Purpose: to make a pathogenetic basis and assessment of the clinical efficacy of transpupillary thermotherapy (TTT) of the optic nerve disc in central retinal vein occlusion (CRVO). Materials and methods: ophthalmological examination with in-depth study of regional hemodynamics, layered structure of the retina, its electrical sensitivity and neural conductivity in 15 patients with CRVO before and after TTT of the optic nerve disc. Results. After TTT of the optic nerve in patients with CRVO, immediately after treatment visual acuity increased twofold, the thickness of the retina significantly decreased in central and peripapillary regions and indices of high-speed blood flow of central retinal vein improved. In 3-6 months, retinal thickness, ERG indices and visual evoked potentials recovered practically to the level of the fellow eye. It was established that after the TTT of the optic nerve the perfusion in the blood vessels of the retina and optic nerve has improved, which was accompanied by a decrease in the height and the area of ischemic edema in the peripapillary area, improved conduction of impulses along nerve fibers. In contrast to conservative therapy and laser coagulation, after a single session of TTT of the optic nerve, visual function improvement occurred in 89 % of cases. Conclusions. TTT of the optic disc is a highly effective, pathogenetically proved and safe method of treatment purposefully influencing the regional hemodynamics, making possible to achieve positive structural and functional changes of the visual system in CRVO.

The goal of this work was the assessment of capability for multidetector computed tomography (MDCT) in the diagnostics of retroperitoneal tumors in children. We studied the results of multidetector computed tomography of 63 sick children (36 boys (58 %) and 27girls (42 %)) between the ages of 1 month to 16 years, from 2012 to 2015. The average age of the patients was 4.9 ± 4.5 years, with a predominance of boys (2: 1.4). Among retroperitoneal tumors in children most often we found neuroblastoma (50.8 %): in 38.1 % it was detected in boys, in 12.7 % - in girls (p < 0.05). Nephroblastoma was detected in 10 %, the other retroperitoneal tumors accounted for 40 %. In 56 % neuroblastoma was located at the upper level of retroperitoneal space. In 44 % tumors localized in para-aortic area, in paravertebral space or in the pelvis. Neuroblastomas on MDCT scans were presented by heterogeneous formations, unevenly accumulating contrast. In 62 % of cases we detected calcifications, in 19 % we observed cysts and in 56 % of cases there were metastatic involvements detected. Thus, the MDCT is a method able to accurately specify the localization of the tumor, to clarify the character and volume of destruction, to determine the exact size of a tumor and its relationship with the surrounding tissues, as well as to reveal metastatic lesions in the abdominal cavity and in other organs.

The goal is to evaluate the effectiveness of the developed technique of the gradual forming of the internal limiting membrane (ML) fragment in the treatment of large macular holes (MH) in comparison with the standard methodology (using classical maculorhexis and rapprochement of MH edges by using of vacuum aspiration). Materials and methods: we observed 137patients (103 women, 34 men) aged from 54 to 78years with large MH (over 400 ßm). Duration of MH ranged from 3 to 60 months. All the patients were divided into groups: 1 (new methodology) and 2 (standard method), and sub-groups: 1a and 2a - patients with MH with a minimum diameter 400-650 μm; 1b and 2b - patients with MH with a minimum diameter more than 650 μm. The new technique is performed in several stages, during which several series of 1LM "petals" removal are made, leaving an intact area on the MH edge. The last ILM "petal" or fragment is inverted and placed on the MH. Results: 1n subgroup 1a, there was a statistically significant increase in best corrected visual acuity (BCVA) during all follow-up with the most pronounced growth in the first 6 months (from 0.15 ± 0.06 to 0.55 ± 0.14) (p < 0.05). 1n subgroup 1b a statistically significant increase in mean values of BCVA was also observed especially during first 6 month (from 0.13 ± 0.06 to 0.36 ± 0.12) (p < 0.05). In group 2 (a, b) BCVA was significantly lower (p < 0.05). Conclusion: the new technique allows to reach higher functional-anatomical results in surgical treatment of MH.

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 38 patients (40 eyes) with diabetic macular edema. All patients received anti-VEGF-ranibizumab therapy at a dose of 0.05 ml. The results were analyzed after three intravitreal injections with 1 month interval. We assessed visual acuity, morphological and anatomical structure of the macular area, the sensitivity of the retina and macular pigment optical density Results. 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 ± 0.01 du, on the background of anti-VEGF-therapy this figure went up to 0.213 ± 0.01 (p < 0.05). According to the optical coherence tomography average retinal thickness before treatment made 404.62 ± 15.23 ßm, after the treatment - 300.91 ± 6.43 ßm (р < 0,05). When comparing data of optical coherence tomography and macular pigment optical density we revealed more pronounced decrease in the macular pigment optical density in the area of the retinal edema and a significant increase in the basic parameters on the background of the therapy. Conclusion. Anti-VEGF-therapy significantly improves visual acuity, the recovery profile of macular edema and reduces the zone in patients with diabetic macular edema.

The purpose of the study was to compare the efficacy of Ex-Press and Ahmed drainage devices for the secondary neo-vascular glaucoma (NVG) in patients with diabetes mellitus. We observed 25 patients (25 eyes) with secondary NVG in the setting of proliferative diabetic retinopathy. The first group consisted of 10 patients (10 eyes) who underwent Ex-Press drainage implantation. The second group consisted of 15 patients (15 eyes) who were implanted Ahmed valve FP7 model. As a result the maximum value of 1OP in the analyzed groups decreased by 66.8 % and 64.2 % respectively immediately after the surgery. By the end of 18 months follow-up period, the absolute hypotensive effect in patients of group 1 was 20 % (2/10) whereas in group 2 - 60 % (9/15). Normal intraocular tension during treatment with glaucoma medications established in 30 % of cases in group 1 (3/10) and in 80 % of patients in group 2 (12/15). Thus, the use of Ex-Press drainage device for secondary NVG in patients with diabetes was ineffective in 70 % of cases. We can recommend choosing implantation of Ahmed valve for secondary NVG in patients with diabetes mellitus as the number of unsuccessful outcomes using Ahmed valve was observed only in 20 % of cases.

