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Pacific salmon fishery in the Sakhalin-Kuril region in 2023 is considered. The landing of 78.2.103 t was forecasted but the actual annual catch was 75.8.103 t or 97 % of the forecast. This ratio was the following for the mass species: pink salmon — 34643 t forecasted and 34402 t actually caught (99.3 %), chum salmon — 41650 t forecasted and 39265 t actually caught (94.0 %). Data on escapement of pink salmon producers to the spawning grounds are provided. The run of pink salmon producers was rather weak in the rivers of Aniva Bay and Patience/Terpeniya Bay, but close to mean values or even stronger in other areas of Sakhalin Island. However, low return of pink salmon producers to the coast of Iturup Island was noted; some suggestions about the reasons are discussed. Efficiency of the fishcounting barrier in the Krasnoarmeysky Strait (in Lake Tunaicha basin) is analyzed on the data obtained in 2022–2023. In order to prevent suffocation of chum salmon, installation of the barrier is recommended on August 20–25, with the purposes to count the migrating fish and to remove excessive producers after the mass run beginning (approximately from September 6–10). On the experience in resolving the conflict of interest between fish farms in 2023, the measures for optimal management of commercial fishery are proposed for the Strategy of pacific salmon fishery in Sakhalin Region in 2024 that include appropriate restrictions for fishing when the forecasted values of chum salmon are landed.

Purpose: To compare the effectiveness of trabeculectomy and evaluate the change of the state of the tissues of the anterior segment of the eye in patients with long-term use of preservative and non-preserved hypotensive therapy before surgery. Patients and Methods. The study was conducted in a group of 30 patients (30 eyes) aged from 58 to 77 years with uncompensated primary openangle glaucoma, who were admitted to the glaucoma surgery. The patients were divided into 2 groups depending on the hypotensive regimen used before surgery: group I - patients who used preservative-containing local hypotensive drugs; Group II - patients who used Traviolan© and other non-preservative hypotensive drugs before antiglaucoma surgery. At the initial examination, the collection and analysis of patient complaints, visometry, tonometry, and biomicroscopy of the structures of the anterior segment of the eye were performed. Patients complaints were assessed on the OSDI test questionnaire. The study of total tear production was investigated using the Schirmer test. The tear film break time study investigated the Norn test. Observation and re-examinations were performed a week, 1 month and 3 months after trabeculectomy. Results. A week after glaucoma surgery, there was a short-term deterioration in the parameters by which dry eye disease (DED) was assessed: in group I, OSDI was 11.8 ± 3.3, Schirmer and Norn tests — 5.3 ± 1.3 mm and 4.3 ± 1.0 sec, respectively. In group II OSDI was 10.7 ± 3.5, Schirmer and Norn tests were 8.2 ± 2.2 mm and 4.7 ± 1.3 sec, respectively. After 1 and 3 months, the DED indicators improved, more pronounced in group I: after 1 and 3 months, OSDI was 12.9 ± 3.7 and 12.9 ± 4.2, respectively; Schirmer’s test — respectively, 7.4 ± 1.9 and 7.0 ± 1.8 mm; Norn’s test — 5.1 ± 0.8 and 5.2 ± 0.9 sec. In group II, 1 and 3 months after trabeculectomy, OSDI was 12.4 ± 3.0 and 12.4 ± 2.4. Schirmer’s test was 9.9 ± 2.1 and 9.5 ± 1.7 mm, Norn’s test was 5.5 ± 1.2 and 5.5 ± 1.3 sec, respectively. At all follow-up periods, except for week 1, there was a significant intergroup difference between the studied parameters of dry eye disease (p < 0.05). Conclusion. Long-term use of preservative-containing hypotensive therapy contributes to the development of chronic toxic-allergic conjunctivitis, which affects the long-term prognosis of trabeculectomy and the quality of life associated with DED. One of the ways to minimize such negative effects is the use of preservative-free drugs in the selection of glaucoma therapy. The use of a preservative-free form of travoprost is justified due to its high selectivity for FP-prostanoid receptors, which ensures high efficiency and less side effects. The improvement in DED parameters associated with cancel of therapy after surgery is more pronounced in the group of patients who initially took preservative-free drugs.

