATERIAL AND METHODS: The study included 105 patients with high myopia (105 eyes, axial length ≥26 mm). The main group consisted of 50 patients with myopic scleral staphylomas (50 eyes). The comparison group - 55 patients (55 eyes) without scleral staphylomas. RESULTS: In the main group, myopic maculopathy was detected in 82% of eyes, it was absent in 96% of eyes in the comparison group. In the main group there were: staphyloma of the posterior pole of the eye with involvement of the optic nerve head (ONH) - 44% of eyes; macular staphyloma - 28% of eyes; peripapillary staphyloma - 12% of eyes; staphyloma below the ONH - 16% of eyes. Atrophic, neovascular and traction maculopathy was revealed in 22 eyes with staphylomas of the posterior pole of the eye. Dome-shaped changes in the macula were revealed in 17 patients (19 eyes) of the main group (15 eyes with staphylomas of the posterior pole of the eye, 4 eyes with macular staphylomas). The highest average value of axial length (30.94±0.81 mm) was noted in eyes with macular staphylomas, and the lowest (28.58±1.62 mm) - with staphylomas near the ONH. CONCLUSION: The presence of myopic maculopathy is associated with the presence of staphylomas with the odds ratio of 120.7 (95%, confidence interval 24.7-589.3). Staphyloma of the posterior pole of the eye and macular staphyloma were associated with the most severe forms of myopic maculopathy and low visual acuity.

[Anatomical and morphometric features of anterior eye segment structures in hyperopia and the risk of developing primary angle-closure glaucoma]. / Anatomo-morfometricheskie osobennosti struktur perednego segmenta glaza pri gipermetropii i risk razvitiya pervichnoi zakrytougol'noi glaukomy.

PURPOSE: To study features of anatomical and morphometric parameters of the structures of anterior eye segment in young patients with moderate and high hyperopia in order to identify the signs of an increased risk of developing primary angle-closure glaucoma (PACG) and its acute attack. MATERIAL AND METHODS: The study included 160 eyes (80 patients) with axial length (AL) of less than 23 mm. Patients with moderate or high hyperopia were divided into two groups according to their age ranges (the 1st - 27 patients (54 eyes) under 40 years old; the 2nd - 27 patients (54 eyes) of 41-50 years old, the comparison group - 26 patients (52 eyes) of 42-50 years old with the initial stage of PACG. AL of the eyes, anterior chamber (AC) depth in the central zone, lens thickness (LT) in the optical zone were measured using IOL Master 700 («Carl Zeiss Meditec AG¼, Germany). AC volume and peripheral AC depth were measured using rotating Scheimpflug camera Pentacam («Oculus¼, Germany). RESULTS: While the average values of AL in patients of the 1st and 2nd groups were comparable, a statistically significant decrease in AC depth and a significant increase in LT were revealed in the 2nd group. There was a statistically significant increase in LT, a decrease in peripheral AC depth and AC volume in the comparison group relative to the 2nd group. In the 1st group: in 2 eyes of one 38-year-old patient the maximum proximity of all 3 indices to the median values of the group of patients with PACG was found; in 4 eyes of two other patients (35 and 38 years old), a combination of small AC volume with increased LT or small AC volume with small AC on the periphery was noted. CONCLUSION: Significant differences in terms of LT, peripheral AC depth and AC volume were found between age-comparable (41-50 years old) healthy individuals with short eyes and patients with initial PACG. In 11% of the eyes of healthy patients with hyperopia aged 21 to 40 years, there was a combination of two or three of the studied morphometric signs, which may indicate the risk of developing PACG.

[Features of retinal blood flow in pregnant women with carbohydrate metabolism disorders]. / Osobennosti retinal'nogo krovotoka pri narushenii uglevodnogo obmena u beremennykh.

