Today, glaucoma is considered to be the most common cause of irreversible blindness. The treatment of this disease is aimed at reducing intraocular tension in order to slow down the deterioration of visual functions and to maintain accept‑ able quality of life. Most ophthalmologists prefer local medicamentous therapy. Despite a significant expansion of the range of antihypertensive medicines, a significant increase in the hypotensive effect is not always achieved in each certain case, at the same time, at long-term (sometimes lifetime) treatment local and systemic adverse reactions arise and intensify. The findings of recent clinical trials presented in this overview demonstrate an adverse effect of active compounds, preservatives and ad‑ ditives of ophthalmic medicines not only on the eye surface but also on the structure of anterior and posterior eye segments. Taking into account possible side effects of each component of medicines used in glaucoma therapy, ophthalmologists will be able to reasonably approach the choice of optimal treatment regimens with the lowest risk for patients.

Review of materials related to scientific principles underlying clinical trials of coagulation factor IX medications obtained using recombinant DNA technique or from donors’ blood plasma. Inherited deficiency of functional active coagulation factor IX or a low level of its synthesis lead to the development of hemophilia B. Patients with hemophilia require a continuous replacement therapy with factor IX medications. Achievements in the area of genetically engineering technologies as well as improvement of production process of biological products allow developing modern highly efficient medications which are successfully used to treat patients with hemophilia. Registration of newly developed medications and medications produced according to the modified technology requires clinical trials. Principles of these trials are regulated by the clauses of regularly updated regulatory documents. Compliance with national and international guidelines determining the conditions for clini‑ cal trials of medications allows us to guarantee their safety and promotes the development of medications efficient to treat patients with hemophilia.

The literature review analyzing national and international researches on health condition of children population and on factors affecting its development. It has been determined that nowadays the trend towards deterioration in health indicators of children and adolescents continues characterized by an increase in the prevalence of functional disorders and chronic diseases, a deterioration in indicators of physical development. Data on the influence of various factors on the health of children are summarized, among which a special place is given to intraschool factors and the regulation of the daily routine.

The literature data is presented covering epidemiological significance of acute cerebrovascular accidents (CVA) in‑ cidence in patients with brachiocephalic arteries lesion. The role of atherosclerotic lesion of carotid arteries in the develop‑ ment of ischemic cerebral stroke is shown. The basic methods for diagnosis of carotid arteries lesion has been analyzed as well as their availability and informative value. A comparative analysis of modern methods for surgical treatment of athero‑ sclerotic lesion of carotid arteries such as carotid endarterectomy (classic and eversion), endovascular procedure has been done. The main advantages and disadvantages of these treatment methods, indications and contraindications for their use are described. The timing of cerebral revascularization in the acute and delayed periods of ischemic stroke was estimated. The role of bilateral lesion of the carotid territory is shown as well as approaches to the treatment strategy of such patients.

Objective: To assess the incidence of central serous chorioretinopathy (CSC) through the example of a large industrial Russian city.

Methods: A retrospective analysis of CSC of Kazan population for 2009–2018 has been done.

Results: From 2019 to 2018, 831 new cases of CSC were registered in Kazan. A statistically significant upward trend with growth rate 105.2% and accession rate 5.2% was typical for the annual track record. The mean age of patients was 50 years, the minimum age was 14 years, the maximum age was 87 years. A statistically significant upward trend was detected in track record of incidence in groups of 30–39-year-old and 40–49-year-old. Seasonal increase of the incidence was recorded in February, March, April, October, and November.

Conclusions: The upward trend and seasonal prevalence are typical for longterm morbidity of CSC in Kazan. The highest morbidity rate of CSC and statistically significant upward trend of its incidence in track record were recorded in the age of 30–39. 

Objective: To assess the patterns of alcohol consumption by HIV-positive patients and to determine effective and ineffective strategies to reduce harm from alcohol consumption.

