PURPOSE: To assess retinal and optic nerve head morphometric parameters as criteria for efficacy of cord blood nucleated cells infusions for glaucomatous optic neuropathy treatment. METHODS: The study included 21 patients (27 eyes) with primary open-angle glaucoma (POAG) aged 38-80 years. Apart from standard ophthalmological examination all patients underwent optic nerve head (ONH) parameters and retinal nerve fiber layer (RNFL) thickness assessment by means of OCT (Stratus ОСТ 3000) and НRТ (“Heidelberg Engineering”). Research data was added to Microsoft Office Excel 2011 database (version 14.0.0) and sorted according to the study tasks. For each data sequence, the minimum and maximum were determined. Nonparametric statistical methods were used due to non-Gaussian value distributions. RESULTS: Comparison to a normative database revealed significant deviations of most ONH and RNFL morphometric parameters confirming POAG diagnosis. All patients had a para- and perifoveal inner retinal layers and RNFL thinning (р<0,001; Mann-Whitney test). All these parameters showed a statistically significant correlation with POAG stage. CONCLUSION: Neuroprotective therapy with cord blood nucleated cells infusions helps stabilize visual functions in glaucoma patients with progressive glaucomatous optic neuropathy. ONH morphometric parameters progression analysis is hindered in patients with advanced glaucoma. KEYWORDS: primary open-angle glaucoma, optical coherence tomography, optic nerve head, retinal nerve fiber layer, stem cells.><0,001; Mann-Whitney test). All these parameters showed a statistically significant correlation with POAG stage. CONCLUSION: Neuroprotective therapy with cord blood nucleated cells infusions helps stabilize visual functions in glaucoma patients with progressive glaucomatous optic neuropathy. ONH morphometric parameters progression analysis is hindered in patients with advanced glaucoma.

PURPOSE: To evaluate Prolatan effectiveness in groups of patients with risk of glaucoma progression. METHODS: We used Moriscos-Green/Blank clinical and psychological tests-scales of compliance to assess 190 patients with primary open-angle glaucoma (POAG). We revealed 57 out of 190 POAG patients (30%) to be insufficiently committed to their treatment. Among them were 22 (38%) women and 35 (62%) men with mean age 64.4±2.5 years. 18 (32%) patients were diagnosed with glaucoma within the last month before admission, while 39 (68%) patients had progressive glaucoma. All patients underwent standard ophthalmic examination and additional Humphrey standard automated perimetry (threshold 30-2 strategy) at baseline and after 3 months. RESULTS: Statistically significant non-compliance factors were the following: age over 60, male gender, POAG duration from 3 to 10 years, comorbid pathology, regimens comprising a large number of drugs, mild glaucoma, cognitive impairment and financial difficulties, hindering the purchase of medicinal products. On the average, Prolatan decreased IOP level by 33%. By the end of the 3rd month our study revealed retinal light sensitivity increase in all sectors of the visual field from 0 to 30 degrees due to IOP stabilization. CONCLUSION: Prolatan increases adherence to treatment by the end of the 3rd month of follow-up, which is associated with a reduction in the number of instillations, no side effects after instillation, patients’ good health during the treatment course, reduction of treatment material costs.

PURPOSE: To evaluate the efficacy and tolerability of travoprost 0.004%/timolol 0.5% fixed-dose combination (TTFC) in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) inadequately controlled on betablocker monotherapy. METHODS: In this phase IV, open-label study, 156 patients on beta-blocker monotherapy with mean intraocular pressure (IOP) between 18 and 32 mmHg were randomized (no washout period) to receive TTFC for 8 weeks (TTFC group) or to continue beta-blocker monotherapy for 4 weeks followed by TTFC for the remaining 4 weeks (beta-blocker group). RESULTS: The mean IOP at baseline in the TTFC and betablocker groups was 22.5±2.5 mmHg and 22.2±2.3 mmHg, respectively, and at weeks 4 and 8, was 16.7±3.1 mmHg and 16.1±3.1 mmHg, respectively, in TTFC group and 21.1±3.1 mmHg and 16.1±2.8 mmHg, respectively, in the beta-blocker group. There was a significant least squares mean difference between TTFC and beta-blocker in 8 a.m. IOP at week 4 (−4.6 mmHg; ????0.0001). Both treatments were well tolerated. CONCLUSION: Superior IOP control was achieved with TTFC in patients with OAG or OHT previously uncontrolled with beta-blockers. No new safety findings were identified.

