№2, 2021, volume 17

Purpose: evaluate the effectiveness of surgical treatment of recurrent operated macular rupture. Material and Methods. The study included 10 patients (10 eyes) with recurrent macular rupture. In 8 out of 10 cases, the macular hole was closed using the inverted internal limiting membrane (ILM) flap technique; in 2 cases — using mechanical convergence of the edges of the rupture. Preoperative vision varied from 0.05 to 0.1-0.2. According to optical coherent tomography, the average rupture diameter ranged from 600 to 800 urn and in one case was 1144 urn. Results. In all cases, an anatomical result was obtained. During ILM application, the most effective anatomical result was obtained in 5 cases with preservation of the neuroepithelium; in 2 cases the retina in the fovea was thinned. In these cases, there was an improvement in visual functions 1-3 months after the surgery. In 3 cases, there was an incomplete closure of the macular hole. In 1 case, the defect remained at the level of ellipsoid zone of retinal photoreceptors; in 2 cases, there was a deformation of the retinal fovea with the destruction of photoreceptor ellipsoid zone. Visual functions remained unchanged. Conclusion. The use of the described inverted ILM flap technique in surgery of recurrent operated macular rupture serves to increase the effectiveness of treatment.

The complexity of the visual analyzer organization is an incentive for the search and improvement of its diagnostic methods, which allow us to assess visual perception and the effectiveness of processing information obtained as a result of the visual pathway. The review considers in detail the methods of studying the central departments of the visual analyzer, which presumably are crucial in the processes of neuroadaptation. A review of Russian and English-language scientific medical literature was carried out using databases of medical and biological publications: PubMed, Russian scientific electronic libraries Elibrary and Ciberleninka; the electronic library of dissertations and abstracts disserCat; the archives of the journals: Bulletin of the Russian Military Medical Academy; Aerospace and Environmental Medicine; Sensory Systems Journal; Annals of the Russian Academy of Medical Sciences; Russian Ophthalmological Journal; Russian Journal of Clinical Ophthalmology; Ophthalmology in Russia; Russian Journal of Physiology and others. The last search query was dated April 14, 2021. On the issue under study, 63 medical publications were selected, of which 47 works (1965-2021) were identified as the most informative publications that meet the purpose of the review.

The review analyzes available data and identifies problems in the diagnosis of amblyopia. Many authors come to the opinion that traditional methods for detecting amblyopia are insufficient and it is necessary to search for other objective methods, considering that the new methods presented in the literature do not have objective confirmation of their effectiveness. The following databases were used to search for information: eLIBRARY, Scopus, Google Academy PubMed. The analysis of 50 sources of literature on the topic of amblyopia for a period of no more than 15 years was carried out, 30 sources dated 2008-2021 were selected for the literary review.

Purpose: to evaluate by microperimetry and ОСТ the morphofunctional parameters of the retina during recombinant prourokinase subretinal introduction followed by pneumodislocation in comparison with anti-VEGF therapy in the long term for patients with submacular hemorrhage. Material and Methods. Depending on the surgical treatment choice, patients were divided into two groups. In the 1st group 11 patients (11 eyes) received anti-VEGF therapy; in the 2nd group 9 patients (9 eyes) underwent standard 25G vitrectomy with subretinal injection of 0.2-0.3 ml of prourokinase solution and airtamponade of 70% of the vitreous volume and introduction of anti-VEGF drugs 14 days afterthe operation. Results. In patients of the 2nd group, successful dislocation of the clot was achieved in 89% of cases; depression of the central retinal thickness was revealed by 4 times; the height of chorioidal neovascularization decreased by 2.8 times based on an improvement in visual functions by 10 times; the number of loci corresponding to areas of absolute scotoma decreased by 4.7 times, while the general photosensitivity of the retina increased by 12.6. Conclusion. The assessment of the retinal morphofunctional parameters demonstrates an increase in visual acuity due to favorable anatomical outcome and the subsequent maintenance of the achieved parameters in the long term in patients with submacular hemorrhage after subretinal injection of prourokinase and pneumodislocation followed by anti-VEGF therapy.