Glaucoma is a chronic neurodegenerative disease that eventually leads to irreversible blindness. The main risk factor for the development and progression of glaucoma is elevated IOP. In cases where the use of prostaglandin analogues is limited, brimonidine is the most rational choice as initial therapy. It is the only molecule that both reduces aqueous humor production and enhances uveoscleral outflow. The use of several hypotensive drugs for a long time can lead to pronounced changes in the tissues of the anterior segment of the eye. In this case, there are complaints characteristic of the dry eye syndrome. The aggravation of this condition can affect the adherence of patients to treatment and worsen the course of the disease. Therefore, it is important to prescribe hypotensive drugs that have a sufficient hypotensive effect with a good safety profile. Purpose. To evaluate the efficacy and safety of Brimonidine SZ in combination therapy for glaucoma after changing the hypotensive regimen. Patients and methods. The study was conducted in a group of 50 patients (50 eyes) with initial or advanced drug-compensated primary open-angle glaucoma (mean age 64.8 years), among them there were 27 (54 %) women and 23 (46 %) men. In patients included in the study, brimonidine 0.15 % or 0.2 % was replaced with Brimonidine SZ as part of combination hypotensive therapy. To analyze the results obtained, data on corneal-compensated IOP, the degree of corneal staining with fluorescein, assessments of conjunctival hyperemia, indicators of the OSDI questionnaire and the level of adherence to treatment at the initial visit, as well as 1 and 3 months after changing the hypotensive regimen, were compared. Results. There were no statistically significant differences in the level of IOP at different times after changing the hypotensive regimen. Objective indicators of the state of the tissues of the anterior surface of the eye did not change. According to the results of the evaluation of the main signs of dry eye syndrome (OSDI) and the degree of adherence of patients to treatment, no significant changes were found either. Conclusion. Brimonidine SZ has a similar hypotensive efficacy with brimonidine 0.15 % and 0.2 % as part of combination hypotensive therapy. The safety profile of Brimonidine SZ is comparable to analogues, which allows us to consider this drug as a possible alternative when choosing hypotensive therapy.

The article presents a study of palliative surgical treatment of patients with pathological fractures of the long bones and chronic trochanteric fractures. Those patients are not indicated for special oncological treatment. Therefore, the article does not provide staging of malignant neoplasms. The surgical treatment was aimed at improving the quality of life of palliative patients, and accompanying therapy in the form of the Altaicae extract adaptogen and the neutral anolyte led in our study to an increase in the effectiveness of surgical treatment of such a severe contingent of patients.INTRODUCTION According to domestic and foreign literature, the number of oncological diseases in young and old people is growing. There is a trend to neglecting the disease and late visits to doctors. Almost all types of cancer of various localization and other malignant tumors metastasize to the bones. An increase in the number of pathological (metastatic) fractures of the trochanteric region and the long bones was also noted. Surgical treatment of patients with such a severe type of fractures leads to an aggravation of the already existing immunodeficiency and, as a rule, creates the prerequisites for the occurrence of infectious complications in the postoperative period. The choice of a conservative method of treatment often does not justify itself as well, it leads to diagnostic and therapeutic errors, and in the future — to chronic pathological fractures.AIM To improve the effectiveness of surgical treatment and the quality of life of palliative patients with pathological (metastatic) fractures of the long bones and chronic trochanteric fractures using original authors’ accompanying therapy.MATERIAL AND METHODS 177 patients were examined and divided into two groups the main and the control groups. 72 patients were included in the main group, and 105 patients in the control group. There were 110 men and 67 women. The patient age ranged from 35 to 90 years. The main group received surgical treatment with the use of new accompanying therapy along with the basic one, and the control group received only surgical treatment and basic therapy.RESULTS In the main group patients with chronic pathological fractures of the trochanteric region, who underwent endoprosthetic replacement, osteosynthesis, a new method of surgical treatment of metastatic fractures of the long bones and the authors’ accompanying therapy, the effectiveness of surgical treatment increased significantly compared to the comparison group. As a result, most of the unwanted symptoms disappeared, time spent in hospital decreased, the psychoemotional status and immunity improved, the functional state of the body was optimized, and the quality of life improved.CONCLUSION The use of new accompanying therapy, the authors’ method of surgical treatment of patients with pathological (metastatic) fractures of the long bones, chronic fractures of the trochanteric region allows us to successfully and effectively operate on such severe patients and perform a fast track surgery program in the early postoperative period.