Studying the condition of retinal blood flow in pregnant women with disorders of carbohydrate metabolism contributes to early detection of diabetic retinopathy (DR), which is necessary for timely treatment and preservation of high visual functions. PURPOSE: To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for manifestation and progression of DR. MATERIAL AND METHODS: The study examined 203 pregnant women in the third trimester: 24 - with type 1 and 2 diabetes (T1D and T2D), 143 - with gestational diabetes (GD), and 36 apparently healthy women with physiological pregnancy that comprised the control group. OCTA imaging was performed on RTVue XR Avanti ("Optovue", USA) system using HD Angio Retina 6.0 mm2 scan protocol. The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied. RESULTS: FVD was significantly lower in pregnant women with diabetes than in pregnant women with GD and in the control group, prompting an assumption that retinal microvascular regulation changes because of chronic disturbances of carbohydrate metabolism in such patients and due to development of microangiopathy. Statistically significant increase in FAZ area and decrease in wiVD were revealed in patients with DR compared to data from the group of pregnant women with diabetes but without DR, in the absence of differences in FVD. In 2 patients with T1D and no ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye. CONCLUSION: OCTA can help identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes and no ophthalmoscopic signs of DR, and determine objective indications for timely retinal laser coagulation.

[Phacoemulsification in prevention of acute angle-closure glaucoma attack]. / Fakoemul'sifikatsiya v profilaktike ostrogo pristupa zakrytougol'noi glaukomy.

Analysis of the effectiveness of preventative phacoemulsification (PE) in anatomically short eyes with an increased risk of an acute glaucoma attack in thickened lens can help in choosing the optimal management tactics for these patients. PURPOSE: To study the changes in morphometric parameters of the anterior segment of anatomically short eyes with an increased risk of acute glaucoma attack before and after preventative PE. MATERIAL AND METHODS: The study included 70 patients (70 eyes) with a high risk of acute glaucoma attack in short anatomical axial length and thickened lens, with posterior and middle positions of the ciliary body. They were divided into 2 groups: the main group consisted of 45 patients who agreed to undergo PE; the comparison group consisted of 25 patients who refused to undergo PE due to good visual functions and no complaints about vision. B-mode ultrasound examination of the anterior segment of the eye was used to evaluate the cross-sectional surface area of the lens (CSAL) and the cross-sectional surface area of the anterior chamber (CSAAC). RESULTS: In the main group, on day 2-3 after PE the anterior chamber depth increased in all eyes, the CSAAC index increased, the anterior chamber angle (ACA) widened to Schaffer grade to II-III. After 1-3 years and 4-5 years, the anterior chamber depth, the CSAAC index and the width of the ACA remained stable. In the comparison group, after 1-3 years the anterior chamber depth and the CSAAC index significantly decreased, the ACA narrowed, and the intraocular pressure increased; after 4-5 years, there was a progressive increase in the CSAL index, the ACA was completely closed (0°). CONCLUSION: In all cases of timely performed preventative PE, already on days 2-3 after surgery there was a statistically significant improvement in the main morphometric parameters of the eye, which remained stable for 4-5 years.

[Development of additive systemic effects when taking ß-blockers in patients with glaucoma and concurrent chronic diseases]. / Razvitie sistemnykh additivnykh effektov pri prieme ß-adrenoblokatorov u patsientov s glaukomoi na fone khronicheskikh zabolevanii.

Examining the somatic state of glaucomatous patients that enroll for treatment, we are increasingly confronted with a serious problem of inconsistency in prescribing beta-blockers (ß-blockers) by ophthalmologists, cardiologists and therapists. PURPOSE: To assess the frequency and extent of adverse reactions at simultaneous local and systemic prescription of ß-blockers to patients with glaucoma and systemic vascular pathology. MATERIAL AND METHODS: The study included 112 patients that have been taking ß-blockers for at least 6 months. The main group consisted of 39 patients with primary open-angle glaucoma (POAG) in combination with cardiovascular disease; the first comparison group - 36 patients with POAG without systemic vascular pathology; the second comparison group - 37 patients with systemic vascular pathology without glaucoma. In the main and first comparison groups, double instillations of 0.5% timolol or 0.5% betaxolol were used as monotherapy. RESULTS: Adverse reactions to the long-term usage of ß-blockers were found in 82% of the main group patients with cardiovascular diseases. They manifested as bradycardia or bronchospasm (38% patients), combination of bradycardia and vascular hypotension or bronchospasm (18%), or combination of 3-4 types of adverse reactions (26%); in the first and second comparison groups - in 36% and 30%, respectively (p<0.05). CONCLUSION: The most severe multifactorial adverse reactions developed due to long-term use of combinations of systemic and local ß-blockers: 100 mg metoprolol or 10 mg bisoprolol with 0.5% timolol.

[Morphometric study of the choroid in pregnant women with disorders of carbohydrate metabolism]. / Morfometriya khorioidei u beremennykh s narusheniyami uglevodnogo obmena.

