PURPOSE: Study of changes in the posterior part of eyes predisposed to primary angle-closure glaucoma (PACG) that contribute to patient's conversion from risk group to the disease. METHODS: 135 patients (223 eyes) anatomically predisposed to PACG development (37-88 years old, 87 females, 48 males) were studied and monitored for 4 years. PACG diagnosis had not been verified previous to the study. 176 eyes were pair eyes of 88 patients; in other 47 cases only one eye of the patient was studied because PACG had already been diagnosed in the second eye. Apart from standard ophthalmological study all patients underwent ß-scan ocular ultrasound and prone-position provocative test for angle-closure glaucoma (Hyams test), during which the patients lay in prone position for 1 hour and IOP was measured before and right after the test. RESULTS: The eyes were divided into 2 groups depending on the Hyams test results: the 1-st group included patients with positive test results (IOP increase >5 mmHg) and the 2-nd group (risk group) - patients with negative test results (IOP increase <5 mmHg). Positive result of the prone-position provocative test was considered to be the main factor for PACG diagnosis verification in predisposed eyes. Patients with negative Hyams test results remained in the risk group without PACG diagnosis verification. Patients from the risk group were monitored without any treatment and re-examined every 6 months. In 31 patients Hyams test results were different in pair eyes: positive in one eye (1-st group) and negative in the other one (2-nd group). It is important to mention that Hyams test positive results were found in eyes predisposed to PACG only in cases of posterior vitreous detachment (PVD) - 67.7% of cases. In all cases with no PVD Hyams test was negative even if the patient had a narrow anterior chamber angle. The change of the prone-position provocative test results from negative to positive during follow-up (the transfer of predisposed eyes from risk group to the PACG) was found in 27 eyes. It happened in cases when PVD occurred during the monitoring process. CONCLUSION: A connection between PVD and change in eyes predisposed to PACG from risk group into real illness was found. We suppose that PVD disturbs the vitreoretinal adhesion and destabilizes the vitreous body position in the vitreous cavity. It can lead to vitreous body microexcursions in the direction of anterior chamber and lens-iris diaphragm displacement. This set of changes may provoke a hydrodynamic block development and lead to IOP increase.

PURPOSE: To conduct a comparative analysis of static perimetry and visual evoked potentials (VEP) informative value and to evaluate the significance of electrophysiological methods of investigation of visual functions in glaucoma and Alzheimer's disease. METHODS: The study involved 27 patients with Alzheimer’s disease (mild dementia) and 30 patients with various stages of glaucoma. The control group consisted of 35 patients without neurological and ophthalmic diseases. All patients underwent static perimetry on Humphrey Visual Field Analyzer. 15 patients in each group underwent pattern and multifocal VEP registration. RESULTS: Static perimetry in glaucoma patients revealed typical for this disease visual field defects that highly correlated with glaucoma stage. Visual fields study in the Alzheimer’s disease group had a low reliability and showed a rapid loss of attention. VEP study showed a statistically significant increase of P100 pattern in both study groups compared to the control group, and pattern (p<0.05). MfVEP latency in patients with Alzheimer’s disease was increased in all areas, except for R4, and only in the peripheral ring of R4-R6 in glaucoma patients (p<0.05). An average correlation between total central visual field sensitivity and P100 latency on pattern 0.3 (r= -0.68), as well as latency of central rings R1 (r= -0.69) and R3 (r= -0.61) in mfVEP has been established in patients with Alzheimer’s disease. A high correlation between total central visual field sensitivity and MD index with R6 peripheral ring latency (r= -0.82) and an average correlation of R6 latency with glaucoma stage (r=0.51) were obtained in glaucoma group. Central ring mfVEP R2 and R3 latency parameters (r=0.68) and latency in upper nasal quadrant (r=0,63) also showed an average positive correlation with glaucoma stage. CONCLUSION: Electrophysiological studies allow for an objective assessment of visual analyzer functional state in glaucoma and Alzheimer’s disease. VEP changes in Alzheimer’s patients confirm the visual pathway involvement in neurodegeneration. High correlations of VEP latency with static perimetry parameters and glaucoma stage allow recommending these studies to identify the disease at preperimetric stage and monitor it.