PURPOSE: To study the effectiveness of laser reconstruction of the non-penetrating deep sclerectomy (NPDS) zone blocked by peripheral iris. METHODS: The study was based on the analysis of 95 cases (95 patients) of postoperative trabeculo-Descemet’s membrane (TDM) blockade with a part of peripheral iris: in 65 patients (65 eyes) — after NPDS in 30 patients (30 eyes) — after laser descemeto-goniopuncture (DGP). IOP level at the time of NPDS zone blockade diagnosis averaged 27.04±5.20 mmHg. All patients underwent laser reconstruction of the surgical zone, which included laser gonioplasty, iridectomy and, if possible, DGP. RESULTS: In 10 out of 65 cases of NPDS zone blockade, a suspension of formed elements was found in the anterior chamber fluid, in 3 of these cases patients presented with a 2 mm hyphema. In 27 cases (41.5%) NPDS zone blockade was not completely eliminated. On the 1st day after laser surgery, IOP decreased to an average of 17.34±3.50 mmHg. A 3 mm hyphema was observed in 2 cases of post-DGP blockade. Patients of the 2nd group had an average IOP level of 18.65±4.65 mmHg. It was possible to remove the operation zone blockade in 21 cases (70%), with 19 cases of partial and 2 cases of complete blockade. In other cases the blockade remained in more than 2/3 of the TDM length. CONCLUSION: One of the main predisposing factors of NPDS zone blockade onset is TDM perforation intraoperatively or during laser DGP.

PURPOSE: To determine the structure of patients’ costs for POAG treatment and costs at each stage of the primary open-angle glaucoma treatment by means of SLT. METHODS: The study included 130 POAG patients, who underwent SLT: 62 women and 68 men aged 42.2-86.0 years (66.1±1.3 years, M±m). All patients were the residents of the Orenburg region. All patients underwent standard ophthalmologic examination before surgery. Selective laser trabeculoplasty was performed using Quantel Medical Optimis with Solutis device. Control examinations were performed at 1 day, 1 month, 3 months, 6 months and 1 year after surgery. The data was processed with Statistica 10 software. RESULTS: The study determined the overall cost for patients on the expenditure side. It showed that the average amount of expenses of a full treatment course per patient amounted to 22 449.0 rubles, with the largest share of the cost related to SLT treatment and repeated diagnosis within 1 year after surgery. The indicator “Price of drops for 1 year” (4 159.0±302.8 rubles, or 18.53%) was the most variable. We also analyzed the cost parameters of conservative treatment after SLT at 5 time stages and structural-cost analysis of prescribed antihypertensive drugs. CONCLUSION: The variability of the cost characteristics of each stage of POAG treatment by SLT proves the presence of a variety of approaches to the treatment of patients, associated with their individual peculiarities. However, conservative treatment of patients, divided into 5 time stages, taking into account its cost and relevance at each stage of the treatment, takes the first place in the variability of cost characteristics.

PURPOSE: To conduct a comparative assessment of the effectiveness of non-penetrating deep sclerectomy (NPDS) and canaloplasty using the new GlauStent ophthalmic device and Glaucolight system in patients with primary open-angle glaucoma (POAG). METHODS: The study included 152 patients (177 eyes) with POAG of mild to advanced stages. Group I consisted of 57 patients (69 eyes), who underwent NPDS enhanced by the microperforation prevention method (patent 2595045). Group II included 45 patients (51 eyes) who underwent canaloplasty with Glaucolight device. Group III comprised 50 people (57 eyes), who underwent canaloplasty with the use of newly developed GlauStent device (patent N 162 617). RESULTS: During canaloplasty a cloudlike haemorrhage in anterior chamber aqueous humour due to blood reflux was detected in patients of Groups II and III in 52.9% (27/51) and 57.8% (33/57) of cases respectively. Maximum IOP decrease was observed immediately after the surgery. In patients with mild and moderate POAG stage IOP decreased by 67.6%, 72.2% and 73.5% in Groups I, II and III respectively. Whereas in patients with advanced POAG IOP level decreased by 70.4%, 68.05% and 66.4% in Groups I, II and III respectively. Relative hypotensive effect in patients with mild and moderate POAG stages by the end of followup period reached 77.7% (28/36) in Group I, 83.3% (25/30) in Group II, and 84.3% (27/32) in Group III. In patients with advanced stages of POAG relative success was achieved in 75.7% (25/33) and 71.4% (15/21) and 72% (18/25) of cases in Groups I, II and III respectively. CONCLUSION: The developed GlauStent canaloplasty ophthalmic device has a better Schlemm’s canal catheterization count compared to Glaucolight: 95% (57/60) vs. 85% (51/60). The developed method of protecting trabeculaeDescemet’s membrane reduces the risk of microperforation in NPDS. Canaloplasty for mild and moderate POAG provides IOP normalization in 84.3%, whereas relative hypotensive effect in advanced glaucoma patients amounted to 72% during 3 years of follow-up period.

