PURPOSE. To determine the clinical and epidemiological characteristics of patients with various forms of secondary glaucoma (SG) for prediction of its prevalence, assessment of the effectiveness of treatment strategies, and production of a model of a typical patient profile.

METHODS. This selective combined observational study was carried out in 24 ophthalmology departments across three countries from January to May 2024. A total of 409 patients with SG (409 eyes; 213 women, 196 men) aged 66 (57; 74) years were included.

Study patients were divided into 5 main groups in accordance with the form of SG: neovascular secondary to diabetic retinopathy — 58 eyes (14.2%); post-thrombotic neovascular — 83 eyes (20.3%); postoperative (after posterior segment surgery) — 97 eyes (23.8%); uveal — 83 eyes (20.3%); and phacogenic — 88 eyes (21.4%).

RESULTS. In most cases (66.7%), SG was diagnosed at advanced or terminal stages, which corresponded to higher intraocular pressure (IOP) levels. The median IOP was 32 (26; 39) mm Hg. The eyes were blind in 57.9% of cases.

The proportion of patients with SG hospitalized or examined on outpatient consultation ranged from 0.2% to 7% (mean 1.8%) of the total number of patients per year. Uveal and postoperative SG were more common in younger patients, while neovascular and phacogenic SG were more prevalent in older individuals.

Topical treatment for IOP included beta-blockers in 75.1% of cases, carbonic anhydrase inhibitors in 79.0%, and prostaglandin analogues in 30.1%. Combination therapy was prescribed in 48.2% of cases.

Surgical treatment was performed in 355 (86.8%) patients. The most frequently used surgical techniques were vitrectomy (24.9%), phacoemulsification (23.9%), and laser cyclocoagulation (11.5%), they were accompanied by a significant number of postoperative complications (36.9%).

CONCLUSION. Secondary glaucoma can have different forms, necessitating further investigation and potential revision of the current classification system. The disease is characterized by rapid progression and pronounced resistance even to aggressive treatment strategies, its management involves a variety of surgical approaches.

PURPOSE. To study the formation and progression of earlystage retinopathy (RP) under the influence of the age factor (AF).

METHODS. A statistical analysis was conducted on data from a prospective observational study (2008–2013) involving a natural cohort of 7959 initially healthy male members of locomotive crews (LCMs) of the Transbaikal Railway aged 18–66 years. The study assessed the formation and progression of degree I–II retinopathy (RP I–II) under the influence of AF. Multivariate analysis, 2×2 contingency tables, Kaplan– Meier models, and relative risk assessment were applied.

RESULTS. Chronological age showed statistical heterogeneity in mathematical models. Peculiarly, its significance varied across different models, revealing contradictory assessments. Thus, chronological years of life showed specific identification features of a trigger factor, allowing for their identification in the cell and further analysis of their effects.

CONCLUSION. The formation of RP varies significantly across different chronological ages, with each specific year of life acting as an independent trigger factor. When considering retinal aging processes within certain intervals of continuous AF, distinct differences may emerge. These findings show the need to identify specific (qualitative and quantitative ultrastructural and biochemical) markers of aging in the endothelium of the microcirculatory bed at different ages, which could help in restoring normal function of the cell and the affected organ as a whole — as long as the endothelial cell, as a target for therapeutic interventions, remains intact.

PURPOSE. To study the optical density and heterogeneity of perilimbal sclera and trabecular meshwork in individuals with and without open-angle glaucoma.

METHODS. The study included 49 patients (89 eyes), divided into two groups: the study group (45 eyes with open-angle glaucoma stages I–IV) and the control group (44 eyes without glaucoma). All patients underwent standard ophthalmological examinations recommended for glaucoma, as well as anterior chamber angle scanning in four quadrants using anterior segment optical coherence tomography (OCT). Parameters of optical density and heterogeneity of the perilimbal sclera and trabecular meshwork were analyzed.

RESULTS. In the study group, the optical density of the trabecular meshwork was higher in the inferior quadrant than in the control group, with a positive correlation to intraocular pressure (IOP).

