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Despite the improvement of the surgical technique of vitreoretinal interventions, the number of recurrences of rhegmatogenous retinal detachment (RRD) remains quite high.Evaluation of the effectiveness of episcleral circular buckling (ECB) in the treatment of recurrent RRD after vitrectomy due to progression of proliferative vitreoretinopathy (PVR).The study analyzed the results of surgical treatment of 21 patients (21 eyes) with recurrent RRD after primary vitrectomy. All patients underwent standard preoperative examination including visometry, tonometry, ophthalmobiomicroscopy, and additionally, optical coherence tomography was performed to assess the involvement of the macular area; the presence of anterior proliferative vitreoretinopathy was determined by ultrasound biomicroscopy, axial eye length was measured with an optical biometer. All patients underwent ECB, in some cases combined with repeated vitreoretinal surgery.Preliminary results of the study showed high efficiency of ECB exclusively, as well as ECB combined with revision of the vitreal cavity in case of RRD recurrence after primary vitreoretinal surgery, which amounted to 95% after one additional operation and removal of silicone oil.Episcleral circular buckling in the treatment of recurrent RRD after vitreoretinal surgery is a multifunctional and safe method that allows achieving favorable functional and anatomical outcomes.Несмотря на совершенствование хирургической техники витреоретинальных вмешательств, количество рецидивов регматогенной отслойки сетчатки (РОС) остается достаточно высоким.Оценить эффективность кругового эписклерального пломбирования (КЭП) в лечении рецидивов РОС после витреоретинальной хирургии (ВРХ) вследствие прогрессирования пролиферативной витреоретинопатии (ПВР).Проведен анализ результатов хирургического лечения 21 пациента (21 глаз) с рецидивами РОС после первичной витрэктомии. Всем пациентам было проведено стандартное предоперационное обследование, включающее визометрию, тонометрию, офтальмобиомикроскопию, а также дополнительно выполняли оптическую когерентную томографию с целью определения вовлеченности макулярной зоны; наличие передней ПВР устанавливали по данным ультразвуковой биомикроскопии, длину глаза измеряли оптическим биометром. Всем пациентам было выполнено круговое пломбирование склеры, в некоторых случаях в комбинации с повторной ВРХ.Предварительные результаты исследования показали высокую эффективность применения только КЭП и КЭП в сочетании с ревизией витреальной полости при рецидиве РОС после первичной ВРХ, составившую 95% после одной дополнительной операции и удаления силиконового масла.КЭП в лечении рецидивов РОС после ВРХ — это многофункциональный и безопасный метод, который позволяет добиться благоприятных функциональных и анатомических результатов.

Purpose. Provide data on the use of gonioscopy-assisted transluminal trabeculotomy (GATT), reflecting its effectiveness and safety when using this technique in various patient models. Material and methods. To perform the review, literature sources which were searched through the PubMed and Scopus databases up to and including 2021, using the keywords "gonioassociated trabeculotomy", "minimally invasive glaucoma surgery", "primary open-angle glaucoma", "glaucoma", "secondary glaucoma". A total of 19 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 2013. Results. GATT can be used at various stages of glaucoma, but at the same time, the maximum effect of lowering intraocular pressure (IOP) is achieved in patients with an early or middle stage of glaucoma. There are also good results of using the GATT technique after vitreoretinal surgery, with the development of secondary glaucoma or ophthalmic hypertension. One of the advantages of GATT is that all manipulations are performed in the anterior chamber, which in turn makes it possible, if necessary, to perform reoperation after an unsuccessful ad-externo trabeculotomy without re-traumatizing the sclera and conjunctiva. It should be noted that the main complication in all studies is the hyphema, which is completely absorbed within a few days. Conclusion. Based on these studies, it can be concluded that the proposed GATT technique is relevant, and meets all modern standards of minimally invasive glaucoma surgery (MIGS): micro-incision, minimal trauma, is able to effectively reduce IOP, has a high level of safety and quick recovery. Key words: glaucoma, primary open-angle glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma

Purpose. To compare the parameters of a light sensitivity (LS) of the central zone of a retina after vitrectomy due to reghmatogenous retinal detachment (RRD) with a silicone oil tamponade (SOT) and gas tamponade (GT). Material and methods. The study included 20 eyes after pars plana vitrectomy due to macula-off rhegmatogenous retinal detachment (RRD) by 25G. All patients were divided in 2 groups depending on the choice of the tamponade. The group I (10 eyes) included cases with the silicone oil tamponade (SOT) (1300 cSt), in the group II (10 eyes) – the gas tamponade (GT) (C2F6). The control group included contralateral eyes without ophthalmic pathology. All patients underwent standard ophthalmological examination and fundus- microperimetry (FMP) on the 30th day after removal of the SOT for the group I, or on the 30th day after the C2F6 tamponade for the group II. Results. According to FMP data, the parameter of average light sensitivity (LS) in the group I was significantly reduced, both in comparison with the group II (p=0.007) and the control group (p=0.003). Differentiation by zones in the group I revealed a decrease in each analyzed parameter in comparison with the control group (p

Actual. Peeling the internal limiting membrane when closing the macular tear is a fundamental procedure. However, recently, additional microtraumatization of the layers of neuroretinal tissue during peeling and changes in morphofunctional parameters have been proven. Purpose. The aim of this study was to propose a technique with autoplasty of the ILM and preservation of the papillomacular bundle in the area and to assess the dynamics of morphofunctional parameters after surgery for a macular hole. Materials and methods. Morphofunctional data of 200 patients (100 eyes) were studied.) Patients of group 1 (100 eyes) were operated on using the introverted flap technique Patients of group 2 (100 eyes) were operated on using the original method with the preservation of ILM in the foveolar zone. All patients underwent a standard ophthalmological examination before and after surgery. The assessment of morphometric data was carried out on the basis of the ACT-study. Statistical processing of the results was carried out using the IBM SPSS Statistics 23 program. Results. According to the results of surgical treatment on the 7th day and on the 30th day after the operation, higher indicators of functional parameters of the retina were revealed in patients of the 2nd group. In comparison with the data before surgery, BCVA increased 2.55 times in group 1, and 4.46 times in group 2. There was a significant decrease in MH height-n in patients of group 1 in comparison with data before surgery and group 2 in comparison with data before surgery by 1.68 and 2.12 times, respectively. This is due to the lack of additional microtraumatization of neuroretinal tissue (no peeling) on the nasal side of the macular hole. Keyword: macular hole, ILM peeling, vitrectomy.