PURPOSE: To assess the anatomical and topographic features of the trabeculo-descemet membrane when forming the outflow pathways of the intraocular fluid after nonpenetrating deep sclerectomy, and also to substantiate the indications and timing of laser descemetopuncture. METHODS: The effectiveness of antihypertensive laser goniopuncture was analyzed in 500 patients with primary open-angle glaucoma. Group 1 consisted of 250 patients (retrospective study), group 2 included 250 patients (prospective study). Clinical groups were comparable by gender, age, glaucoma stage and hypotensive therapy regimen. The follow-up period lasted for 3 years. All patients postoperatively underwent ultrasound biomicroscopy of internal fistula, intrascleral channel and filtering blebs by means of UBM-Hi (Opticon, Italy). The principal difference of the second clinical group was strict adherence to the technology of surgical stage of the operation (the height of the wave function was at least 0.8±0.09 mm), and to laser goniopuncture terms and technology. RESULTS: We determined optimal UBM-criteria of internal fistula: height — 0.8±0.09 mm, thickness — 0.09±0.004 mm. Performing laser goniopuncture 1-1.12 months after the surgery was justified in 100% of cases. In group 1 laser goniopuncture was conducted 3.4±1.9 months after the surgery. Intraocular fluid outflow pathways were functional in 59.6% 1 year after laser goniopuncture as compared to 24.8% after 3 years. In 2 group laser goniopuncture was conducted in 1.12±0.08 months. Absolute surgical success after 12 months amounted to 84.8%, and 60.4%after 3 years of follow-up. CONCLUSION: Regarding penetrating deep sclerectomy as a two-step procedure in all cases, strict implementation of the technology and time intervals between surgical and laser stages allows optimizing the morphogenesis of outflow pathways and increasing the hypotensive effect of the combined intervention.

PURPOSE: Retrospective analysis of intraocular pressure after phacoemulsification in POAG patients with initial medically normalized IOP. METHODS: We conducted a retrospective analysis of 60 case histories of POAG patients who underwent surgery for age-related cataract in the Scientific Research Institute of Eye Diseases during the period from 2013 to 2016 and developed a postoperative IOP elevation. The results of dynamic bidirectional pneumotonometry (Ocular Response Analyzer, USA) were used to study IOP dynamics in the operated patients. Corneal-compensated IOP parameters were analyzed. RESULTS: To identify the possible causes of postoperative ocular hypertension, patients were divided into groups depending on the course of both the operation and the postoperative period (complicated and uncomplicated), degree and duration of ocular hypertension as well as undertaken hypotensive measures. The first group included 50 patients, divided into 2 subgroups. In 30 patients (1A subgroup) I-II stage of POAG was diagnosed, and preoperative steady IOP compensation was achieved either by monotherapy with prostaglandin analogues, carbonic anhydrase inhibitors or β-blockers; or by fixed combination of drugs of the same pharmacological groups. IOPcc before the operation ranged from 11.1 to 21 mmHg with a median value of 15 mmHg. On the first day after the operation, a statistically significant increase in intraocular pressure of varying severity in patients of the first subgroup was registered, for which some patients (19 patients, 19 eyes) required an increase in local antihypertensive therapy. By the end of inpatient treatment IOPcc was normalized in all the patients, almost reaching the initial level. 1B subgroup included 20 patients with I-III stages of glaucoma, who required two or more local antihypertensive drugs for preoperative IOP normalization. Initial IOPcc values ranged from 17.7 to 24.1 mmHg with a median value of 20.8 mmHg. These patients developed a persistent increase in IOPcc after uncomplicated phacoemulsification, which required additional antihypertensive therapy. By the end of the treatment period, intraocular pressure in 9 patients was lowered to the initial values. The remaining 11 patients underwent glaucoma surgery at different times. The second group consisted of 10 patients with different stages of POAG, whose operation was complicated by postoperative inflammation and intraocular pressure decompensation. IOPcc values prior to phacoemulsification ranged from 15.5 to 19.3 mmHg with a median value of 17.2 mmHg. In the early postoperative period, these patients showed signs of inflammation of varying severity and an average IOPcc increase by 14 mmHg. In these cases we started systemic and local anti-inflammatory and dehydration therapy and increased local hypotensive regimen. With the above-listed measures, inflammatory conditions completely regressed, and intraocular pressure in these patients reached the baseline level by the end of the inpatient treatment. CONCLUSION: Glaucoma patients may present with IOP elevation in early postoperative period after uncomplicated phacoemulsification, which in most cases is transient. However, some patients may develop a persistent IOP decompensation, requiring additional antihypertensive therapy and/or glaucoma surgery. In cases of complicated phacoemulsification the severity and duration of ocular hypertension are defined, as a rule, by the rapidity of postoperative inflammation regression.

