PURPOSE: To study the role of autoimmune inflammation of the orbit in the development of ocular hypertension in patients with endocrine ophthalmopathy (EOP) and Graves’ disease (GD). METHODS: 317 patients with GD and EOP were included in the study. All patients underwent endocrine and ophthalmological examination. Ophthalmologic study included visometry, perimetry, tonometry, ophthalmoscopy and exophthalmometry. Orbit structure was examined with the help of multispiral computed tomography. Endocrinological study combined measuring the levels of thyroid hormones, TSH and rTSH antibodies with thyroid ultrasound. The dynamic study was carried out during a one-year period of thyroid diseases (surgical and radioiodine therapy) and endocrine ophthalmopathy (38 patients, 76 eyes) treatment. Patients were monitored every 6 months or more often in cases of necessity (in patients with a highly active progressive ophthalmopathy). RESULTS: The disease activity score estimation in patients with ophthalmopathy revealed a close, direct and statistically significant connection between the ocular tonus and the inflammation activity index. The orbital inflammation activity had a direct correlation with the level of IOP. The distribution frequency analysis of different IOP indices in patient groups with low-, moderate-, and highly active forms of EOP showed that ocular hypertension develops more rarely in patients with low inflammation activity than in patients with a highly active inflammatory process (e.g. 3.3% versus 50%, p <0.001). In other words, half of the eyes with highly active forms of EOP had ocular hypertension (>25.0 mm Hg) on the first visit. In general, the ocular hypertension group was represented by 86.1% patients with orbital inflammation clinical activity score (CAS)≥3. The treatment with glucocorticoids led to a reliable decrease in the ocular tonus. Maximum therapeutic effect was achieved by a combination of intravenous pulse therapy and retrobulbar injections. CONCLUSION: A statistically significant direct correlation was revealed between the ocular tonus and inflammatory activity index. The endocrine disease treatment resulted in both the decrease in inflammatory activity in the orbit and a hypotensive effect.

PURPOSE: To assess the long-term efficacy of selective laser trabeculoplasty (SLT) in the treatment of pseudoexfoliative glaucoma (PEG) and primary open-angle glaucoma (POAG). METHODS: 75 patients with PEG (64 eyes) and 70 patients with POAG (63 eyes) were included in the study. The groups were homogeneous for age (69.67±0.93 years in PEG group and 65.63±0.33 years in POAG group, p = 0.09) and stages of glaucoma (MD -7.29±1.08 dB in PEG group and -5.95±1.12 dB in POAG group, p=0.39). Baseline IOP was 23.9±0.65 mm Hg in PEG patients and 21.4±0.44 mm Hg in POAG patients (p=0.002). The follow-up period was four years. RESULTS: There was a significant reduction of the IOP level in PEG patients after SLT as compared to the baseline at all stages of the study. By the end of the follow-up period the IOP was 19.00±0.97 mm Hg (p=0.023). A significant reduction of the IOP level in POAG patients occurred only during the first six months after surgery (IOP=18.92±0.46, p=0.000) and by the end of the follow-up period it was 20.8±1.13 (p=0.938). The amounts of topical ocular hypotensive drugs after SLT in the PEG group decreased from 1.69±0.107 to 1.45±0.092 (p=0.05), and in the POAG group - from 1.42±0.091 to 1.2±0.111 (p=0.137). There was no statistically significant progression of glaucomatous neuropathy in both groups: the MD index was not significantly changed in the PEG group during the follow-up period: -7.29±1.08 dB before SLT, and 7.6±1.36 dB in the late postoperative period (p=0.10), in the POAG group the index values were 5.95±1.12 dB and -6.63±1.28 (p=0.37) dB, respectively. CONCLUSION: SLT may be considered an effective and safe treatment for PEG patients, which not only significantly reduces the IOP level, but also helps preserve visual functions at least four years after the surgery.

PURPOSE: To study the efficiency of complex treatment of primary open-angle glaucoma (POAG), that includes histochrome application both intraoperatively in the course of trabeculectomy (STE) and combined with magnetic therapy in the early postoperative period. METHODS: 30 patients (age 69±1.6) diagnosed with POAG stages I-III with increased intraocular pressure were included in the study. Two groups were formed: main group comprised 15 subjects who underwent STE combined with histochrome application and magnetic therapy, while 15 patients of the control group underwent standard STE. All patients before and after treatment on the 10th day, after 1, 3 and 6 months were surveyed, including visometry, biomicroscopy, gonioscopy, ophthalmoscopy, tonometry, perimetry, the definition of critical frequency of flicker fusion and HRT. RESULTS: The following results were obtained in the control group: a more prominent decrease of intraocular pressure (from 27.7±0.91 to 14.4±0.93 on the 10 day and 17.2±1.2 6 months after surgery), a trend towards stabilization of visual acuity; widening of the field of view (from 426±31.7 to 487±25.3 1 month and 488±20.2 6 months after the surgery); improvement of the morphological parameters of the optic disc: Rim Area - from 0.996±0.10 to 1.187±0.10 after 3 months and up to 1.212±0.14 after 6 months of follow-up; Rim Volume - from 0.140±0.03 to 0.226±0.05 after 3 months and up to 0.260±0.09 after 6 months of follow-up; Mean RNFL thickness - from 0.126±0.03 to 0.157±0.03 after 3 months and 0.170±0.04 after 6 months of follow-up. CONCLUSION: Complex treatment of primary open-angle glaucoma (POAG), that includes histochrome application both intraoperatively in the course of trabeculectomy (STE) and combined with magnetic therapy in the early postoperative period, can improve visual functions and stabilize the glaucoma process in to the course of 6 months follow-up period.