Pacific salmon fishery in the Sakhalin-Kuril region in 2022 is analyzed. The data on predicted and actual catch are presented.

TThe most important factor limiting sports performance is insufficient fluid intake by athletes and dehydration of the body, while a significant decrease in performance and sports endurance begins with a dehydration level of 2 % and above.Objective: to study the effectiveness and safety of rehydration of the body of athletes­skiers of children and youth using isotonic drinks «Izonok» and «Izonok+».Materials and methods: the main group (n = 12, 16.2 ± 1.4 years) took isotonic drinks for 30 days to compensate for fluid losses, the comparison group (n = 8, 15.7 ± 1.1 years) — drinking water. Bioimpedance body composition analysis was carried out on a KM-AR-01-”Diamant” device (RF, St.Petersburg), and central hemodynamic analysis was carried out on a «SIMONA 111» (LLC “Okulyus 2000”, RF). The content of secretory immunoglobulin A (sIgA) and lysozyme in saliva samples of athletes was carried out by the enzyme immunoassay on an ANTHOS 2010 analyzer (Austria). Statistical data processing was carried out using the Statistica 6.0 software package from Stat Soft @ Ink USA.Results: The intake of an isotonic drink is accompanied by the stimulation of the production of secretory immunoglobulin (sIgA) and lysozyme compared to the consumption of drinking water. The total volume of fluid and the volume of extracellular fluid tended to increase; the volume of intracellular fluid remained practically unchanged; the amount of total water when taking isotonic increased.Conclusion: The investigated isotonic drinks “Izonok” and “Izonok+” are effective sports drinks for maintaining optimal water-salt balance and local immunity

Rapeseed (Brassica napus L.) and turnip rape (B. rapa L. subsp. campestris (L.)) are important agricultural plants widely used for food, fodder and technical purposes and as green manure. Over the past decades, a large number of perspective varieties that are being currently cultivated in every region of Russia have been developed. To increase the breeding efficiency and facilitate the seed production, modern molecular-genetic techniques should be introduced as means to estimate species and varietal diversity. The objective of the presented research study was to investigate DNA polymorphism of the rapeseed and turnip rape varieties developed at Federal Williams Research Center of Forage Production and Agroecology and detect informative markers for varietal identification and genetic certification. To genotype 18 gDNA samples, 42 and 25 combinations of respective SSR and SRAP primers were used. The results obtained demonstrate that SRAP markers were more effective for polymorphism analysis: 36 % of the tested markers revealed genetic polymorphism compared with only 16.7 % of microsatellite loci. Molecular markers to detect differences at interspecific and intervarietal levels have also been found. For the investigated set, such microsatellite loci as Na12A02, Ni2C12, Ni02-D08a, Ra02-E01, Ni03H07а and SRAP-marker combinations as F13-R9, Me4-R7, F11-Em2, F10-R7, F9-Em2 and F9-R8 proved to be informative. Application of the two marker techniques made it possible to detect a higher level of DNA polymorphism in plants of different types (spring and winter varieties) if compared against the intervarietal differences within a species or a group. According to Nei’s genetic diversity index, in the cluster of winter rapeseed, VIK 2 and Gorizont varieties had the longest genetic distance, and in the spring cluster, these were Novosel and Veles. A high level of similarity was found between Vikros and Bizon winter rapeseed varieties. The results obtained have a high practical value for varietal specification of seed material and genetic certification of rapeseed and turnip rape varieties.

