Purpose: to quantify the vessel density of the superficial and deep plexuses of the macular zone using optical coherence tomography with angiography (OCTA) after surgical treatment of rhegmatogenous retinal detachment by microinvasive ultrasonic and pneumatic guillotine vitrectomy.Material and methods: this study was conducted on 54 patients with a diagnosis of rhegmatogenous retinal detachment (RRD) with an intact macula. Surgical treatment included ultrasonic (main group, n=28) and pneumatic (control group, n=26) 25G vitrectomy. In the preoperative and postoperative periods, all patients underwent a comprehensive ophthalmological examination, as well as OCTA up to 3 and up to 6 months after surgery.Results and discussion: in the studied groups, there was a statistically insignificant increase in the vessel density of the superficial and deep plexus of the macular zone up to 6 months after vitrectomy compared to up to 3 months (p≥0.05). There were no statistically significant differences in the intergroup comparison of ultrasonic and pneumatic guillotine vitrectomy (p≥0.05).Conclusions: the dynamics of the studied parameters of the vessel density of superficial and deep plexuses of the macular zonein the two study groups may indicate that microinvasive ultrasonic vitrectomy 25G does not have a specific effect on the microvasculature of the macular zone.

Purpose: to evaluate the clinical and immunological efficacy and safety of combined surgical treatment of cataract and neovascular age-related macular degeneration (nAMD) with intraoperative intravitreal injection (IVI) of anti-VEGF drugs.Material and methods. 52 patients with a combination of cataract and nAMD were examined: 32 women and 20 men, with an average age of 68.06±2.40 years. Cataract phacoemulsification (CFE) was performed with implantation of an intraocular lens (IOL), followed by IVV of ranibizumab (21) or aflibercept (20). Ophthalmological examination and examination of 28 cytokines in the lacrimal fluid (LF) were performed before and 31 days after surgery in comparison with the control.Results and discussion. After performing CFE with IOL and IVI anti-VEGF there were determined an increase in visual acuity to 0.49±0.1 and a decrease of the center retina thickness in all examined groups. In the LF before treatment was found an increase in the concentration of VEGF, bFGF, IFN-γ, IP-10, and MIP-1β, with a decrease in the concentration of TGF-β. On the 31st day wasdetected a decrease in the level of VEGF, TNF-α, and an increase of the IP-10.Conclusions. Combined treatment for a combination of cataracts and nAMD leads to increased visual acuity, improved macular morphology, and reduced angiogenic and proinflammatory factors in the LF.

Purpose: to evaluate the efficiency of the operation with the transplantation of autoepithelial cells and the use of Alloplant biomaterial in patients with symptomatic bullous keratopathy.Material and methods. The study group consisted of 44 patients (21 men, 23 women) aged 57 to 85 years with a diagnosis of bullous keratopathy. The patients underwent epithelioceratoplasty with autoepithelial cell transplantation and the use of Alloplant biomaterial as a corneal biopsy.Results and discussion. Results of the operation showed a decrease in pain in 79.5% of cases, a decrease in lacrimation and photophobia - in 72%.Conclusions. Epithelioceratoplasty can be successfully used for the treatment of symptomatic bullous keratopathy. The operation helps to relieve pain and corneal syndrome and improve the condition of the cornea in the majority (>70%) of operated patients.

Purpose: to assess the possibility of using the latency of the N75 component of pattern-reversal visual evoked potentials (VEP)for predicting the effect of treating amblyopia in children.Material and methods. The study included 20 children between ages 3 and 15 with amblyopia. The analysis of the latency of the N75 VEP component recorded under standard conditions was carried out. Registration of VEP was carried out before and after apparatus treatment. Sequential series of checkboard patterns with a check size of 240’, 96’, 48’, 24’ and 12’ was used as a stimulus. For the treatment of patients, the devices «Ambliokor», «Ambliother», «Speckle-M» were used.Results and discussion. In the course of therapeutic measures, a statistically significant decrease in the latency of the N75 component of VEP was observed, which was most pronounced upon stimulation with high spatial frequencies. It was found that the registration and analysis of the latency of the N75 VEP for a checkboard pattern with a check size of 12´ and 24´ are effective for the prognosis and assessment of the effectiveness of treatment of amblyopia.Conclusions. The data obtained confirm the effectiveness of using the latency of the N75 component of VEP registration as a reliable method for predicting and evaluating the effectiveness of hardware-based treatment of amblyopia in children.