The study group also exhibited lower heterogeneity of the perilimbal sclera in the temporal quadrant compared to the control group. A trend toward reduced optical density in the inferior quadrant as glaucoma stage progressed was observed. Changes in the perilimbal sclera did not correlate with IOP.

The optical density of the trabecular meshwork in the superior quadrant and of the perilimbal sclera in all quadrants negatively correlated with age. Meanwhile, perilimbal scleral heterogeneity in the temporal and inferior quadrants positively correlated with age, while in the temporal, superior, and inferior quadrants, it negatively correlated with axial length.

CONCLUSION. The optical density and heterogeneity of the perilimbal sclera and trabecular meshwork differ between normal and glaucomatous eyes. Specific parameters vary with glaucoma stage and correlate with IOP. Changes in the optical density and heterogeneity of these structures, as identified by OCT, are consistent with the histopathological findings, suggesting their potential use in clinical practice as predictors of the development and progression of open-angle glaucoma. Further studies on a larger cohort of patients are needed.

PURPOSE. To investigate the use of betamethasoneloaded bioresorbable drainage in patients with primary open-angle glaucoma undergoing fistulizing surgery to increase the stability of its hypotensive effect.

METHODS. The study included two groups of 50 patients (50 eyes): the main group underwent surgery using a bioresorbable polylactic acid drainage device loaded with betamethasone solution, while the control group received the same drainage device without betamethasone. Patients were examined at baseline, postoperatively, then at 1 and 2 weeks, as well as at 1, 3, 6, and 12 months. Interleukin-6 (IL-6) and interleukin-10 (IL-10) levels in tear fluid were assessed before and after surgery using enzyme-linked immunosorbent assay (ELISA).

RESULTS. At 1 year postoperatively, intraocular pressure (IOP) was significantly lower in the main group compared to the control group (15.48±1.74 vs. 17.52±2.25 mm Hg; p <0.05).

In the main group, IL-6 levels in tear fluid decreased postoperatively from 32.7 [0.0; 784.2] to 8.15 [0.0; 1031.2] pg/ml, remaining significantly lower than in the control group (p=0.026), whereas IL-10 levels remained unchanged. IL-6 levels in the control group did not change postoperatively. No significant differences were observed between the groups in IL-10 levels preoperatively (p=0.817) or postoperatively (p=0.029).

The superior hypotensive effect of the novel surgical approach was associated with greater filtration bleb height compared to the control group (0.71±0.20 vs. 0.57±0.13 mm; p=0.002), scleral cavity height (0.47±0.16 vs. 0.39±0.14 mm; p=0.015), and intrascleral cavity volume (3.58±1.51 vs. 2.07± 0.82 mm³; p < 0.001). The incidence and severity of postoperative complications did not differ between groups (6.8%).

CONCLUSION. The findings confirm the high efficacy and safety of glaucoma surgery using a bioresorbable polylactic acid drainage device loaded with betamethasone for primary open-angle glaucoma. ELISA results indicate that the use of this drainage method is associated with reduced postoperative inflammation.

PURPOSE. To assess the influence of major factors, including the type of surgical intervention, on the structural and functional state of the corneal endothelium.

METHODS. The study included 58 patients (61 eyes) diagnosed with primary open-angle glaucoma (POAG) who underwent three different types of surgical interventions: non-penetrating deep sclerectomy with implantation of the Reper-NN A2 device (22 patients, 23 eyes), implantation of the Ex-PRESS device (17 patients, 18 eyes), and modified sinus trabeculectomy (19 patients, 20 eyes). Endothelial cell density was assessed using the Tomey EM-4000 microscope before surgery and one month postoperatively. Additionally, the following parameters were considered: baseline intraocular pressure (IOP), the number of antiglaucoma drugs used before the surgery, and anterior chamber angle width as assessed with optical coherence tomography. The total follow-up period was one year, it included control examinations at each stage of the postoperative period.

