Historically, intraocular pressure has been the key classification criterion for glaucoma. However, the boundaries of normal IOP remain a subject of debate despite the abundance of criteria that define the patient's status. A critically important but often unknown parameter is the individual baseline IOP of the patient prior to the onset of the disease. Another important aspect is the role of tono- meters and the potential measurement errors that depend on concomitant local and systemic factors. Which devices provide the most accurate IOP measurements, and how can measurement errors be avoided? In addition, there is a need for a more thorough approach to the interpretation of tonometry results in patients with normal tension glaucoma, where IOP is within the "normal" range but the disease continues to progress. These issues remain relevant and still require further discussion. The modern grading of IOP levels in individuals diagnosed with glaucoma requires a shift from average population norms to more personalized algorithms, which should be considered in future glaucoma classifications, given their significance for diagnostic search and assessment of disease progression risk.

The staff of the Academic Department of Ophthalmology of the Military Medical Academy made a significant contribution to the creation of glaucoma classification. In 1948, B.L. Polyak developed a dynamic classification of glaucoma, which reflected both the staging of the disease — based on the degree of visual field constriction, and the threat of its further progression — based on the degree of intraocular pressure compensation; this classification was approved by the Ministry of Health of the USSR in 1952 and served as the national glaucoma classification for nearly 25 years. Subsequently, an improved and updated version of primary glaucoma classification by A.P. Nesterov and A.Ya. Bunin was approved in 1975 at the 3rd All-Russian Congress of Ophthalmologists and remains the official classification to this day. Since 2003, in accordance with international standards, the diagnosis of glaucoma has been based primarily on the identification of structural changes in the optic nerve heard (ONH) characteristic of glaucoma and the associated functional changes in the visual field. The concept of glaucoma 

based on the disruption of the transmembrane gradient between intraocular and intracranial pressure, and has contributed to the development of a structural and functional approach to its diagnosis long before the international standards were established. The results of studies performed at the department in the late 20th century, including morphometric analysis of the ONH, were incorporated into the classification of primary open-angle glaucoma developed by V.V. Volkov.

In light of the above, we propose refining the classification scheme of glaucoma stages presented in the current Ministry of Health of the Russian Federation guidelines, "Clinical Guidelines: Primary Open-Angle Glaucoma — 2024", by providing structural and functional diagnostic criteria for glaucomatous optic neuropathy with not only qualitative but also quantitative parameters, taking into account the developments in this field achieved in Russia.

Pseudoexfoliation syndrome (PEX) is a systemic disease characterized by the accumulation of abnormal extracellular material in various ocular structures and extraocular tissues. Numerous studies have confirmed its association with the development of pseudoexfoliative glaucoma (PEXG), which, along with typical glaucomatous features, exhibits a range of genetic, morphological, immunological, biochemical, and clinical characteristics that distinguish it from "classic" primary open-angle glaucoma. This allows PEXG to be considered not merely as a subtype of primary or secondary open-angle glaucoma but rather as a distinct form of the disease requiring — in addition to standard approaches — the development of qualitatively new, specific strategies for early diagnosis, monitoring, and medical or surgical treatment.

This article discusses the place of PEXG in current classifications, their debatable nature, possible correlations of PEX with angle-closure glaucoma and normal-tension glaucoma, and attempts to identify pathogenetically justified treatment methods. The emergence of such therapeutic options in ophthalmology may prompt a reconsideration of existing classification frameworks and the potential recognition of PEXG as a separate category.

In this article, the authors attempt to answer the question of which classification form (primary or secondary open-angle) should be assigned to pigmentary glaucoma, which is a clinical stage that completes the progressive course of pigment dispersion syndrome (PDS). The article presents risk factors, pathogenetic mechanisms, and clinical manifestations of PDS at successive stages of its development and briefly discusses the issue of pigmentary glaucoma prevention. Based on literature data and the authors’ own research, the evidence strongly supports the secondary nature of pigmentary glaucoma and the need to revise current classification schemes.

PURPOSE. To study the features of daily fluctuations in the biometric and structural parameters of the optic nerve (ON) in patients with different stages of primary open-angle glaucoma (POAG).

METHODS. The study included 105 patients with POAG at various stages. The control group consisted of 20 individuals without glaucoma. Daily patterns of biometric and structural parameters of the ON were analyzed in addition to standard ophthalmic examination.

