IntroductionThis article presents the results of an international, multicenter, randomized, double-masked, placebo-controlled clinical study of Visomitin (Mitotech LLC, Moscow, Russian Federation) eye drops in patients with dry eye syndrome (DES). Visomitin is the first registered (in Russia) drug with a mitochondria-targeted antioxidant (SkQ1) as the active ingredient.MethodsIn this multicenter (10 sites) study of 240 subjects with DES, study drug (Visomitin or placebo) was self-administered three times daily (TID) for 6 weeks, followed by a 6-week follow-up period. Seven in-office study visits occurred every 2 weeks during both the treatment and follow-up periods. Efficacy measures included Schirmer’s test, tear break-up time, fluorescein staining, meniscus height, and visual acuity. Safety measures included adverse events, slit lamp biomicroscopy, tonometry, blood pressure, and heart rate. Tolerability was also evaluated.ResultsThis clinical study showed the effectiveness of Visomitin eye drops in the treatment of signs and symptoms of DES compared with placebo. The study showed that a 6-week course of TID topical instillation of Visomitin significantly improved the functional state of the cornea; Visomitin increased tear film stability and reduced corneal damage. Significant reduction of dry eye symptoms (such as dryness, burning, grittiness, and blurred vision) was also observed.ConclusionBased on the results of this study, Visomitin is effective and safe for use in eye patients with DES for protection from corneal damage.FundingMitotech LLC.

This review provides information on the features, incidence, pathogenetic mechanism, possibilities of conservative, laser and surgical treatment of glaucoma in pregnant women. The purpose of this literature review is to study the features of managing patients with glaucoma during pregnancy. Glaucoma is a large group of eye diseases characterized by a gradual development of visual impairments and atrophy of the optic nerve. The pathology is most common among the population over 40 years old, but due to the advancement of reproductive technologies, the availability of diagnostic methods, as well as high clinical awareness, the frequency of ophthalmologists managing glaucoma in pregnant women increases. Elevated intraocular pressure in pregnant women is becoming more common and, therefore, is an urgent problem. There is a trend towards an increase in the number of pregnant women who experienced elevated intraocular pressure for the first time. Previously identified pathology in childhood or secondary glaucoma due to previous ophthalmic diseases or severe somatic pathology is a special category of patients. Such patients are encountered regularly and require close supervision by both an ophthalmologist and a gynecologist. The evidence base for antiglaucoma drugs is small; there are clinical experiments on animals, which results do not always carry over to humans, and retrospective studies. The doctor's arsenal presently includes a number of drugs that have possible side effects for the fetus, as well as laser and surgical treatment. There is no standard treatment, so each case should be considered individually with an understanding of the physiology, mechanism of action of the drugs and their possible effects. Therefore, glaucoma during pregnancy and lactation is a serious medical problem, and its solution depends on interdisciplinary medical approach.

PURPOSE. To determine the types of reaction to pilocarpine in patients with low-tension glaucoma (LTG) and study the nature of fluid outflow along the main pathways in different types of reaction to pilocarpine.METHODS. The observation group included 21 people (42 eyes) with LTG aged 51 to 80 years (average age 68±9.8 years). The criteria for inclusion in the study were emmetropic refraction and no previous laser and surgical interventions on the examined eye. The anterior chamber angle corresponded to medium–wide or wide according to the classification by A.P. Nesterov. The initial stage of LTG was established in 16 eyes, developed stage — 12 eyes, advanced stage — 14 eyes.The examination was carried out both in patients with newly diagnosed glaucoma and in patients with previously established diagnosis who received hypotensive drug therapy; in the latter case the patients were recommended to cease instillations of hypotensive drugs 10–14 days prior to the examination.RESULTS. Among the studied LTG patients, positive pilocarpine test was registered in 5 eyes (12%), negative — in 6 eyes (14%), and paradoxical — in 31 eyes (74%).The obtained data revealed no statistically significant differences in the initial values of anterior chamber depth, lens thickness and axial eye length between patients with paradoxical and positive reactions to pilocarpine. Therefore, there are no anatomical prerequisites for the development of a particular type of reaction to the pilocarpine test in the studied eyes.The ease of outflow coefficient (EOC) for the drainage pathway is significantly reduced in patients with positive reaction to pilocarpine, which in absolute numbers approaches normal values. In these patients the drainage outflow reserves are preserved.In persons with paradoxical reaction to pilocarpine, EOC for the drainage pathway is significantly reduced and is low in absolute numbers. Deterioration of the outflow along the uveoscleral pathway in pilocarpine instillations leads to elevated intraocular pressure.CONCLUSION. The majority of patients with low-tension glaucoma have a paradoxical reaction to the pilocarpine test. The sufficiently high sensitivity of the sample allows recommending it as a diagnostic test for this type of glaucoma.Different types of reaction to pilocarpine in patients with low-tension glaucoma are associated with the intensity of intraocular fluid outflow over the drainage and uveoscleral pathways.

G Ключевые слова: заболеваемость; этиологическая верификация; увеиты.

The article presents three clinical cases of severe pathologies of the anterior segment of the eye, which developed in patients with serious concomitant somatic diseases and COVID-19 under the pandemic. Our observations show that the SARS-CoV-2 virus can contribute to the onset of severe keratitis and keratouveitis, characterized by a long torpid course, relapses, and a poorly predicted outcome. In patients with coronavirus and severe somatic pathology, these diseases have atypical symptoms that complicate the diagnosis, are resistant to treatment, and require an extended period of convalescence. This can be explained by pronounced vascular inflammatory reactions, a possible invasion of eye tissue by viral particles, disruption of tear production, a decrease in local immune defense factors of the eye and systemic immunity, and a violation of the hemato-ophthalmic barrier. Local and general drug treatment brought weakly positive changes. The course of the disease took an undulating character. The description of the clinical cases reflects the polymorphism of symptoms and the multiorganic character of damages associated with COVID-19.