Purpose. The aim of the study was to evaluate the morphological and functional parameters of the retina after subretinal administration of recombinant prourokinase followed by pneumodislocation in comparison with anti-VEGF (Vascular endothelial growth factor) monotherapy in the long term in patients with subfoveal hemorrhage. Material and methods. Depending on the choice of surgical treatment, the patients were divided into two groups: Group 1 – 11 patients (11 eyes) – patients receiving anti-VEGF therapy as the main treatment according to the treat and extend regimen; Group 2 – 9 patients (9 eyes) – patients who underwent translocation of submacular hemorrhage followed by intravitreal administration of anti-VEGF drugs according to the treat and extend regimen. Results. Elimination of the clot to the peripheral regions made it possible to achieve an improvement in the architectonics of the retina in the central zone, in particular, a decrease in the central thickness of the retina in the group with subretinal administration of tissue plasminogen activator by an average of 654.67 µm after 3 months. According to a comparative analysis of morphological parameters at the end of the observation period, in the 2nd group, the decrease in central foveal thickness exceeded the data shown in the 1st group by 16 times. Analysis of the height of choroidal neovascularization showed a depression of the final results 4.34 times relative to the initial values in the combined treatment group. Positive dynamics persisted throughout the entire period of treatment against the background of ongoing anti-vasoproliferative therapy. Conclusion. The technique of subretinal injection of recombinant prourokinase followed by tamponade with an air mixture used in the study demonstrates an increase in visual functions against the background of a favorable anatomical outcome. Key words: submacular hemorrhage, tissue plasminogen activator, pneumodislocation.

The main treatment for macular holes is vitrectomy with peeling of the internal limiting membrane, however, despite the rapid development of macular surgery, the percentage of negative anatomical results after primary surgery remains high. The aim of this work was to evaluate and compare the functional parameters of the central part of the retina using surgical techniques for blocking unclosed macular holes (creating a ILM-free flap in combination with silicone oil tamponade, or creating a ILM-free flap with the application of an ACP mass and tamponade with a gas-air mixture). Material and methods. This study involved 42 patients, the patients were divided into groups in accordance with the technique of reoperative intervention, all patients underwent microperimetry. Results. The retinal photosensitivity along the small radius in patients in the group with tamponade with a gas-air mixture is 1.11 times higher than in patients with silicone oil tamponade, 1.51 times higher in the middle radius, 1.53 times higher in the large radius. Conclusions. In the 2nd group the photosensitivity indicators were higher than in 1st group of patients with using silicone oil tamponade, which can be explained by the negative effect of silicone oil on the macular area. Key words: macular rupture, rigid, free flap, silicone oil, ACP mass, microperimetry.

The purpose of this study is to conduct a comparative analysis of the correction of aphakia by various models of intraocular lenses using silicon oil tamponade (SO) of the vitreous cavity. Materials and methods. The studies were conducted on 16 eyes of patients aged from 56 to 75 years (65.5±12 years) with aphakia and pathology of the vitreal cavity. The duration of the silicone tamponade was 2-3 months. Depending on the use of the type of IOL, all patients were divided into 2 groups. Results. When using an anterior chamber intraocular lens (IOL), the presence of ophthalmic hypertension was revealed in 75% of cases, which is 2.02 times higher than when using transcleral IOL fixation. In 37.5% of cases, the SO output to the anterior chamber is determined, in contrast to the group where IOL hemming was used. A higher percentage of SO migration to the anterior chamber of the eye in group 2 patients is due to a violation of the anatomy of the anterior chamber barrier and the vitreal cavity. Conclusion. Thus, in patients who underwent transcleral IOL fixation, visual acuity is 2.1 times higher than in patients who were implanted with an anterior chamber IOL. Transcleral fixation of the IOL can form the necessary barrier between the anterior and posterior chambers of the eye, and is also the closest IOL position to the physiological one. Key words: intraocular lens, silicone oil, transcleral fixation.

Purpose. To assess the morphological parameters of the central retina in different groups with unblocked macular rupture after primary surgery for macular rupture (MR). Material and methods. This study involved 32 patients (35 eyes), including 19 women, 13 men. 3 groups were formed according to the principle of primary surgery. All patients underwent standard ophthalmological examinations, as well as optical coherence tomography (OCT). Results. According to OCT data, the morphological and functional parameters were different depending on the primary method of surgical treatment. The diameter of the MR along the large and small radius is the biggest in the 3rd group. The area of edema in the analysis of various methods of surgical treatment did not differ statistically. Conclusion. The functional parameters of the central part of the retina do not depend on the initial method of surgical intervention. The use of mechanical action on the retina causes rigidity of the edges of the macular rupture, and when using an introverted flap, the small and large diameters of the macular rupture remain minimal, in contrast to the use of platelet mass and mechanical closure of the MR. Key words: macular hole, platelet rich mass, introverted flap, mechanical closure, rigid.

Introduction. The integrity of photoreceptor's inner segment/outer segment connection plays great importance in predicting visual acuity in eyes with retinal pathology. However, even optical coherence tomographic study showed the intact of retinal layers, including photoreceptor's inner segment/outer segment line, after surgery due to rhegmatogenous retinal detachment (RRD), low visual acuity is observed. Purpose. to identify predictors of high visual acuity in the foveolar zone in patients after successful RRD repair according to SD-OCT. Material and methods. Group 1 consisted of 20 cases – eyes after successful primary RRD repair performed through pars plana vitrectomy using silicone oil tamponade (1300 cSt), followed by removal of silicone oil with a replacement for sterile air. Group 2 – control, followed eyes without ophthalmopathology and visualisation of foveolar bulge according to OCT. All patients underwent a standard ophthalmological examination and OCT on the 30th day after silicone oil removal. OCT examination was performed by Retina Map and Cross Line modes. The lengths of the outer segments of photoreceptors, inner segments of photoreceptors and the outer nuclear layer of the layer were measured in manual mode. Retina Map was used to measure retinal foveolar thickness. Results. During the study, the data of the foveolar thickness of the retina, the outer nuclear layer and the length of the outer segment of photoreceptors in the main group showed a significant decrease in comparison with the control group (p=0.002, p=0.006, p=0.02, respectively). In this case, a strong correlation was obtained only between the length of the outer segments of photoreceptors and visual acuity (r=0.68). Conclusion. The length of the outer segments of the cones in the central retinal area, or foveolar bulge, should considers a predictor of high visual acuity twostage surgical treatment of primary RRD using silicone oil. Key words: retinal detachment, foveolar bulge, ellipsoid zone, vitrectomy, OCT.

BACKGROUND: The «gold standart» for surgical treatment of patients with proliferative diabetic retinopathy (PDR is vitreoretinal surgery. However, the question of the timing of the removal of primary cataract in this category of patients remains open.AIM: To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patientsMETHODS: 67 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsifi tion surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsifi tion performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity.RESULTS: Visual functions improved in 88.6% of cases in group 1, and in 68.7% in group 2.CONCLUSIONS: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.

