[The first experience of using femtosecond laser in the treatment of anterior capsular contraction syndrome]. / Pervyi opyt primeneniya femtosekundnogo lazera dlya lecheniya perednekapsulyarnogo kontraktsionnogo sindroma.

Prevention and treatment of anterior capsular contraction syndrome (ACCS) is a relevant problem in cataract surgery. PURPOSE: The study was performed to develop a femtosecond laser-assisted technique for anterior capsulotomy in anterior capsular contraction syndrome and assess its preliminary results in preventing the progression of pathological changes in the capsular bag. MATERIAL AND METHODS: The examination and femtosecond laser-assisted treatment without additional surgical intervention was performed in 6 patients (6 eyes) aged 69 to 73 years with anterior capsular contraction syndrome. Femtosecond laser-assisted anterior capsulotomy was performed using the VICTUS system (Technolas Perfect Vision, Germany). Capsulotomy diameter was 4.0-4.5 mm, laser radiation energy - 9000 nJ, laser exposure depth 900-1000 µm. RESULTS: The diameter of the anterior capsulotomy before treatment was 2.85 mm [2.75; 2.93]. After 1 month, the diameter of the anterior capsular opening was 2.88 mm [2.78; 2.96] (p>0.05). One year after femtosecond laser intervention, the anterior capsulotomy opening was almost the same shape and diameter - 2.84 mm [2.74; 2.94] (p>0.05). CONCLUSION: Femtosecond laser-assisted circular capsulotomy is an effective and safe method for preventing the progression of anterior capsular contraction syndrome in the absence of severe IOL decentration and for maintaining the diameter of the anterior capsular opening of at least 2.5-3.0 mm.

[Intraoperative optical coherence tomography in vitreoretinal surgery]. / Intraoperatsionnaya opticheskaya kogerentnaya tomografiya v vitreoretinal'noi khirurgii.

This article reviews literature on the use of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery, describes the historical aspects of the development of this technology from portable devices to optical coherence tomographs integrated into the surgical microscope, considers the advantages, limitations and disadvantages of this technology, which are now becoming obvious due to the accumulated experience. The review also explores the prospects for the development of iOCT and possible ways to solve its problems. In addition, the review presents and systematizes clinical findings that can be revealed with iOCT in such diseases as rhegmatogenous retinal detachment, complications of proliferative diabetic retinopathy, macular pathology, etc.

[Faricimab: from research to clinical practice]. / Faritsimab: ot klinicheskikh issledovanii k real'noi klinicheskoi praktike.

Development of new molecules for anti-angiogenic therapy pursues the following objectives: to increase the interval between injections, which can reduce the treatment burden; to improve the effectiveness of treatment by affecting various links of pathogenesis; to ensure a good safety profile. Faricimab is a humanized immunoglobulin G antibody that targets two key angiogenesis sites: vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2). In the STAIRWAY clinical trial, faricimab was shown to produce similar results to monthly ranibizumab at longer intervals and fewer intravitreal injections in patients with neovascular age-related macular degeneration, specifically in terms of visual preservation and reduction in central retinal thickness (CRT). In the BOULEVARD trial, which lasted 36 weeks, the severity of diabetic retinopathy according to DRSS improved in previously untreated patients with diabetic macular edema by two stages and more in 12.2% of the 0.3 mg ranibizumab group, in 27.7% of patients in the 1.5 mg faricimab group, and in 38.6% of patients in the group treated with 6.0 mg faricimab. In the TENAYA, as well as LUCERNE, YOSEMITE and RHINE trials, the increase in best-corrected visual acuity (BCVA) from baseline in the faricimab group was comparable to that in the aflibercept group. Real clinical practice showed an increase in BCVA from 59.5 to 60.6 letters (p=0.035) due to a decrease in CRT from 334.3 to 303.3 µm (p=0.001). The first published studies are now appearing, and their results correspond to the clinical trials, which indicates a stable effect of the drug and the prospects for use in a large cohort of patients.

[Morphological evaluation of the results of laser activation of scleral hydropermeability in the treatment of glaucoma]. / Morfologicheskaya otsenka rezul'tatov operatsii lazernoi aktivatsii gidropronitsaemosti sklery v lechenii glaukomy.