Purpose. To estimate the accuracy of IOP measurement using artificial intelligence (AI) technologies and applanation tonometry with fixed strength. Material and methods. 290 patients (576 eyes) underwent applanation tonometry according to Maklakov with tonometer weights of 5, 10, and 15 g using a modified elastotonometry technique followed by an analysis of impression quality and diameter measurements by three independent ophthalmologist experts. The prints were then fed into a neural network to check the repeatability and reproducibility of the measurements. Results. The comparison of the diameters of the Maklakov tonometer prints determined by AI based on the neural network with the measurements data provided by three experts showed that neural network underestimates the measurement results by an average of 0.27 (-3.81; 4.35) mm Hg. At the same time, the intraclass correlation coefficient for all prints was 98.3%. The accuracy of diameter measurements of prints by neural network differs for tonometers of different weights, e.g. for a 5 g tonometer the difference was 0.06 (-3.38; 3.49) mm Hg, for 10 g and 15 g tonometers was 0.14 (-3.8; 3.51) and 0.95 (-3.84; 5.74) mm Hg, respectively. Conclusion. High accuracy and reproducibility of the measurements by the neural network, was shown to surpass the reproducibility of human-implemented measurements.

Purpose: to develop a comprehensive algorithm for choosing the optimal method for monitoring and treating patients with primary openangle glaucoma (POAG). Material and methods. 30 patients with POAG, aged 30 to 86, underwent an ophthalmological examination which included visometry, standard automatic perimetry, tonometry, ophthalmoscopy, and biomicroscopy. The data obtained were evaluated on a point scale according to the innovative algorithm, on the basis of which a plan of patient management was recommended. Then the recommendation of the algorithm was compared with the suggestion of an expert specializing in the treatment of glaucoma. Results. The proposed innovative algorithm for treating POAG patients sets up four stages in the appointment of topical hypotensive therapy. When gaining a certain number of points, the algorithm recommends surgical treatment. The treatment tactics suggested by the algorithm, agreed with the opinion of glaucoma expert in most of the cases (27 out of 30 cases; 90%). Conclusion. An algorithm for the treatment of patients with POAG has been proposed and tested. The algorithm makes it possible to assess the progression of the glaucomatous process and select the optimal tactics for managing the patient in real time of examination.

Most of the medicines used for the treatment of glaucoma include a preservative in various concentrations. With long-term topical therapy, patients with glaucoma may develop dry eye syndrome (DES). The severity of symptoms depends on the number of drugs used and the presence of a preservative in them. Against the background of DES progression, compliance to glaucoma therapy may decrease, and, consequently, the effectiveness of the treatment may decrease. Currently, new non-preservative hypotensive drugs containing brimonidine, as well as a fixed combination (FC) of dorzolamide and timolol, are available on the market.Purpose: to compare assessment of the hypotensive effect and tolerability of preservative-free drugs FC Dorzolamid 20 mg/ml, Timolol 5 mg/ml (Dortmol Antiglau ECO) and Brimonidine 2 mg/ml (Brim Antiglau ECO) when switching from similar drugs containing a preservative in patients with compensated glaucoma.Patients and methods. In this prospective clinical study, 60 patients (60 eyes) with compensated primary open-angle glaucoma on combined topical therapy were examined. In group 1 (30 patients, 30 eyes), the combinations of dorzolamide / timolol or brinzolamide / timolol were switched with the non-preservative Dortmol Antiglau ECO. In group 2 (30 patients, 30 eyes), the brimonidine as part of the medication regimen were replaced with the non-preservative Brim Antiglau ECO. The level of corneal-compensated IOP was assessed before the switch in therapy and after 1 month. Subjective feelings and objective signs of the treatment’s use were monitored during examination and using a questionnaire, which was compiled to study the tolerance of therapy.Results. Switching to a preservative-free combination of dorzolamide and timolol resulted in a reduction in complaints of irritation, lacrimation, and foreign body sensation. The efficiency control did not reveal a significant change (p > 0.05) in the cornealcompensated intraocular pressure (IOPcc). When transferred to the Brim Antiglau ECO as part of the local hypotensive treatment, intraocular pressure decreased significantly (p < 0.05). The average total score characterizing drug intolerance, when evaluated by the patient, decreased by 2.4 times, by the attending physician-by 1.9 times. The degree of conjunctival hyperemia on the MacMonnies photographic scale decreased in both groups.Conclusion. Preservative-free drugs can be recommended for most patients with glaucoma as a starting treatment and as a replacement for current therapy.

