PURPOSE: To investigate intraocular pressure (IOP) dynamics after phacoemulsification in patients with glaucoma.

METHODS: A total of 63 patients (65 eyes) planned for cataract extraction were included in the study and divided into 2 groups. The study group included 27 patients (28 eyes) with POAG and normalized IOP who used topical ocular hypotensive medications. The control group included 36 patients (37 eyes) without concomitant ocular pathology. Ophthalmological examination was conducted before the operation, a week later, and then at 1, 3 and 6 months after the operation. Corneal-compensated intraocular pressure (IOPcc), determined by means of dynamic bidirectional corneal applanation (ORA), was analyzed. In order to detect IOP circadian rhythm, the measurement was performed twice a day.

RESULTS: During the first 7 postoperative days about 30% of glaucoma patients showed an increase of the median intraocular pressure by 8.3 mmHg (initial IOP increase by 53%) which required amplification of local hypotensive therapy. In 45% of patients increased IOP in the early postoperative period was insignificant and was transient. It decreased by 1 month timepoint (after discontinuation of local anti-inflammatory therapy) and by the end of observation reached baseline levels. The remaining 25% of patients showed an insignificant IOP level change (≤1.5 mm Hg). In addition, changes in IOP, depending on the initial circadian rhythm, have been studied. In 44% of the control group patients IOPcc decreased by 15.9% compared to baseline in the early postoperative period. By the end of the observation the difference was 18.7%.

CONCLUSION: IOP level in glaucoma patients in the early postoperative period after phacoemulsification depends on the initial circadian rhythm. In the majority of cases IOP increase is transient. According to our data, 30% of patients show a persistant IOP decompensation requiring additional antihypertensive therapy. 

PURPOSE: To study the prevalence of geriatric syndromes in primary open-angle glaucoma patients of different age groups.

METHODS. The study involved 366 patients with I-IV stages of glaucoma, living in the Altai region and undergoing treatment in the Altai Ophthalmological hospital. 3 age groups were formed: Group 1 consisted of 104 middle aged patients (45-59 years), Group 2 included 164 elderly people (60-74 years), Group 3 comprised 98 senile patients (75 years and older). For the analysis of geriatric syndromes depending on the stage of the disease, patients were divided into two groups: the first glaucoma group had stages I and/or II (253 patients), the second glaucoma group — stages III and/or IV (113 patients). For the study of geriatric syndromes, we used the methodology of a specialized geriatric examination: we determined the degree of mobility, the degree of malnutrition (malnutrition syndrome), conducted an evaluation of cognitive and moral condition of the patient and the degree of independence in their daily life.

RESULTS: With increasing age there was an increase of general motor activity abnormalities: mild disorders were present in 26.9% of middle aged patients, in 34.1% of the elderly and 64.3% of senile patients; moderate degree of general motor activity impairment was observed in 5.8% of middle aged patients, 23.8% of the elderly and 50.0% of senile patients (p<0,05); a significant degree of general motor activity impairment was detected in elderly and senile patients (14.6 and 23.5%, respectively). A significant increase in the prevalence of malnutrition syndrome was observed in elderly and senile patients (39.0 and 28.6%, respectively) and in all of the patients with advanced glaucoma stages (second glaucoma group). The cognitive abilities in senile patients were significantly different from the cognitive abilities of middle aged and elderly patients. Satisfaction with life in senile patients (51.0%) was significantly lower compared to the middle aged and elderly (79.8 and 65.9%, respectively). When assessing the level of independence in daily life, we noted significantly higher levels of dependence in the elderly and the senile as well as in the patients of the second glaucoma group (advanced stages) compared to the middle-aged and patients from the first glaucoma group.

CONCLUSION: Based on these results, we believe that the presence of geriatric syndromes necessitates a special, complex, individual approach to the management and treatment of patients with primary open-angle glaucoma. 

PURPOSE: To determine pathogenic mechanism of alfaadrenergic agonists’ hypotensive action by brimonidine 0.2% administration in patients with open-angle glaucoma.

