PURPOSE:To compare the traditional morphometric characteristics of the neuroretinal rim and the new indicator «Bruch’s membrane opening – minimum rim width» (MRW) in the diagnosis of early primary-open glaucoma.

METHODS: The study included 82 people (82 right eyes, 25 women and 57 men). The main group (group 1) consisted of 45 patients (45 eyes) with the mild stage of primary openangle glaucoma, the control group (group 2) consisted of 37 healthy people (37 eyes). The research was conducted: Maklakov tonometry (10 g.), standard automated perimetry (SAP), contour perimetry (Heidelberg Edge Perimetry, HEP), the Heidelberg retinotomography (HRT) and spectral optical coherence tomography (OCT). The study examined the mean/global and sectoral morphometric parameters of the optic nerve disc: area and cup, the area and volume of the neuroretinal rim, the retinal nerve fiber layer thickness (RNFL) and the new indicator — MRW.

RESULTS: No statistically significant differences were found in the ONH and cup area groups. There was a ten- dency toward RNFL thinning in all sectors in group 1 patients compared to group 2, but statistically significant differences were found in the «classic» sectors: inferior and superior temporal, as well as in global values. Statistically significant differences were found in all sectors of the rim area/volume, except the temporal one. The greatest differences were found when comparing the superior temporal sector (p<0.00007; Z=3.96). The rim thinning of the in this sector are corresponded to the changes in the thickness of the RNFL detected above. The analysis of the characteristics determining the state of the minimum distance from the edge of the MRW established the reliability of differences in the superior temporal sector (p<0.04; Z=2.07), but at the same time, in other cases, statistically significant differences between the studied groups were not found.

CONCLUSION:The results of the study found that in the majority of cases, changes in patients with early glaucoma are found in the analysis of traditional rim parameters (area and volume), as well as in the study of the RNFL in the specific rim sectors. The study of a new index of the rim — MRW, has established its importance in the diagnosis of the early glaucoma, but so far only in the analysis of a limited number of rim sectors.

The article contains optical coherence tomography (OCT) assessment of patients with different stages of keratoconus. OCT method has previously been successfully used for diagnostics and monitoring of the optic nerve head (ONH) and retina condition in glaucoma. The morphometric changes of the eye fundus in primary open-angle glaucoma have been studied and described in detail. However, the potential of OCT assessment of ONH and peripapillary retina in keratoconus patients has not been previously realized, which defines the scientific novelty and relevance of the present study.
PURPOSE: To study morphometric changes of ONH, peripapillary retina and ganglion cells complex (GCC) in keratoconus patients by means of optical coherence tomography.
METHODS: All keratoconus patients underwent standard ophthalmological examination. Morphometric parameters of the ONH and peripapillary thickness of the retinal nerve fiber layer (RNFL) were studied by means of OCT. The complex examination also included computer assisted corneal topography, corneal OCT, ultrasound biomicroscopy, endothelial microscopy and other research methods.
RESULTS: The average age of the surveyed keratoconus patients was 28.43±0.89 years. Non-corrected visual acuity (NCVA) amounted to 0.39±0.04 (ϭ=0.33), best corrected visual acuity (BCVA) — 0.58±0.04. The average value of the corneal thickness was 459.19±4.55 µm, which is 1.1-1.2 times less than normal values. The true intraocular pressure equaled 11.35±0.07 mm Hg. RNFL thickness in keratoconus patients was more than 3 times lower than in healthy individuals of similar age. Keratoconus patients of all stages manifested with optic nerve cup enlargement up to 0.73 which allowed suggesting that keratoconus occurs in people suffering from undifferentiated connective tissue dysplasia. Echocardiography revealed heart indices changes in 70.9% (22 of 31) of surveyed keratoconus patients. Triplex scanning of the extracranial parts of the brachiocephalic arteries (ACUSON S2000 ultrasound scanner) found vascular changes in 41.9% (13 out of 31) of keratoconus patients. Fundus changes similar to those found in glaucoma patients were regarded as manifestations of pseudoglaucomatous optic neuropathy development due to a systemic connective tissue deficiency. These findings led to a new understanding of keratoconus pathogenesis and changes in diagnostic and treatment tactics.
CONCLUSION: OCT helped reveal morphometric changes of the ONH and peripapillary retinal nerve fiber layer in patients with different keratoconus stages, which define the scientific novelty of this research and change the idea of keratoconus as a pathology constrained to the anterior eye segment. We believe that corneoscleral changes in keratoconus eyes are only “the tip of the iceberg”, while the pathological process actually involves deeper structures — retina and the optic nerve.

