This report presents a clinical case of complex differential diagnosis of optical neuritis in demyelinating disease (multiple sclerosis and neuromyelitis optica). We observed 5 relapses of optic neuritis within 4 years from the onset of the disease, in the absence of both clinical and neuroimaging signs of myelitis. The diagnosis of neuromyelitis optica became valid only after the neurologist identified motor symptoms and the corresponding criteria on the MRI picture. Recurrent optic neuritis, especially bilateral with incomplete recovery of visual functions (despite the absence of acute myelitis and postrema area syndrome and a negative blood test for AQP4-IgG) requires special caution of the doctor and can be considered as a potential case of Devic’s neuromyelitis optica. Key words: devic’s neuromyelitis optica, neuromyelitis optica, optic neuritis, multiple sclerosis, neuromyelitis optica spectrum disorders, AQPR4

Optic disc drusen (ODD) is a bilateral anomaly of the optic nerve, in which hyaline calcified intercellular inclusions appear in the optic disc head area in front of the cribriform plate. As a rule, in the early stages, ODD patients have no complaints, central vision does not suffer, while perimetry data may show an expansion of the blind spot and narrowed visual field. As complications are developing and the optic nerve atrophy is progressing, visual acuity may decrease. The visual functions are deteriorating gradually. In the clinical case discussed, a patient with optic disc drusen was examined for a second time after a prolonged interval (27 years).The ophthalmoscopic picture and functional parameters obtained during this examination clearly confirmed the unfavorable course of optic disc drusen and the need for such patents to be regularly examined for changes in visual functions (visual field), the state of the retina and the optic nerve.

According to the literature data, a significant number of hereditary syndromes associated with neuro-ophthalmological pathology have been identified. This article discusses the results of the examination of two sisters, 28 and 23 years old, with visual impairments and neurological pathology. The manifestation of the same type of symptoms and clinical manifestations in members of the same family is most likely hereditary and is subject to extended genetic research. The combination of pituitary adenoma, cerebellar ataxia, and congenital atrophy of the optic nerves in members of the same family in the framework of differential diagnosis with other hereditary syndromes is described in the Russian literature for the first time. Key words: family forms of pituitary adenoma, hereditary genetic syndromes, neuro-ophthalmological pathology

The neuro-ophthalmic symptoms and signs associated with COVID-19 infection are varied and span the course of the infection to the convalescent phase. In addition to the anterior segment of the eye, there is a possibility of damage to the posterior segment of the eyeball. The described cases are isolated and there are no results of treatment of patients who have undergone COVID-19. Purpose: To describe the outcome of treatment of bilateral optic nerve edema after COVID-19. Methods. A 59-year-old man with reduced visual functions in the post-surgical period was examined. A standard ophthalmological examination was performed. In addition, spectral optical coherence tomography (OCT) of the macular area of the retina and optic disc (OND) was performed using the RTVue XR Avanti apparatus (Optovue, USA). The patient underwent a laboratory study. Results. Bilateral papilledema was detected in a patient after COVID-19. According to OCT data, a thickening of the nerve fiber layer of the retina of both eyes was revealed, according to OCT angiography, a decrease in the density of the RPC. Conducted a course of conservative and physiotherapy treatment. Conclusion. The COVID-19 epidemic poses several challenges for the ophthalmological community: to determine algorithms for timely diagnosis and treatment, as well as to ensure the prevention of complications from the organ of vision in patients who have undergone COVID-19. It may make sense to screen for coronaviruses in patients with inflammatory diseases of the posterior segment of the eye of unknown etiology. The inclusion of spectral optical coherence tomography with the function of angiography in a comprehensive examination of patients is important for the early detection of microcirculatory and morphometric changes in the optic disc, macular and peripapillary retina. It is advisable to use physiotherapeutic methods of treatment in patients with visual impairment in the post-COVID period, which will reduce the long-term drug load and increase the effectiveness of treatment.