Purpose: to assess the dynamics of changes in visual functions by Fundus microperimetry (FMP) at various times of observation after vitrectomy using silicone oil tamponade (SOT) for macula-off reghmatogenous retinal detachment (RRD). Material and Methods. The duration of primary macula-off RRD in the group I was up to 13 days (10 eyes); in the group II — from 14 to 30 days (10 eyes). Contralateral eyes without ophthalmological pathology represented the control group. All patients underwent FMP on the 3rd, 30th, and 90th days after SOT and on the 30th day after removal of the silicone oil (SO). Results. There was a tendency to an increase in the maximum corrected visual acuity (MCVA) for periods up to 90 days in the group I and up to the 30th day in the group II. After a SO removal the MCVA index was 0.48±0.11, which exceeded the data on the 90th day by 1.92 times (p=0.002), and the data on the 3rd day by 2.8 times (p<0,001). In the group II the MCVA value was 0.28±0.16, which exceeded the data on the 90th day by 1.47 times (p=0.12) and the data on the 3rd day by 2 times (p=0.05). After the SOT removal in the group II in the 1st zone was detected a decrease in the light sensitivity (LS) parameter by 1.33 times (p=0.05), in comparison with the data on the 90th day, associated with a shift in the fixation point. In the group I the MCVA index had a strong positive correlation with the LS in the 1st zone (r=0.73) and the average value of the LS (r=0.66). In the group II, the moderate positive correlation was demonstrated, both between the MCVA and the SP in the 1st zone (r=0.55), and the average value of the LS (r=0.51). Conclusion. In cases with RRD using SOT revealed different dynamics in the MCVA, LS and fixation parameters, depending on the duration of RRD.

Purpose: to present a clinical case of Valsalva retinopathy in a patient treated using a new technology "digital chromovitrectomy". The choice of the treatment method was determined by the duration of the disease, the localization of the hemorrhage, its area and depth of location relative to the structures of the vitreomacular interface. For surgical treatment, digital chromovitrectomy was used: 3D visualization (NGENUITY, Alcon) with Digitally Assisted Vitreoretinal Surgery software, the CONSTELLATION surgical system and the new UltraVit ® 25+ beveled vitractor (10000 cut/min) in combination with Triamcinolone acetonide. A rapid positive anatomical and functional result of treatment shows that modern vitrectomy provides an effective and safe treatment of Valsalva retinopathy.

Purpose: to describe a rare pathology of the macular area — Best vitelliform macular dystrophy (BVMD), diagnosed in an adult patient after successful bilateral cataract surgery with intraocular lens implantation. The clinical examination and ОСТ examination made it possible to diagnose a homogeneous monofocal focus of yellowish color ("egg yolk") in both eyes in the projection of a rounded fovea. On ОСТ of both eyes, a smoothed foveolar contour was diagnosed, the cause of which was a projecting cone-shaped hyperreflective vitelliform material spreading from the destroyed and atrophied retinal pigment epithelium and Bruch membrane to the photoreceptor layer of the retina. The described clinical case shows that one of the rare causes of low visual acuity in an adult patient may be BVMD — a disease that requires dynamic monitoring and, first of all, ОСТ control.

The proportion of sports injuries in the overall structure of eye injuries is relatively small. However, the sports eye injuries, the prevention and treatment of its consequences have a great urgency and social significance, because most of these patients are young, able-bodied and are aimed at constant physical progression. The review presents works published between 1972 and 2021, available for study in the main scientific databases: PubMed, eLibrary.ru. The literature examination focused on sports eyeball injuries. The final analysis includes 37 literary sources.

Currently, there is no single surgical treatment tactic for pathology in the ligamentous apparatus of the lens, what induced by different approaches to intraocular lenses fixation and clinical picture polymorphism. The review presents works published over the past 30 years and available for study in the main scientific databases: PubMed, eLibrary.ru. The literature review allowed a detail assessment of the advantages and disadvantages of surgical approaches to scleral sutureless fixation of intraocular implants. The final analysis includes 50 literature sources.

Purpose: to analyze heart rate variability and parameters of autonomic regulation in patients with emmetropia and axial myopia. Material and Methods. 30 volunteers (with emmetropic and myopic refraction) aged from 23 to 30 years were examined. In addition to the standard ophthalmological examination, everyone underwent cardiointervalography (Varicard 2.51, Ramena, Russia). Results. In patients with myopia, a significant decrease in the total power of the spectrum of cardiac oscillations (p=0.034) and the activity of the parasympathetic link of the autonomic nervous system (ANS) (p=0.046) was revealed. The value of objective refraction was statistically significantly correlated with the parameters of vegetative regulation and the adaptive status of the organism. Conclusion. The general indicators of the activity of regulatory systems in patients with myopia differ from the control in terms of the total power of the spectrum of cardiac oscillations and the activity of the parasympathetic innervation link. An increase in the degree of myopia is consistent with a decrease in the total regulatory activity on the part of the ANS and an increased shift in the balance of the ANS towards the predominance of the sympathetic component.