PURPOSE: To determine the degree of influence of different local hypotensive instillation regimens on the development and progression of corneal-conjunctival xerosis in patients with different stages of primary open-angle glaucoma (POAG). METHODS: 530 people (866 eyes) were included in a database study conducted from January to May 2016. The main group consisted of 398 patients with POAG, the control group included 132 people without POAG. The average age of patients was 68.45 (62.7; 74.5) years in the main group, and 60.9 (52.00; 68.8) years in the control group. Ophthalmic examination included tonometry, morphometric and functional analysis. Examination with the purpose to verify «dry eye» syndrome (DES) included tear film break-up time test (TBUT), Schirmer’s test, lissamine green staining and ocular surface disease index (OSDI) test. RESULTS: To determine the effect of different modes of local hypotensive drug therapy on the severity of DES symptoms all glaucoma patients were divided into two groups based on glaucoma duration: from 0.5 to 2 years (282 eyes) and from 2 to 4 years duration of glaucoma (275 eyes). To avoid problems related to differences in the average age in the main and control groups, comparative analysis was conducted in the age groups of 50-60, 61-70 and 71-80 years. The comparability of the results in both groups of patients was established. We established that maximum medication regimen was marked by a pronounced depression of functional indices of tears and tear film despite topical treatment duration. OSDI was significantly higher in patients who received prostaglandin analogues. It was established that the DES intensity was significantly higher in patients with advanced stages of the disease. CONCLUSION: The findings prove that ophthalmologists should consider the possible onset and progression of DES when they plan glaucoma medical treatment strategy.

PURPOSE: To evaluate the antihypertensive efficacy and safety of Brinzopt (Brinzolamide) in patients with POAG and in patients with transient postoperative ocular hypertension following phacoemulsification. METHODS: A total of 56 patients aged from 46 to 82 years (mean age 64 years) were enrolled. Group I included 20 patients (26 eyes) with newly diagnosed primary open-angle glaucoma, mainly the initial stages (the initial corneal compensated IOP (IOPcc) ranged from 21 to 25 mm Hg). Group II comprised 20 patients (23 eyes) with initial and advanced stages of POAG and decompensated IOPcc on prostaglandin monotherapy. Group III consisted of 16 patients (16 eyes) with reactive ocular hypertension ranged from 21 to 25 mmHg developed in the early postoperative period after senile cataract phacoemulsification. All patients received Brinzopt as monotherapy or in combination with previously used antihypertensive agents in one or both eyes twice daily at 12 hour intervals. Registration of the investigated parameters was carried out at the beginning of the study, and at intervals of 1 week, 2 weeks and 3 months under treatment. In addition to standard ophthalmologic examination patients underwent static perimetry on the Humphrey Visual Field Analyzer II (HFA II) 750i (Germany), ophthalmotonometry using dynamic ORA (Ocular Response Analyzer, USA) and optical coherence tomography (OCT) of the retina and the optic nerve head by means of RTVue-100 (Optovue, USA). RESULTS: Patients of the first two groups used Brinzopt during the entire follow-up period. In Group III Brinzopt instillations were cancelled by the end of the second month after the development of moderate hypotension against the background of reactive postoperative inflammation subsidence and corticosteroid withdrawal. Hypotensive efficacy of Brinzopt by the end of the follow-up period in Group I was 16.6%, in the second group — 13%, in the third group — 16.9%. CONCLUSION: Brinzopt is a safe, well-tolerated drug. It has a sufficient and fairly persistent antihypertensive effect as well as a positive influence on morphofunctional state of the optic nerve head and retina. It also doesn’t have a systemic effect and is comfortable for patients. The investigated drug makes it possible to achieve rapid and stable IOP normalization and enhance the abatement of reactive inflammatory process in early postoperative period after phacoemulsification in patients with symptomatic ocular hypertension.