The review presents data on the prospects for the diagnosis of optic neuritis in neuromyelitis optica (NMO). The differential diagnosis of NMO with multiple sclerosis and other autoimmune diseases is complicated by the similarity of the clinical manifestations of optic neuritis. The diagnostic approach, tactics of using and interpreting the results of modern laboratory, instrumental and hardware research methods are described. Additional diagnostic criteria are described for AQPR4-IgGseronegative patients with clinical symptoms of acute urinary tract infections. NMO is characterized by severe unilateral damage to the optic nerve with poor recovery of visual functions after conservative therapy, frequent recurrences of optic neuritis in one or both eyes, bilateral simultaneous damage to the optic nerves or chiasm. Timely diagnosis makes it possible to prescribe pathogenetic therapy for NMO and reduce the number of relapses of optic neuritis and prevent patients’ blindness. Key words: neuromyelitis optica, optic neuritis, OCT, multiple sclerosis, neuromyelitis optica spectrum disorders, AQPR4

Recent years have seen an increase in tobacco mixture smokers using hookahs. Dangerous substances released during smoking cause substantial harm to the entire body, and bring about visual impairment with toxic optical neuropathy. Eye structures which are the most susceptible to toxin damage are the cells of the optic nerve and retina. Substances released when smoking hookah tobacco mixtures have a direct neurotoxic impact on the optic nerve and cause metabolic damage to the retinal nerve fiber layer and ganglion cells. Timely detection of this damage is complicated by the similarity of its clinical picture with other optic nerve diseases, which requires a thorough differential diagnosis.

A case with ophthalmological manifestations of two genetically determined diseases in one patient with a progressive decrease in visual functions is considered. The clinical picture and modern diagnostic methods necessary for the clinical diagnosis are reflected. The rare occurrence of combinations of congenital diseases of the cornea and optic nerve disc requires special attention during ophthalmological examination. Key words: corneal dystrophy, comorbidity, inherited diseases, optic nerve atrophy, optic disc drusen.

The review discusses the development of optical coherence tomography with the function of angiography, focusing on its advantages, features, and prospects for the diagnosis of fundus pathologies.

A clinical case of observation of a patient who had branch retinal vein occlusion with the development of macular edema, against the background of a moderate-severe course of COVID-19, was considered. The clinical picture and diagnostic methods necessary for the diagnosis are described. Some aspects of pathological changes in the organ of sight in COVID-19 are discussed. Key words: COVID-19, branch retinal vein occlusion, macular edema, renin-angiotensin-aldosterone system.

Учебное пособие «Дакриоциститы у детей: проблемы и решения» включает разделы: причины дакриоцистита новорожденных, методы обследования пациентов с нарушением слезоотведения, методы терапевтического и хирургического лечения. Отдельная глава посвящена описанию технологии оптимизированного хирургического лечения врожденного стеноза носослезного протока. При подготовке учебного пособия использован практический и научный опыт профессорско-преподавательского состава кафедры глазных болезней Института непрерывного профессионального образования ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России, кафедры Центра офтальмологии ФМБА России, Воронежского государственного медицинского университета им. Н.Н. Бурденко. В учебном пособии, освещен последовательно, логично, в доступной форме. Информация систематизирована, соответствует современному уровню развития науки и клинической практики.

In recent years, the range of combined narcotic drugs has widened. New chemical modifications have emerged, including so-called designer drugs, whose action on the body and in particular on the state of vision is increasingly difficult to determine. While the problem of drug abuse is growing drastically, timely detection of a possible toxic damage to the eye induced by drugs and reliable diagnosis differentiating such damage from other etiologies becomes a topical practical issue. The paper presents a clinical case of poppers maculopathy (poppers being a slang name of aromatic volatile alkyl nitrite compounds). Ophthalmological manifestations and differential diagnostic criteria of the damage are described. The mechanisms of action and possible treatment methods are discussed.

