[Complications of femto-LASIK and features of cavitation injuries]. / Oslozhneniya femto-LAZIK i osobennosti kavitatsionnykh povrezhdenii.

Modern approach to refractive laser surgery features three main types of lamellar surgery. Two of them are types of open laser keratomileusis (LASIK and femtosecond laser-assisted LASIK), and the third - closed (SMILE). All of these techniques allow achieving good clinical outcomes but differ in possible complications. This article reviews the complications of femto-LASIK and specifically the post-operative cavitation injuries, describes the mechanism of their occurrence, variants of their course, and presents the prevention measures.

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

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

[Multifocal analysis of the bioelectric potential and light sensitivity of the retina in thrombotic microangiopathy associated with malignant arterial hypertension]. / Mul'tifokal'nyi analiz elektricheskogo biopotentsiala i svetovoi chuvstvitel'nosti setchatki pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei.

PURPOSE: This study evaluates the function of the retina according to multifocal electroretinography (mfERG) and its light sensitivity according to microperimetry (MP) in patients with thrombotic microangiopathy (TMA) associated with malignant hypertension (MH). MATERIAL AND METHODS: The study analyzed mfERG and MP data of 20 patients (40 eyes) aged 40.4±7.4 years (18 men, 2 women) with MH-associated TMA. In all patients TMA of the kidneys was verified by nephrobiopsy. The control group consisted of 20 healthy individuals (40 eyes) of the appropriate age. RESULTS AND DISCUSSION: A statistically significant decrease in the response density of P1 mfERG (nV/deg2) of the central retinal zone (0-27.7°) was found in study patients in comparison with the control group (p<0.05), differences in the latency of P1 mfERG (ms) were statistically insignificant (p>0.05). Analysis of MP data in study patients revealed a statistically significant decrease in the mean light sensitivity (dB) of the central field of vision (30°) (p<0.05) compared to the control group. A statistically significant correlation was found between the response density of P1 mfERG (nV/deg2) and mean light sensitivity (dB) in the corresponding quadrants of the visual field (p<0.05). A number of statistically significant correlations were found between the indicators of MP and mfERG and some non-ocular clinical manifestations of TMA in MH. CONCLUSION: A statistically significant decrease in the light sensitivity of the central field of vision caused by marked decrease in retinal function, probably of an ischemic nature, is characteristic for MH-associated TMA. In this disease the response density of P1 mfERG (nV/deg2) is a sensitive indicator of impaired retinal function. With the activation of systemic TMA, increase in blood pressure and deterioration of kidney function in MH, the light sensitivity of the eye also decreases.

[Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation)]. / Glubokaya perednyaya posloinaya keratoplastika pri ekstruzii nepolnogo intrastromal'nogo kol'tsa (klinicheskoe nablyudenie).

Intrastromal corneal ring segments (ICRS) of in various shapes are used to correct structural changes in the cornea and improve visual acuity in keratoconus (KC). The most serious complications of the technology infection, vascular ingrowth, and extrusion. In this study a 44-year-old patient underwent deep anterior lamellar keratoplasty (DALK) 5 years after implantation of ICRS in the shape of an incomplete ring to treat its extrusion of up to 30%, vascular ingrowth into the cornea and corneal syndrome. The following DALK technique was used: excision of the free part of the corneal segment, removal of the remaining part of the corneal segment, excision of 80% of thickness of the corneal block with a 8.5-mm trepan, pneumatic dissection of the stroma down to the Descemet membrane (DM), removal of the remaining stroma on the viscoelastic pillow, laying and suture fixation of the donor graft. There were no complications during the postoperative period, the graft remained transparent for up to 10 months. Uncorrected visual acuity (UCVA) increased from 0.01 to 0.4, best corrected visual acuity (BCVA) increased from 0.3 to 0.7. The number of endothelial cells decreased from 2980 to 2670 cells/mm2 (10.4%). This clinical case demonstrates that DALK surgery can be a reliable method of patient rehabilitation in cases of extrusion of ICRS in the shape of an incomplete ring and vascular ingrowth.

[Biomarkers of retinal ischemia in thrombotic microangiopathy associated with malignant arterial hypertension on optical coherence tomography]. / Markery retinal'noi ishemii pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei, po dannym opticheskoi kogerentnoi tomografii.