PURPOSE: To create an optimal scientifically based system of management of diagnosis and treatment process (diagnosis, follow-up, rational medication treatment, surgical treatment) in patients with primary open-angle glaucoma. METHODS: The final protocol of combined analytical research and clinical multicenter study conducted from July to November 2015 included data from 591 patients (824 eyes). Age, disease duration, disease stage, IOP level and visual field parameters during treatment and treatment regimens were analyzed. Regimen included various combinations of medical, laser and surgical treatment used in the disease management. RESULTS: Average patients' age at the time of diagnosis establishment was 64.3 (57.5; 70.4). Mean disease duration was 4.1 years (2.0; 7.1). The administered regimen was considered to be effective when IOP level was below 20 mm Hg. The IOP level between 21 and 25 mm Hg was considered to be a sign of reduced treatment effectiveness and need for change of the regimen. 8 regimen changes were analyzed in total, though 90% of cases had 1-5 regimen changes. The first three regimens were used for 1.2 (0.4; 2.6), 1.3 (0.5; 2.5) and 1.1 years (0.5; 2.4) respectively. B-blockers and prostaglandin analogues monotherapy was used as a first-line therapy in 40.1% and 20.8% of cases respectively. Treatment was started with combination therapy in 27.82% of cases. Proportion of surgical treatment was 9.9% in regimen 2 and achieved 73% in regimen 5. Laser treatment was started from regimen 3 though the frequency of administration did not exceed 20%. Combination treatment using 3 and more components was found starting from regimen 5 (57.3%). CONCLUSION: First line therapy choice is still not rational in many cases. Laser and surgical treatment are used ineffectively after 3-4 years from the diagnosis.

PURPOSE: To determine consistent patterns of structural and functional reorganization of the accommodative system in patients with hypermetropia during normal aging and hydrodynamic block formation. METHODS: The study included 110 patients with low and moderate hypermetropia (220 eyes), divided into 5 groups: young patients, mature patients, elderly patients without evidence of hydrodynamics disturbance, elderly patients with a functional angular block and elderly patients with macrophakia. In addition to the standard ophthalmologic examination all patients underwent ultrasound biomicroscopy, Scheimpflug imaging assessment and pupillometry. RESULTS: In young patients with hypermetropia the accommodation value depends on the state of the ciliary muscle and the size of the pupil. In patients of mature age the lens dimensions are increased by 15-20%, decreasing the angle of the ciliary body by 24-30%, and the acoustic features of hypertrophy of the circular portion of the ciliary muscle are also found. Accommodation value correlates with the thickness of the lens (r=0.53), the posterior chamber dimensions (r=-0.45) and the value of the ciliary body inner apex angle (r=-0.57), as well as IOP increase gradient after the load test (r=0.43). Normal aging process involves degenerative changes of the ciliary muscle and there is a strong correlation of accommodation reserve with IOP level (r=-0.81; p=0.001). When a hydrodynamic block occurs, the increase of the lens mass becomes critical, and hypertrophy of the ciliary muscle is preserved. Thus there is a change in configuration of the internal top of ciliary body and the decrease of apex angle in patients with functional angular block by 30-40%, while in patients with macrophakia it is decreased by 50-60%. Accommodation value in patients with functional angular block correlates with the facility of intraocular fluid outflow (r=-0.71; p=0.021) and in patients with macrophakia - with IOP level (r=-0.72; p=0.009). CONCLUSION: Accommodative system in young patients with hypermetropia is characterized by active participation of the ciliary muscles and pupillary diaphragm. In normal aging hypertrophy of the ciliary muscle is replaced with dystrophy. In patients with hydrodynamic blocks ciliary muscle hypertrophy phenomenon persists, the increase in the lens mass becomes critical, suggesting a disorder of accommodative response regulatory mechanism.