The patient complained of a severe, yet painless, reduction in vision of both eyes after an accidental intramuscular injection of Klozantrem with a dose of 4.0 ml in S. Fedorov Eye Microsurgery Federal State Institution. The standard ophthalmological examination was performed (OU visual acuity was counting fingers at a distance of 10 cm, OD intraocular pressure was 10mm Hg, OS intraocular pressure was 9 mm Hg, eye movement unremarkable). Biomicroscopy showed both eyes were calm, pale pink conjunctivae, transparent cornea, medium depth anterior chamber, transparent lens. OU ophthalmoscopy showed the optic disc was discolourated, its boundaries were indistinct, arteries and veins were narrowed, macular area of the retina without a visible physical pathology. Perimetry showed the correct light projection. A reduction in the thickness of the external and internal layers of the retina was observed as a result of the OCT of the macular zone OU. OCT showed the thickness of the layer of nerve fibres in the upper and lower nasal segments. OS has the prominence of the optic disc in the vitreous body. The threshold of the electrical sensitivity OU was 300 mkA by electrophysiological research; the electrical latency was not defined. During the MRI scan, the fascinated changes of the cerebral cortex have not been found. Acute optic neuropathy of toxic genesis was diagnosed in both eyes. A course of complex conservative treatment was prescribed: anti-inflammatory, nootropic, metabolic, vitamin therapy, as well as magnetotherapy, electrical stimulation and electrophoresis. As a result of the reported case by patient due to unintentional application of Closantel, we found that toxic damage of the ganglion cells of the retina was initially occurring, resulting in a reduction of the central visual acuity, followed by the development of the optic nerve atrophy. Care must be exercised when dealing with medicines. Potentially, any medicines are toxic and, if used improperly, may cause a number of side effects from the visual and central nervous system.

Drug dependence is one of important social problems in modern society. It became more actual because of the high morbidity in young working-age patients. The central nervous system is the main target for psychoactive substances. Long-term drug intoxication results in functional and structural brain alterations, it leads to cognitive impairment and disturbances of higher mental functions rendering patients’ disadapted in their work and daily life activities. Eye disorders due to drug abuse are multifaceted and can vary from conjunctival damage to severe endogenous endophthalmitis. Opioid dependence can result not only from intentional self-administration of narcotic drugs, but also from long-term prescribed use of these medicinal products owing to their potent analgesic effect exhibited in somatically ill patients with severe chronic pain. Opioid derivatives act as partial or full agonists of three types of opioid receptors (δ, κ, and µ) extensively expressed by the neurons of the central and, to a lesser extent, peripheral nervous system. The most dangerous complication of intoxication with this group narcotic drugs is opioid induced-respiratory depression resulting in hypoxaemia and hypercapnia. The paper presents a case report of bilateral optic nerve atrophy that developed in a young female patient after a long period of intravenous heroin use. There are practically no reports of optic nerve damage due to heroin intoxication in the current literature. Possible optic nerve atrophy mechanisms under discussion include generalized hypoxia developing against a background of chronic heroin intoxication and direct toxicity of admixtures used to dilute home-made narcotic drugs. In view of the growing use of these substances, physicians have to consider their effects in the differential diagnosis in patients with atypical eye disorders.

Purpose. Study the thickness of periapillary retina, ganglion cell complex and optic disc parameters in patients with nonarteritised anterior ischemic optic neuropathy using the spectral OCT angiography. Material and Methods. We examined 17 people (17 eyes) with unilateral non-arteritised anterior ischemic optic neuropathy (no more than 30 days from the appearance of complaints), the average age was 64.1±8.1 years. The control group consisted of 37 volunteers. All the subjects were treated with spectral OCT angiography on RTVue XR Avanti device (Optovue Inc., USA). Results. In patients with non-arteritised anterior ischemic optic neuropathy, compared to the control group, there was a statistically significant increase in the average thickness of periapillary retina nerve fiber layer from 136 to 403 µm, an increase in optic disc area and neuroretinal belt (p < 0.0001) and the absence of cupping (Cup Volume = 0). A decrease in average thickness of ganglion cell complex was found in 8 out of 17 patients, while all patients showed increases in FLV (p=0.008) and GLV (p=0.036). A direct correlation relationship between FLV (r=0.64; p<0.05) and GLV (r=0.51; p<0.05) was found, as well as a moderate negative correlation relationship between uncorrected visual acuity (r=-0.58; p<0,05), moderate direct correlation relationship between average thickness of periapillary retina nerve fiber layer and thickness of ganglion cell complex (r=0.68; p<0,05), and high inverse correlation relationship between FLV (r=-0.77; p<0,05) and GLV (r=-0.76; p<0,05). Conclusion. A comprehensive analysis of thickness of periapillary retina nerve fiber layer and parameters of ganglion cell complex using spectral OCT angiography may allow for a more accurate detection of early retinal structural abnormalities and the timely commencement of conservative therapy to preserve functional parameters. Key words: spectral OCT angiography, anterior ischemic optic neuropathy, ganglion cell complex, optic disc.