Methods: A survey of 286 HIV-positive inpatient and outpatient patients was carried out as well as a qualitative study by focus group method of HIV-positive individuals living in St. Petersburg.

Results: Almost the half of patients has demonstrated a dangerous level of alcohol consumption that affected adherence to treatment. Persons closest to HIV-positive patients have both positive and negative effect on the patterns of alcohol consumption.

Conclusions: Alcohol consumption is a common behavioral practice among HIV-positive patients requiring periodic monitoring. Persons closest to a patient influence his/her behavior and can be used in planning of preventive measures in addictive pathology. 

Objective: Clinical assessment of chorioretinal hemodynamics in women at risk for vascular retinal pathology before and after long-term courses of preventive care.

Methods: 60 women having undergone preeclampsia during pregnancy were exam‑ ined. The 1st group of patients (30 people) got courses of medicamentous correction of endothelial dysfunction: sulodexide, ginkgo biloba (Tanakan), ascorbic acid. The 2nd group (30 women) did not get preventive care. The control group included 30 women having undergone physiological pregnancy (vaginal delivery, without complications). Parameters of chorioretinal hemodynamics were determined 6–8 months later and 3–4.5 years later after delivery.

Results: By the end of the follow-up, in the 1st group, the blood flow velocity in the posterior short ciliary arteries statistically significantly increased; the density of the retinal vessels and subfoveolar thickness of the choroid and the area of the avascular zone of the retina decreased.

Conclusions: The long-term medicamentous correction of endothelial dysfunction reduces the risk of vascular pathology development in women having undergone preeclampsia during the pregnancy. 

Objective: Evaluation of efficacy of the application of artificial intelligence technology and neural networks in the analysis of the condition of the optic disc and the peripapillary retina in healthy individuals.

Methods: Prospective analysis of the condition of visual organs in 54 patients aged from 49 to 71 years (100 eyes) was conducted. The examination included autorefractometry, visometry, tonometry, automated perimetry, spectral domain optical coherence tomography, Heidelberg retina tomography. A pre-trained neural network evaluated only a photograph of the optic nerve disc and the peripapillary retina.

Results: Neural network identified twelve images with suspected glaucoma, five of which were selected by medical experts. The comparison of all study groups has demonstrated the presence of statistically significant differences between them according to a range of visiometric indicators.

Conclusions: The study results showed high efficiency of artificial intelligence and the prospects of its use for the diagnosis of glaucoma. 

Objective: Quantitative morphometric and topographic analysis of specific changes of the retina in patients with the acute central serous chorioretinopathy (CSC) based on annotated tomograms.

Methods: 39 patients with the acute CSC (44 eyes – 45 scans) were examined. A complex ophthalmological examination was carried out including 3D optical coherence tomography of maculae. The data was uploaded into CVAT. Three classes of pathological changes were differentiated: 1) retinal neuroepi‑ thelium detachment; 2) retinal pigment epithelium alteration; 3) percolation zones. The analysis of topographical localization of changes and their morphological relations were assessed with a programming language Python.

Results: A moderate trend towards vertical asymmetry of the neuroepithelial detachment zone with an excess of cumulative distribution in the lower part of the macula was revealed. Retinal pigment epithelium alteration sites and percolation zones demonstrated a relative peak of representation in the upper nasal part of the macula. In 69.9% and 80% of cases, respectively, abnormalities of retinal pigment epithelium and percolation zones were localized within the limits of neuroepithelial detachment. Direct correlation between the area of neuroepithelial detachment and the area of percolation zones; the area of percolation zones and the area of retinal pigment epithelium alteration; the area of neuroepithelial detachment and the area of retinal pigment epithelium alteration.

Conclusions: Percolation zones and abnormalities of retinal pigment epithelium demonstrate similar trends in topo‑ graphical localization and quantitative characteristics and are related to the area of neuroepithelial detachment in CSC. Thus, the number of retinal pigment epithelium abnormalities can serve as an indicator of disease severity.