METHODS: 88 patients (age 69.1±7.25) diagnosed with mild open-angle glaucoma and with disease history of less than 1 year were included in the study. Patients were divided into two groups according to their drug regimen. Group 1 consisted of 12 patients (24 eyes) with brimonidine 0.2% instillations. Group 2 consisted of 76 patients (133 eyes) and was further divided into four subgroups. The 1st subgroup included 36 patients (66 eyes) with brimonidine 0.2% monotherapy; the 2nd subgroup included 18 patients (29 eyes) with a combined treatment with brimonidine 0.2% and prostaglandin analogues; the 3rd subgroup included 13 patients (20 eyes) with brimonidine 0.2% added to timololum 0.5%; the 4th subgroup included 9 patients (18 eyes) with brimonidine 0.2% added to dorzolamidum 2%. Patients of Group 1 underwent uveoscleral outflow examination and had the following coefficients calculated: general outflow facility coefficient (Cgen), uveoscleral outflow facility coefficient (Cuveo), aqueous humor minute volume (F). Hypotensive regimen efficiency action in Group 2 was measured by means of dynamic contour tonometry (Pascal tonometer, «SMT Swiss Microtechnology AG»).

RESULTS: In Group 1 intraocular pressure (Po) decreased to 17.5±4.01 mmHg (р=0.04) (by 28% from the initial level), Cgen increased up to 0.23±0.06 mm3 /min/mmHg (р=0.01) (by 35% from the initial level), Cuveo increased up to 0.12±0.02 mm3 /min/mmHg (р=0.01) (by 71% from the initial level), F decreased to 1.5±0.6 mm3 /min (р=0.04) (by 48% from the initial level). Only one patient on the group had intolerance to the drug. In Group 2 after 3 months of follow-up Po decreased from 23.2±4.92 to 16.3±4.64 mmHg in the 1st subgroup (by 29.7% from the initial level); from 23.4±3.84 to 18.2±4.83 mmHg (р=0.04) in the 2nd subgroup (by 22.2% from the initial level); from 23.3±3.19 to 17.2±4.53 mmHg in the 3rd subgroup (by 26.2% from the initial level); from 22.0±2.85 to 17.4±2.82 mmHg in the 4th subgroup (by 21.9% from the initial level). Brimonidine 0.2% was discontinued in 14 patients (15.9% of the total number of patients) due to various reasons (intolerance to the drug or insufficient hypotensive action).

CONCLUSION: Pathogenesis of α2-adrenergic agonists’ hypotensive action involves aqueous humor outflow increase by uveoscleral pathway and significant aqueous humor minute volume reduction. Hypotensive efficiency with IOP decrease by 24.6% was revealed in case of brimonidine 0.2% monotherapy. Additional reduction of intraocular pressure by 21.1% from the initial level was revealed in case of brimonidine 0.2% prescription in combination with other drugs. A more prominent hypotensive effect was revealed after 3 months of treatment compared to a 1 month treatment course. In most cases patients showed a high tolerability to brimonidine 0.2%. 

AIM: To compare the efficacy and safety of Prolatan in terms of hypotensive effect, dynamic changes in functional tests, and adverse reactions.

METHODS: 60 patients newly diagnosed with primary open-angle glaucoma (POAG) were randomized into two groups. In group 1 (n=36), Xalatan® once daily was prescribed. In group 2 (n=38), Prolatan once daily was prescribed. IOP (IOPcc) was measured using Reichert® 7 Auto Tonometer at baseline and week 2, 6, and 12. Functional tests (i.e., mean deviation, pattern standard deviation, RNFL Thickness, Rim Area, Disc Area, Cup Volume, and Average Ganglion Cell Complex Thickness) were performed at the enrollment and by the end of week 12. Adverse reactions were reported at every step.

RESULTS: 12-week treatment with Xalatan® and Prolatan resulted in IOP lowering by 30% and 31%, respectively, as compared with baseline level (P0). Maximum hypotensive effect was observed after 6 weeks (31% and 34%, respectively). By week 12, insignificant IOP rising (by 29% and 32%, respectively) as compared with baseline level was observed. Therefore, IOP-lowering efficacy of these agents is similar. By the end of week 12, visual acuity improved in Prolatan group (p<0.05) while mean deviation and pattern standard deviation improved in both groups (p<0.05). Average RNFL Thickness improved in Xalatan® group while disc area and average Ganglion Cell Complex Thickness improved in Prolatan group. In general, other parameters improved as well, however, these changes were less significant. After 2 weeks of the treatment, 2 patients of group I and 4 patients of group II complained of ocular discomfort and mild conjunctival hyperemia. By the end of week 12, none of these adverse reactions were reported. Neither systemic adverse reactions nor treatment discontinuation were reported.