The objective assessment of status of intraocular fluid outflow pathways afterfistulizing antiglaucomatous surgery is a necessary efficacy prediction component of glaucoma surgery. Based on complex assessment of operative zone, including ultrasound biomicroscopy, at different dates after non-penetrating deep sclerotomy the attempt of development of clinical classification of fluid outflow pathways was made. The basis of this classification is sign of morphological heterogeneity of the examined structures. In the study the parameters of the functional state of the trabeculae-Descemet's membrane were determined: the height 0.8 ± 0.09 mm, thickness 0.09 ± 0.004 mm and acoustic density < 55 ± 10 %; timelines of sclerosis -1-1.5 months after surgery. This was the rationale for the principle of a two-stage non-penetrating deep sclerectomy and indication for laser descemetogoniopuncture in terms of 1-1.5 months after the operation in the absolute number of cases. Postoperative UBM monitoring allowed determining the period of active remodeling of newly formed intraocularfluid outflow pathways in norm and their pathological formation - 6 months after the intervention. Developed system of assessment of surgically formed fluid outflow pathways by proposed method allows monitor dynamics of fluid outflow pathways forming, standardize results and determine choice of further treatment.

The impaired adaptation is a dynamic condition, structurally comprising the combination of independent components: the syndrome of professional-psychological disadaptation (SPPD) (psychological component), morbidity (somatic component), and psychosomatics, including the interaction of the above components. Thus, a psychological component is the initial phase, and a somatic one, to a more marked degree, leading to further disruptions in the increase of psychological disorders and morbidity, i.e. disadaptation. The study found that the highest rates of the syndrome of professional psychological disadaptatiion are noted in the group with work experience of 0-5years. The cause is a long period of not working in their specialty, which leads to a decrease in self-regulation, psychological defenses, general theoretical and practical professional level. Preventive work in the organization should focus on psychological trainings, refresher courses or the introduction of mentoring.

The importance and the need to establish standards for the quality of life for HIV-infected patients with eye diseases were proved. The scheme of follow-up of ophthalmic patients with HIV infection was created; it allows identifying the relationship between the organ of vision and quality of life of infected patients. An algorithm of examination of patients with a combination of HIV infection and ophthalmological pathology was developed. It is proved that with the growth of the severity of internal organ involvement in HIV-infected patients a decrease in quality of life occurs pro rata, particularly in patients in 3-4^th stages of HIV infection associated with atrophy of the optic nerve, uveitis, retinitis. It was established that on the background of an effective anti-viral and vascular therapy of HIV-infected patients there is a positive dynamics of vision in patients with retinal angiopathies.

We analysed the effect of prostoglandins analogues application on the course of postoperative period of cataract phakoemulsification in 58 patients with primary open-angle glaucoma. All patients before the operation had normal intraocular pressure (on average 15.6 ± 0.07 mm Hg), the optical coherent tomography showed normal parameters of retina thickness in 1 mm zone and the macula volume in 6 mm zone. Instillation of nonsteroid anti-inflammatory drug after the operation lasted 6-8 weeks, and prostoglandins analogues continued to be instillated during all period of observation. The course of the early postoperative period was areactive. Average visual acuity on the first day was 0.69 ± 0.05, in 6-8 weeks - 0.85 ± 0.05. The average level of intaocular pressure during application of prostoglandins analogues on first day was 16.9 ± 0.37 mm Hg, and in 6-8 weeks -15.1 ± 0.28 mm Hg. Optical coherence tomography revealed little change of retina thickness and macular area volume before the operation and in 6-8 weeks after it was regarded as an error of measurement method. Thus, continuation of instillations of prostoglandins analogues in pre- and postoperative period in uncomplicated phakoemulsification in patients with primary open-angle glaucoma promote continuity in treatment, support com-plience and provide stable intraocular pressure without the expressed reactive hypertensia. Application of nonsteroid anti-inflammatory drug during 6-8 weeks after phakoemulsification in patients with primary open-angle glaucoma serves as an effective measure of prevention of inflammation of an anterior and posterior eye segment during prostoglandins analogues treatrment.

Authors analyze efficiency of application antiseptics of a miramistin in prevention of infectious complications in case of repeated intravitreal injections of VEGF inhibitor Ranibizumab in 156 patients with the age related macular degeneration. 0,01% solution of antiseptic Miramistin (Okomistin®) was instillated 4 times per day two days before operation to all patients for the purpose of infection prevention. Just before the operation (60 and 30 minutes before) and right after it instillations of antiseptic continued within a week after intravitreal injection. During the operation in the conditions of the operating room with keeping of all rules of aseptic, three minutes prior to operation the surgery field and the conjunctival cavity of the patient were twice processed by 5% povidone-iodine solution (Betadine). The results analysis showed no expressed signs of irritation of the eyes connected to miramistin treatment preceding the operation. In the postoperative period all patients endured antiseptics well. Within a week of applications there were no complaints about pain, burning, foreign body sensation or hazy vision after the medicine instillation, and biomicroscopic research revealed no signs of inflammatory injection of conjunctiva or sclera, no cornea epitheliopathy, there was no cellular response in moisture of the anterior chamber and vitreous body. Thus, the authors state that antiseptics Okomistin® as an additional measure of prevention of infectious complications in case ofintravitreal injection provide high level antimicrobic protection with no risk of development of microbial resistance.