In recent years, much attention is being paid to studying the state of the choroid in various eye pathologies, but changes in the choroid of pregnant women with disorders of glucose metabolism remain unexplored. PURPOSE: To study choroidal thickness in pregnant women with disorders of carbohydrate metabolism in the III trimester. MATERIAL AND METHODS: The study included 376 pregnant women in the third trimester of pregnancy: 49 of them had type 1 diabetes (T1D), 248 had gestational diabetes (GD), and 79 were healthy pregnant women who comprised the control group. Three subgroups were distinguished among patients with GD, depending on the timing of the development of GD in the I (160 patients), II (56 patients), or III (32 patients) trimesters. Optical coherence tomography was performed to measure choroidal thickness in the foveal region. RESULTS: In patients with GD, no significant differences in average indexes of choroidal thickness in subgroups with different timing of diabetes development were observed, however, the pregnant women of the GD subgroup with beginning of its development in the first trimester had the smallest indexes of average choroidal thickness. In pregnant women with GD who received insulin, choroidal thickness was lower than in patients who did not receive it, although statistical significance of that was not established. In patients with T1D and diabetic retinopathy (DR), choroidal thickness was significantly lower compared to patients with T1D without DR, GD and control groups. Obtained data indicates the presence of changes in the choroid and development of diabetic choroidopathy in pregnant women with T1D and DR. CONCLUSION: The study of choroidal changes in pregnant women with disorders of carbohydrate metabolism can help identify criteria for manifestation of diabetic microangiopathy, choroidopathy, and predict the progression of DR.

[Clinical features of diabetic retinopathy in pregnancy]. / Osobennosti klinicheskogo techeniia diabeticheskoi retinopatii u beremennykh.

INTRODUCTION: Pregnancy is a risk factor for progression of diabetic retinopathy (DR). Despite the common opinion about the regression of DR after childbirth, it is possible for the disease to progress aggressively, which can cause loss of visual functions when treated untimely. PURPOSE: To present clinical cases with different course of development of DR in pregnant women with type 1 diabetes mellitus (DM1). MATERIAL AND METHODS: Five pregnant women with DM1 lasting more than 8 years were examined. Glycemic level of all patients was higher than normal (glycated hemoglobin (HbA1c) of more than 6.1%). Ophthalmologic examination was carried out including fundus photography, optical coherence tomography (OCT) of the macular area, Angio-OCT. RESULTS: The most significant factors in the progression of DR in pregnant women are DR1 compensation, severity and stabilization of DR during the preconception period, presence of a concomitant pathology. Timely detection of signs of progression of DR and therapeutic measures taken during pregnancy, in particular laser coagulation, were shown to stabilize the course of the disease and prevent loss of vision in pregnant women with DM1. CONCLUSION: Clinical course of DR in pregnancy can vary between absence of manifestation, stabilization, and progression. Progression of DR during pregnancy is determined by a number of factors including compensation of DM during the preconception period and throughout pregnancy, severity and stabilization of retinopathy during the preconception period, and presence of a concomitant pathology. Timely detection of the signs of DR progression and its treatment, in particular laser coagulation of the retina, can help stabilize the course of the disease during pregnancy. The course of DR may be aggressive in some pregnant women involving progression in the postpartum period, which warrants active monitoring of patients with retinopathy after childbirth.

[Correlation between biochemical markers of endothelial dysfunction, free radical oxidation and morphometric parameters of macular retina in pregnant women with preeclampsia]. / O vzaimosviazi mezhdu biokhimicheskimi faktorami éndotelial'noi disfunktsii, svobodnoradikal'nogo okisleniia i morfometricheskimi pokazateliami makuliarnoi zony pri preéklampsii.

