[Comparative analysis of clinical and functional parameters in patients with stable stage II-III keratoconus after implantation of corneal segments and fitting of scleral rigid contact lenses]. / Sravnitel'nyi analiz kliniko-funktsional'nykh pokazatelei u patsientov so stabil'nym keratokonusom II­III stadii posle implantatsii rogovichnykh segmentov i podbora skleral'nykh zhestkikh kontaktnykh linz.

The modern treatment strategy for keratoconus (KC) involves sequential application of medical technologies aimed at stabilizing pathological changes in the cornea and restoring visual acuity. PURPOSE: This study compares the effect of implantation of intrastromal corneal ring segment (ICRS) and fitting of individual scleral rigid contact lenses (RCLs) on visual functions in patients with stage II-III KC after previously performed corneal collagen cross-linking. MATERIAL AND METHODS: The Helmholtz National Medical Research Center of Eye Diseases examined and treated 34 patients (69 eyes) aged 18 to 33 years with stage II-III KC. The study included patients who had previously undergone standard corneal collagen cross-linking. Depending on the type of optical correction, the patients were divided into two groups: patients in group 1 underwent ICRS implantation using a femtosecond laser; patients in group 2 were fitted with individual scleral RCLs. RESULTS: Improvement in clinical and functional parameters was observed in both groups. A higher clinical and functional result was achieved in group 2. CONCLUSION: For patients with stable stage II-III KC, it is advisable to recommend fitting of individual scleral RCLs for visual rehabilitation.

[The population morbidity with diseases of ear and mastoid and accessibility of otorhinolaryngological care].

The article analyses level and dynamics of morbidity of diseases of ear and mastoid in the Sakha Republic (Yakutia) in 2020-2021 and availability of otorhinolaryngological care. The methods of comparative statistics and mathematical analysis were applied to analyze official data provided by the Yakut Republic Medical Information and Analytical Center, the specialized Department of Otorhinolaryngology, the Republic Hospital № 2 - Center for Emergency Medical Care and the Federal State Statistics Service of Russia. The study established increasing trend of increasing morbidity of these diseases in both the adult and child population. In 2021, the growth rate of overall morbidity of adult population reached 17.7% and 8.8% in children, as compared to 2020. The primary morbidity of adults made up to 22.3%, in children - 15.7%. The comparative analysis demonstrated higher rates of general morbidity in the Republic: by 0.5% as compared with the Russian Federation and by 14.1% as compared with the Far Eastern Federal Okrug. The level of primary morbidity was lower than similar indicators of the compared territories by 17.1% and 3.0%, respectively. It is worth noting that analyzed morbidity of diseases of ear and mastoid reflects prevalence of ENT diseases in the region only indirectly, as the statistical data do not allow to estimate separately rate of upper respiratory tract lesions. Meanwhile, respiratory diseases rank first in the structure of population diseases in Yakutia. The growth of disability in children due to diseases of ear and mastoid requires attention. Among children of 0-17 years old, the indicator of primary disability increased from 0.38 to 0.8 per 10,000 of children population (increase of 110.5%); in children 0-3 years old - from 0.9 to 2.3 per 10,000 of the child population (an increase of 155.6%). The analysis of the number of beds in otorhinolaryngology wards established that that the bed capacity per 10,000 population was 0.6 that is significantly lower than the established standards. The article emphasizes need to adjust the Federal standards for hospital bed capacity, taking into account climatic and geographical conditions of the region, which contribute to spread and chronization of ENT diseases.

[Legal and forensic medical problems of postmortem donation]. / Pravovye i sudebno-meditsinskie problemy posmertnogo donorstva.

The article is devoted to legal and forensic medical problems of postmortem donation. The substantive provisions of postmortem donation, as well as normative legal documents regulating the processes of organs harvesting from deceased persons for subsequent transplantation and governing the work of transplantologists and forensic medical experts have been considered. The practical examples illustrating the essence and nature of the problem of postmortem forensic medical expertise of persons with absent organs has been given and the importance of the participation of a forensic medical expert involved in the decision-making process on possibility (or impossibility) of the corpse's organs and tissues explantation without prejudice to the further expert examination has been emphasized. The authors pay particular attention to the inadequacy of the legal framework, including the lack of a clear understanding of the legal status of the person holding the position of forensic medical expert, who provides an expert opinion on the organs' explantation.

Comparative study of calcification in human choroid plexus, pineal gland, and habenula.