Objective: Comparison of complications development rate in various methods for implanting intraocular lenses (IOLs) in the surgical treatment of congenital cataract.

Methods: The results of surgical treatment of 16 children under 5 years old with bilat‑ eral congenital cataract were assessed. In each case, IOL was implanted according to the technique “optic capture” into one eye (the 1st group of study); the lens was implanted after capsulorrhexis and extraction of anterior segments of vitreous body into the second eye (the 2nd group of study).

Results: Fibrinoplastic complications in the postoperative period were more often recorded in the 2nd group than in the 1st one (5 and 1 eyes, respectively). Epithelial proliferation in the 2nd group developed in 10, in the 1st group – in 5 eyes.

Conclusions: In the surgical treatment of congenital cataract, implantation of IOLs according to the technique “optic capture” is an effective way of epithelial proliferation and opacity prevention reducing visual acuity in postoperative period. This method is safe regarding inflammatory fibrinoplastic reactions and allows maintaining normal anatomical position of the vitreoretinal structures of the growing eye. 

Objective: Analysis of age-related changes of microcirculatory bed of bulbar conjunctiva.

Methods: 46 individuals of both sexes, divided into 5 age groups according to WHO recommendations, were examined. Biomicroscopy of bulbar conjunctiva was performed using a non-mydriatic retinal camera TOPCON TRC-NW8F (Japan); the obtained images were processed with a mea‑ suring device of automated analysis system ImageScope (Leica, Germany).

Results: The average diameter of arterioles, arterioleto-venule ratio (AVR) and specific density of capillaries were the largest, and the diameter of venules was the smallest among the subjects aged 18–44 years. The most sensitive indicators of the state of microcirculatory bed were AVR and the specific density of capillaries, the values of which in the group of 45–59-year-olds were 10–11% lower than in people aged 18–24 and 25–44 years. Differences in other indicators between people aged 18-24 and 45–59 years were not significant. Between the groups of 60–74 and 75–86-year-old participants of the study, pronounced differences (about 18%) were found only in the specific density of capillaries: compared with 18–24 and 45–59-year-olds, this indicator decreased by almost 1.5 times, AVR – only by a third, and changes in the average diameter of arterioles and venules did not exceed 9–12%. Elderly people more often demonstrated arteriolar spasm, their uneven caliber, avascular fields and other disorders of the structure of the micro‑ circulatory bed.

Conclusions: As the body ages, in the microcirculatory bed of the bulbar conjunctiva, the number of atypical vascular formations increases, the diameter of the arterioles decreases, the AVR and the specific density of capillaries decrease, the diameter of the venules increases. 

Objective: To detect early morphological and functional signs of neurodegeneration of the retina in patients with type 2 diabetes mellitus (DM) without signs of diabetic retinopathy (DR), to determine the presence and nature of the relationship between the studied parameters.

Methods: The study included 30 patients with type 2 DM without DR (main group) and 30 healthy individuals (control group). Optical coherence tomography and microperimetry were performed.

Results: In the main group, a significant decrease in the average photosensitivity of the retina and a decrease in its photosensitivity in the fovea and in the upper, lower, and temporal quadrants of parafovea were revealed. A significant difference between the groups was also recorded in the thickness of the inner layers of the retina in the temporal quadrant of parafovea. There was also a significant difference in the volume of focal loss of retinal ganglion cells.

Conclusions: Neurodegenerative and related functional changes in the retina were revealed in patients with type 2 DM without signs of DR. Retinal neurodegeneration is one of the reasons for the deterioration of visual function in patients with DM and can aggravate the prognosis of the disease. Optical coherence tomography and microperimetry can be used for early diagnosis and monitoring of this process. 

Objective: Comparative evaluation of the effect of regulatory peptides on lipid peroxidation in brain tissue after traumatic brain injury (TBI).