Malignant arterial hypertension is a clinical syndrome characterized by severe diastolic arterial hypertension with signs of ischemic damage to various organs. In some malignant arterial hypertension cases, thrombotic microangiopathy occurs - a rare life-threatening condition characterized by multiple systemic thrombosis of the microvasculature, including in the eyes, which can be clarified by optical scanning of the retina. PURPOSE: To determine markers of retinal ischemia in the eyes with thrombotic microangiopathy associated with malignant arterial hypertension. MATERIAL AND METHODS: The study included 6 patients (12 eyes) with thrombotic microangiopathy associated with malignant arterial hypertension who were examined by optical coherence tomography (OCT) and OCT angiography (OCT-A). All patients suffered from renal dysfunction, which etiology was determined by renal biopsy verifying the presence of renal thrombotic microangiopathy in all cases. RESULTS: According to OCT findings, there were bilateral local foci of thinning of the inner nuclear layer with elevation of the outer plexiform and outer nuclear layers of the retina in 5 out of 6 patients (83%). OCT-A revealed that in most cases (67%), these changes had perivascular localization and corresponded to the areas of attenuation of the deep capillary plexus. A statistically significant thinning of the inner nuclear layer of the retina was found in thrombotic microangiopathy associated with malignant arterial hypertension in comparison with the control group. CONCLUSION: Presence of renal thrombotic microangiopathy confirmed by renal biopsy and the anatomical similarity of the microvasculature of the kidneys and the eyes, give basis to consider the foci of «chronic¼ paracentral acute middle maculopathy detected with OCT in patients with malignant arterial hypertension as biomarkers of thrombotic microangiopathy of the eye.

[The role of optical coherence tomography angiography in the assessment of retinal microcirculation in thrombotic microangiopathy associated with malignant arterial hypertension]. / Rol' opticheskoi kogerentnoi tomografii s funktsiei angiografii v otsenke retinal'noi mikrotsirkulyatsii pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei.

Optical coherence tomography angiography (OCT-A) allows detailed assessment of the state of local blood flow in various systemic ischemic diseases, which include thrombotic microangiopathy (TMA) associated with malignant arterial hypertension (MAH). PURPOSE: To evaluate retinal microcirculation using OCT-A imaging data in the group of patients with TMA associated with MAH. MATERIAL AND METHODS: The study consisted of a qualitative and quantitative analysis of OCT-A data from 7 patients (14 eyes) with TMA associated with MAH and verified by renal biopsy. The control group included 7 healthy individuals (14 eyes). The following parameters were analyzed: area size of the foveal avascular zone FAZ, mm, vessel density (VD, %) and vessel skeleton density (VSD, %). The indicators were measured separately in the deep and superficial vascular plexuses and divided by localization into: the total density of the entire measured area, central density, density by quadrants (superior, inferior, nasal and temporal). All quadrants were subdivided into inner (corresponding to parafovea) and outer (corresponding to perifovea). RESULTS: Local foci of vascular attenuation of the deep retinal capillary plexus, pathological tortuosity of blood vessels in the deep and superficial retinal capillary plexuses were found in 100% of study group patients. Per-quadrant analysis of OCT-A finding in the macular zone revealed a statistically significant decrease in VD of the deep retinal capillary plexus (p<0.05). A direct correlation was found between glomerular filtration rate and the VD index in the outer inferior (r=0.567; p=0.034) and inner temporal quadrants (r=0.613; p=0.020) of the deep retinal capillary plexus, as well as the level of hemoglobin in blood serum and VD in inner temporal quadrant of the deep vascular plexus (r=0.596; p=0.025). CONCLUSION: Changes revealed with OCT-A are the symptoms of TMA in MAH patients spreading to the retinal microvasculature, mainly at the level of the deep retinal capillary plexus.

[Opto-functional results in keratoconus patients after intrastromal keratoplasty]. / Optiko-funktsional'nye rezul'taty posle intrastromal'noi keratoplastiki pri keratokonuse.