The eye traumas, in a number of cases, may have the most adverse consequences even many years after. The scleral staphyloma forming against the background of the prolonged intraocular pressure is one of these complications.Purpose: development of an algorithm for the selection of Alloplant biomaterials for surgical treatment of scleral staphilomas.Material and methods. To achieve the goal of the study, information from literature sources, as well as the clinical experience of the Federal State Budgetary Institution «Russian Eye and Plastic Surgery Center» of the Ministry of Health of the Russian Federation have been used.Results and discussion. The Alloplant biomaterial selection algorithm in staphyloma based on the use of the ultrasonic biomicroscopy method, which makes it possible to determine the scleral defect thickness to an accuracy of 0,1 mm, has been developed. The algorithm allows surgeons to select of Alloplant biomaterials for staphylomas, depending on the thickness of the scleral defect (0,1-0,2 mm; 0,3-0,4 mm; 0,4-0,5 mm).Conclusions. The proposed tactics of the developed algorithm allows to restore the integrity of the fibrous capsule of the eye and opens up real prospects for creating a favorable appearance of the eyeball and improving the quality of life.

Aim is a morphological study of the alternative cadaver tissue of thigh fascia lata during the manufacturing process of dispersed allotransplants for ophthalmosurgery.Material and methods. We have studied the native cadaver tissues of the thigh fascia lata conserved in 70% ethanol and dispersed form (10 samples each) by standard histological methods. We measured bundle thickness of the collagen fibres and lumenbetween them in the integral samples; glycosaminoglycans were histochemically detected (Hale’s reaction).Results and discussion. It is established that the technological treatment doesn’t have a pronounced effect on the structure and glycosaminoglycans in the allotransplants of the thigh fascia lata which is important both for the quality of dispersed biomaterials and regenerative processes when they are used in ophthalmosurgery. The final morphological assessment to determine the regenerative potential of the dispersed allotransplants from the cadaver tissue of thigh fascial lata will be given after carrying out the experiment on animals. The obtained results allow to recommend further research of the alternative cadaver tissues.

Purpose: evaluation of the fibrous framework condition, basic substance and biomechanical properties of various types of connective tissue.Material and methods. There were studied the specimens of various types of connective tissue: tendons of various localization, derma of the supporting foot areas (reticular layer), visceral membranes, costal cartilage, subcutaneous fat. We used the followingmethods: those of polarizing-optical, electron-scanning microscopy as well as morphometry, histochemical analysis. The physico-mechanic properties of the specimens were evaluated for tension and compression.Results and discussion. There was carried out the assessment of the fibrous framework condition, basic substance and physicomechanical properties of the specimens under study. Macro- and microphotographs with different magnification were the results of the microscopic studies. As a result of the morphometric studies there were obtained the thickness mean values of the collagen fiblre bundles and size of the interbundle spaces. As a result of the carried our physico-mechanical tests of the specimens we obtained data on elastic-strength properties of different tissues, namely tensile strength, relative elongation, Young modulus. The carried out histochemical analysis showed the glycosaminoglycan content degree in the basic substance.Conclusions. A set of the universal methods is defined for the assessment of the structural and physico-mechanical properties of different connective tissues when manufacturing allotransplants.