Choroid plexus, pineal gland, and habenula tend to accumulate physiologic calcifications (concrements) over a lifetime. However, until now the composition and causes of the intracranial calcifications remain unclear. The detailed analysis of concrements has been done by us using X-ray diffraction analysis (XRD), X-ray diffraction topography (XRDT), micro-CT, X-ray phase-contrast tomography (XPCT), as well as histology and immunohistochemistry (IHC). By combining physical (XRD) and biochemical (IHC) methods, we identified inorganic (hydroxyapatite) and organic (vimentin) components of the concrements. Via XPCT, XRDT, histological, and IHC methods, we assessed the structure of concrements within their appropriate tissue environment in both two and three dimensions. The study found that hydroxyapatite was a major component of all calcified depositions. It should be noted, however, that the concrements displayed distinctive characteristics corresponding to each specific structure of the brain. As a result, our study provides a basis for assessing the pathological and physiological changes that occur in brain structure containing calcifications.

[The relationship between the relative length of leukocyte telomeres and mtDNA copy number and acute coronary syndrome in a 15-year follow-up.]

OBJECTIVE: to study the association of relative leukocyte DNA telomere length with death from natural causes during a 15-year follow-up in a middle-aged and elderly Siberian population. Study of the association of the relative length of leukocyte telomeres (LTL) with fatal outcomes during a 15-year follow-up of a random population sample formed in 2003-2005 (n=9 360, 45-69 years old, Novosibirsk, HAPIEE project). The main group included the persons died from natural causes (except external) without a previous history of CVD and cancer (n=609); controls were stratified by sex and age (n=799). The analysis of relative LTL at baseline was performed using quantitative real-time PCR. We estimated the odds ratio of all-cause death per 1 decile shortening of LTD as a continuous variable in a multivariable-adjusted logistic regression. The carriers of shorter telomere carriers had an increased risk of death from natural causes over the next 15 years (OR=1,37, 95% CI 1,31-1,44) per decile of LTL decrease, regardless of other factors. The risk coefficients were similar for death from CVD (1,39), cancer (1,42), and other non-external causes (1,51). In studied middle-aged and elderly Siberian (Caucasoid) population cohort the LTL was an independent inverse predictor of the 15-year risk of death from natural causes.

The Influence of Adiponectin on Transport of Low-Density Lipoproteins through Human Endothelial Cell Monolayer In Vitro.

The influence of adiponectin, a protein secreted by adipocytes, on the activation of transendothelial LDL transport, the initial event of atherogenesis, was studied. The addition of adiponectin to the cultured endothelial hybridoma EA.hy926 cells did not affect both basal and TNF-stimulated transendothelial transport of LDL. In addition, adiponectin affects neither expression levels of CAV1, SCARB1, and ACVRL1 genes encoding proteins involved in transendothelial LDL transport, nor the MMP secretion by the EA.hy926cells. At the same time, adiponectin suppressed the TNF-stimulated IL-8 production and expression of the adhesion molecule gene ICAM1 in these cells. Thus, adiponectin reduces proinflammatory activation of EA.hy926 cells, which is not accompanied by changes in the transendothelial LDL transport. We speculate that anti-inflammatory action of adiponectin is the base for the influence of this adipokine on atherogenesis.

[Transplantation of the Bowman's layer in combined treatment of recurrent pterygium]. / Transplantatsiya boumenova sloya v kombinirovannom lechenii retsidiviruyushchego pterigiuma.

Pterygium is among the most frequent indications for extraocular ophthalmic surgery. The main method of pterygium treatment - its excision - is often combined with transplantation, non-transplantation, medication and other methods. However, the frequency of pterygium recurrence can exceed 35%, and the cosmetic and refraction outcomes satisfy neither the patient, nor the surgeon. PURPOSE: The study analyses the technical capability and feasibility for transplantation of the Bowman's layer in the treatment of recurrent pterygium. MATERIAL AND METHODS: The transplantation of the Bowmen's layer was performed according to the developed technique on 7 eyes with recurrent pterygium (7 patients aged 34 to 63 years). The combined surgery technique consisted of pterygium resection, laser ablation, autoconjunctival plasty, exposure to a cytostatic drug, non-suture transplantation of the Bowman's layer. Maximum length of the follow-up was 36 months. Analysis involved data from refractometry, visometry (without correction and with spectacle correction), and optical coherence tomography of the retina. RESULTS: There were no complications in any of the studied cases. The cornea and the transplant retained transparency throughout the entire follow-up duration. 36 months after surgery mean spectacle-corrected visual acuity amounted to 0.86±0.2, topographic astigmatism - 1.48±1.4 diopters. Recurrence of pterygium was not observed. All patients were satisfied with the cosmetic outcomes of the treatment. CONCLUSION: Non-suture transplantation of the Bowmen's layer recovers normal anatomy, physiology and transparency of the cornea after repeat surgical intervention for pterygium. No pterygium recurrences were observed throughout the entire follow-up after treatment with the proposed combined technique.