The purpose of the study was to identify the relationship between the initial state of the organism and the result of the treatment of hypertrophic scars. 38 women of 16-35years of age were examined on the 5-7^th days of the menstrual cycle, 16 of them had normotrophic scars and 22 - hypertrophic scars. The quality of scars, lipid profile, the concentration of thyrotropin, free fraction of thyroxine, growth hormone (GH), luteinizing and follicle stimulating hormone (FSH), cortisol, prolactin, estradiol, testosterone, progesterone, the concentration of TNF-a, lL-4, lL-6, lL-10, and the level of autoantibodies to DNA, lFN-a, lFN-y, b2-glycoprotein, Fc-fragments, collagen-2 were determined. Further on the laser treatment was performed: the scar surface was treated by multiple perforations under local anesthesia. Treatment outcome was assessed in 3 months by the clinical characteristics of the scar. lt was found that in 10 women hypertrophic scars reformed in normotrophic scars after the treatment, and 12 women still had hypertrophic scars. Patients with a positive result of treatment had a low concentration of GH (0.5 ± 0.1) and high concentrations of progesterone (6.0 ± 0.4) and FSH (6.7 ± 0.5 in the follicular phase of the cycle). The negative result of the treatment obtained in patients with significant shifts reactivity indicators: high atherogenic index (2.6 ± 0.2) and the level of GH (2.1 ± 0.5), low levels of cortisol (346.8 ± 39), testosterone (1.5 ± 0.2), lL-10 (3.89 ± 1.6) and antibodies to lFN-y (0.206 ± 0.05), lFN-a (0.385 ± 0.02), Fc-fragments (0.317± 0.04).

Purpose of the study: to study the efficacy and safety of Ranibizumab in patients with pathologic myopia and choroidal neovascularization (CNV). 22 patients (22 eyes) with myopic CNV were included in the study. Mean age was 54.0 ± 14.4 years, axial length -28.25± 1.9 mm,follow-up-from 12 to 59 months (mean follow-up - 26.9 ± 13.8 months). Ranibizumab was administered intravitreally according to the label in patients with active CNV confirmed by fluorescein angiography. The treatment was shown to have favorable early and long-term outcomes. For example, visual acuity increased (from 0.25 to 0.54; p < 0.01), central retinal thickness decreased (from 335.8 to 273.25 μm; p < 0,05), subretinal neovascular membrane area decreased (from 1272 to 969 ßm; p < 0.05). Clinically significant treatment complications were not observed. Conclusions: The study confirmed high efficacy and safety of anti-angiogenic therapy.

1249 children of 5-10 years (716 boys, 533 girls) with consequences of perinatal lesions of the CNS were examined, 230 of them were treated with the transcranial magnetic stimulation method (TMS). Selection of the TMS regimens was carried out taking into account the specific clinical neurophysiological features of the patients both as monotherapy, as well as a part of complex neurorehabilitation. For example, when intensifying of the synchronizing influences of thalamic structures and EEG signs of a delay of formation of electrical cortical rhythmicity, in children with developmental dysphasia and difficulties of school training, a high-pitched stimulation in the projection of the sensomotor and speech zones of a cerebral cortex was chosen; when intensifying of desynchronization influences of a reticular formation of a brainstem; at motor type of a developmental dysphasia and clinical signs of ADHD syndrome, a low-frequency regimen of stimulation offront-parietal and central areas of a cerebral cortex were chosen. Efficiency of therapy within 55-60 % concerning indicators of the speech sphere and the psychological status is reached at sessions of TMS together with correctional occupations with auxiliary specialists of the rehabilitation center - speech pathologists and psychologists. Efficiency of monotherapy of TMS in children with retardation of psycho-speech development made 30-35 %. Sufficient clinical performance and safety of the technique, a possibility of holding sessions of TMS against the background of course neuroprotective therapy at children with cerebral palsy is shown.

The aim of the study was to detect significant biochemical changes in antioxidant status during acute period of ischemic stroke in its various pathogenic subtypes in patients aged 45-74 years. The most important results were blood levels of ascorbic acid, malondialdehyde and free/ oxidized glutathione ratio. Cardioembolic stroke was associated with: the reduced ascorbic acid level of 62-74 % comparable to control group; 5-times increased malondialdehyde level at the end of the first week of the disease; and also 50 % decreasing of cell antioxidant capacity comparable to control group and other stroke subtypes. In lacunary stroke minimal changes in antioxidant status were measured, possibly because of small size of brain damage. Positive clinical dynamics was followed by decreasing of free glutathione levels. It could be related with its previous significant expenditure in process of cell recovery in penumbra area. In case of favorable outcome all of the markers return to the levels which were comparable to control group. The differences in the dynamics of the cells antioxidant capacity and consumption of native antioxidants, the time from the onset of the disease, the severity of the clinical picture, depending on the stroke subtype, were revealed. Further research of this problem may help to create new methods of diagnostics and selective pharmacological correction of this pathology.

The article presents the results of clinical studies of the effectiveness of artificial pneumothorax in the treatment of 124 patients with cavernous pulmonary tuberculosis patients and extensively drug resistance. Clinical trials of the use of artificial pneumothorax in young patients with cavernous pulmonary tuberculosis MDR and XDR MBT have proved its high efficiency and that it can be recommended for widespread clinical use. The indications for the use of artificial pneumothorax is a cavernous pulmonary tuberculosis with the release of MDR and XDR MBT with unformed or formed thin-walled cavity not larger than 4 cm in diameter. Pleuropulmonary adhesions revealed at primary application of artificial pneumothorax are the direct indications fpr surgical burn of adhesions. With the diameter of cavities up to 2 cm the artificial pneumothorax treatment is applied for 6 months and with cavities of 2-4 cm in diameter - for 12 months. Contraindications to the use of artificial pneumothorax are cavities in the lungs more than 4 cm in diameter, massive pleural commissures, with the impossibility of their surgical burnout; specific lesion bronchial tubes and severe comorbidities (mental illness, organic lesions of the central nervous system, chronic obstructive lung disease, chronic cardiovascular diseases in the stage of decompensation, congenital malformations of the heart and lungs, chest wall deformity). Treatment of patients with artificial pneumothorax cavernous pulmonary tuberculosis MDR and XDR pathogen can be recommended for use in stationary phase in TB facilities with thoracic surgery, where the implementation of operational burnout pleural commissures is possible.