PURPOSE: To compare the diagnostic efficiency of 6 different computerized perimetric methods in patients with primary open-angle glaucoma (POAG) in an open comparative clinical research. METHODS: The study involved 52 patients (96 eyes) aged from 41 to 76 years old (average age 63 years) with POAG. Patients were divided into three groups depending on the stage of POAG: Group 1 included patients with mild (41 eyes), Group 2 - with moderate (36 eyes) and Group 3 - with advanced stages (19 eyes) of POAG. The control group consisted of 20 healthy persons (40 eyes) aged from 44 to 67 years old (average age 59 years). The patient examination included a standard ophthalmic assessment as well as computerized perimetry (CP) on Humphrey Visual Field Analyzer II (HFA II) 745i (Germany-USA), automated perimeters AP1000 («Tomey», Germany) and Pericom (Russian Federation), Micro-Perimeter MP-1 («Nidek Technologies», Japan), our modifications of Frequency Doubling Technology (FDT) perimetry and investigation of the multifocal Visual Evoked Potentials (mf VEP) as well as optical coherence tomography ОСТ RTVue-100 («Optovue», USA). RESULTS: FDT perimetry data demonstrated the same sensitivity (84%) as the HFA II ones (81%) and the greatest specificity (96%), the lowest variability of repeated results and the minimum testing time of one eye (1.5±0.04 min). Perimeters AP1000 and Pericom had lower levels of sensitivity (76/74%) and specificity (71/88%); the testing was longer (9.1±0.4 and 9.3±0.3 min). Data of MP-1 showed the high sensitivity (88%) and the lowest specificity (54%), the testing took place even longer (13.5±7.1 min.). The results of mf VEP had a quite high sensitivity (78%) and specificity (81%) and the maximum testing time of one eye (20.2±0.7 min.). CONCLUSION: To diagnose glaucoma, determine its stage and progression several methods of CP should be used. If it is impossible, it is necessary to repeat the same perimeter test a few times comparing perimetry data with the condition of the optic nerve head.

PURPOSE: To determine whether transient intraocular pressure (IOP) acute elevation alters optic nerve head structural parameters using spectral domain optical coherence tomography (SD-OCT). METHODS: Twenty-five eyes of 25 patients (aged 63-81) with wet age-related macular degeneration (AMD) were included in the study. Patients received anti-VEGF intravitreal injection for wet AMD. Ophthalmic examinations included visual acuity and autorefractor testing, slit-lamp examination, ocular biometry, fundus photography and angiography. IOP was measured using a rebound tonometer (Icare Tonolab®, Icare Finland Oy), optical coherence tomography (OCT) of the optic disс was conducted prior to and after antiVEGF injection. We measured horizontal and vertical cup disk ratio (CDR) and anterior lamina cribrosa insertion (ALI) in two perpendicular scans. Intravitreal injections were administered in the operating room by the same surgeon according to a standard technique. RESULTS: There was a statistically significant (p=0.004) increase of IOP level to 36.4 mm Hg (confidence interval 30.8÷44.1) immediately after the injection. There was a statistically significant widening of the horizontal CDR with its median increase by 20.0 pm (confidence interval 3.0÷25.0). Vertical CDR also underwent statistically significant changes, but to a lesser extent, the median increased to 12.0 pm (confidence interval 3.0÷22.5). The rest of the studied parameters remained unchanged. Findings on the perpendicular scan differed from the first one. While horizontal CDR expansion median increased by 28.0 pm (confidence interval 9.0÷40.0), vertical CDR, width of the Bruch's membrane opening and ALI did not change significantly. CONCLUSION: Transient intraocular pressure (IOP) acute elevation after anti-VEGF injections may cause changes in superficial optic disc structures without statistically significant reliable changes in lamina cribrosa.