[Clinical, biochemical and histological indicators of Del Nido cardioplegia efficacy in patients with severe myocardial hypertrophy]. / Klinicheskie, biokhimicheskie i gistologicheskie pokazateli effektivnosti kardioplegicheskogo rastvora Del Nido u patsientov s vyrazhennoi gipertrofiei miokarda.

OBJECTIVE: To evaluate the effectiveness of two cardioplegia techniques in patients with severe myocardial hypertrophy undergoing septal myectomy or aortic valve replacement. MATERIAL AND METHODS: A comparative pilot prospective single-center randomized study included 46 patients between 2022 and 2023. Patients were randomized into 2 groups: Del Nido (n=23) and Custodiol (n=23). We analyzed perioperative echocardiography data, troponin I at several time points, perioperative complications and histological data. RESULTS: Both groups were comparable in time of myocardial ischemia, cardiopulmonary bypass, duration of anesthesia and surgery (p>0.05). The maximum ischemia time in the Del Nido group was 84 min. The same group showed significantly higher percentage of spontaneous rhythm recovery (65.2% vs. 30%, p=0.008). None patient required mechanical support, high-dose inotropes or vasopressors. Troponin I in 2 hours after cardiopulmonary bypass (p=0.415), 12 (p=0.528) and 24 hours after admission to the intensive care unit (p=0.281) were similar in both groups. No significant difference was found in ventilation time, ICU- and hospital-stay. CONCLUSION: Del Nido cardioplegia has some advantages compared to Custodiol and does not lead to perioperative complications in case of aortic cross-clamping time <90 min in patients with myocardial hypertrophy.

[Postgenomic and structural changes in the myocardia of Wistar rats fed a high-salt diet].

The relationship between dietary sodium, hypertension, and cardiovascular injury is far from clear. One of the important links in this process can be microRNAs that have the ability to modulate gene expression at the post-transcriptional level. However, their role in this process has not been fully studied. In addition, further studies require the identification of structural changes in the myocardium in conditions of long-term consumption of a high-salt diet. The aim of the study was to evaluate the expression levels of nuclear transcription factor κB (NFκB), microRNA (miRNA)-21 and structural changes in the myocardium during long-term consumption of a diet containing 8% (high) sodium chloride in Wistar rats. Material and methods. 20 Wistar rats with initial body weight 280.5±42.7 g were divided into two equal groups. The high salt (HS) group received 8% NaCl in the diet, the control (NS) group received the standard diet (0.34% NaCl). After 4 months, systolic blood pressure was measured in rats using the cuff method on the tail; the myocardial mass index was assessed after dissection; histological and electron microscopic examination of the myocardium was performed, and the expression levels of miRNA-21 and NFκB in the myocardium were determined. Results and discussion. Consumption of a diet high in sodium chloride for 4 months did not significantly affect the level of systolic blood pressure in normotensive Wistar rats, but led to an increase in myocardial mass index by 25.0% (p<0.05). In the HS group, hypertrophy of cardiomyocytes and an increase in the wall thickness of arterial vessels were revealed. The area of perivascular fibrosis in rats of the HS-group was almost 1.8 fold higher than in the NS-group. In animals of HS-group, the relative levels of expression of NFκB (more than 2 times) and miRNA-21 (almost 6 times) increased compared with the control. It can be assumed that the negative impact on the cardiovascular system of high-salt diets is partially realized through NFκB-associated signaling pathways and miRNA-21 activation. Conclusion. In Wistar rats, long-term use of a high-salt diet results in myocardial remodeling that is not associated with changes in blood pressure. At the same time, the adverse effects of high salt intake on the myocardium are mediated, in particular, by postgenomic mechanisms, namely an increase in the expression levels of NFκB and microRNA-21.

[Regional differentiation of demographic dynamics in Russia and the role of healthcare].