On the sample of 90 patients with chronic heartfailure at the stage of stabilization we studied the influence of concomitant depressive and anxiety disorders on functional ability, quality of life and adherence to therapy. In our investigation we used the integrated and interdisciplinary approach to evaluation of psychosomatic status of patients, including test six minute walk, the method of clinical-scale evaluation, and an expert evaluation by a doctor. The data were processed using the program Microsoft Office Excel 2007 statistical software package SPSS Statistics 17.0. Significant frequency of anxious, depressive and comorbid anxiety and depressive disorders, which affect compliance and aggravate the functioning of the patients, was confirmed. It is shown that the results of treatment and rehabilitation activities are mediated by the presence and severity of anxiety and depressive disorders.

Purpose: To evaluate the clinical efficacy and safety of modified SMILE surgery for mild myopia. Methods: The study involved 68 patients (135 eyes), operated by SMILE methods for mild myopia. The first group included patients operated by standard technology with a l5 ßm thickness of neural optical lenticular layer, the second group - patients, operated by a modified SMILE technology monolayer with thickness of 30 μm. A comprehensive ophthalmology examination was performed before the surgery and after the surgical treatment - on the following day, in one month and in 12 months. Results: In all patients of both groups the monocular uncorrected visual acuity after the operation after the period of one day, one month, and a year did not differ and made 0.88 ± 0.15, 0.92 ± 0.1 and 0.95 ± 0.08 respectively, for the second group - 0.87 ± 0.18, 0.92 ± 0.15 and 0.96 ± 0.10 (p > 0.05). Follow-up in the early and late postoperative period convincingly demonstrated that visual acuity, refraction, spatial sensitivity, corneal hysteresis indices and even a subjective assessment of visual quality have no statistically significant differences among patients in both groups. During the operation and late postoperative period the complications were not noted. Conclusion: the study found that the modified technology provides high visual acuity, while minimally changing the biomechanical properties of the cornea. Thus, a modified SMILE operation is highly predictable and safe method in correction of slight degree myopia.

The article presents the results of the studies of the central and peripheral nervous systems, psychoemotional status of patients with vibration disease associated with exposure to the local vibration in the post-exposure period. The studies were performed in patients with vibration disease (n = 18) who do not work in the contact with the local vibration at present. The mean age of the patients was 50.7 ± 5.4 years, the mean length of service in the contact with local vibration -17.9 ± 2.8 years, the mean post-exposure period - 5.2 ± 2.2 years. 30 male persons having no contact with industrial hazard were comprised the control group. Electroencephalography, electroneuromyography, recording of somatosensory evoked potentials were carried out and patients' personality peculiarities were studied. The changes of the brain bioelectrical activity, disorders of the autonomic and afferent regulation of the cerebral level, dysfunction in diencephalic structures, disorders of the subcortical and cortical structures of the central afferent pathways; demyelization of the peripheral nerves of the upper and lower extremities were set in patients with vibration disease in the post-exposure period. Psychological studies have shown that patients with vibration disease in the post-exposure period preserve such psychological peculiarities as neuroticism manifested with inner tension, nervousness and chronic feeling of discomfort; depressive tendencies being a sign of the existing distress, and anxious-hypochondriac features in the structure of personality traits. All of the above result in formation of stable uncompensated clinical conditions observed in patients with vibration disease caused by local vibration exposure, even after the termination of harmful production factors.

The aim of the study was to evaluate the effectiveness of multifocal contact lens correction in patients with presbyopia and myopic refractive error. The study involved 45 patients with myopia ranging in age from 43 to 56 years in conditions of habitual monofocal contact lens correction, a month after the selection and wearing multifocal contact lenses. Contact correction was carried out according to standard procedures taking into account the accuracy of contact lens fitting, with carrying out functional tests for the "dry eye" syndrome and evaluation of corneal epithelial thickness (Optovue, USA). The assessment of the following parameters of visual perception was made: far, near and middle distance (monocular and binocular) visual acuity, the spatial contrast sensitivity, stereovision (I & II Lang test), the area of binocular interaction field (binarymeter), the quality of vision (VF-14 test ). The use of multifocal contact lenses for the correction of presbyopia with the initial myopic refraction ensures high functional results at different distances. Patients with a myopic refraction, previously used contact lenses, easy pass to multifocal correction option. The greatest satisfaction by achieved vision noted in those patients who had achieved refraction (-)0.5 diopters. In the selection of contact lenses in older patients the thickness of the corneal epithelium and tear film validity must be taken into account.

The purpose of the investigation was to clarify the importance of gender factor in the clinical picture of recurrent (RD) and bipolar depression (BD) with somatization. Total of 99 patients had taken part in the testing including 70 (70.7 %) women and 39 (39.3 %) men. The general trend identified was intensive anxious and somatized signs in clinical structure of depression. In comparison with the men the female patients with RD had predominantly "psychic" and "physical" signs of anxiety, and men had more "typical" traits (depressive somatization). In the clinical picture of BD gender differentiation had shown the signs of anxiety again. In other words, the women with BD had mostly the signs of "mental" anxiety and neurosal (phobic anxiety and hysterical conversion) somatized signs, while male patients with BD more often had vegetal equivalents of anxiety (anxiety disorder) making hypochondriac ideational abnormalities (ideational somatization) in combination with physical signs of depression. In both testing groups women had the common traits - frequent complaints about paracenesthesia over extended periods (SSI); it can show some inclination to formation of a morbid personality, exacerbating a patient's condition. The findings indicate that gender differentiation expresses mainly in bipolar course of an affective disease in the clinical picture of somatized depression. The study outcome suggests the improvement of diagnostics and somatized depression treatment.