Diabetic retinopathy (DR) is the one of severe complications of diabetes, associated with macular edema (DME), which is the main course of visual acuity loss in diabetic patients. The main pathological factors in diabetic retinopathy and diabetic macular edema (DME) are the inflammation and increasing of vascular endothelium growth factor activity (VEGF). The treatment of DME remains challenging during the times. We know that not all eyes respond optimally to anti-VEGF therapy. No clinical effect or minimal one among patients with persistent DME has led to an urgent need to develop new treatment protocols for this group of patients. In this case adding intravitreal corticosteroids to the treatment regimen is the most effective and predictаble than continued anti-VEGF therapy alone. According to results of randomized trials the functional and anatomical outcomes in eyes with refractory DME, which were switched to DEX implant had shown statistically significant better outcome, compared to anti-VEGF therapy alone. Another important question is efficiency and safety of using intravitreal corticosteroids as the first-line therapy in patients with DME. These new findings can help to define better the role of early switch to DEX implant in the current treatment algorithm of eyes with refractory DME. And find the optimal protocol of treatment patients with DME, determine the predictors of switching from anti-VEGF therapy to steroid intravitreal injections, in DME should be on the agenda of the future studies. Key words: anti-VEGF, DME, early switch, implant dexamethasone.

Age-related macular degeneration complicated by submacular hemorrhage if not treated timely leads to permanent loss of central vision. The basis of effective therapy is its early start, dislocation of blood from central parts of the retina and blockage of neovascularization. This review examines the current methods of treatment of submacular hemorrhages, anatomical and functional outcomes, risks of postoperative complications, as well as trends in the use of combined methods of surgical intervention.Возрастная макулярная дегенерация, осложненная субмакулярным кровоизлиянием, при несвоевременном лечении приводит к безвозвратной потере центрального зрения. Основой эффективной терапии являются ее раннее начало, дислокация крови из центральных отделов сетчатки и блокирование неоваскуляризации. В данном обзоре рассмотрены имеющиеся на сегодняшний день методы лечения субмакулярных кровоизлияний, анатомические и функциональные результаты, риски развития послеоперационных осложнений, а также тенденции в использовании комбинированных способов хирургического вмешательства.

R.R.Fayzrakhmanov, E.A.Larina, O.A.Pavlovskiy N.I.Pirogov National Medical Surgical Center, Moscow, Russian Federation Aim: to assess functional parameters of the central retina using microperimetry in patients who underwent surgery for macular holes after prior procedures using free ILM flap peeling. Patients and Methods: 40 patients underwent surgery using free ILM flap peeling and autologous conditioned plasma to close macular hole. Examination was performed using MAIA microperimeter. Customized Expert Test mode (fixation point, fixation stability, fixation point shift during the examination) was applied. Macular integrity index was calculated. 12-point retinal sensitivity within 3 circles (small, medium, and large) was evaluated. Microperimetry was performed before the surgery and in the early and late postoperative periods. Results: after the surgery, fixation point gained physiological position in 70%, stable position in 80%, and relatively stable in 20% of patients. Higher macular light sensitivity was demonstrated in the late postoperative period (5 dB) as compared with the early postoperative period (3.01 dB). However, retinal light sensitivity tended to reduce insignificantly in the late postoperative period (to -1.065 dB) as compared with the early postoperative period. Conclusion: microperimetry is the key method of functional diagnosis to assess macular integrity as well as the efficacy of free ILM flap peeling technique using in patients with macular holes after prior surgery. Analysis of fixation point, fixation shift and stability as well as foveal light sensitivity evaluation are a valuable tool to assess vision quality and treatment efficacy. Keywords: retina, macula, macular hole, microperimetry, reoperation, free ILM flap peeling. For citation: Fayzrakhmanov R.R., Larina E.A., Pavlovskiy O.A. Microperimetry as a tool to assess retinal functional parameters in patients with recurrent macular hole. Russian Journal of Clinical Ophthalmology. 2020;20(2):51–55. DOI: 10.32364/2311-7729-2020-20-2-51-55.

Diabetic retinopathy (DR) is one of the most severe complications of diabetes mellitus, its treatment involves specialists of different areas - endocrinologists, diabetes specialists, therapists, cardiologists, surgeons, anesthesiologists etc. For ophthalmologists the objective is to diagnose ocular pathological changes associated with diabetes mellitus, and to prescribe required treatment in a timely manner. Treatment methods used in DR can be divided into three main groups: laser coagulation of the retina, intravitreal injection of medications - inhibitors of the vascular endothelial growth factor (VEGF) and glucocorticoids, as well as surgical treatment. The present literature review addresses the use of anti-VEGF drugs in the therapy of DR, specifically the latest medications, the most important studies on the treatment of DR and diabetic macular edema (DME), as well asДиабетическая ретинопатия (ДР) является одним из наиболее тяжелых осложнений сахарного диабета, в лечении которого принимают участие врачи разных специальностей — эндокринологи, диабетологи, терапевты, кардиологи, хирурги, анестезиологи и др. Задача врача-офтальмолога состоит в выявлении патологических изменений в глазу, связанных с сахарным диабетом, и своевременном назначении соответствующего лечения. Методы лечения ДР можно разделить на три основные группы: лазерная коагуляция сетчатки, интравитреальное введение лекарственных препаратов — ингибиторов сосудистого эндотелиального фактора роста (vascular endothelial growth factor, VEGF) и глюкокортикоидов, а также хирургическое лечение. Данный обзор литературы затрагивает применение ингибиторов VEGF в терапии ДР, а именно: наиболее актуальные лекарственные препараты, наиважнейшие исследования по терапии ДР и диабетического макулярного отека (ДМО), а также