Methods: Reproductive Wistar male rats were divided into 3 groups: the first group received 0.1 mg/kg of “Selang” peptide solution (Thy-Lys-Pro-Arg-Pro-Gly-Pro) within 5 days after the experimental traumatic brain injury, the second group received 0.1 mg/kg AGAPGP peptide (Arg-Gly-Arg-Pro-Gly-Pro), the third (control) – 0.9% sodium chloride solution. Drugs were administered retroperitoneally.

Results: According to chemiluminescence in the biomaterial taken from rats of the first group, indicators of oxidative stress were less pronounced.

Conclusions: The Selang has a more pronounced antioxidant effect on brain tissue after traumatic brain injury compared with the AGAPGP peptide. 

Objective: A comparative analysis of C-reactive protein (CRP) and procalcitonin concentration in blood serum and seminal plasma of healthy men and men with reduced concentration of sperm cells.

Methods: 73 fertile men were examined. The experimental group included 36 patients with a reduced fertility; the comparison group (control) included 37 men with normal indicators of ejaculate composition. The concentrations of CRP and procalcitonin were determined by the method of enzyme-linked immunosorbent assay.

Results: Differences in level of CRP between blood serum and seminal plasma in experimental and control groups occurred to be statistically significant in both groups. There was no correlation between these parameters. The concentration of procalcitonin was almost ten times higher in the seminal plasma than in the blood serum. In the experimen‑ tal group, it was significantly higher in ejaculate than in the comparison group. The concentration of CRP and procalcitonin did not correlate neither with the ejaculate volume nor with concentration or amount of sperm cells in it.

Conclusions: The levels of CRP and procalcitonin in seminal plasma can indicate the fertility status of the ejaculate. 

Objective: Analysis of the frequency and clinical manifestations of emergence agitation in children with background psycho‑ neurological disorders after general inhalational anesthesia during ophthalmic surgery.

Methods: 1155 children aged 2–6 years having undergone different ophthalmic surgeries were examined. Children were conventionally divided into two groups: a main one (n=516) – children with different psychoneurological disorders; a comparison one (n=639) – children without psy‑ choneurological disorders. All patients got the general inhalational anesthesia with sevoflurane. The induction was performed intravenously with propofol.

 

 

Objective: To assess the relation between key factors of inflammation and myocardial infarction complications in different stages of the diseases in patients with visceral obesity.

Methods: Men with the diagnosed myocardial infarction were examined: 64 of them with visceral obesity (the first group) and 30 of them without visceral obesity (the second group). On the 1s t and 12th day of hospitalization, the serum concentrations of interleukins (IL) 1β, 6, 8, 10 and 12, tumor necrosis factor α (TNFα) and C-reactive protein (CRP) were determined. The control group included 30 healthy men.

Results: The cytokine profile in visceral obesity was characterized by the increase in concentration of proinflammatory ILs and the decrease in concentration of IL-10. The concentration increase was: 1.3 times for IL-1 and TNFα, 2 times for IL-12, 6 times for IL-6 and 24 times for IL-8 and CRP. The increase in IL-6 and CPR levels in blood serum was associated with the obesity.

Conclusions: The development of adverse cardio‑ vascular complications a year later after the previous myocardial infarction is typical for patients with visceral obesity and is followed by the activation of proinflammatory cytokines and deficiency of IL-10. 

Summary: Age related macular degeneration of the retina is a leading cause of severe loss of central vision among elderly people. The introduction into clinical practice of inhibitors of vascular endothelial growth factor has become an important milestone in the treatment of this disease. The article demonstrates three cases of aflibercept (Eylea) application in elderly patients with wet age-related macular degeneration. The medication has demonstrates a high clinical efficacy. Further obser‑ vation is required to assess long-term results.