Hyperglycemia and dyslipidemia are common metabolic abnormalities in adults with type 1 diabetes mellitus (T1DM) and both increase cardiovascular disease risk. Normalization of lipid metabolism is a mandatory element in prevention of diabetic micro- and macroangiopathies in patients with T1DM and it is directly related to improvement of health outcome. We aimed to investigate serum lipid profiles in patients with T1DM and poor glycemic control. Among observed patients with T1DM, 76 % were classified as having dyslipidemia, dyslipidemia rate was higher in patients with diabetic microangiopathies. Patients with T1DM and microvascular complications, arterial hypertension (AH) and the level of glycated hemoglobin (HbA1c) > 8 % had significantly higher levels of total cholesterol (TC), very low density lipoproteins (VLDL), triglycerides (TG) and non-high density lipoproteins (non-HDL). Therefore, management of patients with T1DM at the outpatient stage requires a strict control of lipid metabolism.

The study included 48 vitreoretinal surgeries performed during 2014-2015 in 39 patients with advanced fibrovascular stage of proliferative diabetic retinopathy. Visual acuity before the surgery averaged from pr. l. certae to 0.01. In 7 cases patients underwent intravitreal injection of Lucentis 2-3 weeks before the surgery. The surgery was performed according to the standard 3-port 25 G vitrectomy. In some cases, short-term tamponade of vitreous cavity by fluid perfluororganic compounds (PFOS) was performed for 2-3 days. This was due to prolonged bleeding during the surgery. In these cases, fibrinolytic of direct action (hemasa) was injected directly to the blood clot. In 4 cases circular retinotomy was needed. In 35 cases tamponade was made by silicone oil 5700 cSt, in 13 - by air-gas mixture. In cases of air-gas tamponade 3 patients had a relapse. After vitreous cavity revision it was plugged with silicone oil 5700 cSt. In 17 cases visual function remained unchanged, in 18 cases the changes were imperceptible, in 9 cases visual acuity improved to 0.2, in 3 cases -visual function increased to 0.4 and in 1 patient - to 0.7. In postoperative period IOP increased in 7 cases. In 5 of these cases compensation was achieved with antihypertensive drugs. 1n one case the patient was implanted leukosapphire drainage, and in one more case transscleral cyclophotocoagulation about terminal aching glaucoma was performed. The silicone oil was removed in 6 patients at the period of 6 months up to 2 years.

We analyzed the results of surgical treatment of 42 patients (42 eyes) with neovascular glaucoma on the background of proliferative diabetic retinopathy. Intravitreal injections of anti-VEGF-drugs allow to remove newly formed vessels in anterior chamber angle, to reduce intraocular pressure, to avoid complications in patients with neovascular glaucoma and the closed anterior chamber angle of the eye. The second stage of the treatment can be laser surgery. This approach helped to reduce intraocular pressure from 28.9 ± 0.9 to 18.5 ± 0.9 mmHg on the background of medical treatment (t > 2.0; p < 0.05). Visual acuity increased from 0.23 ± 0.07 to 0.44 ± 0.08 (t > 2.0; p < 0.05). In patients with NVG and closed anterior chamber angle of the eye, having aching glaucoma the use of laser surgery as the first stage of treatment allows to reduce intraocular pressure and to eliminate pain, and to apply intravitreal anti-VEGF-therapy as the second stage. The mean value of IOP decreased from 30.9 ± 1.2 to 20.1 ± 1.1 mmHg. During the year period, the second stage (intravitreal introduction of Lucentis) was performed in all patients. As a result, IOP was reduced to 17.5 ± 0.09 mmHg. Visual acuity increased from 0.18 ± 0.1 to 0.25 ± 0.07 (p > 0.05).

Sixty patients at the age of 43 to 79 years with anxiodepressive symptoms with comorbid cardiovascular disease have been examined after admission to psychotherapeutic department. Patients have been divided into two groups. The first group including 30 patients were treated by the tricyclic antidepressant amitriptyline with the average daily dose of 34.4 ± 12.9 mg. The 30 patients from the second group were treated by antidepressants of the selective serotonin reuptake inhibitors group. The sociodemographic characteristics in both groups did not differ significantly; the severity of cardiovascular disease, additional somatic and other diseases were certainty lower in the first group than in the second (p < 0.05). Examination of the patients with the use of Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale (HDRS and HARS) was carried out three times: at admission, in 1 week and in 4 weeks. At the time of admission, anxiety and depression in the first group were more expressed (p < 0.05) than in the second due to frequent psychogeny. The treatment scheme included tranquilizers, neuroleptics, neurometabolic drugs, basic cardiotropic therapy and psychotherapy. After 4 weeks anxiodepressive symptoms were more than 50 % reduced in both groups: 61 % in the first group and 50.7 % in the second group by the HDRC scale; 65.9 % in the first group and 59.8 % in the second group by the HARS scale. It has been shown that the small doses of antidepressant including amitriptyline involved in the complex treatment scheme were efficient and did not cause cardiotoxic effect.