Vitreoretinal surgery (VRS) is the «gold standard» for surgical treatment of patients with proliferative diabetic retinopathy (PDR). However, the timing for the removal of primary cataract in this category of patients remains uncertain.To evaluate the effectiveness of multistage surgical treatment of patients with advanced PDR complicated with primary cataract.The study involved 94 cases of surgical treatment of patients with PDR and complicated primary cataract. These patients were divided into two groups depending on the treatment tactics. In the first group, patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade performed as the first step in their treatment followed by phacoemulsification, silicone oil removal, and IOL implantation, respectively, as the second step. In subgroup 1a - VRS was performed with standard pharmacological support. In subgroup 1b - intravitreal injection of angiogenesis inhibitors preceded VRS. In the second group, the first step was phacoemulsification performed simultaneously with vitreoretinal surgery with silicone oil tamponade; the second step consisted of removing silicone oil from the vitreous cavity. Subgroup 2a - surgical treatment was performed with standard pharmacological support (similar to subgroup 1a). Subgroup 2b - intravitreal injection of anti-VEGF drugs preceded VRS.Visual functions improved in 88.8% and 83.4% of cases in subgroups 1a and 1b, and in 51.3% and 66.7% in subgroups 2a and 2b, respectively.The study confirms the effectiveness of staged (multi-step) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated primary cataract. Conducting phacoemulsification sometime later along with silicone oil removal in PDR patients with preoperative intravitreal injection of angiogenesis inhibitors is a gentler approach for the anatomic structures of the eye during the first stage (VRS) and contributes to the reduction in the number of intraoperative and postoperative complications.«Золотым стандартом» хирургического лечения пациентов с далекозашедшей стадией пролиферативной диабетической ретинопатии (ПДР) является витреоретинальная хирургия (ВРХ). При этом вопрос о сроках удаления начальной катаракты у этой категории больных остается открытым до настоящего времени.Изучить эффективность многоэтапной витреальной хирургии у пациентов с далекозашедшей стадией ПДР и осложненной начальной катарактой.В исследование включены 94 пациента с ПДР и осложненной начальной катарактой, разделенных на две группы. 1-я группа: первый этап — ВРХ с силиконовой тампонадой, второй этап — факоэмульсификация катаракты (ФЭК) с имплантацией ИОЛ одновременно с плановым удалением силиконового масла (СМ). Подгруппа 1a — ВРХ проводилась со стандартным фармакологическим сопровождением. Подгруппа 1b — ВРХ с предварительным интравитреальным введением (ИВВ) ингибитора ангиогенеза. 2-я группа: первый этап — ФЭК с имплантацией ИОЛ одномоментно с ВРХ+силиконовая тампонада, второй этап — удаление СМ из витреальной полости. Подгруппа 2a — хирургическое лечение выполняли на фоне традиционной фармакотерапии (аналогично подгруппе 1a). Подгруппа 2b — перед ВРХ интравитреально вводили анти-VEGF-препарат.Улучшение зрительных функций в подгруппах 1a и 1b достигнуто в 88,8 и 83,4%, в подгруппах 2a и 2b— в 51,3 и 66,7% случаев соответственно.Результаты проведенного исследования подтверждают эффективность поэтапного хирургического лечения пациентов с далекозашедшей стадией ПДР и осложненной начальной катарактой. Выполнение ФЭК вторым этапом после ВРХ во время удаления СМ у пациентов с предварительным ИВВ ингибиторов ангиогенеза обеспечивает наиболее щадящий подход к хирургическому лечению этой категории больных, что позволяет улучшить анатомические и функциональные результаты ВРХ и способствует уменьшению числа интра- и послеоперационных осложнений.

Background . In 8–10% of cases after the surgical treatment, macular ruptures do not close. Aim: to assess the morphological and functional parameters of the macular area following the surgical closing of previously operated macular ruptures using a free flap of the internal limiting membrane and silicone oil tamponade. Methods . This study involved 31 patients, all the patients underwent a surgical treatment applying a free ILM flap and silicone tamponade, the standard diagnostic procedures and optical coherence tomography and microperimetry were also used (before the operation, on the 14 th and on the 30 th day after the operation). Results . The change in the morphological parameters of the retina directly correlates with the change of the functional parameters of the macular zone, and a peak of the increase in the retina photosensitivity occurs in the early postoperative period with a slight further increase in the long-term postoperative period. Conclusions . The surgical treatment of unclosed macular holes, namely the creation of a “free flap” of the internal limiting membrane, or a “plug”, as well as the use of silicone tamponade, ensures a reliable positiveanatomical and functional postoperative result.

The book deals with the main issues of fixing an intraocular lens with a complete loss of the lens support apparatus. This is the first illustrated guide to understanding the technology of trans-scleral IOL fixation. Special attention is paid to the technique of surgical treatment. The author's techniques and features of each stage of surgical treatment are considered.

Macular hole is an urgent vision impairment problem among the population of developed countries. The main method of treatment of the macular hole is vitrectomy with removal of the internal limiting membrane (ILM). However, the pilling has been recently proved to have negative impact on neurophysiological processes in the macular zone.To suggest a new technique and to evaluate the dynamics of anatomical and functional parameters after surgery for macular hole with preservation of ILM.The study examined the results of treatment of 52 patients (52 eyes) with end-to-end macular holes of stages 2 to 4 according to the Gass classification. Patients of the 1st group underwent standard surgical treatment: vitrectomy and then circular maculorhexis. Patients of group 2 were operated according to the original method with partial preservation of ILM in the foveolar zone. All patients underwent standard ophthalmological examination before and after the surgery. The morphometric data was evaluated using optical coherence tomography (OCT). Statistical processing of the results was carried out using IBM SPSS Statistics 23 software.Morphofunctional parameters of the retina did not differ between patients of the two groups before treatment. According to the results of surgical treatment, on day 7 after the operation, higher indices of functional parameters of the retina were observed in patients of the 2nd group. On day 30, patients of group 2 were observed to have an increase in best-corrected visual acuity (BCVA) in comparison with these indicators on day 7, and a significant increase in comparison with the data before surgery. In patients of group 1, no improvement of vision was observed. It was also revealed that holes with permanent cystic cavities have the worst prognoses in terms of increasing visual functions and restoring the foveolar profile.The described procedure allows partial preservation of ILM, which reduces the risk of intraoperative damage to the retinal layers; the observed functional results were higher.Макулярный разрыв - весьма актуальная проблема слабовидения населения развитых стран. Основной способ лечения макулярного разрыва - проведение витрэктомии с удалением внутренней пограничной мембраны (ВПМ). Однако в последнее время доказано негативное влияние пилинга на нейрофизиологические процессы в макулярной зоне. Цель исследования - предложить новую технику и оценить динамику анатомических и функциональных параметров после операции по поводу макулярного разрыва с сохранением ВПМ. Материал и методы. Изучены результаты лечения 52 пациентов (52 глаза) со сквозными макулярными разрывами 2-4-й стадии по классификации Гасса. Пациенты 1-й группы оперированы по стандартному методу: после витрэктомии проводили круговой макулорексис, пациенты 2-й группы - по оригинальной методике с частичным сохранением ВПМ в фовеолярной зоне. Всем пациентам до и после операции выполняли стандартное офтальмологическое обследование. Оценку морфометрических данных осуществляли на основании ОКТ-исследования. Статистическую обработку результатов проводили при помощи программы IBM SPSS Statistics 23. Результаты. Перед операцией морфофункциональные параметры сетчатки у пациентов обеих групп не отличались. По результатам оперативного лечения на 7-е сутки после операции выявлены более высокие показатели функциональных параметров сетчатки у пациентов 2-й группы. На 30-е сутки в этой группе диагностировано повышение максимальной корригированной остроты зрения в сравнении с данными показателями на 7-е сутки и достоверное повышение по сравнению с данными до оперативного лечения. У пациентов 1-й группы улучшения зрения не отмечалось. Также выявлено, что разрывы с кистозно-измененными полостями имеют худший прогноз с точки зрения повышения зрительных функций и анатомического восстановления фовеолярного профиля. Заключение. При проведении данной методики происходит частичное сохранение ВПМ, что снижает риск интраоперационного повреждения слоев сетчатки. Получен более высокий функциональный результат.