RESULTS. Ultrasonographic examination of the ON over a 12-hour period (from 8:00 to 20:00) revealed a statistically significant reduction in ON thickness, both with and without its sheaths, in patients with advanced POAG compared with the control group (p<0.05). In eyes with advanced glaucoma, acoustic density (AD) of the ON and its sheaths showed a statistically significant increase compared with normal values (p<0.05).

CONCLUSION. Marked alterations in the acoustic parameters of the ON characteristic of advanced POAG may indicate pronounced internal structural changes and atrophic damage of the nerve.

PURPOSE. To evaluate the effectiveness and safety of combined surgical treatment for primary open-angle glaucoma (POAG) and cataract in patients with grade I–II lens subluxation due to pseudoexfoliation syndrome (PEX). The study analyzed early outcomes of phacoemulsification (PE) with optic capture fixation of the intraocular lens (IOL) and non-penetrating deep sclerectomy (NPDS) using the Healaflow drainage in the presence of zonular weakness.

METHODS. The study included 20 patients (20 eyes) with stage II–III POAG, age-related cataract, and grade I–II lens subluxation associated with PEX. All patients (mean age 73 years) underwent simultaneous phacoemulsification with implantation of an AcrySof MA60AC IOL (Alcon) using the optic capture technique and NPDS with Healaflow. Uncorrected (UCVA) and best-corrected visual acuity (BCVA), intraocular pressure (IOP), tonographic parameters, static perimetry, and optical coherence tomography (OCT) findings were evaluated over 12 months.

RESULTS. At 12 months, UCVA improved from 0.07±0.06 to 0.35±0.22 (p<0.001), and BCVA increased from 0.26±0.19 to 0.68±0.23 (p<0.001). IOP decreased from 26.4±6.6 mm Hg to 16.7±5.1 mm Hg (p<0.001), with 90% of patients not requiring hypotensive therapy. The aqueous outflow facility coefficient (C) increased by 75%, while the minute volume (F) decreased by 28%. OCT confirmed IOL stability (tilt 6.55±2.71°, decentration 0.44±0.14 mm). The mean deviation (MD) decreased by 14%, and the pattern standard deviation (PSD) decreased by 20%.

CONCLUSION. The combined approach to the treatment of POAG, cataract, and lens subluxation associated with PEX provided sustained IOP reduction, improved visual function, and maintained IOL stability. The optic capture technique proved effective for IOL fixation in cases with zonular weakness, while NPDS with Healaflow ensured safe glaucoma control. Further long-term studies with larger cohorts are warranted to confirm these findings.

Intraocular pressure (IOP) is the only modifiable risk factor for the development and progression of glaucomatous optic neuropathy, making its reduction the primary goal of glaucoma therapy. Despite advances in medical and laser treatment, filtering surgery remains a key (and often the only) method of IOP control. However, in patients with a long history of glaucoma, chronic exposure to topical hypotensive medications, particularly preservative-containing formulations, induces a spectrum of pathological ocular surface alterations characterized predominantly by inflammation. These pathological changes are characterized by the activation of inflammatory mediators and cellular infiltration of the ocular surface tissues, which significantly impairs postoperative wound healing and ultimately determines surgical outcomes. A comprehensive understanding of the pathophysiological mechanisms underlying these changes provides the foundation for developing targeted preventive and therapeutic strategies aimed at improving long-term surgical success. This review evaluates current evidence regarding the consequences of long-term hypotensive therapy on the ocular surface, with particular emphasis on differential assessment of the effects of active ingredients and preservatives in eye drops, the impact of previous ophthalmic surgeries, and the pro-inflammatory effects associated with recent glaucoma filtration surgery

Long-term use of topical hypotensive medications, particularly preservative-containing formulations, in glaucoma patients induces significant ocular surface alterations. The pathogenic mechanisms underlying these changes involve reduced tear production and tear film stability, goblet cell loss, upregulated pro-inflammatory cytokine expression, growth factor dysregulation, and cellular infiltration of ocular surface tissues. The resulting subclinical inflammation leads to unpredictable postoperative wound healing. These changes represent a critical link in the cascade of events leading to early subconjunctival fibrosis, which in turn becomes the primary cause of failure in filtration surgeries. This review evaluates current strategies aimed at improving long-term outcomes of glaucoma filtration surgery. The work examines critical aspects of preoperative ocular surface preparation, including surface-sparing medication regimens, the use of anti-inflammatory agents and artificial tears. Modern approaches to pharmacological modulation of postoperative wound healing are also reviewed, with particular emphasis on the role of antiinflammatory therapy.