The article examines the role of the processes of natural and migration movement of the population in changing the total population of the regions of Russia for more than two decades of the XXI century. Six possible combinations of these processes are proposed, which result in either an overall increase in the population or a reduction. During the period under review, various scenarios in a number of regions had fairly stable trends - a constant decline in the population or a stable increase in it. Moreover, such stability was determined either by a stable natural increase exceeding the migration decline, or by a stable decrease in the population as a result of a stable natural decline or migration outflow. But many regions experienced both the turbulence of reproduction and migration processes, as a result of which the overall result for population dynamics also changed. For the first time, a typology of Russian regions was carried out according to the frequency of the influence of natural and migration growth on the total population of the regions. This allowed further studies to consider the role of migration processes on the demographic aging of the population of the regions.

MicroRNA miR-133a-3p Facilitates Adrenergic Proarrhythmic Ectopy in Rat Pulmonary Vein Myocardium by Increasing cAMP Content.

Cardiac-specific microRNA miR-133a-3p modulates adrenergic signaling. Adrenergic receptors and their intracellular pathways are the key players in proarrhythmic ectopy derived from the myocardial sleeves of the pulmonary veins. We studied the effect of miR-133a-3p on ectopy induced by norepinephrine in myocardial tissue of rat pulmonary veins. Using microelectrode technique, we revealed facilitation of proarrhythmic pattern of spontaneous bursts of action potentials induced by norepinephrine in tissue preparations of the pulmonary veins isolated from rats in 24 h after injection of a transfection mixture containing miR-133a-3p (1 mg/kg) in vivo. According to ELISA data, the cAMP level in the pulmonary vein myocardium of rats receiving miR-133a-3p was 2-fold higher than in control animals. Bioinformatic analysis showed that mRNA of protein phosphatases and some phosphodiesterases are most probable targets of miR-133a-3p. The proarrhythmic effect of miR-133a-3p can be related to inhibition of the expression of phosphodiesterases accompanied by cAMP accumulation and increased intracellular ß-adrenergic signaling.

Effect of Biocides on the Activity of Extracellular Enzymes Produced by Degrader Fungi from Technical Objects Used in Tropical Climates (Vietnam).

Activity of extracellular enzymes was assessed in 20 strains of microscopic fungi involved in biodegradation of technical objects exploited under tropical climate conditions (Vietnam). It was found that 19 strains possessed catalase activity, 18 strains had phenol oxidase activity, and eight strains had protease activity. The effect of industrial biocides on the activity of these enzymes was also assessed. The biocides Bior-1, Bioneutral A 10, and Bioneutral A 101 were shown to inhibit the enzymatic activity to various extent. All biocides inhibited extracellular catalase activity in most fungal strains studied. The inhibition of protease and phenol oxidase activity of same test strains was less pronounced. The response to biocides varied at the strain level; its characteristics could differ significantly even between strains of the same species. In several cases, it was observed that exposure to biocides resulted in an increase in enzyme activity.

[Clinical picture and ultrasound manifestations of secondary lymphedema of the maxillofacial region]. / Klinicheskaya kartina i ul'trazvukovye proyavleniya vtorichnoi limfedemy chelyustno-litsevoi oblasti.

OBJECTIVE: The aim of the study is to determine the main clinical symptoms and ultrasound manifestations of secondary lymphedema of the maxillofacial region. MATERIAL AND METHODS: This study is based on the study of a comprehensive examination and the effectiveness of treatment of 15 patients diagnosed with lymphedema of the maxillofacial region, who are on outpatient treatment at the Federal State Budgetary Institution "National Medical Research Centre for Dental and Maxillofacial Surgery" of the Ministry of Health of the Russian Federation from 2020-2021 at the age of 18 to 70 years. The examination of patients included the study of complaints, anamnesis of life, anamnesis of the disease, external examination and examination of the oral cavity, palpation of soft tissues of the maxillofacial region, X-ray examination (if necessary). All patients underwent ultrasound examination of the soft tissues of the maxillofacial area. RESULTS: When examining patients, it was revealed that the main clinical symptoms of lymphedema of the maxillofacial region are the presence of edema, a feeling of heaviness and stiffness of movements in the area of edema and the absence of symptoms of inflammation such as fever, hyperemia and pain. 100% of patients had the following ultrasound manifestations in the area of lymphatic drainage disorders: an increase in tissue thickness, impaired tissue differentiation into layers, a diffuse increase in tissue echogenicity, and the presence of dilated lymphatic vessels. CONCLUSION: Lymphedema of the maxillofacial region is a polyetiological disease that is difficult to diagnose, requiring a thorough examination of the patient, including basic examination methods, radiography, and mandatory ultrasound examination of soft tissues.