ABSTRACT. We report a case of treatment of a 60-year-old female patient D. with a metastatic fracture of the upper and middle third of the left humerus. We made a radical removal of the metastasis, which was complicated by pathological fracture of the left humerus. To replace the removed tumor defect we performed metal and polymer endoprosthetic replacement of the left humeral diaphysis using a locking screw system and bone cement (methyl methacrylate). For accelerated recovery and rehabilitation we applied adaptogenic immunomodulator «Vitavis» (Altai elixir) and neutral anolyte (NA). After the removal of the tumor, postoperative wound was treated with neutral anolyte (NA). Dressings also contained neutral anolyte (NA). These drugs were successfully combined with postoperative basic therapy. The patient was discharged from the hospital on the 4th day after surgery. The functional results of the left upper limb are satisfactory.

Aim. To review foreign approaches to the evaluation and financing of in vivo gene therapy drugs.Materials and Methods. The first stage of the review included the systematic search for publications of clinical-economic studies (CES) on in vivo gene therapy drugs registered on the international pharmaceutical market. The analysis of the methodology used in the found CESs was performed based on the given criteria. The second and third stages of the review included the search for the information on the approaches and results of the evaluation of in vivo gene therapy drugs by foreign agencies on the assessment of healthcare technologies (AHT) and the implemented approaches to the financing of expensive medical technologies.Results. Totally, four in vivo gene therapy drugs registered on the foreign markets were found: talimogene laherparepvec (Imlygic), voretigene neparvovec (Luxturna), onasemnogene abeparvovec (Zolgensma), and alipogene tiparvove (Glybera). The analysis of the methodology of CES on in vivo gene therapy drugs did not reveal general methodological peculiarities. The analysis of the approaches to the reimbursement for the cost of these four drugs in the European countries showed that there were no special procedures intended for gene drugs. However, in the majority of countries, there are some mechanisms of reimbursement for orphan drugs and the majority of the above-mentioned in vivo gene therapy drugs are orphan. It was revealed that the most perspective methods of payment for in vivo gene therapy drugs were installment payments, risk-sharing agreements, and their combinations. Still, none of these payment methods are implemented in Russia because of the lack of regulatory and legal framework.Conclusion. The design and methodological peculiarities of CES on in vivo gene therapy drugs are similar to orphan drugs (in some countries, there is a special flexible procedure). In the Russian Federation, there is no special procedure of ATH for orphan drugs, which can provide difficulties in the reimbursement for these drugs. Besides, in the Russian Federation, the issue of the implementation of innovative models for drugs provision (risk-sharing, installment payments is acute). The changes in this area would also lead to the optimization of the influence of expensive healthcare technologies on the budget of the system of healthcare.

Research objective was to study the changes of intraocular pressure (IOP) in the postoperative period after a fistulizing antiglaucomatous operation by measurement with the method of a bidirectional cornea pneumoapplanation. Material and methods. Clinical trial was performed on the sampling from 50 patients (50 eyes) underwent antiglaucomatous operation - a trabeculectomy with basal iridectomy. The research by means of the biomechanical Ocular Response Analyzer was carried out before operation, in 1-2 months and in 6-12 months. The control group was made of 100 patients (100 eyes) with glaucoma against the background of hypotensive therapy. Results and discussion. The surgical glaucoma treatment led to IOP depression and normalization in all cases of research group. Level of the corneal compensated IOP before operation was in the range from 19.3 to 34.3 mmHg. The glaucoma surgical treatment led to the corneal compensated IOP expressed depression on average on 8.5 mmHg (34 % of initial). The augmentation of this indicator on average on 1,4 mmHg was revealed in the remote period. The corneal compensated IOP in this situation is more important indicator from the prognostic point of view. The revealed difference of IOP is similar to a tonometry according to Goldman emphasizes high probability of mistakes in this group of patients. Important feature of cornea bidirectional application is the possibility of the corneogram analysis and estimating the quality of IOP measurement.