Intrastromal keratoplasty with allograft implantation can stop the progression of keratoconus (KC) and improve visual acuity (VA). Although optimization of keratometric parameters and an increase in VA improve the quality of vision (QoV), there are other indicators that affect the QoV and the quality of life (QoL) of patients and require further study. PURPOSE: Analysis of quantitative and qualitative characteristics of vision in patients with stage II and III keratoconus who underwent intrastromal allokeratoplasty. MATERIAL AND METHODS: The study included 15 patients (15 eyes) with stage II-III KC (Amsler-Krumeich classification) aged 17 to 38 years old (28.8±6.2). All patients underwent intrastromal keratoplasty with implantation of an allograft in the form of a wide incomplete ring. The following parameters were assessed before and 6 months after surgery: distance VA with and without correction, near VA with and without correction, VA with glare effect, high-order aberrations (HOA), thickness of the tear film lipid layer, spatial contrast sensitivity (SCS) under photopic and mesopic conditions with light filters, reading speed. RESULTS: VA without correction increased from 0.15 to 0.7; with correction from 0.35 to 0.7. The glare effect with varying degrees of illumination did not affect VA either before or after surgery. Statistically significant changes were observed when comparing the aberrations «coma¼, «spherical¼, «trefoil¼ before and after the intervention, they became inverted. The thickness of the tear film lipid layer did not change significantly when comparing pre- and postoperative data. The use of light filters (orange, yellow) did not lead to significant changes in the VA and SCS under photopic and mesopic conditions. CONCLUSION: The use of a wide intrastromal allograft to correct deformity and stabilize the cornea in keratoconus improves the patients' quality of vision and visual performance.

[Long-term outcomes of bandage therapeutic-optical keratoplasty in the treatment of keratoconus]. / Otdalennye rezul'taty bandazhnoi lechebno-opticheskoi keratoplastiki pri lechenii progressiruyushchego keratokonusa.

Intrastromal keratoplasty has recently been widely used in the surgical treatment of keratoconus (KC). In 2013, a new type of interlamellar keratoplasty operation was developed - bandage therapeutic-optical keratoplasty (BTOK). PURPOSE: Evaluation of the long-term outcomes of surgical treatment of stages II and III progressive KC with BTOK technique. MATERIAL AND METHODS: The study included 107 patients (126 eyes): group 1 with stage II KC - 78 eyes, 100% of these patients were observed for 1 year, 52 eyes (66%) for 3 years, and 18 eyes (23%) for 5 years; group 2 - 48 eyes with stage III KC, with 100% of them observed for 1 year, 39 eyes (81%) for 3 years, and 12 eyes (25%) - 5 years. All patients received a customized allograft in the form of an intrastromal corneal ring segment (ICRS). RESULTS: During the first year after BTOK surgery, the uncorrected and corrected visual acuity (UCVA and CVA) in the first group increased by 0.5±0.04 (p<0.05) and 0.2±0.02 (p<0.05), respectively, in the second group - by 0.46±0.05 (p<0.05) and 0.47±0.05 (p<0.05) due to a decrease in refractive indices in the central 3.0 mm zone. In the first group, mean refraction in the central 3.0 mm zone (Km) was within 45±3.75 (p<0.05), in the second - 48.63±.2 diopters (p<0.05), while maximum refraction in the central 3.0 mm zone (Kmax) decreased from 50.02±2.20 (p<0.05) to 44.61±1.03 diopters (p<0.05) in the first group, from 58.21±3.43 (p<0.05) to 50.45±3.46 diopters (p<0.05) in the second group. The values of UCVA, CVA and refractive indices of the central corneal zone in the first and second groups did not change statistically significantly after three and five years. Minimum corneal thickness in the first group increased from 476.23±13.35 to 485.08±15.80 µm (p<0.05), in the second - from 412.73±38.63 to 422.00±42.25 µm (p<0.05). CONCLUSION: BTOK surgery can be used in patients with stages II and III KC to improve the visual functions, strengthen the ectatic cornea and stop the progression of the disease.

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

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

[Changes in the quality of vision after intrastromal allokeratoplasty for keratoconus (clinical observation)]. / Izmenenie kachestva zreniya posle intrastromal'noi allokeratoplastiki po povodu keratokonusa (klinicheskoe nablyudenie).

Scleral lenses, corneal collagen crosslinking, corneal implants and deep anterior keratoplasty are used to correct deforming changes in the cornea at advanced stages of keratoconus, which improves the quality of vision (QoV). The article presents an analysis of changes in QoV in a 30-year-old patient with stage III keratoconus who underwent intracorneal implantation of an allograft with a width of 2.75 mm and thickness of 300 µm at a depth of 370 µm. The following parameters were measured before and 6 months after the procedure: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), VA with glare, higher order aberrations (HOA), thickness of the lipid layer of the tear film, spatial contrast sensitivity, visual productivity. Observation results show that the Kmax index decreased from 55.9 D to 48.0 D, Kmin - from 39.8 D to 39.4 D, UCVA increased from 0.1 to 0.8 and BCVA - from 0.35 to 0.8. Thickness of the lipid layer of the tear film remained the same. The glare effect with different degrees of brightness did not affect visual acuity. Spatial contrast sensitivity in photopic conditions at medium frequencies increased from 19 to 37 dB, at high frequencies from - 0.5 to 22.5 dB, in mesopic conditions at medium frequencies from 11 to 28 dB, at high frequencies from - 0.5 to 12 dB. The «coma¼ and «spherical¼ aberrations decreased by 2 and 3 times, respectively, while «trefoil¼ increased by 3 times. Visual productivity increased by 36.8%. It may be concluded that the use of a wide intrastromal allograft in keratoconus improves the patient's visual quality and visual productivity. At the same time, the «vignetting¼ effect from the graft side is negligible in photopic conditions and is significant in mesopic conditions.