Purpose. The article discusses a clinical case of a 12-year-old child with occlusion of the central retinal artery of its inferior temporal branch. This pathology of vision practically does not occur in childhood, which, accordingly, is of interest to this clinical case in modern ophthalmology. Material and methods. The article presents and describes diagnostic methods such as initial examination by a doctor, visual acuity, intraocular pressure (IOP), optical coherence tomography (OCT) of the macular region, magnetic resonance imaging (MRI) of the brain and blood vessels, computer perimetry (30o), electroretinography (ERG), visual evoked potentials (VEP) for reversible pattern and flash and treatment methods within the first 1.5-2 months from the onset of occlusion.Results and discussion. In the course of treatment, a relatively favorable and stable result was achieved. There was a gradual expansion of the visual fields in the upper pole of the eye and a decrease in retinal edema, normalization of its blood circulation in the lower temporal region.Conclusions. Despite an early visit to a medical institution, timely complex treatment, complete restoration of the visual fieldsis not observed.

Purpose. to describe a clinical case of successful surgical treatment of a patient with an epiretinal membrane using a 25G ultrasonic vitrectomy.Material and methods. A 63-year-old female patient came to «Optimed» Center for laser vision recovery (Ufa, Russian Federation) with complaints of decreased visual acuity in her left eye, the appearance of fog in front of her eyes and distortion of objects. Based on a comprehensive ophthalmological examination, the patient was diagnosed with idiopathic epiretinal membrane, stage 2. A threeport subtotal 25G ultrasonic vitrectomy on a universal ophthalmosurgical system «Optimed Profi» («Optimedservice», Russia) with the application of a dye («Optimed») and removal of epiretinal membrane with tweezers is conducted to the patient.Results. After the surgery, a positive clinical and functional result as restoration of the retinal anatomy of the macular zone, an increase in functional indicators (visual acuity, photosensitivity, elimination of complaints) was achieved.Conclusion. This clinical example of surgical treatment of epiretinal fibrosis demonstrates the efficacy and safety of subtotal ultrasonic vitrectomy 25G.

Purpose: description of the clinical case and surgical treatment of the patient with a complex combined pathology i.e. congenital glaucoma complicated by corneal leucoma.Material and methods. The conducted method of surgical treatment including two operations performed at a time, namely lamellar keratoplasty with Alloplant biomaterial and sponge drainage antiglaucomatous operation with the use of alloplant spongy biomaterial.Results and discussion. The performed surgical operations were carried out without complications. The patient was discharged with a normalized intraocular pressure on the seventh day following the surgical intervention. Subsequently he is planned to have anopticalreconstructive operation i.e. removal of complicated cataract.Conclusions. This clinical case demonstrated the possibility of the performance of two operations at a time with different ocular pathologies which allows to shorten the duration of treatment. This is particularly relevant to children, since they are operated on under anesthesia. The use of such a wellgrounded approach allows to preserve the psychological background of patients.

The ablepharon-macrostomia syndrome is an extremely rare genetic pathology which causes serious craniofacial deformations and other numerous anomalies of the face, genitals and skin. It refers to the ectodermal dysplasia and is inherited in an autosomal-dominant manner. The reference literature regarding this condition is scarce.Purpose: to describe a case of surgical formation of eyelids in a girl with aplasia of the eyelids in both eyes with ablepharon-macrostomy syndrome (AMS).Material and methods. In this article, we report on the case of plastic surgery to form the eyelids in a girl with ablepharon-macrostomy syndrome.Results and discussion. Based on the child's clinical data, a multistage formation of the eyelids with a free skin flap and with theuse of the Alloplant biomaterial was carried out. Subsequently, the palpebral fissure was lengthened with an optical purpose. Expansion of the palpebral fissure in the subsequent periods was not performed because of the danger of lagophthalmos development. Further surgical correction of the patient's eyelids was postponed until the formation of the facial skeleton.Conclusions: AMS treatment should be directed to the elimination of the specific symptoms that appear. Surgical correction should be carried out in stages, taking into account the growth of the facial skeleton. Thus, in order to carry out the maximum complete treatment of the AMS, the collaborative work of many specialists is required.