Present concept of central serous chorioretinopathy classification does not reflect the true picture of the pathological process. The purpose of the study was the development of diagnostic criteria of central serous chorioretinopathy clinical forms and basing on that extend and optimize its classification with assessment of risk factors and prognosis of disease. Full ophthalmologic and somatic examination of 56 men with central serous chorioretinopathy was made. Focal laser coagulation was performed in patients with fluorescein leakage and local injury of pigment epithelium by angiographic data (22 patients). In the case of extended damage of pigment epithelium and diffuse leakage of fluorescein (23 people) transpupillary thermotherapy of optical disk was conducted. Detailed expert evaluation of retinal changes by fluorescein angiographic data allowed dividing the patients into 3 groups. The main criterion for the division was the damaged area of the pigment epithelium: group 1 - central serous chorioretinopathy with local injury of pigment epithelium (with leakage point); group 2 - central serous chorioretinopathy with extensive damage of pigment epithelium with diffuse leakage; group 3 - central serous chorioretinopathy with extensive damage of pigment epithelium combined with leakage point (recurrence of leakage). The results of our study brought us to the following conclusion. Development of new classification criteria of the disease allows to construct a more specific algorithm of therapeutic measures and to determine prognosis of central serous chorioretinopathy already at the stage of diagnostics.

Purpose. To assess the long-term results of presbyopia correction in patients with primary cataract depending on type of implantable lOLs. Material and methods. A profound study of visual functions and assessment of visual quality of 90 patients (mean age 63.3 ± 1.2 years) with partial cataracts and presbyopia. The studies were conducted before surgery and in late postoperative period after bilateral cataract phacoemulsification with implantation of different models IOLs that provide a high visual acuity in distance and at close range. Results. Bilateral implantation of monofocal lOLs for monovision principle leads to a significant increase in far visual acuity of leading the eye and near visual acuity of slave eye. However, patients need long-term adaptation to artificial anisometropia. As a result of bilateral implantation of accommodating lOLs a significant improvement in visual acuity at distance and near occurs. Surgical treatment provides best visual quality of patients up to 6 months after surgery. ln period from 12 to 24 months after surgery, there was a decrease of visual functions as a result of fibrosis of capsular bag. The correction of presbyopia by creating a multifocal optical system as a result of bilateral multifocal refractive IOL implantation leads to a stable improvement of visual acuity at far and close distance. But thus the contrast sensitivity deteriorates, especially in low- and high-frequency ranges. Conclusion. lntraocular correction of presbyopia is a highly effective method of treatment, allowing obtaining high visual acuity in distance and at close range. However, the results depend on chosen strategy of intraocular correction

Purpose: to identify the most informative diagnostic criteria for the formation of glaucomatous optic neuropathy at various stages of the pathological process. Methods: 94 people with early stages of glaucoma were examined using spectral optical tomography, chromatic methods of perimetry, electroretinography and electrophysiological examination. The following main criteria for inclusion of patients in the study were identified: elevated levels of intraocular pressure (IOP), visual acuity not less than 0.6, similar in dimensions to the value of the optic nerve, which allowed comparing the results of research in these patients populations. Thus, through careful clinical analysis of data and assessment of excavation size of the optic nerve, using certain optical coherence tomography (OCT), all patients were divided into 3 groups. To get an accurate representation of the formation features of glaucomatous neuropathy it was necessary to evaluate not only the structural changes of the retina and optic nerve, but also the changes of their functional activity in all groups. Results: The most important criterion for the structural changes of the retina in patients in the latent stage of the pathological process was the global indicator of the volume loss of ganglionic complex (GLV %). IOP decrease in this group of patients was accompanied by normalization criteria of central perimetry, PERG, which is indicating their functional transient depression on the background of elevated intraocular pressure. Decrease perimeter indices of all kinds of computer perimetry were observed in patients with more advanced stage of disease.

The article presents data examination of children and male adolescents, aged 8 to 17 years without eye pathologies, with primary hypertension diagnosis - established at the clinic of Scientific Centre for Family Health and Human Reproduction Problems. Examination results were: 42 patients (84 eyes) had primary hypertension with optic disc drusen, 8 patients (16 eyes) had primary hypertension without optic disc drusen. Characteristics of basic functional changes of patients ophthalmic status with and without optic disc drusen on the basis of data of visometry refractometry, keratometry, computer perimetry, ultrasonic ehobiometry. Doppler angiographic examination of ocular vessels, electroretinography (ERG) according to registration standards proposed by the International Society of Clinical electrophysiology of (ISCEV), visual-evoked potentials (VEP), biomicroscopy of the eye, fundus photo registration. To verify and differentiate the prominence of the optic disc drusen in cases of the prominence of stagnant disc with characteristic extension of perineural space, all patients underwent an ultrasound scan procedure of the eyeball. The study obtained data on early pre-clinical manifestations of hypertensive angiohorioretinopaty. The risk factors for the formation of drusen of the optic nerve were identified. We determined that the presence of drusen does not lead to the aggravation of the changes of the visual system, formed under the influence of high blood pressure, affecting only the indicators characterizing ischemic processes in the retina and the optic nerve, which is due to the influence of compression of drusen on glial tissue and the vascular wall.

Smoking is a significant risk factor of chronic noncommunicable diseases. Smoking prevalence is variable in different populations. A study of the prevalence of this risk factor allows to estimate its contribution to the development of cardiovascular pathology, to plan the necessary amount of medical care for people using tobacco, and to determine the effectiveness of prevention activities in the region. As a result of the study, smoking frequency in population of the Irkutsk region older 18 years of age or over was established as 29.5 %. The number of smokers increased with age, reaching maximum value of 38.6 % in the group 30-39 years. Male smokers made maximum in the age group 30-39 years, women - in the age group of 18-19 years. The average age of smokers was 34 years, the one of nonsmokers - 43 years. The age difference was 9 years, and it was lower in the group of men than in the group of women (5 and 11 years, respectively). The number of the smoking men were 3 times larger, than women: 50.2 % and 13.5 %, respectively. Among persons with arterial hypertension, 22.1 % were smoking with the maximum frequency of smoking in age groups from 20 to 49 years. These figures point to a considerable problem of smoking in the region.