Information about relationship between biochemical indexes of endothelial dysfunction in preeclampsia and morphometric parameters of macula is necessary for prediction of the risk of retinal vascular disorders. PURPOSE: To study the relationship between biochemical indexes of blood serum, lacrimal fluid (LF) and the macular retinal volume (MRV) in pregnant women with preeclampsia. MATERIAL AND METHODS: The study included 42 pregnant women aged 21 to 40 years with preeclampsia of different severity (the main group): 1st subgroup - mild degree (22 people); 2nd subgroup - average degree (12 people); 3rd subgroup - severe degree (8 people). The comparison group included 20 pregnant women aged 19 to 38 years experiencing physiologically natural pregnancy. RESULTS: By the 3rd trimester, in the 1st subgroup the index of MRV was between 6.4 and 9.5 mm3; the index of von Willebrand factor (vWF) - 88.9±7.3%; endothelin (ET) content in LF was 1.35±0.2 ng/ml; the indices of free radical oxidation (FRO) in lacrimal fluid (Ssp and Sind) were significantly higher than in the comparison group (p<0.01). In the 2nd subgroup: MRV was 7.4±0.5 mm3, ET - 2.2±0.3 ng/ml, and vWF - 117.2±8.5% (p<0.01); the indices of FRO were higher in comparison with the 1st subgroup. In the 3rd subgroup: MRV was 8.5±0.7 mm3, ET - 3.2±0.3 ng/ml, and vWF - 157±9.5% (difference with the 2nd subgroup p<0.01). The indices of FRO (Ssp, Sind and h) indices were maximum high (difference with the 2nd subgroup p<0.01). CONCLUSION: A trend of increase of MRV by the 3rd trimester correlating with the degrees of preeclampsia severity was found. In the main group (r from 0.71 to 0.83), strong, direct, statistically significant association was found between the increase of ET levels in LF, vWF and MRV on the one side, and FRO on the other side.

[Effectiveness of the system for predicting the risk of developing an acute angle closure glaucoma attack]. / Éffektivnost' sistemy prognozirovaniia riska razvitiia ostrogo pristupa zakrytougol'noi glaukomy.

One of the most severe urgent conditions of the eye capable of leading to untreatable blindness is an acute attack of glaucoma. This condition is an acute decompensation of eye hydrodynamics, which develops with primary angle-closure glaucoma (PACG). Detectability of PACG is only high at the sudden development of an acute attack, which can cause a sharp decrease or even irreversible loss of vision. PURPOSE: To assess the effectiveness of predicting the development of PACG in eyes with short anterior-posterior axis. MATERIAL AND METHODS: The study included 69 patients (90 eyes) aged 46 to 80 years with short anterior-posterior axis. We used our own mathematical formulas for calculating the risk of PACG development. According to these formulas, two groups of patients with high risk of PACG were selected. Patients of the main group underwent cataract phacoemulsification for preventive purposes, while patients of the comparison group did not undergo any operative treatment. RESULTS AND DISCUSSION: In the long-term, PACG did not develop in the patients of the main group. Patients of the comparison group refused to undergo cataract phacoemulsification, and had PACG develop in 38% of cases in the long-term follow-up. CONCLUSION: The high efficiency of the developed screening model for estimating the risk of PACG developing in eyes with short anterior-posterior axis has been proved. Preventive cataract phacoemulsification in the eyes with a high risk of PACG development in all cases helped to avoid it, retaining and even improving visual functions.

[Selection of optimal method of general anesthesia for intubation of nasolacrimal duct in young children]. / Vybor optimal'nogo metoda obshchei anestezii pri zondirovanii sleznogo kanala u detei mladshego vozrasta.

PURPOSE: comparative assessment of safety and clinical efficacy of Sevoflurane and Halothane in general anesthesia for nasolacrimal duct intubation in children. MATERIAL AND METHODS: Clinical results of nasolacrimal duct intubation in 288 children with persistent obstruction of tear duct were analyzed. A newly developed method of general anesthesia in the supine position was used for all cases. General anesthetic Phthorothanum was used in 146 children; general anesthesia with Sevoflurane - in 142 children. RESULTS AND DISCUSSION: A new safe and efficient method of general anesthesia for nasolacrimal duct intubation was developed. In the first group, aspiration complications (coughing) occurred in 7 patients under the age of 1 year and short apnea - in 2 children. In the second group, depression of respiration was seen in a three-year-old child caused by the action of the anesthetic, and coughing - in one patient under the age of 1 year during the final phase of intubation. CONCLUSIONS: The newly developed method of general anesthesia in the supine position with oropharyngeal aspiration for nasolacrimal duct intubation in children was effective because it helped avoid aspiration complications at a more physiological position (on the back) in children of both groups. Comparative analysis of safety and efficacy of mask anesthesia with Sevoflurane and Halothane for nasolacrimal duct intubation in children in the supine position showed Sevoflurane to be more preferable. The advantages of Sevoflurane anesthesia for nasolacrimal duct intubation in children in the supine position are higher anesthesia induction speed, absence of respiratory tract irritation, cardiodepressive effects or suppression of laryngeal reflexes, and minimum time between the end of anesthesia and awakening.