RESULTS. Statistically significant (p < 0.05) but weak correlations were found between endothelial cell density and the studied parameters: a weak negative correlation with baseline IOP (r=-0.145), a weak positive correlation with the number of antiglaucoma medications (r=0.0032), and a weak positive correlation with anterior chamber angle width (r=0.05). A decrease in mean endothelial cell density was recorded in all studied groups one month after surgery. The most pronounced decrease was observed in patients who underwent sinus trabeculectomy.

CONCLUSION. Anatomical features of the anterior segment of the eye, drug history and the type of surgical intervention influence the postoperative state of the corneal endothelium. Although individual parameters do not demonstrate a significant relationship with changes in endothelial density, their combined effect may impair endothelial viability. These finding emphasize the importance of comprehensive preoperative assessment and individualized selection of surgical tactics, particularly in patients with initially compromised endothelium. When indicated, preference may be given to less invasive interventions to minimize the risk of endothelial decompensation.

The current gold standard of glaucoma surgery is trabeculectomy, which allows sustained reduction of intraocular pressure (IOP). However, trabeculectomy is relatively traumatic and is associated with a risk of specific complications. As a result, a number of devices for microinvasive glaucoma surgery have been developed, designed to create a hypotensive effect comparable to trabeculectomy, coupled with minimal surgical trauma.

Microshunt PRESERFLO™ (Santen) is a polymer microshunt that facilitats the outflow of aqueous humor into the subconjunctival space with the formation of a filtering bleb. It is implanted through a subconjunctival approach, typical for trabeculectomy, however, due to the controlled aqueous outflow it minimizes the risk of complications typical for glaucoma interventions.

Long-term (up to 5 years) efficacy and safety of PRESERFLO™ microshunt implantation have been demonstrated in a number of studies, including those comparing PRESERFLO™ with other surgeries. Meta-analyses comparing PRESERFLO™ and trabeculectomy show comparable efficacy of the interventions with a lower risk of complications in PRESERFLO™. Studies comparing PRESERFLO™ with similarly designed microshunt XEN (Allergan, Plc, Ireland) show that PRESERFLO™ is either equally or more effective.

This article provides an overview of devices self-measurement of (IOP) measurement devices, with a detailed analysis of transpalpebral tonometry techniques.

Glaucoma is a dangerous condition that can lead to blindness. Regular IOP monitoring is essential for disease management and assessment of treatment efficacy. Although IOP measurements are typically performed during ophthalmology visits, frequent in-office monitoring is not feasible for all glaucoma patients. In such cases, self-measurement becomes a vital alternative.

This review examines various devices that allow patients to measure their IOP without assistance. The following devices are discussed: Self-Tonometer, Proview Phosphene Tonometer, Ocuton tonometer, Tono-Pen and AccuPen devices, rebound tonometry devices iCare HOME and iCare HOME 2, the Triggerfish wearable IOP sensor (designed as a contact lens), and implantable sensors EyeMate IO and SC, as well as ballistic and dynamic transpalpebral tonometers. The article particularly focuses on Russian transpalpebral tonometry devices as a promising method available to a wide range of patients.

The main complication of glaucoma surgery is cicatricial changes in newly formed outflow tracts. This process leads to a repeated increase in intraocular pressure (IOP) and is the reason for a decrease in the effectiveness of glaucoma surgeries. In the cascade of successive stages of surgical wound healing, the inflammation phase is considered the most important. Reducing its severity and duration is the main goal of postoperative therapy, since excessive inflammation leads to the formation of scar tissues. In turn, its excessive suppression leads to the development of "ineffective resolution". In this case, the inflammation becomes chronic, and the next healing phase does not occur. For complete restoration of the damaged tissue architecture, the healing process must consistently go through all phases. The use of pro-resolving mediators can contribute to the correct completion of inflammation.

This review explores the physiological processes of restoration of the damaged tissue architecture, as well as the causes of cicatricial changes in the newly formed intraocular fluid outflow tracts.