PURPOSE: To study the effect of post-trabeculectomy adjuvant ranibizumab injection into the bleb area on hypotensive surgical efficacy. METHODS: 90 patients (90 eyes) with primary open-angle glaucoma were randomized into 3 groups of 30 each: patients in group I were injected with 0.05 ml (0.5 mg) subconjunctival ranibizumab into the bleb area on day 2 after the surgery, group II - on day 7, whereas patients in the Control group received no postoperative injections. Tonometry was conducted on the following day after the surgery, as well as on weeks 1, 2 and 1, 3, 6 and 12 months after the injection in groups I and II and after the surgery -in the Control group. Bleb characteristics were assessed on corresponding timepoints according to the Wurzburg bleb classification score. Bleb hyperemia was measured by means of specially designed software “Hyperemia-3". Complex ophthalmological examination including visometry, perimetry, and retinal tomography was conducted before trabeculectomy and 6 and 12 months after. Endothelial cell count was taken prior to the operation, 1 week and 1 month after to assess possible toxic effect of ranibizumab. The rate of postoperative surgical and medical interventions (needling, hypotensive therapy), absolute and qualified success rate, IOP level as well as the ability to reach target IOP, individual IOP (tolerable IOP, tIOP) and tIOP buffer zone levels were used as surgery outcome measures. RESULTS: Mean IOP median a year after trabeculectomy reached 12.9+1.8, 12.4+2.6 and 13.9+2.0 mmHg in groups I, II and Control correspondingly. Postoperative needling was required in 23, 37 and 50% of patients in the same groups, further hypotensive therapy - in 17, 20 and 27%. Absolute success in groups I, II and Control was achieved correspondingly in 80, 73 and 70% for target pressure, 50, 40 and 23% for tolerable IOP and 83, 73 and 67% for tIOP buffer zone, which showed the efficacy of ranibizumab injections, especially on day 2 after the surgery. Qualified success during the same period (93, 87 and 83% for target pressure, 57, 47 and 23% for tolerable IOP and 100, 87 and 83% for tIOP buffer zone) revealed a similar tendency. Bleb characteristics dynamics according to WBCS confirmed positive effect of ranibizumab injection on the bleb morphofunctional state compared to the Control group. Hyperemia index analysis showed a significant bleb hyperemia decrease after adjuvant ranibizumab, starting from the first day after the injection and reaching as much as 20% in difference with the Control group. Insignificant changes in endothelial cell count showed the absence of subconjunctival ranibizumab toxic effect 1 week and 1 month after the injection. CONCLUSION: Subconjunctival ranibizumab injections (0.05 ml, 0.5 mg) into the bleb area help increase postoperative success rates, prolong hypotensive effect, enhance bleb morphological and functional characteristics and subdue postoperative hyperemia. Injections on day 2 were superior in efficacy and had a more pronounced hypotensive effect to those on day 7.

PURPOSE: To evaluate the influence of treatment compliance and follow-up care on the glaucoma process progression rate. MATERIALS AND METHODS: Glaucoma process progression analysis was performed on 90 patients with primary open-angle glaucoma (POAG). All patients were divided into 3 groups according to their non-compliance level. Group A had a zero compliance level (no treatment, no follow-up care after the diagnosis). Group B included those having partial compliance (not complying with the treatment regimen in full). Group C consisted of patients who complied with the treatment regimen in full, whereas the doctor didn't observe POAG treatment standards. 160 eyes were analyzed. Glaucoma process dynamics was assessed according to structural and functional changes that occurred within the period between two consultations in glaucoma centre (41.55 months on average). RESULTS: The first consultation in glaucoma center indicated early or moderate glaucoma in most patients (66 out of 90). The second consultation marked a significant aggravation. 86 patients were diagnosed with advanced or terminal glaucoma which was caused by the lack of intraocular pressure compensation between the two consultations. Average progression rate in all groups was a stage per each 2.5 years. The patients needed complex medication and surgical treatment. However, developed structural and functional changes prevented visual function improvement. CONCLUSION: The conducted analysis showed a high glaucoma process progression rate related to varied noncompliance due to a lack of intraocular pressure compensation. Glaucoma process progression rate was higher in Group A and Group B and lower in Group C. However, it was still high in Group C which indicates equal responsibility of both the patient and the doctor during a longterm follow-up and glaucoma treatment.

