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Late complications of radial keratotomy (RK), are as a rule caused by a change in the biomechanical properties of the cornea.Purpose: to study the long-term stabilizing effect of the Bowman’s layer (BL) transplantation after RK.Material and methods. In a limited, prospective, monocentric pilot study we operated 2 male patients (2 eyes) aged 60 and 55. The radial incisions had been performed 34 and 38 years ago. The indications for surgery were progressive biomechanical instability of the cornea and functional refractive visual fluctuations. Within 12 months after the operation, complications, corrected visual acuity, keratometric parameters, biomicroscopic transparency of the cornea, and patient satisfaction were assessed.Results. No complications were noted during the follow-up period, the cornea and graft retained transparency. The average thickness of the BS graft was 20±2.1 µm. The average visual acuity corrected by contact lenses increased from 0.4±0.3 to 0.65±0.1, the average indicator of keratometric astigmatism changed from 1.9±1.6 to 3.0 D, these indicators remained after 6, 9 and 12 months, which indicates that biomechanical stability of the cornea was achieved and that the refractive-visual fluctuations are absent.Conclusion. In late term RK complications, BS transplantation partially restores the normal anatomy of the anterior surface of the cornea and ensures its biomechanical stability during a 12-month follow-up period. For the conclusions to be maximally objective, more clinical cases should be studied within a longer observation period.

Purpose: to evaluate the results of spontaneous non-penetrating keratoprosthesis with a Fedorov — Zuev prosthesis in a patient with severe chemical burns in both eyes. Material and methods.Patient K., 38, who had sustained a severe burn injury in the past and numerous reconstructive plastic operations on both eyes (amniotic tissue implantation, allolymbal transplantation, layer-by-layer and penetrative keratoplasty, cataract extraction with IOL implantation, total auto-conjunctival corneal plastic surgery) with no functional effect, was subjected to a multi-stage keratoprosthesis of the left eye according to the method practiced by the Helmholtz National Medical Research Center of Eye Diseases. Results.After one of the stages (implantation of the haptic part of the keratoprosthesis with a temporary cylindrical plug), an aseptic necrosis of the tissue above the cylinder occurred. As a result, an unexpected functional effect was revealed: visual acuity of the operated eye 0.02 sph -20.0 D = 0.2. During a dynamic follow-up that lasts 2.5 years, visual acuity remains stable, and the corneallayers behind the cylinder retain transparency. During this time, all stages of keratoprosthesis were performed on the fellow eye with a functional result of 1.0. Conclusion. The long-term result of spontaneous non-penetrating keratoprosthesis indicates the need to study the prospects and develop a method of non-penetrating keratoprosthesis with a Fedorov — Zuyev prosthesis.

Purpose: to study the efficiency of Bowman layer transplantation (BLT) in corneal stroma for the treatment of progressive keratoconus (KC).Material and methods. 30 patients (30 eyes) with progressive KC stages III to IV (according to Amsler — Krumeich classification), underwent BLT into a mid-stromal pocket. At the time of surgery, the patients were 14 to 37 (averagely 26.6 ± 6.2 years). Before and after the surgery, the maximum keratometry index (Kmax) and the corneal thinnest point (CTP) values were determined. Also, we evaluated visual acuity before and after surgery in scleral contact lenses, endothelial cells density (ECD) and the depth of graft location. The indication for surgery was the refusal of corneal transplantation, progression of KC, contraindications for ultraviolet crosslinking or implantation of intracorneal ring segments based on the CTP and Kmax values. The follow-up continued 6 to 36 months (averagely, 26.6 ± 6.0 months).Results. Throughout the observation period, no intra or postoperative complications associated with BLT or deterioration of CTP, Kmax or best corrected visual acuity (BCVA) in scleral lenses were noted.Conclusions. Kmax, CTP and ECD values remaining stable during the follow-up is the evidence of a stabilizing BLT effect on the KC progression. The absence of BCVA decrease in scleral lenses indicates a functional safety of BLT.