[Results of the application of complex physiotherapeutic neurostimulation in optical neuropathies of various genesis]. / Rezul'taty primeneniya kompleksnoi fizioterapevticheskoi neirostimulyatsii pri opticheskikh neiropatiyakh sosudistogo geneza.

Optical neuropathies (ON) are the outcome of many diseases of various origins. The main ones are classified as inflammatory, vascular and traumatic ON. ON lead to subatrophy of the optic nerve, but even after the completion of treatment, it is possible to improve visual functions by using physiotherapeutic means of ophthalmic rehabilitation. OBJECTIVE: To evaluate the effectiveness of complex physiotherapeutic neuro-ophthalmostimulation in case of ON of vascular origin. MATERIAL AND METHODS: The study included 60 patients (120 eyes) with a verified diagnosis of optic neuropathy of vascular origin, who were divided into 2 groups comparable in age, gender and anatomical and functional characteristics: the main group of 30 patients (60 eyes) and the control group - 30 patients (60 eyes), including 24 men and 36 women, mean age was 66.2±4.1 years, disease duration was 4.1±1.7 years. All patients underwent courses of conservative treatment with vitamins according to the available ophthalmological standards, repeating them 1-2 times a year, the last of which was six months before the present study. Physiotherapy courses and patients did not pass. 20 healthy volunteers were taken to create basic indicators of the «norm¼ of the applied research methods. Patients of the main group used a set of procedures: transcranial magnetic electrical stimulation, endonasal electrophoresis with the drug neuroprotector Semax 0.1%, oxybaric chamber and acupuncture. Patients in the control group were prescribed basic therapy, including taking the vitamin complex BEROCCA for 3 months. Breakpoints: before treatment and at times: 1st week, 12 weeks and 24 weeks after the course of treatment, according to the standard recommendations for international multicenter studies. The following were assessed: visual field boundaries (dilation meridians; in deg.), light sensitivity (MS, MD; in dB), indicators of the state of the retinal ganglion layer (GCS thickness, volume loss): Avg CCG (in µm), FLV, GLV (in %). RESULTS: When evaluating the results in patients of the main group who received complex neurostimulation, the therapeutic efficacy in a week after the end of treatment was 94%, in 12 weeks - in 88% and in 24 weeks - 83%, while in patients of the control group for all studied indicators showed only a positive trend and therapeutic efficacy did not exceed 30-42%. CONCLUSION: Under the influence of the developed neurostimulating complex, the activity of nerve cells objectively increases, leading to a significant increase in the boundaries of the field of view and light sensitivity and a decrease in global losses of the retinal ganglion complex and optic nerve.

[Physiotherapeutic methods in ophthalmic rehabilitation of patients with glaucoma and cataract]. / Fizioterapevticheskie metody v oftal'moreabilitatsii patsientov s sochetannoi glaukomoi i kataraktoi.

The authors analyzed scientific data on physiotherapeutic measures in the treatment of combined glaucoma and cataracts as one of the main causes of blindness and low vision.

[Retinal tomography features of thrombotic microangiopathy associated with atypical hemolytic-uremic syndrome]. / Retinotomograficheskie osobennosti tromboticheskoi mikroangiopatii, assotsiirovannoi s atipichnym gemolitiko-uremicheskim sindromom.