PURPOSE: To analyze the influence of the anterior chamber angle pigmentation on the hypotensive effect of 0.005% of Russian latanoprost (Trilactan, “Solopharm”) in patients with primary open-angle glaucoma (POAG).
METHODS: The study was based on clinical and functional data of 120 patients (150 eyes) aged 42 to 87 years with primary open-angle glaucoma. The early stage of glaucoma was diagnosed in 102 (68%) eyes, moderate — in 36 (24%) eyes, advanced stage — in 12 (8%). Patients were divided into three groups: patients with treatment-naïve glaucoma; patients with a previously diagnosed POAG who received hypotensive therapy (β-blockers, or inhibitors of carbonic anhydrase); patients who received monotherapy with prostaglandin analogues for less than 2 months. Trilactan was administered once a day (at 8 pm). The hypotensive effect was evaluated after 1, 4 and 8 weeks. The observation period lasted 8 weeks.
RESULTS: The intraocular pressure reduced by 30% from the baseline level of tonometric intraocular pressure (IOP). On the 4th week of observation the hypotensive effect reached 32%, as an additional drug up to 20%. There was no statistically significant dependence between hypotensive effect and the anterior chamber angle pigmentation grade.
CONCLUSION: Trilactan showed hypotensive effect both in monotherapy and in combination with other antihypertensive drugs, comparable to the original drug. The effect of prostaglandin analogues on the condition of the trabecular meshwork, and an improvement of trabecular outflow seem promising for further studies.

PURPOSE: To evaluate the efficacy of trabeculectomy with Glautex drainage implantation in children with uveitic glaucoma (UG).

METHODS: We analyzed the results of trabeculectomy with Glautex drainage implantation in 11 children with UG aged 4-15 years, including 4 children who already previously underwent glaucoma surgery.

RESULTS: Qualified success rate 3, 12 and 24 months after the surgery (with and without hypotensive medications) amounted to 72.7, 54.5 and 45.4% respectively, absolute success — to 36.4, 27.3 and 27.3%. IOP decompensation in all cases was caused by excessive wound healing in the filtering bleb area. All patients with long-term glaucoma compensation Glautex drainage implantation was the first glaucoma surgery they underwent, and the efficiency of repeated operations was lower than that of primary ones. There were no significant differences in the efficacy of operations in phakic eyes and in cases of artiphakia or aphakia. The results also showed no clear dependence on systemic immunosuppressive therapy or lack thereof, and on uveitis etiology (rheumatoid, idiopathic). Postoperative adverse effects included 1 case of drainage eruption through the conjunctiva 3.5 weeks after the operation with conjunctival healing after the removal of the exposed drainage fragment followed by topical medical treatment, and 1 case of flat ciliochoroidal detachment, which reversed after medical treatment.

CONCLUSION: Trabeculectomy with Glautex drainage implantation, especially if performed as a repeated hypotensive surgical intervention, is not effective enough in children with UG due to extremely intense excessive scarring in extrascleral and scleral areas of the surgical site. Further research is needed to find effective methods of surgical treatment and excessive proliferation prevention in children with UG.

PURPOSE: To study efficacy and safety of endoscopic laser cycloplasty in treatment of patients with angle-closure glaucoma with plateau iris.

METHODS: The study included 15 patients (23 eyes) with angle-closure glaucoma with plateau iris, 13 women, 2 men. Mild glaucoma was diagnosed in 24.7% of cases; moderate — in 34.8 %; advanced — in 30.4 %. Mean age was 69.1±8.7 years. Intraocular pressure (IOP) level before surgery with medical therapy ranged from 17 to 30 mm Hg (mean of 22±3.4 mm Hg). Mean number of hypotensive instillations used by the patients — 3.1±1.8. During the postoperative period all patients underwent tonometry, tonography, anterior segment OCT and ultrasonic biomicroscopy (UBM). Follow-up period was 3 months.

RESULTS: All patients had an improvement of visual acuity during the postoperative period. In all cases we observed a decrease in IOP from 22±3.4 mm Hg (before surgery) to 19.3±2.2 mm Hg (in 3 months) and an increase of the aqueous humor outflow facility coefficient from 0.18±0.06 mm3/min⋅mm Hg (prior to the surgery) to 0.34±0.05 mm3/min⋅mm Hg (in 3 months). According to OCT data in 3 months, the anterior chamber angle remained open with a mean width of 32.6±3.5 degrees. UBM results showed an increase in morphometric values of the anterior chamber angle with a reduction in ciliary processes length from 512.1±118.6 µm before surgery to 403.3±112.4 in 3 months.

CONCLUSION: Endoscopic laser cycloplasty in all the cases allowed for IOP reduction without hypotensive therapy and glaucoma progression halt due to opening of the anterior chamber angle and eliminating risk of IOP increase. 