PURPOSE: To evaluate the necessity of including the selective alpha-adrenergic agonist brimonidine in the complex drug treatment of primary open-angle glaucoma (POAG) patients with normal intraocular pressure. METHODS: 38 patients with different POAG stages were examined. The main group included 23 patients (29 eyes) aged 46-77 years, and the control group consisted of 15 pts (17 eyes) aged 48-79 years. Patients in the main group received brimonidine (Alphagan® P 0.15%, Allergan) as an adjunctive therapy to their baseline IOP-lowering regime according to the following instillation scheme: 1 drop 3 times a day with 8 hours interval. Patients from the control group received their baseline IOP-lowering regime. Total duration of the study was 24 months. During follow-up visits at months 1, 6, 12, 18 and 24 structural and functional clinical assessment was performed. RESULTS: Adjunctive therapy with brimonidine had a statistically significant influence on IOP level, decreasing it on average according to different measurement methods by 2.9-4.2 mm Hg. The analysis of the average statistical index sLV, that characterizes the inhomogeneity in the hill of vision, in the brimonidine therapy group showed a decrease in the number of relative defects of different depths (from 4.12 dB to 2.69 dB). OCT data analysis showed a tendency for an increase of retinal nerve fiber layer thickness in patients with early (from 0.25 to 0.27 mm) and advanced (from 0.19 to 0.21 mm) glaucoma stages in the brimonidine therapy group. CONCLUSIONS: The use of brimonidine in the complex treatment of patients with POAG as an adjunctive therapy to necessary topical IOP-lowering regime showed its positive influence on structural and functional parameters in eyes with glaucomatous optic neuropathy.

This paper presents the history of ophthalmoscopy development and establishment, emphasizes the necessity of using this method for diagnosing various eye diseases. The initial changes in the fundus can be crucial for establishing the diagnosis and monitoring them is essential for assessing the therapy effectiveness, defining surgical indications, as well as predicting disease progression in glaucoma patients. The article underlines the necessity of a detailed description of all the changes in the optic nerve head (ONH) and the surrounding tissue. In addition to describing we suggest making ophthalmoscopic sketches of the optic disc and retinal nerve fiber bundles, because in some cases a doctor can note and depict some changes in the fundus, that are not always well visualized later photographic images. The article describes basic principles of such methods as stereophotogrammetry, stereochronoskopy, stereochronometry, raster stereography and mentions diagnostic equipment available at different times on the ophthalmic devices market. Advantages and disadvantages of fundus photography are brought forward, as well as the techniques of confocal scanning laser ophthalmoscopy. Confocal laser scanning tomography, laser polarimetry and optical coherence tomography, which can be justly called the modern technologies, are described in this article along with a range of modern diagnostic equipment, necessary to perform these procedures. In this paper we present our own data and that of other researchers, both Russian and foreign, on how frequently ophthalmoscopy, sketching and fundus photography are used, and the application of modern methods of recording the state of the optic disc and surrounding structures. In addition to that we present the data from Russian and foreign guides and reference books on the application of various methods of recording the state of the fundus all over the world and standard frequency of performing these studies. The percentage of progression of various diseases is estimated according to ophthalmoscopy results. Finally, the paper underlines the necessity of using this technique in routine ophthalmological practice for diagnostic purposes, assessment of the disease dynamics and progression, making a correct choice of therapy and surgical indications in order to preserve the visual functions and patients’ quality of life.