CONCLUSIONS: Prolatan is similar to original latanoprost in terms of hypotensive effect and reduces IOP in POAG by, on average, 30% as compared with baseline level. IOPlowering effect is accompanied by indirect neuroprotection illustrated by the improvement of functional tests. This agent is characterized by minor topical adverse reactions. Prolatan may be recommended for POAG to reduce IOP. 

PURPOSE: Analysis of long-term results of cataract phacoemulsification combined with non-penetrating deep sclerectomy (NPDS) and lens capsule drainage.

METHODS: The study included 67 patients (107 eyes) with cataract and glaucoma. Mean patient age at the time of surgery was 64.3±8.1 (51-84) years. Standard ophthalmological examination was performed in all cases. BCVA before surgery ranged from light perception to 1.0 (0.44±0.12). Mean preoperative IOP was 26.4±3.9 (16 to 45) mm Hg. Mild stage of glaucoma was detected in 18 (16.8%) eyes, moderate stage — in 64 (59.8%) eyes, advanced stage — in 20 (18.7%) eyes and terminal stage — in 5 (4.7%) eyes. The number of topical hypotensive drugs in the preoperative period ranged from 1 to 3 (2.6±0.75). A combined surgical treatment (phaco + NPDS + lens capsule drainage) was performed. Follow-up was 15 to 17 (15.8±0.9) years.

RESULTS: By the end of the follow-up period average BCVA was 0.59±0.12, which is 0.15 higher than before surgery (p<0.05). Mean IOP was 17.8±3.1 (8 to 25) mm Hg, the difference with pre-operative parameters was statistically significant (8.6 mm Hg; p<0.05). On average, patients received 1.4±0.6 (0 to 2) hypotensive drug instillations, which is 1.2 less than before the operation, statistical trend is significant (0.05<p<0.1). Re-operations were needed in 22.4% of cases and included laser descemetogoniopuncture (7.4%), NPDS (9.3%) and ExPRESS drainage implantation (5.6%). The progression of glaucoma process in patients with IOP levels below the individual norm was observed in 35.5% of cases, and stabilization — in 64.5% (n=69), of which 37 patients (53.6%) — without the use of hypotensive drugs.

CONCLUSION: The article discusses a surgical modification of the classical non-penetrating deep sclerectomy combined with cataract phacoemulsification and lens capsule drainage. A 15-years follow-up analysis is presented. The proposed combined surgery may be recommended for use in clinical practice for treatment of patients with cataract and primary open-angle glaucoma.

PURPOSE: To conduct a comparative analysis of primary and repeated disability caused by glaucoma in the adult population of the Republic of Bashkortostan (RB) during the period of 2014-2015 compared to data from 2010.

METHODS: A retrospective comparative analysis of the reporting indicators used by the «Main Sociomedical Assessment Bureau in RB» FGA for 2014-2015 was conducted. Intensive and extensive indicators (disability structure in %) were calculated. The research data was statistically analyzed by means of Statistica software (version 6.0).

RESULTS: During the period of 2014-2015 in the Republic of Bashkortostan 1.48 and 1.98 people per 10 thousand respectively were primarily disabled due to the diseases of the eye and adnexa. In 2014 and 2015, 0.8 and 0.64 per 10 thousand people respectively had a primary disability caused by glaucoma. Glaucoma ranked first in the structure of new disability cases as a result of diseases of the eye and adnexa in Bashkortostan in 2015 — 43.2% (2014 — 40.3%). This figure increased by 11.9% in 2015 compared to 2010, when glaucoma ranked second (36.2%). In 2014-2015 glaucoma dominated in seniors in the structure of primary disability — 88.9%, the share of men exceeded women — 55.0 and 45.0% respectively (57.1% and 42.9% in 2014). The share of I degree of disability among newly disabled patients was 32.2% (2014 — 23.8%), II degree — 30.3% (2014 — 33.3%), III — 37.5% (in 2014 — 42.9%). In 2015 0.99 disabled per 10 thousand people were repeatedly examined due to glaucoma, in 2014 — 1.18. In 2015 80.7% among the repeatedly disabled were seniors, 14.9% — of working age and 4.4% — young people (2014 — 81.1%, 16.2% and 2.7% respectively). The share of people with I degree of disability in the structure of repeated disability caused by glaucoma was 34.7% (2014 — 39.2%), II — 32.9% (2014 — 35.7%), III — 32.4% (2014 — 25.1%).