Purpose: to study general clinical and immunological parameters in a patient with diabetic nonproliferative retinopathy afterCOVID-19.Material and methods. A comprehensive examination of the patient has been carried out, including the use of general clinical and immunological methods of laboratory diagnostics.Results and discussion. The complex of laboratory studies has been carried out which showed the activation of cytotoxic reactions of the cellular and humoral immunity, representing the risk of the development and exacerbation of the autoimmune process.In order to prevent the development of pathological autoimmune manifestations in the choroid and retina, the patient underwent intravitreal injection of the angiogenesis inhibitor Lucentis in combination with the Alloplant biomaterial for therapeutic retroscleroplasty. After the surgery, the patient's visual functions have been improved.Conclusions. The obtained results indicate that early diagnosis of impaired immune functions makes it possible to choose the appropriate surgical and therapeutic methods of treatment aimed at preventing the development of the autoimmune process.

Purpose: to evaluate the effectiveness of revascularization surgery in macular degeneration.Material and methods. A patient with bilateral macular degeneration underwent revascularizing surgery on the worse eye, where the formation of the epiretinal membrane and macular edema with complete disappearance of the central macular fossa against the background of more pronounced complaints were observed. The control method was the value of visual acuity and the results of optical coherence tomography.Results and discussion. After 5 years, 100% of the vision of the operated eye was preserved against the background of regression of anatomical disorders in the macula in the form of resorption of the epiretinal membrane with the restoration of the configuration of the central fossa of the macula and the disappearance of the patient's complaints. The common pathogenesis speaks in favor of the effectiveness of revascularization surgery in all types of degenerative diseases of the retina, and not only in macular degeneration, and the permissibility of combining this intervention with all known methods of treatment significantly increases the chances of preserving vision even with a very aggressive course of the pathology under consideration.Conclusions. The effectiveness of the mechanisms of the proposed operation can serve as a reason for its inclusion in the algorithm of surgical treatment of macular degeneration and other degenerative diseases of the retina.

The primary rhegmatogenous retinal detachment is a severe disease which is characterized by the accumulation of the subretinal fluid through the retinal tear between the neurosensory layers and underlying pigment epithelium, requiring urgent surgical treatment. Total irreversible blindness will take place if no rhegmatogenous retinal detachment surgery is performed. The surgical treatment consists of closing the retinal tear by sealing the place of the retinal tear with the episcleral filling and this procedure results in the adaptation of the tear margins to the choroid or by the endovitreal tamponage accompanied by endolasercoagulation of the tear margins following vitrectomy. The purpose of this study was the development of the method to increase the efficacy of revealing the retinal tears intraoperatively by way of the intraocular method including the transconjunctival sclera puncture in the projection of the flat part of the ciliary body at a distance of 3-4 mm from limbus, at an angle of 900 with respect to the sclera performed in the direction of the eyeball centre with a preliminary shift of the conjunctiva by means of a trocar with port of 25-27 G caliber at the end which is placed on the opposite side from the sector with a detached retina. A light guide is introduced through the placed port into the eye cavity with the ability to view the detached retinal area and search for tears in it.

Purpose: search for keratoplasty materials alternative to donor cornea.Material and methods. To realize this aim the following materials were proposed: recombinant fibrillary collagens (collagenic hydrogels), collagenic sponges, collagenic films, modified collagenic gels.Results and discussion. There are two main directions of bioengineering in the creation of the artificial cornea. The first one is based on the creation of the artificial extracellular matrix and the second one is based on cellular technologies. When developing the models,collagenic hydrogels are more often implemented and earlier, collagenic sponges and films were used. The disadvantages of the collagenic matrices are their weak biomechanical properties which is reflected on the condition of the peripheral sutures in keratoplasty and accelerated enzymatic degradation after transplantation. Therefore, an additional chemical treatment is performed by crosslinkers which allows to strengthen the intercollagenic links and slow down the process of degradation and stromal remodeling. The corneal bioimplants are also obtained with the use of 3D bioprint method based on the existing 3D digital models of the human cornea.Conclusions. The proposed materials possess both positive properties (porous structure, transparency) and negative ones (weak biomechanical properties). In spite of the efforts of many researchers to create a transplantational material, it is impossible so far to completely replace the donor cornea.