PURPOSE: To evaluate the demographic makeup of polyclinic ophthalmologists, their qualification, patient reception organization and meeting dispensary observation standards. METHODS: Adult ophthalmologists working in Yaroslavl polyclinics were surveyed in May-June 2013. The questionnaire was developed by the Yaroslavl glaucoma department. The questionnaire consisted of three parts. The first part included questions covering the age, qualifications, workload and professional training. The second part covered glaucoma patient reception procedures and meeting the patient examination standards. The third part of the questionnaire related to doctors’ working conditions expectations. The survey was conducted anonymously. 29 ophthalmologists working in 15 municipal polyclinics participated in the survey. RESULTS: The average age of polyclinic ophthalmologists is 47 years old, all of them are female. The number of retirement age doctors (55 years old and over) exceeds the number of younger doctors (under 35 years old). For only 10 out of 29 surveyed the job in the polyclinic is the main one. All the others have either an extra job or extended hours in the main workplace. Work overload does not allow the doctors to participate in scientific society meetings and conferences, hence to receive up-to-date information on glaucoma diagnosis and treatment. Glaucoma consultation days and hours were eliminated in most polyclinics - 20 of the surveyed ophthalmologists could not allocate any special time to glaucoma patients. Only 7 out of 29 participants initiate the next appointment with their glaucoma patients. Despite the organizational problems, ophthalmologists try to keep up the glaucoma patient visit scheduling system mainly by phone of via a district therapist. The survey showed that glaucoma patients’ examination standards are not fully complied with. The main reasons named by the surveyed doctors were the lack of time allocated to each patient and poorly equipped consulting rooms. At the same time, the third part of the questionnaire showed that the doctors’ needs and expectations were realistic and feasible. Among them are a pay raise (the average salary expectation is 37 212 rubles), patient time allocation increase and up-to-date consulting room equipment. CONCLUSION: The results of the conducted survey helped identify some problems with polyclinic ophthalmologist professional profile: predominance of the retirement age employees, work overload, low salary, lack of motivation for professional development etc. The factors listed above decrease the quality of doctors’ work.

In order to improve the accuracy of glaucoma diagnostics, the use of the modern imaging technologies in routine practice has become necessary. Scanning laser polarimetry (SLP) is one of the widely-used modern imaging technologies. It was developed to measure the thickness of the retinal nerve fibre layer (RNFLT) around the optic nerve head, and to automatically compare the results with the corresponding normative database reference values. The method is based on retardation (slowing down) of the polarized illuminating laser light of the instrument along one axis (“slow axis”) by the birefringent retinal ganglion cell axons. Certain surgical interventions which involve the corneal tissue (such as LASIK) may have clinically significant influence on the corneal retardation, which may potentially lead to misinterpretation of the results. Since corneal refractive surgery has become a widely-used method to correct for ametropia, and many young people, who in future may develop glaucoma, undergo different types of refractive surgery, this issue gained great clinical significance. Following the introduction of GDx-VCC, the next generation of the GDx devices, the influence of corneal retardation became easily manageable, which helped to confirm that the virtual decrease of the post-LASIK polarimetric RNFLT was an artifact, and was not the sign of true RNFLT damage. Recently a new polarimetric software version (enhanced corneal compensation, GDx-ECC) was developed and investigated by different research groups for its ability to remove the LASlK-induced corneal retardation artifacts, proving the new method to be more accurate than GDx-VCC. It all led to a conclusion that since GDx-ECC is able to neutralize changes of corneal retardation induced by LASIK, this software may be even more suitable to long-term follow-up of eyes which undergo corneal refractive surgery.

The pathogenesis of glaucomatous optic neuropathy has been linked to the blood supply of the optic nerve, specifically within the prelaminar part of the optic nerve head. As the blood supply of this region comes from the peripapillary choroid, the choroid has been implicated in the pathogenesis of glaucoma. However, the relationship between choroidal blood flow and glaucoma has not been yet definitively established by means of histologic examination, angiography and Doppler sonography. The development of an enhanced imaging technique for spectral domain optical coherence tomography (SD-OCT) has allowed for reproducible measurements of choroidal thickness and measurements of choroidal thickness that are more accurate than previously possible. Therefore, the SD-OCT may be capable of documenting those particular changes in the choroid that relate to glaucoma. Several reports have been published about choroidal thickness within the macula and peripapillary area in glaucoma patients. However, the results of these studies are controversial. The relationship between choroidal thickness and ocular perfusion pressure as well as the role of the choroid in primary angle-closure glaucoma development are also discussed in this review.

Today glaucoma remains one of the main reasons of visual function loss all over the world, regardless of differences in social conditions and living standards in the country. Summarizing literature data on the structural distribution of glaucoma and its clinical forms, we can conclude that, firstly, the spread of the disease in different climatic regions across the globe has a mosaic pattern, and secondly, that the epidemiological characteristics of the disease in a particular area depend on multiple factors, including ethnic, climatic, social and economic. Blindness is not only a medical phenomenon; it has profound social and economic importance, and consequently has attracted attention not only in medicine, but also on the national and even international level. Various groups of experts developed recommendations for diagnostic and therapeutic measures to fight glaucoma-related blindness, conferences are being held worldwide, as well as special training for medical personnel. Unfortunately, despite these efforts, there still is a high prevalence of blindness in some countries. It is primarily related to the level of their socioeconomic development that impedes the country to take an adequate amount of preventive measures against blindness.