Purpose: to report the first case of the same day use of a single donor cornea tissue for 5 consecutive transplantations in patients with endothelial dystrophy and keratoconus. Material and methods. The Descemet membrane (DM) and the endothelium were fully detached from the stroma of the donor on the endothelial side, using first a circular and then a direct corneal cutter, forming four partial triangle-shaped Descemet grafts (each constituted a 1/4 Descemet graft). The stroma of the donor's cornea was separated by a circular cutter of a preset diameter. One patient with keratoconus underwent deep anterior lamellar keratoplasty (DALK) using the big bubble technique. Then, each of the four Descemet grafts was sequentially transplanted by the Descemet membrane endothelial keratoplasty (DMEK) method to 4 patients with Fuchs dystrophy and pseudophakia. Results. During and after the surgery, there were no complications requiring additional intervention. Six months after DALK, the best corrected visual acuity (BCVA) was 0.66. Six months after four operations each using ¼ DMEK the average BCVA was 0.95 ± 0.1 (from 0.8 to 1.0) and the endothelial cell density was, respectively, 2839 after DALK and 1680 ± 254 cells/mm2 (from 1492 to 2039 cells/mm2) after ¼ DMEK. Conclusion. One donor cornea can be successfully transplanted to at least 5 patients. Despite the fact that the implementation of DALK and several operations using the ¼ DMEK technique within one day is technically difficult, this approach can contribute to a drastic reduction in the deficit of donor tissue. This approach requires a thorough selection of patients and an extensive surgical experience. For citation: Oganesyan O.G., Makarov P.V., Grdikanyan А.А., Getadaryan V.R. A new strategy of keratoplasty: laminating and splitting the donor cornea. Russian ophthalmological journal. 2018; 11 (3): 11-8 (In Russian). doi: 10.21516/2072-0076-2018-11-3-11-18. The full English version is available online at http://roj.igb.ru/eng/issues

Purpose: to study the results of toric intraocular correction following a surgical treatment of cataract in a 69-year-old patient with the 2nd stage of keratoconus by Amsler-Krumeich classification with intrastromal corneal segments implanted. Methods. During the first visit, the patient had 0.1 best corrected visual acuity (BCVA). The choice of an intraocular lens Tecnis Toric IOL (Abbott, USA) and the optimization of the planned operation was performed on the website of the IOL manufacturer according to the data obtained by partial coherence optical biometry IOL-Master (Carl Zeiss, Germany), dual Scheimpflug Placido keratotopography on the Analyzer of anterior eye segment Galilei G6 (Ziemer, Switzerland), and keratotopography on Magellan Mapper (Nidek, Japan).Results. 6 months after the implantation of intrastromal corneal ring segments, BCVA was 0.2. On the next day after cataract phacoemulsification with implantation of a toric IOL, BCVA was 0.4. 2 years after the implantation of intrastromal corneal segments and phacoemulsification with implantation of a toric IOL, the patient's BCVA was 0.7. Conclusions. We obtained high refractive outcome of a combined staged use of intrastromal corneal segments and correction of aphakiaby a toric IOL in a patient with stable stage 2 keratoconus. A two-year follow-up showed that BCVA and the position of the toric IOL axis remained stable after surgery. For citations: Oganesyan O.G., Romanova L.I., Milash S.V., Penkina A.V. Toric intraocular correction following cataract extraction in a patient with keratoconus after implantation of intrastromal corneal ring segments: a clinical case. Russian ophthalmological journal. 2017; 10 (3): 102-106. doi: 10.21516/2072-0076-2017-10-3-102-106 (in Russian).

Purpose: to compare clinical, functional and morphological results of treatment of progressing keratoconus by femtosecond, trans-epithelial and standard corneal collagen crosslinking. Material and methods. 114 patients aged 18-35 (148 eyes) with progressing keratoconus of stages I-III and iatrogenic keratectasia were divided into three groups. Group 1 (39 patients, 47 eyes) received femtosecond corneal collagen crosslinking; group 2 (33 patients, 45 eyes) underwent transepithelial crosslinking and group3 underwent crosslinking performed with standard technique. Results. The analysis of data of confocal microscopy performed 1 year after femtosecond and standard corneal collagen crosslinking revealed the effect of cross linkage in the anterior and middle corneal stroma, an increased density of the extracellular matrix, regeneration of subepithelial and stromal nervous fibers, and keratocyte repopulation. 1 year after trans epithelial crosslinking, keratocyte population was restored. Slight folding in the anterior stroma was observed due to the cross linkage effect. Conclusion. The preserved epithelial layer of the cornea reduces the risk of infectious complications on the eroded surface of the cornea, diminishes visual discomfort and sensation of pain in patients in the early postoperative period, and shortens the rehabilitation period. After trans-epithelial corneal collagen crosslinking, no pronounced effect of cross linkage in the stroma was observed. The available weak positive result justifies the recommendation to use this technique in children, patients with thin cornea, those likely to develop complications during reepithelization, and as a preventive measure in cases of slow progression rate // Russian ophthalmological journal. 2017; 10 (2): 47-53. (in Russian). doi: 10.21516/2072-0076-2017-10-2-47-53.