Purpose: to examine the state of the problem to create an artificial cornea based on the analysis of literature for the last 10 years.Material and methods. We have studied the results of the research based on 42 foreign scientific sources. In these publications the authors offer the following materials: gelatin hydrogels, acellular cornea, collagen-like peptides, silk fibroin and synthetic polymers.Results and discussion. Unlike collagen, these bioconstructions are more stable in biomechanical properties but cause a morepronounced immune response of the body after transplantation. Only gelatin hydrogels cause a lesser antigenic reaction. Collagenlike short peptides have the ability to selfassemble and create chains with desired properties. This process resembles an embryonic development of the cornea. The cornea of pigs treated by different methods is used to create an acellular cornea which has low immunogenicity and structurally is close to the native cornea. The silk fibroin is characterized by high strength and is used as an alternative to the amniotic membrane. Synthetic polymers are often used in combination with native compounds of the extracellular matrix. The destruction of these substrates depends on the concentration of polymers and takes a long time.Conclusions. Thus, despite a wide variety of the proposed non-collagen materials for the creation of the artificial cornea, further search for optimal bioconstructions with donor corneal qualities is required.

A considerable increase in the incidence of glaucoma, the leading cause of blindness and low vision has been observed in the last decade. Many aspects of glaucoma pathogenesis are still unclear. The disease multifactoriality is generally recognized: mechanical, vascular and metabolic factors are the most studied. The results of the experimental investigations with the modeled glaucoma testify that the specified changes are the result of the violations in the primary link of immunity, namely in the population of the antigen-presenting cells. The immunohistochemical studies showed that the stromal melanocytes had been playing the role of the antigen-presenting cells in the eye vascular layer, iris and ciliary body. Further experimental studies allowed to reveal functional potential in these cells typical for macrophages, those of lysosomal, phagocytic and migratory. The decrease of stromal melanocytes leading to the pathology in the drainage zone of the eye anterior chamber angle and optic nerve was observed in the corticosteroid glaucoma experiment. The population recovery of the stromal melanocytes with the assistance of the antigen stimulation led to the leveling of fibrotic changes in the drainage zone and optic nerve. Thus, the immunomorphological violations in glaucoma can be considered as autoimmune pathology.

The life of a great idea - this is how the presented essay can be defined, including selected pages of history from the inception of the concept of bioimplantation to the creation of modern xenogenic transplant materials. The article focuses on the development of technologies for the transplantation of biomaterials and tissue components. The role of scientists of Ancient Rome and the Renaissance is noted. The contribution of domestic scientists to the development of tissue transplantation methods (I.A.Golyanitsky, V.P. Filatov, and others) is described. Based on the literature data, as well as their own experimental and clinical experience, the authors express their vision of possible ways of further development of one of the trends in modern surgery - bioimplantology.

The pandemic of novel coronavirus disease (COVID-19) has affected more than 165 million of people worldwide so far. Among the reported ocular manifestations of COVID-19 is central and branch retinal vein occlusion and isolated retinal artery occlusion.Purpose: to study a clinical case of combined central retinal artery and central retinal vein occlusion secondary to COVID-19. Material and methods. Visual acuity measurement, tonometry, slitlamp and fundus examination, spectraldomain optical coherence tomography, ultrasonic Doppler examination of the eye and the orbit, magnetic resonance imaging of the brain, blood pressure examination, general blood test, blood chemistry and coagulation test.Results and discussion. We believe that this rare case of combined vascular occlusion is associated with a combination of factors of which the key role plays the occlusive retinal vasculitis caused by immune-mediated endothelial damage and the hypercoagulable state specific to COVID-19.Conclusions. We hope this study will provide valuable insights into ocular manifestations of COVID-19 and contribute to betterunderstanding of coronavirus disease pathogenesis.