Purpose. To investigate the effects of the implant with the Dexamethasone on the structural parameters of the central retina in case of retinal vein occlusions porch occlusion complicated with macular edema.Material and methods. The study involved 13 individuals (9 female and 4 male, 13 eyes) with the firstly diagnosed thrombosis of the central retinal vein (6 eyes – the group I) or its branches (7 eyes – the group II). The average patient age was 60.8±2.1 years. The disease duration averaged 2±0.5 months. The control group included seven fellow eyes of the examined patients (the exclusion criterion was the presence of cornea and lens opacity, diseases of retina and optic nerve, except angiopathy). All patients of study groups underwent a single performed intravitreal input of the implant with dexamethason (0.7 mg) according to a standard technique, as well as a standard course of conservative treatment. The follow-up period was 1 month.Results. In the control group the visual acuity equaled 0.94±0.06, the total photosensitivity – 19.7±0.3 dB, the mean central foveal thickness was 224.5±5.38 μm, the total macular thickness – 299.41±3.73 μm, including external layers – 165.89±2.87 μm, and internal layers – 132.77±2.26 μm (in the ratio of 0.55/0.45). A month after the treatment patients reported an improvement in the best corrected visual acuity (BCVA) from 0.04±0.02 to 0.16±0.08 in the group I (compared to the control group, p

Purpose. To identify the features of macular pigment and sensitivity of the central retina in case of vitreoretinal surgery for diabetic macular edema. Material and methods. Vitreoretinal interventions were performed in 31 patients (31 eyes) with diabetic macular edema combined with vitreomacular traction syndrome. All patients underwent the seamless closed 3-port vitrectomy with peeling of internal limiting membrane using the 25G systems. The analysis of retinal changes was carried out according to results of evaluation of optical density of macular pigment and retinal sensitivity pre- and post-operatively. Results. There was revealed a sharp decrease in the parameters of the optical density of macular pigment (ODMP) associated, apparently, with their screening in case of vitreomacular traction syndrome combined with diabetic macular edema. Vitreoretinal intervention led to an increase in the average optical density of the macular pigment by 50.24% indicating a normalization of vitreoretinal interface. Correlative analysis between the parameters of retinal sensitivity and ODMP showed an average correlation (r=-0.66, p

Diabetes mellitus is the third most dangerous disease of our time preceded by cardiovascular diseases and oncologic pathology. According to the International Diabetes Federation (January 1, 2016), worldwide approximately 415 million people aged 2079 years suffer from diabetes. The most significant manifestations of diabetes mellitus are lesions of the retina and blood vessels, which manifest as diabetic retinopathy and macular oedema, which lead to the inevitable loss of vision and disability in patients of working age. The existence of multile diagnostic methods and a broad classification provide an evidence of the complex nature of the pathological process of the macular zone in diabetes mellitus. However, to date, a single, generalised and accepted classification does not exist. Difficulties in the treatment of diabetic maculopathy are attributed to various forms of retinal lesions and ambiguities in the approach used to choose the disease management. It determines the importance of the development of diagnostic methods for the further correction of the standard treatment approach. New directions of surgical treatment allow relying on the best results of diabetic maculopathy treatment.

Purpose. To evaluate the effectiveness of vitrectomy in combination with internal limiting membrane peeling associated with the gas-air tamponade of the vitreous cavity at the advanced stage of proliferative diabetic retinopathy. Material and methods. The study involved 52 patients (52 eyes) with diabetes mellitus of type 2, who underwent the vitreoretinal surgery with a preliminary antivasoproliferative therapy. In all cases, a traction syndrome was found only from the side of posterior hyaloid proliferative tissue with gliosis of degree II-III, without signs of an epiretinal membrane. In the first group of patients (n=28) the 27-Gauge vitrectomy was performed, with the removal of only posterior hyaloid proliferative tissue followed by a tamponade of the vitreous cavity with a gas-air mixture, and in the second group (n=24) a similar volume of vitreoretinal surgery combined with peeling of the internal limiting membrane was carried out. Results. In all patients, before the combined surgical treatment, the visual acuity averaged 0.06±0.02. Before the treatment in patients of both groups according to optical coherence tomography the thickness of zone «nerve fibers layer – internal limiting membrane» in the macular area averaged 25.38±3.11μm, in the fovea and parafovea – 457.41±36μm and 701.51±24μm, respectively. The mean value of the optical density of the macular pigment before the treatment was 0.094±0.01 du. After the performed vitreoretinal intervention, the visual acuity in patients of the group 1 improved up to 0.10±0.02 (p< 0.05), in the group 2 – up to 0.25±0.05 (р1-2< 0.05). Six months after vitrectomy, the thickness of zone «nerve fibers layer – internal limiting membrane» in the macular area in patients of the group 1 increased 1.6 times (p< 0.05), due to the formation of a secondary epiretinal membrane, which occurred in 39.2% cases (11/28), 54.5% of cases (6/11) showed traction macular edema, and diabetic macular edema (without epiretinal membrane) was detercted in 28.5% of cases (8/28). In the group 2 of patients, the «nerve fibers layer» zone decreased by 1.5 times (р1-2< 0.05), the epiretinal membrane and the traction macular edema were not diagnosed in any case (0/24), but 5 patients (20.8%) had diabetic macular edema (5/24). According to the data of optical coherence tomography, the thickness of the retina in the fovea and parafovea after the combined surgical treatment in patients of the group 1 averaged 212.49±36μm and 365.74±28μm, in the group 2 – 190.11±24μm and 334.18±21μm, respectively (р1-2< 0.05). The average value of macular pigment optical density after treatment was 0.109±0.01 du in the group 1 and 0.122 ± 0.01 du in the group 2. Conclusion. Vitrectomy combined with peeling of the inner limiting membrane in patients with advanced proliferative diabetic retinopathy contributes to obtain a higher visual acuity minimizing a risk of secondary epiretinal membrane and diabetic macular edema.

International audience; Exfoliation syndrome (XFS) is the commonest known risk factor for secondary glaucoma and a significant cause of blindness worldwide. Variants in two genes, LOXL1 and CACNA1A have been previously associated with XFS. To further elucidate the genetic basis of XFS, we collected a global sample of XFS cases to refine the association at LOXL1, which previously showed inconsistent results between populations,and to identify new variants associated with XFS. We identified a rare, protective allele at LOXL1 (p.407Phe, OR= 25, P=2.9 x 10-14) through deep resequencing of XFS cases and controls from 9 countries. This variant results in increased cellular adhesion strength compared to the wild-type (p.407Tyr) allele. A genome-wide association study (GWAS) of XFS cases and controls from 24 countries followed by replication in 18 countries identified seven genome-wide significant loci (P < 5 x 10-8). Index variants at the new loci map to chromosomes 13q12 (POMP), 11q23.3 (TMEM136), 6p21 (AGPAT1), 3p24 (RBMS3) and 5q23 (near SEMA6A). These findings provide biological insights into the pathology of XFS, and highlight a potential role for naturally occurring rare LOXL1 variants in disease biology.