OBJECTIVE: To evaluate structural and morphological changes in the retina using optical coherence tomography (OCT) in patients with thrombotic microangiopathy (TMA) associated with atypical hemolytic-uremic syndrome (aHUS). MATERIAL AND METHODS: The study analyzed OCT data of 14 patients (28 eyes) with an established diagnosis of aHUS including such indicators as central retinal thickness (CRT), thickness of the retinal nerve fiver layer (RNFL), ganglion cell layer (GCL), retinal pigment epithelium (RPE), etc. RESULTS: Patients with aHUS were noted to have an increase in CRT, paracentral acute middle maculopathy in the form of a hyperreflective defect primarily of the inner nuclear layer of paracentral localization, as well as disorganization of the RPE, which was observed statistically significantly more often compared to healthy persons (p=0.0001, p=0.001 and p=0.009 respectively). In the subgroup with thrombotic retinopathy (6 people) a statistically significant increase in CRT and peripapillary RNFL was found (p=0.004 and p=0.001) compared to patients without thrombotic retinopathy, as well as the presence of paracentral acute middle maculopathy and transudative macular retinoschisis (p=0.0001 and p=0.004). A statistically significant thinning of the peripapillary RNFL was revealed (p=0.0001) in the subgroup with symptoms of Purtscher-like retinopathy (PLR) found retrospectively (4 people) compared to patients without retrospective PLR symptoms. A statistically significant decrease in CRT was revealed (p=0.018) in the subgroup of patients receiving systemic therapy with eculizumab (5 people) compared with patients not receiving this therapy. Statistically significant correlations were recorded between the studied OCT indicators, laboratory indicators, and the level of systolic blood pressure (p<0.05). CONCLUSION: According to OCT, paracentral acute middle maculopathy is a biomarker of thrombotic retinopathy and the activity of systemic TMA associated with aHUS. Arterial hypertension is an additional aggravating factor in the development of paracentral acute middle maculopathy and transudative macular retinoschisis. Targeted therapy with eculizumab leads to an effective decrease in CRT, which is potentially associated with regression of ischemic edema. The outcome of PLR involves thinning of peripapillary RNFL.

[On the tactics for surgical treatment of keratoconus in significantly altered corneal thickness]. / K voprosu o taktike khirurgicheskogo lecheniya keratokonusa pri sushchestvennykh izmeneniyakh tolshchiny rogovitsy.

PURPOSE: To evaluate the clinical and functional outcomes of bandage therapeutic-optical keratoplasty (BTOK) surgery in patients with keratoconus (KC) and significant changes in corneal thickness. MATERIAL AND METHODS: Surgical treatment was performed in 15 patients (15 eyes) with stage IV KC aged from 22 to 51 years (mean age - 32.61±7.94 years). The follow-up period lasted 3 years. All patients underwent BTOK surgery using an interlamellar graft with a thickness of 320 to 350 µm. RESULTS: Uncorrected and best corrected visual acuity increased in all patients after BTOK surgery and did not change statistically significantly during the entire follow-up period (3 years), amounting to 0.47±0.12 and 0.53±0.13, respectively. Keratometric parameters also remained stable by that observation time point and amounted to: Kmax - 53.01±2.30 D; Kmin - 41.63±2.24 D; Km - 47.32±1.91 D. CONCLUSION: The BTOK surgery helps achieve long-term (3 years) visual, optical and strengthening outcomes in stage IV KC patients when the use of other known techniques (corneal collagen crosslinking, corneal segments) is technically impossible because of the risk of complications due to significantly thinned cornea (less than 400 µm).

[Ocular iontophoresis]. / Lekarstvennyi elektroforez v oftal'mologii.

Iontophoresis in medicine is a combined pharmacological and physical method of treatment that unites the therapeutic effect of an electric current with the pharmacological effect of medicinal substances administered at the same time via an electric current. The article describes the physical basis of the therapeutic effect of direct electric current on biological tissues, and highlights the physical and chemical mechanisms of target administration of pharmaceutical substances into the human body through intact skin or mucous membrane by means of direct electric current. In addition, it presents the results of international as well as Russian domestic scientific studies on the clinical effectiveness of iontophoresis in ophthalmology.

[Comparative assessment of the quality of life of keratoconus patients before and after intrastromal keratoplasty]. / Sravnitel'naya otsenka kachestva zhizni do i posle intrastromal'noi keratoplastiki pri keratokonuse.