[Optic nerve pathology in the structure of diagnostic errors inpatients referred for cataract surgery]. / Patologiyazritel'nogo nerva v strukture diagnosticheskikh oshibok pri napravlenii patsientov na khirurgicheskoe lechenie katarakty.

AIM: to study the frequency of misdiagnosis of cataract in patients with optic nerve pathology or amblyopia and to identify its main causes. MATERIAL AND METHODS: The study enrolled 381 patients (381 eyes) wrongly diagnosed with cataract. A standard set of eye tests was performed. In-depth examination of the macular area was done through biomicroscopy with contactless aspheric lenses of 60 and 90 D. Part of the patients underwent optical coherence tomography and static perimetry as well as examination of electrical sensitivity threshold and electrical lability of the optic nerve. RESULTS: In 190 patients (190 eyes - 49.9%), the true cause of central vision impairment was optic nerve pathology associated with its partial atrophy of different origins: vascular (77.8%) or post-traumatic (22.2%). Glaucomatous atrophy of the optic nerve was found in 175 patients within the age range from 57 to 70 years (175 eyes - 45.9%). These were newly diagnosed cases of advanced open-angle glaucoma. In 16 eyes (4.2%), the true cause of low vision appeared to be amblyopia of some type: strabismic (9 eyes - 56.3%), refractive (4 eyes - 25%), or mixed (3 eyes - 18.7%). CONCLUSION: The main diagnostic errors of attending ophthalmologists were the following: underestimation of the discrepancy between low visual functions and small degree of lens opacity as well as the neglect of careful examination of the fundus (specifically, the optic disc and macula), additional perimetry, thorough history taking, and cover-testing for suspected amblyopia.

[Study of vitreomacular interface in patients with pseudophakia by means of spectral optical coherence tomography]. / Issledovanie vitreomakulyarnogo interfeisa s pomoshch'yu spektral'noi opticheskoi kogerentnoi tomografii u patsientov s artifakiei.

AIM: to investigate the state of vitreomacular interface in pseudophakic patients by means of spectral optical coherence tomography (OCT). MATERIAL AND METHODS: Spectral OCT of the macular region was performed in 58 pseudophakic eyes that underwent laser treatment for secondary cataract, 28 newly pseudophakic eyes (day 1 after cataract phacoemulsification with IOL implantation), and 40 eyes with early senile cataract. RESULTS: A higher incidence of subclinical fibrosis of the internal limiting membrane was noted in pseudophakic patients after YAG laser surgery for secondary cataract as compared to cataract patients and those right after cataract phacoemulsification. CONCLUSION: Fibrosis of the internal limiting membrane significantly more often develops in the late period after cataract extraction as compared to patients with early senile cataract and those who have just underwent phacoemulsification surgery. Fibrosis of the internal limiting membrane arising in the late period after cataract extraction cannot be unambiguously attributed to either primary or secondary. The resolution of spectral OCT is high enough to allow detection of preclinical ultrastructural changes in the vitreomacular interface.

[Vogt-Koyanagi-Harada syndrome (clinical cases)].

OBJECTIVE: to analyze two female cases of Vogt-Koyanagi-Harada (VKH) syndrome. MATERIAL AND METHODS: The first patient presented with bilateral panuveitis and unilateral keratomalacia (left eye). For the latter, blepharorrhaphy was performed. Methylprednisolone (Metypred) and azathioprine pulses, subsequently switched to oral therapy, caused regression of uveitis. In 1 month the patient was operated for retinal detachment and associated cataract in her right eye. The second patient presented with bilateral detachment of neuroepithelium. Complete reattachment in both eyes was achieved with Metypred pulses followed by oral prednisolone and azathioprine. Bilateral panuveitis with pupil occlusion developed 6 months after the cessation of prednisolone, however, began to resolve as soon as the treatment was resumed. RESULTS: Timely diagnosis and combination pulse therapy (methylprednisolone and azathioprine) enabled rapid resolution of acute condition. CONCLUSIONS: Pulse Metypred is the mainstay of the treatment of VKH syndrome. Supplementing the treatment of autoimmune uveitis with low doses of azathioprine slows progression of the disease and minimizes prednisolone-induced side effects. It is important that VKH patients are treated with pathogenetic therapy in close cooperation with an immunologist. Long-term monitoring (not less than 2-3 years) is also necessary.