The prevalence of multi-drug resistance (MDR) in separate territories of the Irkutsk region is different, which is associated with the geographical features and the availability of microbiological research facilities. Between 2003 and 2015, the proportion of new TB cases with MDR increased in most of the territories of the region except "Large Cities" and the Buryat national district. In Large Cities of Irkutsk region and Buryat district MDR level is high, but the growth rate is insignificant. The area of "Major settlements along the railway" was characterized by an intensive increase in the proportion of first-time detected and previously treated TB patients with MDR. One reason for this phenomenon is the intense migration of the population. In "Northern areas" there was an accumulation of MDR among contingents associated with the empirical assignment of anti-TB drugs and low availability of microbiological testing. In the "Rural areas" MDR was rarely identified due to troubles with microbiological diagnostics.

The urgent detection of tick-borne pathogens in attached ticks or in human blood followed by the prophylaxis of infection with specific immunoglobulin and/or antibiotics is one of the most reliable measures to prevent human disease. The aim of this work was to evaluate the usability of real-time PCR (RT-PCR) assay in early detection of tick-borne infections. Using commercial RT-PCR assay (Amplisens, Russia) we studied 361 Ixodes persulcatus ticks, 33 Dermacentor sp. ticks and 448 samples of human blood delivered by people attacked by ticks in Irkutsk region during 2013-2014for presence of DNA/RNA of tick-borne encephalitis virus (TBEV), Borrelia burgdorferi sensu lato (B.b.s.l.), Anaplsma phagocytophilum and Ehrlichia chaffeensis/E. muris. The ELISA assay and direct microscopy were used to validate the detection of TBEV and B.b.s.l. respectively. The highest prevalence of tick-borne infections was observed for I. persulcatus ticks - 6,9; 23,8; 6,9; and 11,9 % for TBEV, B.b.s.l., A. phagocytophillum and E. chaffeensis/E. muris respectively. The Dermacentor sp. ticks were less frequently infected with abovementioned pathogens - 3,0; 6,1; 3,0 and 9,1 % respectively. The prevalence of infection in blood samples was lowest and comprised 2,5; 4,2; 2,2 and 4,5 % respectively. Mixed infections were documented in 6,5 % of ticks and 0,7 % of human blood samples. The testing of blood samples in ELISA and testing of ticks in ELISA and direct microscopy corresponded to the results, obtained by RT-PCR. Thus, RT-PCR is valuable and reliable approach for urgent detection and prophylaxis of tick-borne infections.

The influence of the complex plant remedy (Urtica dioica L., Polygonum aviculare L., Achillea millefolium L., Zingiber officinalis L., Cinnamomum cassia L.) on the morphofunctional state of the liver in rats with ethanol-induced hepatitis was studied. The liver injury was simulated with 40% ethanol introduction to rats in dose of 10.0 ml/kg for 7 days. The extract of the complex remedy was administered to animals in dose of 200 ml/kg for 14 days. The findings showed that the tested remedy inhibited the development of microcirculatory impairments, decreased the intensity of inflammatory infiltration and diminished the amount of hepatocytes subjected to adipose and cloudy degeneration as well as to necrotic changes. The increased amount of hypertrophied and binuclear hepatocytes in the area of the portal tract and central vein testifies reparation processes in the liver of the rats treated with the tested plant extract.

In order to analyze the influence of perfluororganic compounds (perfluorodecalin) on growth of Staphylococcus epidermidis there was an in vitro experiment conducted. During 24 hours St. epidermidis cell crop was grown on meat-peptone agar in the Petri dishes: 1.1 water-salt BSS+ solution, 1.2-3,5 ml BSS+ solution and 1 mg of vancomycin in 0,1 ml of 0.9% sodium chloride solution, 1.3 perfluororganic compound, 1.4 the mixture of perfluororganic compound and 1 mg of vancomycin in 0,1 ml of 0.9% sodium chloride solution. Similarly the Petri dishes were numbered and the second experiment was conducted when the initial Staphilococcus epidermidis concentration was two times reduced. To hold control the pure crop of bacteria was cultivated without adding any additional materials in cups 1.0 and 1.2. No growth of colonies were detected in cups 1,2,2,2, local absence of growth was found in 1.4,2,4. In cups 1.1 and 2.1 there was more intensive growth detected and approximately the same intensive growth of crop was found in cups 1.3, 2.3. comparing to the controlled crop. The findings confirm the effectiveness of vancomycin regarding Staphylococcus epidermidis and the possibility of its use together with perfluororganic compounds. This fact can be used in the process of treatment of postoperative endophthalmitis.

Infections received in the course of healthcare delivery continue to be an urgent medical and socio-economical issue. This problem is exacerbated by formation and wide spread of strains polyresistant to current germicides. The article presents the results of a study of antibiotic resistance of microorganisms isolated from patients of surgical hospital of Neryungri Central Regional Hospital. Microorganisms were resistant to various antimicrobial drugs. E. coli were resistant to ampicillinum, ampicillinum/sulbactam and ceftriaxonum; Klebsiella spp. - to ampisiillinum, chloramphenicolum and cefotaxime; Pseudomonas aeruginosa - to ciprofloxacinum and gentamicinum, Acinetobacter spp. - gentamicinum, ceftazidime and ceftriaxonum; Staphylococcus - to penicillinum. Escherichia coli and Klebsiella spp. produced extended spectrum beta-lactamases (ESBL). Among E. coli, Pseudomonas aeruginosa and Acinetobacter spp. were identified strains resistant to carbapenems. MRSA and MRSE were identified.