PURPOSE: To assess the pharmacoeconomic effectiveness and profitability of different methods of primary open-angle glaucoma (POAG) neuroprotective therapy. METHODS: The study included 296 patients (530 eyes) with advanced primary open-angle glaucoma and compensated IOP. The patients were randomized into 5 groups. Group I consisted of 50 patients (89 eyes) who received only standard therapy course. Group 2 included 51 patients (95 eyes) who additionally received 10 mg (100 mg per course) of intramuscular polypeptides of cattle cerebral cortex (Cortexin) q.d. for 10 days. Group 3 comprised 65 patients (114 eyes), who along with standard medical treatment underwent percutaneous electrical stimulation of the optic nerve for 10 days. 60 patients (111 eyes) of Group 4 received subtenon injections of water-soluble polypeptide fractions of cattle retina (Retinalamin). Group 5 consisted of 70 patients (121 eyes) who received comprehensive treatment in 3 stages: 1st stage - standard therapy course together with intramuscular injections of polypeptides of cattle cerebral cortex for 10 days, 2nd stage - 10 day course of percutaneous electrical stimulation of the optic nerve, 3rd stage - subtenon injections of water-soluble polypeptide fractions of cattle retina. All patients before and after the treatment underwent a standard ophthalmic examination, including visiometry, tonometry, kinetic and static perimetry, ophthalmoscopy, electrophysiological studies (electric sensitivity threshold and electrolability determination). Economic profitability in comparison groups was estimated taking into consideration clinical effectiveness, consumer value and comfort. RESULTS: Patients in all groups marked a subjective improvement and improvement of visual acuity. Computer perimetry showed positive dynamics: expansion of peripheral visual field, reduction of paracentral scotomas size and depth. Electrophysiological examination results improved in all groups. CONCLUSION: Complex 3-stage comprehensive treatment method allows to increase the treatment efficiency for patients with non-progressive advanced open-angle glaucoma, improves vision prognosis and rehabilitation measures quality.

Glaucoma is a chronic optic neuropathy, characterized by ganglion cell loss and specific changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL). Early glaucoma detection plays an important role in preventing permanent structural damage development and irreversible vision loss. Glaucoma diagnostics is based on examination of structural damage to the optic nerve and visual functions evaluation. The results of ONH and RNFL clinical evaluation are subjective and can vary to a great extent. As a result, much recent research has been devoted to developing additional objective diagnostic methods, such as the use of confocal scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography for evaluating the OHN status. In order to provide early detection of visual field defects some researchers consider the possibility of replacing standard automated perimetry (SAP) with the selective automated perimetry, that includes the short-wavelength automated perimetry (SWAP) and frequency-doubling technology perimetry (FDT). This article presents a review of modern methods available for glaucoma diagnostics with emphasis on their clinical use.

The problem of clinical trials organization has become essential in the field of modern glaucoma surgery. The development of evidence-based medicine requires a high level of reliability of obtained data, which requires a comprehensive organization and statistic level. Publication of Guidelines on Design and Reporting of Glaucoma Surgical Trials by the World Glaucoma Association and introduction of CONSORT standards into this field became first steps to solve this problem. Glaucoma surgery specifics define requirements for clinical trials in this field. Surgery success and failure criteria have to be defined in a study design. Clinical examination methods in pre- and post-operative period have to be standardized for subsequent statistical processing of received data. Statistical analysis and data visualization are essential parts of a clinical trial. Any kind of received data has to be compiled and statistically analyzed to help define its scientific value.