PURPOSE: The study attempted to experimentally substantiate the possibility of using the laser activation of scleral hydropermeability (LASH) technique in glaucoma treatment by morphological evaluation of treatment outcomes. MATERIAL AND METHODS: The pulsed-periodic radiation from an Er-glass fiber laser (λ=1.56 µm) was used. The model experiment consisted of evaluating ultrafiltration of fluid through the tissues of human sclera autopsy specimen according to the original technique using neodymium chloride-based labeling agent and scanning electron microscopy. The clinical part of the study consisted of optical coherence tomography (OCT) and laser confocal microscopy of the sclera and conjunctiva (CMSC) performed in vivo immediately after laser treatment in the laser application sites in 5 patients (5 eyes) aged 57 to 68 years with uncompensated advanced (IIIb-c) stage of glaucoma who had previously underwent LASH surgery. RESULTS: Results of morphological evaluation after LASH revealed structural changes indicating increased transscleral ultrafiltration: increased intrastromal hyporeflective areas in the sclera, thinning of collagen fibers, formation of porous structures. Using an original technique involving neodymium chloride-based labeling agent and scanning electron microscopy, we were able to prove the enhancement of transscleral ultrafiltration. The results of the experiment were confirmed by in vivo OCT images of the sclera and CMSC performed in 5 patients with advanced glaucoma after LASH surgery, in which tissue decompaction in the laser-exposed areas was clearly visualized. CONCLUSION: The revealed structural changes indicate the possibility of reducing intraocular pressure after LASH by the means of forming scleral porous structures and increasing transscleral ultrafiltration. Experimentally selected optimal mode of laser exposure (0.66 W with total exposure time of 6 seconds) during LASH helps avoid gross destructive changes in the eye tissues, making the proposed intervention a sparing approach to the treatment of glaucoma.

[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.

[Phaco surgery in disorders of the capsular-zonular apparatus of the lens]. / Fakokhirurgiya pri narusheniyakh svyazochno-kapsulyarnogo apparata khrustalika.

The article presents authors' original methods of phaco surgery that can be used in disorders of the capsular-zonular apparatus of the lens. The cataract surgery techniques for lens subluxation developed and introduced into clinical practice allow using the most physiologically correct intracapsular intraocular lens (IOL) fixation in the vast majority of cases. The introduction of femtosecond laser at key stages of phacoemulsification in complicated clinical situations reduces the dependence of the results on the human factor and allows performing removal of complicated cataracts at a qualitatively new level.

[Hybrid (femtolaser) phacoemulsification: technical aspects and functional results]. / Gibridnaya (femtolazernaya) fakoemul'sifikatsiya: tekhnologicheskie aspekty i funktsional'nye rezul'taty.

This article summarizes scientific and practical results of hybrid femtosecond laser-assisted phacoemulsification (HFE) including study of clinical and technical aspects of the intervention and evaluation of post-surgical functional state of the eye on the basis of clinical, morphological and biomechanical data. The HFE technology should be considered the method of choice for microinvasive phaco surgery, its main advantage being the possibility of controlled handling of such important surgical stages as anterior circular continuous capsulorhexis and nucleus fragmentation on a closed eyeball, which significantly reduces the risk of complications and decreases of effective ultrasound time.

[Prognostic factors and a customized approach to anti-VEGF therapy for exudative age-related macular degeneration. Analysis of the risk of macular atrophy development]. / Prognosticheskie faktory i kastomizirovannyi podkhod k anti-VEGF-terapii pri ekssudativnoi forme vozrastnoi makulyarnoi degeneratsii. Analiz riska vozniknoveniya makulyarnoi atrofii.