Purpose. To evaluate the effect of intravitreal implant with dexamethasone on the morphological changes of macular area in patients with central retinal vein occlusion.Materials and methods. Results of optical coherence tomography of the central retinal area of 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema (ME) are presented. All the patients underwent single intravitreal injection of dexamethasone implant. Maximal follow-up period – 12 months.Results. In 1 month after dexamethasone implant injection, we observed a decrease of foveal retinal thickness from 425.36 ± 57.87 to 273.75 ± 36.65 µm. In 1 year after treatment, foveal retinal thickness increased by 1.2 times compared to results got in 1 month after dexamethasone implant injection. The transformation of the macular area under the implant action was mainly due to changes in thickness and structure in the outer and inner nuclear and plexiform retinal layers.Conclusion. Intravitreal injection of dexamethasone implant provides a decrease in post-thrombotic macular edema in 1 month since implantation. Retinal layers transform selectively at various pathological conditions of the retina, including macular edema. Retinal thickness changes in post-thrombotic ME, including those occurring under the dexamethason implant action are mainly related to changes in the outer and inner nuclear and plexiform retinal layers. The duration of morpho-functional effect persists not less than 12 months after treatment.

To draw attention to characteristic features of the clinical manifestations of vitreopapillary traction syndrome (VPTS) in patients with proliferative diabetic retinopathy (PDR), to determine the role of the biomechanical factor in pathophysiology of this syndrome, and to evaluate the results of surgical treatment.The features of clinical manifestations of VPTS of 50 patients with PDR who were treated at the ophthalmology center of the National Medical and Surgical Center named after N.I. Pirogov in the period from 2014 to 2018 were analyzed retrospectively. The preoperative study included standard ophthalmological examination methods, as well as ultrasound B-scan, computer perimetry, optical coherence tomography (OCT), fluorescence angiography (FA) in the first two years of observation. The comparison group consisted of 45 patients with PDR without signs of VPTS, who were treated in the center during the same period of time.The obtained results suggest that the pathophysiology of VPTS in diabetes mellitus has distinctive features and is determined by the topography of the peripapillary zone, as well as choroidal vascularization of the optic nerve head; biomechanical factor plays an important role in the formation of a fibrovascular stem (FVS) in VPTS.The results indicate that patients with VPTS have a worse prognosis for achieving best corrected visual acuity (BCVA) after surgery than patients without signs of VPTS. Correct and timely diagnosis, early treatment by vitreoretinal surgery give a greater chance of achieving higher BCVA in the postoperative period in this category of patients.Акцентировать внимание на особенностях клинических проявлений витреопапиллярного тракционного синдрома (ВПТС) у пациентов с пролиферативной диабетической ретинопатией (ПДР), определить роль биомеханического фактора в патофизиологии данного синдрома и оценить результаты хирургического лечения.Ретроспективно проанализированы особенности клинических проявлений и течения ВПТС у 50 пациентов с ПДР, которые проходили лечение в Центре офтальмологии НМХЦ им. Н.И. Пирогова в период с 2014 по 2018 г. Предоперационное исследование включало стандартные офтальмологические методы, а также ультразвуковое B-сканирование, компьютерную периметрию, при наличии прозрачных оптических сред — оптическую когерентную томографию, флюоресцентную ангиографию в первые два года наблюдения. В качестве сравнения взяты результаты наблюдений за 45 пациентами с ПДР без признаков ВПТС, пролеченными в стационаре центра в тот же период.Полученные данные позволяют утверждать, что патофизиология ВПТС при сахарном диабете имеет отличительные особенности и определяется топографией препапиллярной зоны, а также хороидальной васкуляризацией диска зрительного нерва; важную роль в формировании фиброваскулярного стебля при ВПТС играет биомеханический фактор.Результаты исследования свидетельствуют, что у пациентов с ВПТС прогноз на достижение максимально корригируемой остроты зрения (МКОЗ) после хирургического вмешательства хуже, чем у пациентов без признаков ВПТС. Правильная и своевременная диагностика, раннее выполнение витреоретинальной хирургии дают больший шанс для получения более высокой МКОЗ в послеоперационном периоде у данной категории пациентов.

Objective: to analyze the structural state of the central area of the retina in diabetic macular edema in the background anti-VEGF therapy.Methods. The study included 38patients (40eyes) with diabetic macular edema. All patients received anti-VEGF-ranibizumab therapy at a dose of 0.05ml. The results were analyzed after three intravitreal injections with 1month interval. We assessed visual acuity, morphological and anatomical structure of the macular area, the sensitivity of the retina and macular pigment optical densityResults. Analyzing optical density of the macular pigment we revealed a significant increase of all parameters in 73% of patients after the therapy. The average value of the optical density before treatment was at 0.102±0.01du, on the background of anti-VEGF-therapy this figure went up to 0.213±0.01 (p

To compare the changes of the macular morphological and functional parameters in the postoperative period in patients with silicone oil tamponade after successful surgery of the macula-on rhegmatogenous retinal detachment (RRD).The study included 20 eyes operated on for macula-on RRD, which made up the first group, and the control group (20 eyes) for comparison. All patients of the study group underwent vitrectomy using silicone oil tamponade. Standard ophthalmological examination was performed on the 3rd day (early postoperative period) and the 14th day (late postoperative period), including OCT and OCT-A that were used to assess morphological and functional changes.A significant decrease in visual acuity was seen on the 3rd day after surgery involving the use of silicone oil tamponade, in comparison with the 14th day (Сравнить изменение морфофункциональных показателей макулярной зоны в послеоперационном периоде у пациентов с силиконовой тампонадой (СТ) после успешного хирургического лечения macula-on регматогенной отслойки сетчатки (РОС).В исследование включено 20 пациентов (20 глаз), прооперированных по поводу macula-on РОС. Прооперированные глаза составили 1-ю группу, которая сравнивалась с группой контроля (2-я группа; 20 парных глаз без офтальмопатологии). На всех глазах 1-й группы выполнена витрэктомия с использованием СТ. Стандартное офтальмологическое обследование выполнялось на 3-и (ранний послеоперационный период) и 14-е сутки (поздний послеоперационный период); кроме того, для оценки морфофункциональных изменений использовали оптическую когерентную томографию, в том числе в режиме ангиографии.На 3-и сутки после операции с использованием СТ выявлено достоверное снижение остроты зрения в сравнении с показателем на 14-е сутки (