Purpose: statistical evaluation of the diagnostic and differential diagnostic significance of spectral optical coherent tomography (SOCT) and microperimetry methods in patients with (1) optic neuritis (ON) with multiple sclerosis (MS) manifestation; (2) inflammation-related ON and (3) optic nerve atrophy (ONA) caused by MS.Materials and methods. The results of examination of the three groups of patients were processed by correlation and multivariate analysis and binary logistic regression. The threshold of electrical sensitivity (EST) and electrical lability (EL) were determined on a Fosphen-tester using a standard technique. S-OCT was performed on Cirrus HD-OCT (Carl Zeiss Meditec Inc., USA) using the RNFL Thickness Analysis, Ganglion Cell Analysis programs. Computer microperimetry was done on MP-1 (Nidek technologies, Vigonza, Italy) using the macula 12º 10 dB program.Results. EST of the retina was found to have a strong bilateral correlation with the average retinal sensitivity, RNFL thickness and thickness of the upper temporal and upper segments layer of the complex GCL + IPL. Diagnostic parameters significant for visual analyzer disorders caused by MS were revealed and confirmed, including the average retinal sensitivity drop within 6º from the center of the visual field according to microperimetry (p < 0.0005), the thinning of RNFL (p < 0.005) and complex GCL-S + IPL, according to SOCT (p = 0.004). intragroup comparisons revealed the diagnostic significance of SOCT in early diagnosis of ONA due to MS (p < 0.0005). It was found that if the RNFL was 62 microns or less, the GCL-S + IPL was 52 microns or less (in the inferior segment it was 50 microns or less, and in the upper segment it was 51 microns or less) then, with a sensitivity of 100 % and a specificity of 87.5–93 %, it is an evidence of the atrophy of the optic nerve.Conclusion: average retinal photosensitivity within 6º from the center of the visual field, RNFL thickness, thickness GCL-S + IPL, including that in the superior, superior temporal and inferior segments can be considered as diagnostically significant values in OH inflammatory-related and demyelinating OH and the development of ONA due to MS.

Recovery and preservation of visual functions during compression in the chiasm-sellar region is possible in the case of early diagnosis of pathology and timely surgical decompression. Today optical coherence tomography (OCT) of the retina is one of the most informative methods for diagnosing pathology of the retina and optic nerve. It can, due to the presence of early diagnostic criteria, promptly detect the compression in the chiasm-sellar region and expand the indications for surgical treatment. The literature review presents the results of optical coherent tomography (OCT) of the retina during compression in the chiasm-sellar region. An analysis of literature data revealed that in patients with chiasmatic compression, the thickness of the nerve fiber layer in the peripapillary and macular areas decreases, the thickness of the macular complex, consisting of the retinal ganglion cell layer and the inner plexiform layer, decreases. Also, there is a change in the value of asymmetry between the GCC thickness indices in the nasal and temporal halves of the macular region. It has been established that a decrease in the thickness index of a macular complex may precede changes in the visual field. According to the results of single studies, a correlation was found between the parameters of the peripapillary RNFL thickness and the the internal capillary retinal plexus density in the same areas. The results of literature sources’s analysis are summarized in the table by the parameters studied, the OCT model; etiology, treating methods and the results of the OCT study. Despite the results obtained, the early specific and sensitive OCT diagnostic criteria for chiasmatic compression have not yet been developed. In addition, a change in the thickness of GCC and RNFL can also be observed in the absence of chiasmatic compression in certain types of tumors and in the presence of comorbidities (arterial hypertension). In this regard, it is necessary to conduct further studies that will reveal the informative OСT-diagnostic criteria for compression in the chiasm-sellar region, develop diagnostic algorithms taking into account the type of tumor, the presence of concomitant pathology. Early diagnostic criteria for chiasmatic compression will expand the indications and improve the result of surgical treatment of patients.