By now, a number of high-tech precise examination methods exist, allowing for a reliable detection of structure and function changes in the optic nerve. They allow performing early glaucoma diagnostics and detecting changes during follow-up. However, the problem of developing comparable criteria of morphofunctional changes according to the data from modern examination methods, usable in clinical practice for patient management, remains a pressing issue.

PURPOSE: To detect and to evaluate additional morphologic and functional criteria of glaucoma stabilization with intraocular pressure (IOP) compensation and neuroprotective therapy use.

METHODS: 27 patients (27 eyes) with moderate and advanced glaucoma stages and compensated IOP were enrolled in the prospective cohort study. The patients underwent a course of Retinalamin treatment (10 intramuscular injections with a second subsequent course after 6 months). Alongside a standard ophthalmologic examination, standard automated perimetry (SAP) (Humphrey Visual Field Analyzer II 750i, Germany), measurement of corneal compensated IOP and biomechanical properties of fibrous eye layer (Ocular Response Analyzer, «Reichert», USA) with consequent evaluation of biomechanic tension, examination of visual cortical potentials (EP-1000 Multifocal «Tomey», Germany) and an ultrasound examination of optic nerve hemodynamics (Voluson 730 РRО, «Kretz», Austria) were performed. The data was statistically analyzed.

RESULTS: We observed normal levels of corneal compensated IOP (11.3-16.9 mmHg) and biomechanic tension coefficient (0.70±0.08) in all patients. SAP data during the course of Retinalamin therapy (except the statistically insignificant changes of photosensitivity) was generally stable. Patients with moderate glaucoma presented with an average photosensitivity increase by 200 dB (8.2%). Electrophysiological studies showed a statistically significant decrease of P100 main component latency and an increase of response amplitude to 1.0° and 0.3° patterns. In most cases ultrasound extraocular hemodynamic examination detected a blood flow enhancement, which was, however, statistically insignificant. The results of blood flow examination correlated with SAP and confocal ophthalmoscopy data.

CONCLUSION: SAP results show positive dynamics of vision functions in patients with glaucomatous optic neuropathy after Retinalamine administration. SAP data conforms to changes in visual cortical potentials. Considering the objectiveness of the method, it can be recommended for vision function dynamic evaluation, especially when SAP is impossible to perform. Duplex ultrasound study of extraocular vessels data correlates with SAP results. This method can also be considered reliable in glaucoma diagnostics.

PURPOSE: To demonstrate the results of conservative treatment for secondary ocular hypertension associated with silicone oil (SO) 5000-s tamponade of the vitreal cavity (VC).
METHODS: We conducted a retrospective analysis of conservative treatment for ocular hypertension associated with SO 5000-s tamponade of the VC in 45 eyes (45 patients). Patients’ age ranged from 28 to 75 years: 22 males (49% of 45 patients), 23 females (51% of 45 patients). Among them 16 patients had high myopia (35% of 45 patients), 17 patients (38% of 45 patients) had moderate myopia, 8 patients (18 % of 45 patients) had mild myopia, 4 patients (9% of 45 patients) had emmetropia. All patients had previously underwent an operation for rhegmatogenous retinal detachment (primary and recurrent) with VC tamponade by means of silicone oil 5000-s. The tamponade duration was 3 months or more.
RESULTS. In 33% of cases (15/45) we noted an intraocular pressure (IOP) increase during the first 48 hours after the insertion of SO 5000-s into the vitreal cavity, in 27% (12/45) — within the 1-4 months timeframe, in 24% (11/45) — 4-6 months, in 16% (7/45) — 6-12 months. IOP fluctuation range was 19-32 mm Hg. The first hypotensive regimen (1) included instillations of fixed combination brinzolamide/ timolol twice daily and sufficiently decreased IOP level in 27 patients (60% of 45 patients; IOP range 14-19 mm Hg). The second regimen (2) included additional instillations of brimonidine 0,15% 3 times per day and lead to IOP normalization in 11 more patients (24% of 45 patients; IOP range 15-20 mm Hg). Patients with persisting IOP decompensation had a further regimen enhancement. The third regimen (3) also included latanoprost 0.005% solution instillation once daily in the evening. IOP level normalization was achieved in 6 patients (14% of 45 patients; IOP range 17-19 mm Hg). One patient (2%) had to undergo a glaucoma operation. Out of 16 high myopia patients, 4 patients reached IOP compensation due to the first regiment, 7 patients — the second regimen; 4 patients — the third regimen, 1 patient — to the glaucoma operation.
CONCLUSION: IOP compensation by means of conservative treatment was effective in most cases (98% of 45 patients). In one case (2% of 45 patients) of persisting IOP decompensation glaucoma surgery had to be performed. The highest IOP level was noted in high myopia patients; they needed a more intensive hypotensive regimen than patients with other kinds of refraction.