Age-related macular degeneration (AMD) is a chronic progressive multifactorial disease characterized by a degenerative process in the retinal pigment epithelium (RPE), Bruch's membrane and choriocapillaris of the fovea with secondary neuroepithelial (NE) damage. Intravitreal administration of drugs that inhibit VEGF is recognized as the only treatment for exudative form of AMD. Literature data is limited, and do not allow drawing conclusions about the influence of various factors (identified using OCT in the EDI mode) on the development of various subtypes of atrophy and their progression, so we decided to conduct our own study and research the possible timing and risks of developing various subtypes of macular atrophy in patients with exudative AMD receiving anti-VEGF therapy. As a result of the study, it was revealed that general macular atrophy (p=0.005) has a predominant effect on BCVA in the first year of the follow-up, while subtypes of atrophy anatomically less pronounced at one year of the follow-up manifest themselves only in the second year of the follow-up (p<0.05). Although color photography and autofluorescence are currently the only approved methods for assessing the degree of atrophy, the use of OCT may reveal reliable precursor endpoints that will facilitate and allow earlier and more accurate assessment of neurosensory tissue loss resulting from the atrophy. Thus, the development of macular atrophy is influenced by such parameters of disease activity as intraretinal fluid (p=0.006952), RPE detachment (p=0.001530) and the type of neovascularization (p=0.028860), as well as neurodenegerative changes in the form of drusen (p=0.011259) and cysts (p=0.042023). The new classification of atrophy according to the degree and localization of the lesion allows more differentiated conclusions about the effect of anti-VEGF drugs on the development of certain types of atrophy, which can be a decisive factor in determining the treatment tactics.

[Current possibilities of laser surgery on anterior eye segment]. / Sovremennye vozmozhnosti lazernogo vozdeistviya na struktury perednego segmenta glaza.

The article summarizes the experience of recent years in the development and implementation of novel original laser technologies used in surgery of the anterior segment of the eye. The presented technology of laser activation of scleral hydropermeability (LASH) in glaucoma is based on the effect of enhanced transscleral filtration and has been shown as effective and safe, which was confirmed by the results of a comprehensive clinical and experimental study. Development of another technique was associated with the need to improve the safety of laser interventions in anterior capsule contraction syndrome in pseudophakia, and resulted in a proposition to change the configuration of the anterior lens capsule incision from the usual linear-radial to T-shaped laser anterior capsulorhexis. The proposed technology of laser photomydriasis based on near-infrared radiation of the diode laser (0.810 µm) has shown its effectiveness and gentle nature (absence of atrophy of the iris stroma and post-burn pigmentation) in ectopias and pupil deformity.

[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.

[The development of laser technologies in vitreoretinal surgery (publications review)].

The article presents review of scientific publications on development of laser treatment methods in vitreoretinal surgery. The use of photo-therapy in medicine dates back to ancient times, when people began to use sunlight as treatment of various diseases. The heyday of photo-therapy falls on the second half of the XIX century, which was associated with the invention of first electric lamps. In 1960, T. Maiman developed the world's first laser, revolutionizing precision and control of light delivery. This was the beginning of heyday of laser surgery primarily in ophthalmology, where potential of lasers was instantly recognized. The subsequent discovery of argon laser in 1964 by W. Bridges (USA) marked new era in retinal photo-coagulation. Then new types of lasers with various systems of delivering laser radiation appeared that significantly expanded range of application of laser technologies in ophthalmology and vitreoretinal surgery. Currently, the lasers are applied in oculoplasty, refractive and corneal surgery, in laser support of phacoemulsification of cataract, in treatment of glaucoma, in laser coagulation of retina and thermotherapy. In vitreoretinal surgery laser technologies remain at the level of the XX century. Thus, they are still applied only for endolaser coagulation of retina. And this despite the fact that there is immense potential for applying lasers as "laser scalpel" to remove vitreous humor, epiretinal fibrosis, retinotomy and choroidotomy.

[Modern approaches to the treatment of anterior capsule contraction syndrome]. / Sovremennye podkhody k lecheniyu perednekapsulyarnogo kontraktsionnogo sindroma.

Anterior capsule contraction syndrome is a specific complication of continuous circular capsulorhexis in various phacoemulsification techniques. Surgical, laser and combined methods have been proposed for its treatment. All approaches in the treatment of anterior capsule contraction syndrome have some advantages, as well as certain problems and difficulties. This review presents the current state of this problem of cataract surgery and possible prospects for improving the treatment.

[Clinical outcomes of laser activation of hydraulic permeability of the sclera in the treatment of advanced glaucoma]. / Klinicheskie rezul'taty lazernoi aktivatsii gidropronitsaemosti sklery v lechenii patsientov s dalekozashedshei stadiei glaukomy.