The literature review presents the results of a static perimetry for the study of the visual field in patients with compression in the chiasm-sellar region on the Humphrey Visual Field Analyzer (HFA) and Octopus. These models of perimeters are recognized as the “gold standard” and are most widely used in the global ophthalmic practice. The analysis of research results using traditional and function-specific perimetry with selective stimulation of the magnocellular and koniocellular (frequency-doubling technology perimetry, FDT; short-wavelength automated perimetry, SWAP) visual pathways was performed. The literature data analysis allows us to conclude that the static perimetry for the study of the visual field in patients with chiasmatic compression is carried out quite widely and is informative. But despite this, there are no generally accepted recommendations on the use of certain testing strategies and programs for the diagnosis and further dynamic observation of changes in the visual field in patients with this pathology. In this regard, it is advisable to conduct further studies that will allow the formation of standard perimetric protocols for diagnosing and monitoring visual field defects in patients with compression in the chiasm-sellar region based on a comparative analysis of the diagnostic informativity of various strategies and programs.

An increase in the growth of cardiovascular diseases has been observed in the last few years. Cardiac rhythm disturbances, especially atrial fibrillation, in absence of cardioversion and proper prophylaxis lead to thromboembolic complications. Drug therapy in rhythm disorders consists of the many antiarrhythmic drugs, prescribed for a long period of time. This fact can result to the ocular toxicy, which have insidious and slow progression. First and foremost, there is a risk of amiodarone-associated toxicity. Amiodarone affects as anterior segment structures (photosensitivity, corneal and conjunctiva deposits, anterior subcapsular cataract) as posterior segment structures (optic neuropathy). Fibers of the papillomacular bundle are the most vulnerable structures in optic nerve to the toxic effect of amiodarone due to the absence of myelination and salutatory conduction, their small size and high-energy requirements. The difficulties in diagnosis of amiodarone-associated optic neuropathy are related to slow progression (patients don’t notice symptoms until the late stages) and clinical similarity to ischemic optic neuropathy.

Актуальность. Сохранение зрительных функций у пациентов с аденомой гипофиза (АГ) возможно при ранней диагностике компрессионной оптической нейропатии и своевременном проведении декомпрессии. Цель. Анализ ОКТ-А параметров у пациентов с АГ. Материал и методы. Обследован 21 пациент (42 глаза) с АГ и 10 здоровых человек (20 глаз), сопоставимых по полу и возрасту. Пациенты были разделены по результатам тестирования центрального поля зрения (ЦПЗ) на периметре Galaxypro(MS WestfaliaGmbH, Германия) с использованием стандартного протокола 30-2 на группы – без нарушений в ЦПЗ на обоих глазах (группа 1 – 22 глаза) и с нарушениями в ЦПЗ (преимущественно темпоральные дефекты) на одном или обоих глазах (группа 2 – 20 глаз). ОКТ-А проведена на спектральном томографе REVO nx/SOCT Copernicus REVO (OptopolTechnologyLtd., Польша). Результаты. В 1-й группе выявлено снижение: плотности сосудов (VD) радиального перипапиллярного капиллярного сплетения (RPC) в верхней перипапиллярной зоне (p=0,002), в верхнем (p=0,005) и верхневисочном (p=0,004) секторах; снижение показателя капиллярной перфузии (VP) поверхностного капиллярного сплетения (SRCP) в нижнем секторе наружного кольца по сетке ETDRS (p=0,009); VP глубокого капиллярного сплетения (DRCP) общего внутреннего кольца (p=0,003). Во 2-й группе выявлено снижение: VDRPC по сравнению с 1-й группой – в верхневисочном секторе (p=0,003), по сравнению с контрольной группой – во всех секторах (p <0,0001); VPSRCP по сравнению с 1-й и контрольной группой в нижнем секторе наружного кольца (p=0,003 и p <0,0001 соответственно). Выявлена корреляционная зависимость между толщиной слоя нервных волокон сетчатки (RNFL) и VDRPC у пациентов обеих групп (в нижнем и назальном секторах, соответственно), толщиной RNFL и VPRPC в нижнем секторе в 1-й группе; у пациентов 2-й группы – толщиной RNFL и VDRPC в верхнем секторе; между толщиной макулярного комплекса (mGCC) и VDSRCP общей; между показателем толщины сетчатки в макулярной области (ILM-RPE) и VPSRCP в верхнем секторе наружного кольца и VDDRCP в нижнем и VPDRCP в назальном секторе внутреннего кольца. Выводы. Результаты исследования позволяют предположить, что хиазмальная компрессия, вызванная АГ, приводит к прогрессированию микроциркуляторных нарушений в перипапиллярной и макулярной областях, диагностирование которых возможно до формирования изменений ЦПЗ.