[Lymphotropic therapy in the treatment of patients with postoperative secondary lymphedema of the maxillofacial region]. / Limfotropnaya terapiya pri lechenii patsientov s vtorichnoi limfedemoi chelyustno-litsevoi oblasti.

OBJECTIVE: The aim of study was to improve the effectiveness of treatment of patients with secondary postoperative lymphedema of the maxillofacial region using lymphotropic therapy. MATERIAL AND METHODS: During 2020-2021 8 patients aged 40 to 70 years with secondary postoperative lymphedema of the maxillofacial region were treated in the Central Research Institute of Dentistry and Maxillofacial Surgery. The article presents the clinical and ultrasound results of a study of the effectiveness of the lymphotropic therapy in the treatment of patients with secondary lymphedema of the maxillofacial region. RESULTS: Six patients with an early stage of lymphedema had a complete regression of edema and normalization of the ultrasound picture of the soft tissues of the maxillofacial region. In 2 patients with late-stage lymphedema there was a regression of edema, but the preservation of residual swelling of soft tissues and signs of fibro-fatty transformation of soft tissues were revealed on ultrasound examination. CONCLUSION: Lymphotropic therapy with antifibrotic and anti-inflammatory drugs is one of the effective methods of treating postoperative secondary lymphedema of the maxillofacial region at the early stages of the disease.

Prototype of a DNA Vaccine against Marburg Virus.

The preparation and study of the biological properties of the pVAKS-GPVM DNA immunogen containing a gene encoding Marburgvirus glycoprotein are described. The specificity of blood serum antibodies of guinea pigs immunized with DNA immunogen was analyzed by ELISA. Inactivated viral preparation, recombinant glycoprotein (GP) obtained in the prokaryotic system and virus-like particles based on the recombinant vesicular stomatitis virus exhibiting Marburgvirus GP were used as the antigens. The neutralizing activity of antibodies of immunized animals was tested in vitro using a pseudovirus system. It was demonstrated that the developed immunogen administered to guinea pigs induced the production of specific antibodies that neutralize virus-like particles and Marburgvirus in cultured Vero cells.

[Personalized medicine in non-communicable diseases: latest advances and future prospects].

Since the human genome was decoded more than 15 years ago, there has been a huge leap forward in the development of genomic and post-genomic technologies. Personalized medicine is engaged in implementing these technologies in clinical practice by developing new methods for risk assessment, diagnosis, and treatment of diseases taking into account individual features of the patient. Significant progress has been achieved in decoding genetic bases of chronic noninfectious diseases; new markers for the risk of complications and targets for effects of drugs are being searched for. This review highlights promising directions in the development of personalized medicine, the problems facing modern scientists, and possible ways to solve them.

Combined Effect of Hypertension and Alcohol Consumption on the Risk of Death (27­Year Cohort Prospective Study).

Aim      To study the effect of arterial hypertension (AH) in combination with frequent alcohol consumption on the formation of risk for cardiovascular death and all-cause death according to results of a 27-year prospective cohort study.Material and methods  This 27­year prospective cohort study of an unorganized population of the Tomsk city (1546 people aged 20-59 years, including 630 men and 916 women) investigated AH prevalence and alcohol consumption (1988-1991) and analyzed the predictive significance of the effect of AH in combination with frequent alcohol consumption on the formation of risk for all-cause and cardiovascular death. AH was diagnosed at blood pressure ≥140 / 90 mm Hg. Frequent alcohol users were defined as those who consumed alcohol more than once a week.Results The combination of AH and frequent alcohol consumption increased the risk of all-cause death 4.1 times compared to that for persons without these risk factors (p<0.001). This was true for all age groups of the total cohort (higher relative risk, RR, was observed for persons aged 20-39 years) and for men (except for the group aged 40-59 years). RR of cardiovascular death was 5.3 (p<0.001) for frequent alcohol users with AH. It was established that frequent alcohol consumption additionally increased RR of all-cause death for persons with AH (RR 1.89; p<0.05) primarily at the expense of persons aged 20-39 years. Prediction of 27­year survival for frequent alcohol users with AH was 35.3 %.Conclusion      A combination of AH with frequent alcohol consumption considerably increases the risk of all-cause and cardiovascular death. Frequent alcohol consumption significantly impairs the prediction of 27-year survival for persons with AH by additionally (1.9 times) increasing the risk of all-cause death. Binary AH combinations with frequent alcohol consumption exert a more pronounced adverse effect on young men and women.