To compare morpho-functional parameters of retina during vitrectomy with and without internal limiting membrane (ILM) peeling in patients with proliferative diabetic retinopathy.The study included 55 patients (55 eyes) that had underwent vitreoretinal surgery in the setting of antivasoproliferative therapy for proliferative diabetic retinopathy. Patients of the 1Best Corrected Visual Acuity before treatment was 0.06±0.02 in both groups; after the treatment it improved to 0.1±0.05 (p0.05) in the 1ILM peeling during vitrectomy with following silicone oil tamponade eliminates the risk of ERM formation in patients with proliferative diabetic retinopathy in the follow-up period of up to 6-month and results in better morpho-functional parameters in comparison with patients who received similar treatment but without peeling.Цель - сравнительный анализ морфофункциональных параметров сетчатки при витрэктомии в сочетании и без пилинга внутренней пограничной мембраны (ВПМ) у пациентов с пролиферативной диабетической ретинопатией. Материал и методы. Обследовано 55 пациентов (55 глаз), которым было проведено витреоретинальное вмешательство на фоне антивазопролиферативной терапии при пролиферативной диабетической ретинопатии. Пациентам 1-й группы (n=27) была выполнена витрэктомия с силиконовой тампонадой, 2-й (n=28) - аналогичный объем вмешательства в сочетании с пилингом ВПМ. Через 3 мес пациентам обеих групп было проведено дополнительное витреоретинальное вмешательство по поводу удаления силиконового масла. Результаты. До лечения максимально корригированная острота зрения в обеих группах составляла 0,06±0,02, после лечения в 1-й группе данный показатель улучшился до 0,1±0,05 (р0,05), во 2-й - до 0,25±0,05 (р

Aim . To assess morphological changes of retinal layers and optical density of macular pigment in patients with diabetic macular edema (DME) for the diagnostic criterion of pathological process. Materials and methods . 31 patients were divided in two groups. The first group (A) included 19 patients with DME (20 eyes), the second group (B) – 12 patients (20 eyes) without retinal pathology. Both groups were comparable with regard to age. Parameter estimation was conducted with the use of following methods: optical coherence tomography (OCT) of the macular area of the retina; fundus photography with the measurement of macular pigment optical density (MPOD); microperimetry. Results . OCT analysis showed that the inner nuclear and plexiform layers of retina were the most involved in pathological process and revealed significant differences in increase of mean retinal thickness in comparison with the control group. Analysis of MPOD revealed a significant reduction of all parameters in group A compared with the control group. On the basis of microperimetry of the central area of retina in group A light sensitivity indicators were reduced by an average of 9 dB and equaled 9.85 ± 0.09 dB. The analysis showed gross violations of retinal structure and distribution of optical density of macular pigment in patients with DME. Correlation analysis of retinal thickness, functional light sensitivity and optical density of macular pigment traced a strong connection (r = -0.93; p

With information about frequency of bone fractures in Russia mostly missing, we assessed the frequency of previous bone fractures in a Russian population. The population-based study Ural Eye and Medical Study included 5899 (80.5%) out of 7328 eligible individuals (mean age: 59.0 ± 10.7 years; range: 40–94 years). The history of previous bone fractures was assessed in a standardized interview for 5397 (91.5%) individuals. Mean frequency of any previous bone fracture was 1650/5397 (30.6%; 95% confidence interval (CI): 29, 3, 31.8). In multivariate analysis, higher frequency of bone fractures was associated with male sex (P P P P = 0.001; OR: 1.46; 95% CI: 1.16, 1.82) and higher prevalence of cardiovascular disease (P = 0.007; OR: 1.29; 95% CI: 1.07, 1.56), low blood pressure episodes with hospital admission (P = 0.001; OR: 2.08; 95% CI: 1.37, 3.16), tumbling (P P P

Since there is a scarcity on population-based health information available for Russia, we conducted this project to assess the prevalence of major ocular and systemic disorders and their associated risk factors.A population-based cross-sectional study (Ural Eye and Medical Study (UEMS)) was performed in Bashkortostan 1300 km east of Moscow. The sampling frame consisted of all inhabitants aged over 40 years and living in an urban study area in the capital city Ufa and a rural region at 65 km outside of Ufa. The target sample size was 2500 individuals for the urban region and 2500 persons for the rural region. The study participants underwent a detailed interview, a detailed ophthalmologic examination including biometry and optical coherence tomography, and clinical examination including assessment of electrocardiography, hearing test, blood sampling, spirometry, and hand grip dynamometry.After a first study period, the study population included 4254 individuals with a mean age of 60.3 ± 11.1 years (range: 40-94 years), mean body weight of 74.8 ± 14.4 kg (range: 31-170 kg), body height of 163.6 ± 8.9 cm (range: 112-196), body mass index of 28.0 ± 5.1 kg/mThe UEMS provides population-based normative data for a Russian region on the quantitative traits such as axial length, quality of life and lifestyle including smoking and alcohol consumption, and prevalence and risk factors of ocular and systemic diseases such as diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, and depression.