CONCLUSION: The revealed pattern of disability caused by glaucoma, indicators of primary and repeated disability demonstrate the importance of problems associated with the disease and the necessity to strengthen measures for its early diagnosis, regular medical check-up and timely treatment of patients with glaucoma to prevent the disease progression and disability in patients. 

PURPOSE: To determine the efficiency of combining ExPRESS glaucoma filtration device and a hydro-gel drainage in secondary glaucoma induced by silicone oil emulsification in patients after vitrectomy.

METHODS: The study included 35 eyes (35 patients) with secondary glaucoma induced by silicone oil emulsification after surgery for retinal detachment with silicone oil tamponade. Preoperative intraocular pressure ranged from 27 to 43 mmHg on maximum hypotensive regimen. All patients underwent a modified implantation of ExPRESS shunt and a hydrogel drainage. Ophthalmologic examination before and after surgery was supplemented by ultrasound biomicroscopy and optical coherence tomography of the anterior segment of the eye. All patients were examined on days 1, 7, 15 and 1, 3, 6, 12 and 18 months after the surgery.

RESULTS: All operations were carried out without complications. Signs of inflammatory reaction were observed in early postoperative period. Hyphema was detected in 5 cases (14%), choroidal detachment — in 2 cases (6%). In early postoperative period hypotensive effect was achieved in all cases. IOP level on the first postoperative day averaged 10.3±3.4 mm Hg. After 6 months of follow-up the average IOP level was 15.7±4.1 mm Hg. After 18 months mean IOP equaled 20.7±5.3 mm Hg, and hypotensive drops were appointed in 23 cases. According to optical coherence tomography data, the intrascleral cavity had a linear profile, with unclear borders and parietal inclusions (emulsified silicone). A thin hydrogel drainage was visualized in the cavity, along which the aqueous humor outflow and emulsified silicone.

CONCLUSION: Application of ExPRESS glaucoma filtration device combined with a hydro-gel drainage in secondary glaucoma induced by silicone emulsification in patients with operated retinal detachment allows to achieve a more stable and pronounced hypotensive effect compared to a separate implantation of ExPRESS glaucoma filtration device. 

PURPOSE: To investigate a possible association between reduced thyroid function and primary open-angle glaucoma (POAG) development.

METHODS: A retrospective study included 71 patients (57 women, 14 men) in the POAG group and 76 patients (52 women, 24 men) in the control group. In the POAG group, the average patient age was 67.12±6.47 years and in the control group — 65.30±5.97 years (p>0.5). To evaluate the thyroid function, we assessed mean levels of thyroidstimulating hormone (TSH), free thyroxine (T4), anti-thyroid peroxidase antibodies and the endocrinologist’s report. Additionally, biochemical blood indicators were measured: levels of glucose, cholesterol, high and low density lipoproteins (HDL, LDL), and triglycerides (TG).

RESULTS: Mean level of free T4 in the POAG group was significantly lower (15.05±2.2 pmol/l) than in the control group (20.65±14.5 pmol/l). Endocrine disorders were more often diagnosed in the POAG group: nodular goiter was observed in 25.35% of patients compared to 15.79% of the control subjects, chronic autoimmune thyroiditis — in 11.27% of patients and 6.58% of the control subjects. Diabetes mellitus was detected 3.7 times more frequently in the POAG group (9.86%) than in the control group (2.63%). Levels of cholesterol and TG tended to be higher in the POAG group. In 70.4% of patients, the level of cholesterol was above normal (compared to 63.2% of the control subjects) and in 12.7% of patients the TG level was above normal (compared to 7.9% of the control subjects).