PURPOSE: to study glaucoma incidence in the Stavropol region (SR), the North Caucasian Federal District (NCFD) and the Russian Federation (RF) over the 2007-2016 period.
METHODS: The official statistical materials of the Ministry of Health of the Russian Federation and Central Research Institute of Organization and Informatization of Health Care of the Ministry of Health of the Russian Federation and the data of the Medical Information Analytical Center of Stavropol region were analyzed during the research. We calculated the level of general and primary incidence per 100 thousand population and the share of glaucoma in the structure of eye diseases. Indicators of the general and primary disease incidence in the Stavropol region in comparison with similar indicators in the North Caucasian Federal District and the RF in 2007-2016 were analyzed. The parameters of glaucoma monitoring per 1000 population were calculated and the data of disability on glaucoma in the Stavropol region for 2013-2017 was analyzed.
RESULTS. General incidence of glaucoma in Russian adult population increased by 24.3%, while primary incidence of glaucoma increased by 11% in comparison with 2007. These indicators were stable for six years (2011- 2016) among the population over working age (fluctuation range — 2.2-4.9%). During the ten years general incidence of glaucoma in adult population of the NCFD was increased by 33% and the primary incidence was decreased by 14.5%. In NCFD among the population over working age the number of cases of general and primary incidence of glaucoma over the six years was increased, respectively, by 4.5% and 4%. In the Stavropol region, the annual incidence rates of glaucoma fluctuate. Peak indicators for the UK in the period under study were registered in 2012, the total incidence of the adult population was 16 443 (735.3 per 100 thousand population), the primary incidence of the adult population was 1 966 cases (87.9 per 100 thousand population). In the Stavropol region there was a low rate of glaucoma patients monitoring. A growth of surgical activity was also identified in the region. Disability due to glaucoma in the SR reached 21.5%, being the second most frequent visual disability cause in the region (2016).
CONCLUSION: Glaucoma epidemiology aggravated during the last ten years in Russia. The share of general and primary incidence of glaucoma among the eye pathology in Russia has steadily increased during the selected period. The NCFD showed the lowest incidence of glaucoma among all federal districts of Russia. The incidence of glaucoma in the Stavropol region had a variable and unstable character.

This review summarizes the concept and value of diurnal and 24-h intraocular pressure (IOP) monitoring and its role in the management of glaucoma. The IOP in healthy persons and glaucoma patients is generally evaluated in single/double IOP measurement during clinic hours, although IOP varies over the course of 24 hours. However, in many cases, the IOP peaks outside clinic hours. Several studies documented the association between IOP peaks and visual field decline in primary open angle glaucoma patients, but the role of IOP fluctuations is still debated.

Current and future technologies for measuring IOP over a 24-h period are discussed and available evidence on the 24-h efficacy of medical, laser and surgical strategies for glaucoma treatment is evaluated. Several controlled trials have significantly enhanced our understanding of the 24-h efficacy of various glaucoma therapy options and have shown that glaucoma therapies differ in their ability to lower IOP throughout the 24-h cycle.

More long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the influence of IOP parameters on glaucoma progression and visual prognosis.

Glaucomatous optic neuropathy in some cases is known to progress despite effective hypotensive therapy. It might be explained by an underlying pathogenic mechanism of neurodegeneration that unites multiple involution-related diseases, such as Alzheimer’s, Parkinson’s and others. Despite differing etiology and clinical picture, they are all united by several common features characteristic of involution-related diseases: age-related morbidity increase, general lack of symptoms at the onset, progressive function deterioration and genetic predisposition. Neuron death in all degenerative diseases including glaucoma follows a common apoptosis mechanism, characterized by the following underlying mechanisms: neurotrophic factor deprivation, excitatory amino acids level increase, oxidative stress and neuroinflammation. This review presents current data on axonal and transsynaptic neurodegeneration, oxidative stress and glutamate exitotoxicity as leading components of the pathological glaucoma process and main targets of neuroprotective therapy.

The article reviews the problem of treatment non-adherence in patients suffering from various chronic diseases, including primary glaucoma. Non-compliance with the drug regimen inevitably leads to the progression of the disease and serious complications up to a lethal outcome (in case of glaucoma — to blindness), reduces patients’ quality of life. The article reveals a high degree of non-compliance in patients with different somatic pathologies and how doctors tend to underrate this problem.

The increase in life expectancy and the gradual aging of the population lead to an increase in the number of chronic diseases. This aggravates the problem of non-adherence to treatment due to the increase in the number of prescribed drugs, their side effects, cost, as well as cognitive impairment associated with age changes.

The article analyzes terminology specifics used in the domestic and foreign literature. The reasons for the low level of adherence, as well as possible ways to improve it, including using modern technologies, are recounted in detail. It also notes the importance of the joint work of the doctor and the patient aimed at the treatment quality improvement.