PURPOSE: This study evaluates the hypotensive effect and the outcomes of intravital morphological changes in the intervention site after laser activation of scleral hydro-permeability (LASH) by pulsed-periodic radiation from an Er-glass fiber laser (λ=1.56 µm) in patients with advanced glaucoma. MATERIAL AND METHODS: LASH surgery was performed in 19 patients (19 eyes) aged 48 to 73 years with uncompensated advanced stage (IIIb-c) glaucoma. In addition to standard methods of investigation, all patients were examined with optical coherence tomography (OCT) and laser confocal microscopy of sclera and conjunctiva (CMSC) at the laser treatment sites, and electronic tonography. RESULTS: The hypotensive effect after LASH in patients with advanced glaucoma was observed in 94.7% (n=18) of cases. The decrease in intraocular pressure (IOP) averaged 24.4% from baseline one month after intervention and 32.96% after six months of follow-up. In 15.7% (n=3) of cases, the recorded IOP decrease was insufficient as its target values were not achieved. However, in the vast majority of patients (n=16), the recorded IOP decrease corresponded to the target values and indicated compensation of the process. Results of complex morphological evaluation after LASH revealed structural changes indirectly indicating possible laser-induced influence on the processes of increased transscleral filtration and uveoscleral outflow. A high positive correlation dependence (r=0.848) was also revealed between the degree of IOP lowering and the increase in the coefficient of ease of aqueous humor outflow, attesting to the fact that IOP lowering was mainly due to the improvement of intraocular fluid outflow. CONCLUSION: The demonstrated efficacy of LASH technology indicates the possibility of its successful application as an independent method of IOP reduction in patients with advanced glaucoma.

[Choroidal changes in patients with diabetes mellitus]. / Izmeneniya khorioidei u patsientov s sakharnym diabetom.

Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) and considered one of the leading causes of vision loss worldwide. The choroid supplies blood to the retina, photoreceptors and the retinal pigment epithelium, it is essential for metabolic exchange in the retina. Many experimental studies have reported that choroidal pathology in diabetic patients may play a role in the development of DR. Choroidal thickness (CT) can be used to assess the vascularization of the choroid. Choroidal vascularity index (CVI) is also used as a marker in assessment of choroidal vascularization. Many studies have been conducted to evaluate choroidal changes in various eye diseases. However, the data on CT in DM patients, especially in those with DR, are conflicting. Thus, the choroidal status in diabetic patients with or without DR remains controversial. In this systematic review we analyze a number of articles dedicated to the relationship between structural changes in the choroid in patients with diabetes mellitus and diabetic retinopathy of different stages, paying particular attention to choroidal thickness and certain other parameters that allow assessment of choroidal changes.

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

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

[Refractive outcomes of out-of-the-bag intraocular lens implantation]. / Refraktsionnye rezul'taty vnekapsul'noi implantatsii intraokulyarnykh linz.

For the moment, the refractive outcomes of out-of-the-bag intraocular lens (IOL) implantation remain insufficiently studied. PURPOSE: To study and compare the refractive outcomes of retropupillary implantation of an iris-claw lens and transscleral suture fixation of IOL in complicated phacoemulsification. MATERIAL AND METHODS: The study included 70 patients (73 eyes) after complicated phacoemulsification in combination with grade 2 lens subluxation. The first group included 36 patients (39 eyes) who underwent complicated phacoemulsification using torsional ultrasound and retropupillary implantation of an iris-claw lens. The second group included 34 patients (34 eyes) after complicated phacoemulsification using torsional ultrasound and transscleral suture fixation of an elastic hydrophobic IOL. In the postoperative period we performed a comparative evaluation of uncorrected visual acuity and best corrected visual acuity, the average absolute error of IOL optical power calculation, the precision of postoperative refraction within ±0.5 diopters, the degree of induced astigmatism, and the tilt of the IOL. RESULTS: At three months after surgery uncorrected visual acuity of 0.8-1.0 was achieved in 33.3% of cases in the first group and 17.6% in the second group, the average absolute error of IOL optical power calculation was 0.34±0.08 diopters in the first group and 0.63±0.19 diopters in the second group, the precision of postoperative refraction within ±0.5 diopters was 94.9% in the first group and 85.3% in the second group, the tilt of the IOL was 0.69±0.21° in the first group and 3.19±0.97° in the second group (p<0.05). There were no significant differences in best corrected visual acuity and the degree of induced astigmatism 3 months after surgery. CONCLUSION: Implantation of an iris-claw lens in the course of complicated phacoemulsification in lens subluxation significantly improves refractive outcomes of the implantation in comparison with transscleral IOL fixation.