CONCLUSION: The results of our study suggest that hormonal profile changes in the thyroid gland can be associated with POAG development. Apparently, thyroid disorders may be considered as a potential risk factor of primary open-angle glaucoma development. 

PURPOSE: To study the character of clinical manifestations of ocular burns in patients with normal IOP and different acetylation phenotypes (APh).

METHODS: We examined 103 patients with ocular burns (141 eyes) during their primary visit to the Republican Clinical Eye Hospital of the Ministry of Health of Uzbekistan, on different time-points during therapy (on days 2, 5, 7, 12 after the beginning of treatment) and then during an active clinical examination 30 days and 4 months after discharge. 44 patients were examined 1-2 years after suffering a burn injury in order to identify the later post-burn complications and their interpretation according to the patient’s APh. 52 (69 eyes) patients out of 103 examined patients (141 affected eyes) had a slow acetylation phenotype (SA) and 51 patients (72 eyes) — a fast acetylation phenotype (FA).

RESULTS: The results of these studies allow us to assert that patients with SA phenotype develop deeper ocular burns, with eye tissue damages less prone to treatment than in FA patients, where less pronounced changes lead to faster process normalization. APh determines the course of the manifestations, their severity and risk of complications in ocular burns patients. Fast acetylation phenotype may serve as a prognostic marker of faster pathological changes regression in ocular tissues, whereas the slow acetylation phenotype suggests the development of more severe disease forms, often requiring a prolonged and complex therapy. 

Neuroprotective therapy is a contemporary and promising direction in glaucoma treatment. This strategy involves retinal protection, as well as the protection of optic nerve fibers from damaging by various factors. Cell therapy is gradually finding its practical application in almost all areas of clinical medicine, including ophthalmology. The positive effect of cell transplantation is associated with several mechanisms, including the trophic one and therefore, retinal cells metabolic stress correction is an important aspect of neuroprotection in glaucoma.

The review analyzes the current state of researching retinal ganglion cells as targets for glaucoma therapy and gives a general idea about the new approaches to the treatment of this disease with the use of cell technologies based on neuroprotection strategies. 

Trabeculectomy is a fistulizing glaucoma operation, now recognized as the «gold standard» for the surgical treatment of glaucoma. J.E. Cairns described it in the late 1960s, more than a hundred years after the glaucoma surgery itself has appeared. The operation technique proposed originally was significantly different from the contemporary one. Thus, initially the trepanation of Schlemm’s canal with hermetic suturing of the scleral flap was considered the main pathogenetic aspect. Later a big number of modifications by P. Watson, M.M. Krasnov, A.P. Nesterov and other researchers were developed, affecting almost every stage of the operation. Optimal properties of the conjunctival incision, scleral flap direction, size and method of its suturing as well as other elements of the operation were determined, and the aim of the operation itself shifted from the natural outflow renovation to creation of a filtering bleb. Afterwards, the operation was improved with new technical possibilities, including the use of cytostatics, viscoelastics and removable sutures. By now, the criteria of trabeculectomy as the «gold standard» of invasive glaucoma treatment are described in the «Murfield safer surgical system» of P. Khaw. If they are followed, the operation becomes a safe and effective method of treating glaucoma, equal to drainage and nonpenetrating surgery.

Postoperative scarring is one of the main reasons of glaucoma surgery failure. At different times it has been proposed to use various drainage implants, intra- or postoperative medications in order to prevent scarring. Mitomycin-C and 5-fluorouracil are widely used today for this purpose. These medications are effective in glaucoma surgery but often lead to severe complications. Nowadays investigations are being carried out in order to find a safer but not less effective substitution to them. Some foreign authors have proposed to use Cyclosporine-A (CsA) as an alternative. CsA selectively affects T-cells causing Interleukin-2 (IL-2) synthesis inhibition. IL-2 is one of the key inflammatory mediators triggering inflammatory cascade leading to fibroblast proliferation. The review deals with pathological bases of scarring after glaucoma surgery as well as possible methods of its modulation, provides results of investigations of CsA effectiveness and safety in glaucoma surgery.