[Diagnostic errors when referring patients for cataract surgery].

AIM: To study the frequency of patients with macular pathology being wrongly diagnosed with cataract and possible reasons for this to occur. MATERIAL AND METHODS: A total of 1390 patients (1390 eyes), in whom cataract turned out to be not the main cause of visual impairment, were recruited as research subjects. To reveal the reasons for misdiagnosis, we resorted to methods of ophthalmic examination that are available at ambulatory care facilities, i.e. visual acuity measurement, slit lamp biomicroscopy of the anterior and posterior eye segments, direct and indirect ophthalmoscopy. RESULTS: In most patients (72.6%) visual acuity was decreased due to macular pathology, especially age-related macular degeneration (AMD)--736 eyes (72.9%). Less common were degenerative myopia (10%), idiopathic macular hole (8.4%), epiretinal macular fibrosis (5.1%), and secondary macular changes of vascular, traumatic, or inflammatory genesis (3.6%). In 76.6% of eyes with macular pathology ophthalmoscopy was perfectly feasible and could be performed by a local ophthalmologist. Only in 23.4% of cases there was a dense posterior capsule opacification or nuclear cataract that impeded visualization of macular structures. CONCLUSIONS: The main reason for misdiagnosis of macular pathology and referring the patient to cataract surgeon was the neglect of apparent discordance between visual acuity and lens transparency. One should aim at adequate assessment of macular zone by all means, including non-contact ophthalmoscopy with 60 or 90 D aspherical lenses or Hruby lens and red-free examination.

[Clinical and morphometric macular changes in patients with diabetes mellitus after cataract phacoemulsification].

Optical coherent tomography (OCT) shows that in patients with diabetes mellitus (DM), a macular morphological response to cataract phacoemulsification (CPE) with intaocular lens (IOL) implantation proceeds as 3 types: 1) areactive without macular morphological changes; 2) hyperreactive with the development of reversible subclinical macular edema; and 3) aggressive with the transition of stress-induced retinal morphological lesions to clinically significant diabetic macular edema. Morphological differences in OCT parameters were established to have impact on the effect of visual rehabilitation. Following 3-4 months of CPE with IOL implantation in DM patients with the areactive type of a macular morphological response to surgical stress, the increase in visual acuity exceeded that observed in the hyperactive and aggressive types of a macular response by 12.8 and 57.7%, respectively. The findings suggest that medical preventive measures reducing the negative consequences of surgical stress should be implemented in DM patients at catarrhal surgery.

[Experimental study of the efficiency of use of sodium hypochlorite in the complex treatment of purulent keratitis].

The experiment has provided evidence for the safe use of 0.1% aqueous sodium hypochlorite for ocular tissues and for its therapeutic efficacy in purulent keratitis. The therapeutic effect is achieved by accelerating the lysis of neurotic tissues, by suppressing the pathogenic microflora, by alleviating an inflammatory reaction, by stimulating epithelization and reparative regeneration, by activating the phagocytic properties of neutrophilic leukocytes by 1.8-times, by increasing their functional reserves by 1.3 times as compared to the similar parameters observed in the use of conventional treatments.

[Administration of epithalamine in the treatment of unstable glaucoma of different types after normalization of intraocular pressure]. / Primenenie épitalamina dlia lecheniia razlichnykh tipov nestabilizirovannogo techeniia glaukomy posle normalizatsii vnutriglaznogo davleniia.

The treatment effect and clinical efficacy of epithalamine solution was studied on 28 patients (42 eyes) with unstable glaucoma and normalized intraocular pressure (IOP). Epithalamine belongs to the group of cytomedines and it has a modeling effect on the functional activity of the simpatico-adrenaline system, adrenal cortex and anti-oxidizing activity. The clinical study showed that the use of epithalamine solution resulted in normalization of the biochemical activity of the neuro-humoral triphism (adrenaline, norepinephrine, and hydrocortisone). It leads to an increased diameter of arterioles of the bulbar conjunctiva and of the optic disk as well as to a decreased degree of congestive angiopathy and of intravascular aggregation of erythrocytes.