[Ocular microcirculation after revascularization of the internal carotid artery in the early postoperative period]. / Mikrotsirkulyatsiya glaza posle rekonstruktivnykh operatsii na sonnykh arteriyakh v rannem posleoperatsionnom periode.

Carotid artery stenosis is the most common cause of ischemic stroke and transient ischemic attacks in the population of developed countries. Carotid endarterectomy (CEA) and carotid stenting (CAS) are effective treatments for carotid stenosis. In view of the need to improve the diagnosis of this condition and the anatomical relationship of the internal carotid arteries and vessels of the eye, studying retinal microvasculature has become an urgent problem. The theory suggesting that changes in ocular blood flow parameters may reflect disease status in patients with internal carotid artery (ICA) stenosis requires further investigation. PURPOSE: To study the impact of CEA and CAS interventions on ocular blood flow in patients with clinically significant ICA stenosis in the early postoperative period. MATERIAL AND METHODS: Thirty-two patients with hemodynamically significant stenosis (≥75%) of the left or right ICA were examined using optical coherence tomography angiography (OCT-A) and flowmetry before and after CEA or CAS in order to assess the changes in ocular blood flow parameters. RESULTS: There were no significant differences in hemodynamic parameters in the eyes on the side of the stenotic and non-stenotic ICA before revascularization. In the early postoperative period (3-7 days) in the ipsilateral eyes, there was an increase in blood flow density and vascular density at the level of the superficial and deep plexuses in the macular area (p≤0.05), as well as an increase in the ocular blood flow volume, the level of tolerated intraocular pressure (p≤0.05) and a decrease in intraocular pressure (p≤0.05) bilaterally. In the contralateral eyes, after ICA revascularization there was a partial improvement in microcirculation parameters according to OCT-A (p≤0.05). Peripapillary blood flow density and peripapillary vessel density did not change significantly either on the ipsilateral or the contralateral side. CONCLUSION: In patients with clinically significant ICA stenosis, ICA revascularization by stenting or endarterectomy contributed to an improvement in retinal microcirculation and retrobulbar blood flow in both eyes. OCT-A and flowmetry allow non-invasive assessment of retinal microvessels and retrobulbar blood flow, and the measurements provided by these methods can serve as valuable biomarkers for predicting and monitoring hemodynamic changes in patients who undergo CEA and CAS surgeries.

[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.

[Gerontological aspects of eye diseases]. / Gerontologicheskie aspekty zabolevanii organa zreniya.

The global rate of aging is rapidly rising due to the increase in life expectancy, and the number of age-related diseases - including eye diseases - is increasing. The most common eye conditions affecting people over 50 years old are age-related macular degeneration, cataract, glaucoma and diabetic retinopathy. Timely and effective treatment of age-related eye diseases requires a deeper understanding of the cellular mechanisms of aging.

[Laser-induced damage to the cornea after YAG laser surgery of anterior segment structures]. / Lazerindutsirovannye povrezhdeniya rogovitsy posle YAG-lazernykh vmeshatel'stv na strukturakh perednego segmenta glaza.

Laser photodestruction (LPD) of tissues is the basis of modern laser reconstructive surgery in ophthalmology. The most common laser technologies based on LPD mechanisms include YAG laser capsulotomy (discission) (LD) of secondary cataract and YAG laser iridectomy (LIE) for glaucoma. Laser reconstructive interventions for secondary cataract, as well as LIE, have a number of advantages over traditional surgery, but at the same time are associated with the risk of complications, including in the cornea. Corneal endothelium is the most susceptible to laser damage, while Descemet's membrane and corneal stroma are injured less often. This review describes cases of iatrogenic perforation and purulent inflammation of the cornea. In the long-term, laser interventions can lead to bullous keratopathy and corneal graft rejection. At this time, the most popular and available among the methods for assessing the cornea after YAG laser interventions is the method of specular microscopy. Ultrasound biomicroscopy is used less commonly. The modern method of corneal confocal microscopy is practically not used for this purpose, and taking into account the risks of developing laser-induced injuries, it indicates its relevance and the need for further research.