to evaluate the effect of dexamethasone intravitreal implant on the functional state of the eye in macular edema associated with central retinal vein occlusion.The study included two groups of patients: group 1 (control group) - 8 patients (16 eyes) without ocular pathology and group 2 (study group) - 8 patients (8 eyes) with macular edema on the background of newly diagnosed thrombosis of the central retinal vein. All the patients from the study group underwent insertion of an intravitreal dexamethasone implant - Ozurdex. Best corrected visual acuity (BCVA) and retinal light sensitivity of the central visual field were followed up. The maximum follow-up period was 12 months.In group 1 (controls), BCVA averaged 0.93±0.2 and retinal light sensitivity of the central visual field - 19.01±1.18 dB. In group 2, baseline BCVA and retinal light sensitivity were 0.08±0.02 and 4.23±0.2 dB, 1 month after Ozurdex implantation - 0.21±0.04 and 11.77±0.98 dB, at 12 months - 0.23±0.17 and 5.2±0.78 dB, respectively.Macular edema associated with central retinal vein thrombosis has a strong deteriorating effect on the functional state of the eye. The dexamethasone intravitreal implant in patients with postthrombotic macular edema contributes to functional improvement, including BCVA and light sensitivity of the central retina, over the first year. At that, different functional parameters show different dynamics after dexamethasone treatment. Light sensitivity values, in contrast to BCVA, change unevenly and significantly during the year. Intravitreal implantation of a dexamethasone implant in patients with postthrombotic macular edema is an effective symptomatic treatment of occlusive processes within the retinal venous system.Цель - изучение влияния интравитреального имплантата с дексаметазоном на функциональное состояние органа зрения при макулярном отеке, связанном с окклюзией центральной вены сетчатки (ЦВС). Материал и методы. В исследование включены 2 группы пациентов: 1-я группа (контрольная) - 8 пациентов (16 глаз) без офтальмопатологии, 2-я группа (исследуемая) - 8 пациентов (8 глаз) с макулярным отеком на фоне впервые выявленного тромбоза ЦВС. Пациентам 2-й группы проведено интравитреальное введение имплантата с дексаметазоном - Озурдекса. Исследовали максимально корригированную остроту зрения (МКОЗ) и световую чувствительность центральной области сетчатки. Сроки наблюдения составили 1 и 12 мес после интравитреального введения имплантата с дексаметазоном. Результаты. В 1-й (контрольной) группе средний показатель МКОЗ составил 0,93±0,2, средний показатель световой чувствительности центральной области сетчатки - 19,01±1,18 дБ. Во 2-й (исследуемой) группе средние показатели МКОЗ и общей световой чувствительности центральной области сетчатки до лечения составили 0,08±0,02 и 4,23±0,2 дБ, через 1 мес после введения имплантата с дексаметазоном - 0,21±0,04 и 11,77±0,98 дБ, через 1 год - 0,23±0,17 и 5,2±0,78 дБ соответственно. Заключение. Макулярный отек на фоне тромбоза ЦВС оказывает выраженное угнетающее влияние на функциональное состояние органа зрения. Интравитреальное введение имплантата с дексаметазоном у пациентов с посттромботическим макулярным отеком способствует улучшению функциональных показателей в виде повышения МКОЗ и общей световой чувствительности центральной области сетчатки в течение года. Влияние имплантата с дексаметазоном на динамику разных функциональных показателей при лечении макулярного отека у пациентов с тромбозом ЦВС неодинакова. Показатели общей световой чувствительности, в отличие от показателей МКОЗ, неравномерно и значительно изменяются в течение года. Интравитреальное введение имплантата с дексаметазоном у пациентов с посттромботическим макулярным отеком является эффективным средством симптоматической терапии при окклюзионных процессах в системе ретинальных вен.

To evaluate functional and morphometric parameters of the central retina in patients with postocclusive macular edema treated with dexamethasone intravitreal implant injection.We examined 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema, including 4 men and 1 woman aged 55.8±3.65 years (experimental group). All the patients received a single injection of dexamethasone intravitreal implant. The maximum follow-up period was 12 months. The control group consisted of 5 presbiopic patients (10 eyes) aged 59.14±3.14 years.One month after injection, the best corrected visual acuity (BCVA) and central retinal light sensitivity improved (from 0.09±0.03 to 0.19±0.05 and from 3.18±0.19 to 11.07±0.97 dB, correspondingly), while foveolar thickness decreased from 425.36±57.87 to 273.75±36.65 µm. One year after the treatment, BCVA remained high and averaged 0.21±0.14. The total light sensitivity also remained higher than that at baseline, however, decreased down to 4.8±0.76 dB. Optical coherence tomography showed some flatness of the fovea. Foveolar thickness appeared 1.5 times higher than that in the control group and 1.2 times higher than that at the 1-month follow-up after dexamethasone intravitreal implant injection. Over the whole follow-up period, IOP has never significantly exceeded the baseline, optical media remained clear.1. Dexamethasone intravitreal implant has been shown effective in resolving postocclusive macular edema, improving visual functions, and increasing central retinal light sensitivity within the first month after injection. 2. Positive changes in morphometric parameters of the central retina induced by the injection involve inner segments of photoreceptors as well as the outer nuclear, outer plexiform and inner nuclear layers. The morphofunctional effect persists for no less than 12 months after injection. 3. Over the 1-year follow-up period, there has been no negative influence of the implant on either intraocular pressure level, or lens transparency.Цель - исследовать функциональные и морфометрические характеристики центральной области сетчатки с посттромботическим макулярным отеком (МО) на фоне интравитреального введения имплантата с дексаметазоном. Материал и методы. Обследованы 5 пациентов (5 глаз) с впервые выявленным тромбозом центральной вены сетчатки, осложненным МО, из них 4 мужчины и 1 женщина, средний возраст которых составил 55,8±3,65 года (исследуемая группа). Всем указанным пациентам проведено однократное интравитреальное введение препарата-имплантата с дексаметазоном. Максимальный срок наблюдения составил 12 мес. В группу контроля включены 5 человек (10 глаз) с пресбиопией, средний возраст 59,14±3,14 года. Результаты. Через 1 мес после введения имплантата с дексаметазоном отмечали улучшение максимально корригированной остроты зрения (МКОЗ) с 0,09±0,03 до 0,19±0,05, суммарной световой чувствительности центральной области сетчатки - в среднем с 3,18±0,19 до 11,07±0,97 дБ, уменьшение толщины сетчатки в фовеоле с 425,36±57,87 до 273,75±36,65 мкм. Через 1 год после лечения МКОЗ составила в среднем 0,21±0,14, суммарная световая чувствительность хотя и снизилась до 4,8±0,76 дБ, но осталась выше, чем до лечения. Оптическая когерентная томография показала сглаженность фовеолярного углубления. Толщина сетчатки в фовеоле стала больше относительно показателей контрольной группы в 1,5 раза, а в сравнении с результатами, полученными через 1 мес после введения имплантата, - в 1,2 раза. В течение всего периода исследования не было выявлено значительного повышения уровня внутриглазного давления (ВГД) относительно исходных данных, сохранялась прозрачность оптических сред хрусталика. Выводы. 1. Интравитреальное введение имплантата с дексаметазоном обеспечивает уменьшение посттромботического МО, улучшение зрительных функций и повышение светочувствительности центральной области сетчатки уже через 1 мес после применения. 2. Положительные морфометрические изменения центральной области сетчатки, связанные с действием имплантата с дексаметазоном при посттромботическом МО, касаются внутренних сегментов фоторецепторов, наружного ядерного, наружного сетчатого и внутреннего ядерного слоев. При этом длительность морфофункционального эффекта сохраняется не менее 12 мес после лечения. 3. Не выявлено отрицательного действия имплантата с дексаметазоном на уровень ВГД и прозрачность хрусталика при наблюдении за больными в течение года.

Background: Systematization of characteristics and morphological changes in the retina, and understanding its role in occlusive diseases involving retinal vessels can contribute to research on the dynamic of the pathological process and to improved understanding of disease treatment. Objective: To research the basic morphometric and structural indicators of the macular region of the retina in patients with central retinal vein occlusion (CRVO). Settings and Design: Ufa Eye Research Institute, retrospective case series. Methods: The basic morphometric and structural indices of the macular region of the retina in 15 patients with CRVO were studied using the optical coherence tomography. Patients with CRVO (15 eyes) were included in Group I (study), and 10 patients with no retinal pathology (10 eyes) were included in Group II (control). Statistical analysis used: For the statistical analysis, the Statistica 6.1 program was used with a parametric method, the Student's test.To consider the probability of statistically significant differences, values beginning with up to p