The review presents data on ocular blood flow anatomy and physiology that is directly related to glaucoma pathogenesis. Specifics of the ocular arterial, venous and capillary vascular bed have been comprehensively examined. Differences in blood supply to different parts of the optic nerve have been pointed out with particular focus on the fact that the posterior ciliary arteries are the only source of blood supply to the prelaminar and lamina cribrosa zones of the optic nerve, as well as the major source of blood supply to the retrolaminar zone. The amount and location of posterior ciliary arteries are individual. Particular attention has been paid to the comparison of retinal and choroidal blood flow with an emphasis on the regulation of these two sources of blood supply to the retina and optic nerve. The characteristic of “watershed areas”, which explain the features of the visual field defects in glaucoma, has been given. Features of the hemato-ophthalmic barrier, in particular the role of retinal capillaries and the retinal pigment epithelium, have been discussed. It is pointed out that the blood-optic nerve barrier, which is strong in all zones of the optic nerve, is nevertheless permeable in the optic nerve’s prelaminar zone.

The article analyses literature data on experimental research on Retinalamin — a peptide complex extracted from animal retinal tissue. A series of cell culture based experiments established peptide bioregulators tissue specificity. Animal experiments conducted since 1988, identified the main effects of Retinalamin: neural induction activity, proliferative activity towards retinal cells and pigment epithelium, and protective action towards ganglion cells and their axons. Various concentrations in vitro had an effect on immunity parameters, platelet aggregation properties and fibrinolysis. A low-molecular plasminogen activator contained in Retinalamin may account for fibrinolytic activity stimulation. The investigated correlation between proliferative action and Retinalamin concentration and course duration indicates a sufficient efficacy of parenteral administration. Peptide bioregulators activity differed in cultivated retinal tissues of young and old rats with growth zone area being bigger in the young ones. The effect of Retinalamin on connective tissue processes may show promise for affecting sclera and cornea in glaucoma patients. Retinalamin membrane stabilizing effect on damaged cellular structures led to a reduction in integrity recovery time for the compromised epithelial, stromal and endothelial corneal layers. Our experiment established the safety of Retinalamin use, including cases of intravitreal administration. Animal experiments present a base for future clinical research planning and studies of possible ways of Retinalamin use in clinical practice. Available publications reveals its potential bioaccessibility in such pathologies as glaucoma, age-related macular degeneration and ocular trauma. The problem of increasing Retinalamin efficacy by delivering it directly to the target tissues still remains relevant.

We present a literature review of Russian and foreign studies on the specifics of the nervous system condition in glaucoma patients. The review demonstrates the possible influence of negative emotions, traumatic factors and stress state on the intraocular pressure (IOP) level and the pathogenesis of primary open-angle glaucoma. The article describes personality characteristics of glaucoma patients and especially their psychological response to the disease associated with loss of vision. We note most typical for these patients dysfunctional vegetative symptoms and astheno-depressive syndrome. Data on how cervical spine pathology can increase IOP level is cited. We gather research data confirming the positive effect of reducing sleep disorders in glaucoma patients on the course of the pathological process and the evidence of primary open-angle glaucoma similarity to such neurodegenerative diseases as Alzheimer’s and Parkinson’s. The study results confirm that glaucoma patients often suffer from officially recognized psychosomatic diseases. Consequently, psychotropic drug therapy, relaxation therapies and moderate physical activity may have a positive effect on the stabilization of glaucoma process. The article aims to convince practicing ophthalmologists that directing efforts on normalizing the state of higher nervous activity in glaucoma patients is pathogenetically justified and can maintain the desire of patients to comply with the doctor’s recommendation.