Surgical treatment of keratectasia, in addition to its cessation, is aimed at increasing the acuity and quality of vision. This can also significantly affect patient's quality of life. The criteria for assessing the quality of life does not always consider the balance between quantitative indicators and subjective perception, which can depend on the psychological aspect of self-esteem.Purpose - to perform comparative assessment of the quality of life of patients with keratoconus (KK) before and after intrastromal keratoplasty by a newly developed method using an original questionnaire. MATERIAL AND METHODS: The study included 20 patients (14 men and 6 women, with mean age of 33 years, from 21 to 45 years old; 20 eyes) diagnosed with degree II-IV KK, with non-corrected visual acuity of 0.3 or lower. The original questionnaire with three blocks of questions about subjective assessment of the severity of discomfort associated with the disease, expectations of treatment results and its effectiveness was used to study the quality of life of KK patients who underwent surgery. The evaluation method used a five-point grading scale. RESULTS: Despite the inability to objectively assess the result of treatment, patients can generally note the trend for improvement. Especially significant are the increase of visual acuity, improvement of general health, feeling of comfort and more optimistic view of one's future. Comparison of the expectations and treatment results has shown that some therapeutic effects are overestimated by the patients, while some others are underestimated. A priori, they overvalue the effects of treatment (actions associated with visual tasks - reading, writing), but at the same time undervalue the characteristics of overall personal and emotional state (except for spatial safety and comfort), i.e. the characteristics that determine the quality of life. CONCLUSION: The aims of writing a valid and reliable questionnaire have been achieved partially, and its further development requires comparison of the obtained results with psychodiagnostic data, which would reveal the nature of psychological factors that form the quality of life perception in patients with various vision disorders.

[Ocular ischemic changes in thrombotic microangiopathy associated with malignant arterial hypertension (case study)]. / Ishemicheskie izmeneniya glaza pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei (klinicheskoe nablyudenie).

The article presents a clinical observation of visual organ damage as an extrarenal manifestation of thrombotic microangiopathy in malignant arterial hypertension with an analysis of structural and functional changes in the eye by modern examination methods. The presence of renal thrombotic microangiopathy was verified by kidney biopsy. Optical coherence tomography was used to determine structural changes in the inner and outer layers of the retina in the form of their disorganization, areas of thickening of the nerve fiber layer, intraretinal inclusions and cysts, alterations of the ellipsoid zone and retinal pigment epithelium. Optical coherence tomography angiography revealed areas of vascular pattern attenuation in the deep and superficial retinal plexuses corresponding to OCT-detected foci of disorganization of the inner retinal layers. Color Doppler imaging showed absence of the diastolic component of the Doppler spectrum with an increase in the peripheral resistance index RI up to 1.0 in the central retinal artery and posterior short ciliary arteries in both eyes. Functional changes observed with multifocal electroretinography and microperimetry corresponded to the structural changes. Taking into account the similarity of microcirculation in the kidneys and the eyes, the probable pathogenetic mechanism underlying the detected structural and functional symptoms of ischemic damage to the visual organ in malignant arterial hypertension is chronic thrombotic microangiopathy. An interdisciplinary approach to studying thrombotic microangiopathy, including those associated with malignant arterial hypertension, using high-tech examination methods can be useful for timely diagnosis and treatment of this pathology.

[Ocular manifestations of primary thrombotic microangiopathy]. / Glaznye proyavleniya pervichnoi tromboticheskoi mikroangiopatii.

The article reviews literature on ocular manifestations of primary thrombotic microangiopathy. Thrombotic microangiopathy is a clinical and morphological syndrome that characterizes a systemic disseminated lesion of the microcirculatory bed, it is a special type of vascular damage that combines thrombosis and inflammation of the vascular wall leading to occlusion of the vessel lumen, causing ischemic damage to various organs and tissues. The classic types of primary thrombotic microangiopathy are thrombotic thrombocytopenic purpura, shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) and atypical hemolytic uremic syndrome. Thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome are characterized by ischemic damage to the visual organ as a result of suspected thrombotic microangiopathy in the microcirculatory bed of the eye. The clinical picture of ocular manifestations of these diseases is similar, however the damage to the eye in the form of ischemic Purtscher-like retinopathy is more characteristic of atypical hemolytic uremic syndrome, which may be due to chronic uncontrolled activation of the alternative complement pathway in this disorder. Timely initiation of systemic therapy of the underlying disease in most cases leads to complete restoration of visual functions. A thorough ophthalmological examination of patients with these diseases is required.

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

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

[Modern treatment of different forms of optic nerve atrophy]. / Sovremennye sposoby terapii razlichnykh form atrofii zritel'nogo nerva.

Optic nerve atrophy (ONA) is one of the most common causes of blindness and low vision in the world. The disease occurs in 60-68% of cases. The causes of optic nerve atrophy are diverse: inflammatory and vascular diseases of the optic nerve and retina, glaucoma, atherosclerosis of the main vessels of head and neck, diseases of central nervous system, intoxication of various etiologies, as well as congenital and hereditary diseases. The literature review presents data on the diagnosis and classification of optic nerve atrophy, as well as on drug and non-drug treatment in combination with physiotherapy.