The literary review is focused on reactive hypertension after eye surgeries. Possible causes of increased intraocular pressure are described. Methods of therapy and prevention of reactive hypertension after cataract phacoemulsification and intravitreal injections are analyzed. Literary data show an emphasis on the efficacy and safety of applying a fixed combination of brimonidine and timolol.

A study of a child with intellectual disability revealed an enlarged p-arm in chromosome 13 and amplified rDNA. qRT-PCR showed an approximately 6-fold increased level of rRNA in the patient’s blood samples. fMRI study revealed changes in uncinate fasciculus. His father is a carrier of the same chromosome, healthy and has a normal level of rRNA.

Oxygen content in body fluids and tissues is an important indicator of life support functions. A number of ocular pathologies, e.g. glaucoma, are of presumable vascular origin which means altered blood supply and oxygen circulation. Most oxygen is transported in the blood in the association with hemoglobin. When passing through the capillaries, hemoglobin releases oxygen, converting from oxygenated form to deoxygenated form. This process is accompanied by the changes in spectral characteristics of hemoglobin which result in different colors of arterial and venous blood. Photometric technique for the measurement of oxygen saturation in blood is based on the differences in light absorption by different forms of hemoglobin. The measurement of saturation is called oximetry. Pulse oximetry with assessment of tissue oxygenation is the most commonly used method in medicine. The degree of hemoglobin oxygen saturation in the eye blood vessels is the most accessible for noninvasive studies during ophthalmoscopy and informative. Numerous studies showed the importance of this parameter for the diagnosis of retinopathy of various genesis, metabolic status analysis in hyperglycemia, diagnosis and control of treatment of glaucoma and other diseases involving alterations in eye blood supply. The specific method for evaluation of oxygen concentration is the measurement of pressure of oxygen dissolved in the blood, i.e. partial pressure of oxygen. In ophthalmological practice, this parameter is measured in anterior chamber fluid evaluating oxygen level for several ophthalmopathies including different forms of glaucoma, for instillations of hypotensive eye drops as well as in vitreous body near to the optic disc under various levels of intraocular pressure. Currently, monitoring of oxygen saturation in retinal blood vessels, i.e. retinal oximetry, is well developed. This technique is based on the assessment of light absorption by blood depending on hemoglobin saturation with oxygen by analyzing spectral composition of light diffusively reflected from the retina. Oximetry of bulbar conjunctival and episcleral microvasculature can be also performed allowing for the evaluation of oxygen saturation in vessels which collect blood from the anterior segment and the characterization of anterior segment metabolism in a number of ocular pathologies and in the course of the treatment.