The article highlights the importance of the problem of endemic liver trematode infection (opisthorchiasis and clonorchiasis) and the principles of their diagnosis from the perspective of the clinician. Closely related pathogens (Opisthorchis felineus, Opisthorchis viverrini, Clonorchis sinensis) of these diseases are group 1 carcinogens, promoting the development of cholangiocarcinoma of the liver, gallstones, pancreatitis and gastroduodenitis. Specific and early diagnosis of opisthorchiasis in humans is crucial for an appropriate and timely treatment. The basic method of diagnostics in the world clinical practice is a detection of eggs in fecal samples. Once a fecal sample is available, the modified formalin-ether sedimentation technique, the modified thick Kato smear and with Kato - Katz are used. As a single examination does not necessarily provide diagnostic certainty, repeated examinations are necessary to improve diagnostic sensitivity. Immunoassay is considered as an addition to parasitological examination. The EL1SA shows the best performance among the serological tests. Molecular-genetic method (PCR and Loop mediated isothermal amplification (LAMP) is ranked as the most promising. Due to their high specificity, such molecular diagnostic tests are likely to play an increasingly significant role in anthelminthic drug efficacy evaluations, the rigorous monitoring of reinfection patterns, and to investigate changes in the endemic range of the liver flukes.

The article provides the review of domestic and foreign literature on the use of the Ex-Press drainage device in patients with refractory and primary open-angle glaucoma. We conducted a detailed analysis of hypotensive effectiveness of Ex-Press implantation combined with anti-VEGF drugs, antimetabolites (5-Fluorouracil, Mitomycin C), Glautex and Ologen drainages. We described the results of drainage device usage for neovascular, aphakic, pseudophakic glaucoma. We determined indications, modified methods of Ex-Press implantation and best options of combinations with drainages; established safe conditions of magnetic resonance imaging in patients with the implanted device. We presented all possible complications both in the early and late postoperative period. The influence of Ex-Press on endothelial layer of the cornea in dynamics was shown. Оп the basis of literature review it can be noted that Ex-press drainage device has proved to have a long hypotensive effect in patients with PОAG and pseudophakia. Whereas in refractory glaucoma it requires a combination with drainage and anti-metabolites. Implantation of Ex-press requires dynamic monitoring of patients due to the risk of long-term postoperative complications.

The review deals with the analysis of modern methods of treatment of chronic generalized parodontitis from the perspective of differentiated principle of treatment of this disease. Particular attention is paid to methods of medical treatment, their diversity on the efficiency and mechanisms of therapeutic effects to select appropriate treatment, taking into account all the individual characteristics of the patient, aetiology, pathogenesis and severity of chronic generalized parodontitis. It has been demonstrated that an important aspect to achieve high efficiency of treatment is a method of drug delivery. The most effective method is a transmembrane dialysis, which makes it possible simultaneously to obtain the maximum concentration of the therapeutic substances in the inflammatory focus and to eliminate from the inflammatory focus the low-medium weight tissue decomposition products, products of metabolism, while maintaining factors of regeneration and protection against infection. It has been evinced the advantages of sanogenetic therapy using vitamin cocktail and some higher plants BAS containing terpenoids (bornylacetate and its semisynthetic stereoisomer - isobornyl acetate), as the least toxic, having analgesic and anti-bacterial properties comparable with antibiotics, and capable to stimulate repair processes. The good water solubility of these substances provides ample possibility of using these drugs in the form of solutions for rinsing, transmembrane dialysis, as liquid at ultrasonic curettage.

With the introduction and development of new diagnostic techniques, the relevance of drusen of the optic nerve diagnostics is increasing. Existing imaging techniques alone or in their various combinations cannot allow to confirm optic nerve drusen in all clinical cases. The diagnosis of optic nerve drusen causes some difficulties because of absence of clear diagnostic standards and classification. Since the advent of new ophthalmological methods of structural and topographic visual analysis evaluation, such as spectral-domain optical coherence tomography, Heidelberg retina tomography, videooculography, B-scan ultrasonography of the orbits and optic nerve, fluorescent angiography of the retina, computed tomography and magnetic resonance imaging of the brain and orbits, the diagnostics of optic nerve drusen becomes more informative. In this article we review the main current imaging techniques in the diagnostics of the optic nerve drusen.

Cardiac involvement is the most important prognostic factor in eosinophilic granulomatosis with polyangiitis (Churg - Strauss syndrome). We report a case of Churg - Strauss syndrome in 65-year-old women masquerading as a non-ST elevation myocardial infarction. She had chest discomfort, dyspnea and ST depression, high troponin level and so myocardial infarction was diagnosed. She had had asthma for 4 years but had no eosinophilia in peripheral blood and lesions in the lungs at the time of the first hospitalization. Her skin was clean without rashes. 3 months later she was hospitalized again having pulmonary infiltrates. Laboratory tests revealed that eosinophil was significantly increased. Cardiac involvement in a pathological process led to death. Histological examination of heart and lungs showed necrotic coronary vasculitis, granulomas and perivascular eosinophilic infiltrates in myocardium, endocardium, pericardium and pulmonary eosinophilic infiltrates.

The article presents the analysis of treatment of several cases of relatively rare malignant tumor in children - sacrococcygeal teratoblastoma. Over last fifteen years there were 8 children with this diagnosis treated in the Irkutsk State Regional Children's Clinical Hospital. Mean age was 1.5 years. All children were admitted to the hospital with stages III and IV of the disease. After the course of chemotherapy the surgical treatment was conducted from perineal section with obligatory coccygectomy. Four children recovered, three died, one child is having the course of postoperative chemotherapy.