Summary: Short-sightedness accounts for up to 25–30% of refractive errors, and according to the authors, over 40% among children of Primorskiy territory. We have analyzed the treatment results of 100 children with moderate and severe myopia having undergone a surgery in the pediatric eye department of Regional Clinical Hospital No. 2 from January 1 to December 31, 2019. In 90 children with anteroposterior length of the eye less than 25 mm, meridional scleral reinforcement of both eyes was performed. In 10 patients with anteroposterior length of the eye more than 25 mm, as well as previously operated on for myopia, scleral reinforcement was performed according to Snyder-Thompson. If there was exophoria of the 1st–2nd degree (25 cases), partial average myotomy of the lateral rectus muscles of the eyeball was performed, and 13 children with exophoria of the 3rd–4th degree had a recession of the lateral rectus muscle of the eye by 5 mm.

Objective: assessment of the bone tissue regeneration of alveolar ridge during implantation of biocomposite based on wollastonite/hydroxyapatite (HA) in the experiment.

Methods: Four female rabbits were performed the extraction of lower left incisors under the general and local anesthesia followed by the augmentation with biocomposite. The results were assessed with cone beam computed tomography.

Results: On the first day, the average density of bone structure of the alveolar socket was 37 HU; on the 60th day, it reached 1090 HU. The contour of the alveolar socket was not already visible on the 35th day. There were no signs of the osteolysis.

Conclusions: The experiment result confirms the the participation of a CaSiO3/HA biocomposite in bone tissue regeneration, as evidenced by the dynamics of the increase in bone volume in the alveoli of the removed teeth of the lower jaw of experimental animals. 

Objective: To assess the benefits of negative pressure wound therapy (NPWT) in complex therapy of patients with enterocuta‑ neous fistulas.

Methods: From 2014 to 2019 in Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 24 patients were managed with vacuum assisted techniques. For comparison, a comparable group of 23 observations (control) was formed retrospectively based on an analysis of medical records.

Results: When using NPWT, the terms of wound cleansing and the formation of a laparostomy were reduced, and conditions were created for its early closure. With a small laparostomy, the use of NPWT contributed to self-epithelialization of the wound around the fistula.

Conclusions: The use of NPWT more than halves the time of formation of a laparostomy, shortens the time for cleansing the wound and creates the conditions for its closure. Surgical tactics using NPWT can more than three times reduce the number of local complications in patients with unformed intestinal fistulas and less often change the combination of antibacterial drugs. 

Objective: Analysis of clinical efficacy and subjective satisfaction of patients with post-thrombotic macular edema after intravitreal administration of Ozurdex (dexamethasone).

Methods: Thestudy included 33 patients (33 eyes) aged from 51 to 75 years with post-thrombotic macular retinal edema. The results were assessed before the intravitreal implantation, after one day, after a month, and three months later after the surgery.

Results: The central retinal thickness significantly decreased on the first day after the surgery remaining almost the same after one and three months. The average retinal thickness had the similar dynamics. The macular volume reduced by 1.5 times in a day after the surgery. The maximum corrected visual acuity gradually increased over the time, remaining on average at the level of 0.5 diopters after one and three months. The subjective evalua‑ tion of quality of life (according to the VF-14 questionnaire) during the observation period progressively increased reaching 47.1 points by the end of the study.

Conclusions: The study findings convincingly indicate the clinical efficacy of the intravitreal administration of dexamethasone and the subjective satisfaction of patients with the quality of treatment both in the early and late postoperative periods.

Summary: When analyzing indicators of primary medical specialized ophthalmic care in Primorsky territory, the main problems were detected: medical staff shortage, insufficient equipment of workplaces in specialized rooms, lack of modern diagnostic equipment in medical organizations of the 1st and 2nd levels. A program “The development of ophthalmic services in the system of healthcare of Primorsku territory” was designed in which goals, objectives and expected results are defined to solve these problems according to the regional program “Primary healthcare modernization”.

Summary: A clinical example demonstrates the diagnostic value of optical coherence tomography and static automatic perimetry in the diagnosis of partial atrophy of the optic nerve with its congenital deep drusen and macular hypoplasia in a 22-yearold patient.