Oxygen content in body fluids and tissues is an important indicator of life support functions. A number of ocular pathologies, e.g. glaucoma, are of presumable vascular origin which means altered blood supply and oxygen circulation. Most oxygen is transported in the blood in the association with hemoglobin. When passing through the capillaries, hemoglobin releases oxygen, converting from oxygenated form to deoxygenated form. This process is accompanied by the changes in spectral characteristics of hemoglobin which result in different colors of arterial and venous blood. Photometric technique for the measurement of oxygen saturation in blood is based on the differences in light absorption by different forms of hemoglobin. The measurement of saturation is called oximetry. Pulse oximetry with assessment of tissue oxygenation is the most commonly used method in medicine. The degree of hemoglobin oxygen saturation in the eye blood vessels is the most accessible for noninvasive studies during ophthalmoscopy and informative. Numerous studies showed the importance of this parameter for the diagnosis of retinopathy of various genesis, metabolic status analysis in hyperglycemia, diagnosis and control of treatment of glaucoma and other diseases involving alterations in eye blood supply. The specific method for evaluation of oxygen concentration is the measurement of pressure of oxygen dissolved in the blood, i.e. partial pressure of oxygen. In ophthalmological practice, this parameter is measured in anterior chamber fluid evaluating oxygen level for several ophthalmopathies including different forms of glaucoma, for instillations of hypotensive eye drops as well as in vitreous body near to the optic disc under various levels of intraocular pressure. Currently, monitoring of oxygen saturation in retinal blood vessels, i.e. retinal oximetry, is well developed. This technique is based on the assessment of light absorption by blood depending on hemoglobin saturation with oxygen by analyzing spectral composition of light diffusively reflected from the retina. Oximetry of bulbar conjunctival and episcleral microvasculature can be also performed allowing for the evaluation of oxygen saturation in vessels which collect blood from the anterior segment and the characterization of anterior segment metabolism in a number of ocular pathologies and in the course of the treatment.

Clinical case of high thin-wall cystic limited filtering bleb needling revision in the early post-op period after trabeculectomy with sinusotomy accompanied by toxic keratopathy is presented. Optical coherence tomography (OCT) demonstrated that filtering bleb height was 2700 μm and bleb wall thickness was 70 μm. Bleb needling revision with its lateralwall dissection and subconjunctival injection of dexamethasone, fluorouracil, and ranibizumab near to the bleb site was performed. In 1.5 hours after the procedure, bleb height decreased to 550 μm (by 5 times) while bleb wall thickness increased up to 100 μm. Topical antibacterial, steroid, and non-steroid anti-inflammatory therapy was recommended. The next day IOP level reduced from 11 mm Hg to 4.5 mm Hg. It was accompanied by choroidal effusion that was managed conservatively with cycloplegic agents (drops and injections) for 3 days. On day 6, central corneal edema affecting all layers, Descemet’s membrane folds, and ocular hypertension were revealed. Metabolic therapy resolved corneal edema within 3 days. Re-needling bleb revision decreased IOP level to 6.2 mm Hg. This resulted in transient Descemet’s membrane folds. This paper describes filtering bleb needling revision with its lateral wall dissection and anti-inflammatory, cytostatic, and anti-VEGF agents use to prolong glaucoma filtering surgery effect in excessive scarring. The procedure was accompanied by toxic corneal endothelium decompensation with corneal edema and Descemet’s membrane folds treated with active metabolic therapy.

The article presents a case report of a patient with a cystic bleb in the early postoperative period after trabeculectomy. Patient complained of discomfort in a recently (4 weeks) operated eye. Medical regimen administered previously had been taken irregularly. Biomicroscopy revealed a high, encapsulated cystic bleb with thin walls and hyperemia. Intraocular pressure at the moment of examination was 27 mmHg. Local hypotensive therapy had been neglected by the patient. A local anti-inflammatory (tobramycin / dexamethasone fixed combination) and hypotensive (brimonidine / timolol fixed combination) therapy was administered. 24 hours later, when intraocular pressure decreased to 20 mmHg, a needle revision procedure was conducted for partial bleb wall destruction and subconjunctival injection of dexamethasone, fluorouracil and ranibizumab. During the next day examination the bleb was diffuse, with less hyperemia and an abundance of conjunctival microcysts in the central bleb’s zone. Intraocular pressure was 10.2 mmHg. No choroidal detachment was noted during ophthalmoscopy and OCT examination. The patient continued anti-inflammatory therapy. Another needling procedure with the same drug combination was repeated two weeks after due to an increased hyperemia. At the end of the four-week follow-up period the filtering bleb remained diffuse and the intraocular pressure was 13.2 mmHg. Dexamethasone drops were prescribed to be instilled 1‑2 times a day for a month. This case report demonstrates the method of restoring a functioning filtering bleb by the needle revision with antiinflammatory, cytostatic and anti-VEGF therapy for prolonging the hypotensive effect of a trabeculectomy in the presence of wound healing.