[Myocardial infarction in a patient with a single ventricle of the heart].

A clinical case of myocardial infarction in a patient with single ventricle heart defect is described.

[Pharmacoepidemiological research of COVID-19 in the Russian Federation EGIDA-2020].

AIM: An analysis of coronavirus infection in Russia and evaluation of different AVT regimens effectiveness. MATERIALS AND METHODS: The study involved a retrospective analysis of 1082 patient records with laboratory-confirmed COVID-19 in 17 regions of Russia. The number of men and women was equal, mean age 48.718.1 (median 50). Patients with moderate COVID-19 (85%) versus mild COVID-19 (15%) were characterized by higher age (median 54 vs 21 years; p0.001), higher body mass index (27.8 vs 23.4; p0.001), prevalence of chronic diseases (75.3% vs 8.5%; p0.001), including circulatory system diseases (37.8%). Moderate COVID-19 characterized higher intoxication (10.86.1 vs 4.22.7 days; p0.001) and catarrhal symptoms duration (10.25.4 vs 6.14.1 days; p0.001). RESULTS: During hospitalization 92% of the patients received AVT, 77% antibiotics, and 16% corticosteroids. Umifenovir therapy resulted in a significant reduction of intoxication (8.75.5 vs 11.75.5 days; p0.001) and catarrhal symptoms duration (8.85.1 vs 12.04.9 days; p0.001) compared to the group without AVT. The usage of INF reduced intoxication symptoms compared with the group without AVT (8.97.5 vs 11.75.5; p0.05). Therapy with hydroxychloroquine, imidazolylethanamide pentandioic acid, and lopinavir + ritonavir combination did not affect the course of COVID-19. Most of adverse reactions were related to antibiotics. CONCLUSION: Umifenovir therapy and inclusion of interferon in AVT regimens was associated improvement in the clinical manifestation of the disease among patients.

[Morphology of outer retinal tubulations in the outcome of exudative age-related macular degeneration according to optical coherence tomography angiography]. / Morfologiya naruzhnykh retinal'nykh tubulyatsii v iskhode vlazhnoi formy vozrastnoi makulyarnoi degeneratsii po dannym opticheskoi kogerentnoi tomografii s funktsiei angiografii.

Outer retinal tubulation (ORT) develops in the later stages of age-related macular degeneration (AMD). It is associated with low visual acuity, severe loss of photoreceptors, choroidal neovascularization (CNV), and geographic atrophy. Despite the frequent detection of ORTs by optical coherence tomography (OCT), their role in the process of outer retinal atrophy and degenerative changes in photoreceptors remains undetermined. PURPOSE: To investigate the evolution of ORT in patients with exudative and disciform-stage CNV. MATERIAL AND METHODS: The retrospective study included 340 patients with AMD, among them 235 (69%) women and 105 (31%) men with mean age of 76±7.4 years; in all, the analysis involved 267 eyes with dry AMD and 174 eyes with CNV: 92 eyes - with exudative AMD, 82 eyes - with disciform-stage disease). In addition to standard OCT, all patients underwent OCT-angiography (OCTA). In 10 cases, patients with exudative AMD were followed up after intravitreal injections of Aflibercept. RESULTS: ORTs were detected in 37 eyes of 32 patients (26%), all of them with CNV: 13 eyes with exudative AMD (group 1) and 24 eyes with disciform scar (group 2; p=0.013).The groups were similar in the type and morphology of ORTs. The most common were closed, i.e. fully formed ORT (92% of cases in group 1, and 88% in group 2). Destruction of the ellipsoid zone associated with ORT was observed in both groups. In one case, there was an increase in the size of ORT corresponding to the volume of cystic macular edema. Disappearance of ORT was noted only in one of ten patients 3 months after intravitreal injection of Aflibercept, but was not accompanied by visual acuity improvement. CONCLUSION: Outer retinal tubulations are more common in the later stages of AMD, being an indicator of a deep destructive process in photoreceptors. In exudative AMD, ORTs serve as a predictive marker for poor functional outcomes.