OBJECTIVE: To develop the probability model of glaucoma development based on the characteristics of regional hemodynamics, clinical, structural and functional characteristics of the eye globe with simple primary and pseudoexfoliative open-angle glaucoma (PEG, POAG) and ocular hypertension (OH).

METHODS:The work was carried out in the period from 2011 to July 2017, the data of analytical, observational case-control studies was analyzed. According to inclusion and non-inclusion criteria, out of 1370 patients under our observation we picked 290 patients (540 eyes) with POAG, PEG and OH, as well as healthy people for control. Among the examined patients there were 243 (83%) women and 47 (17%) men. 140 (25.9%) eyes of patients diagnosed with POAG and aged 69.7±9.0 years (64.1-76.1) comprised the first group of patients. PEG was detected in 104 (19.2%) eyes (age — 70.2 (67.1; 76.6); 71.2±6.6 years) were included into the 2nd group of patients. Ocular hypertension was established in 116 eyes (21.5%) (age — 64.3 (60.1; 686); 64.3±8.4 year) — the third group of patients. The fourth group (control) included healthy people, 125 (23.1%) eyes (age — 63.6 (58.7; 68.6); 63.7±8.3 years). In a separate group of unilateral PEG, contralateral eyes were diagnosed with one-sided PEG — a total of 55 eyes (10.3%) (age — 69.6 (65.4; 75.0); 70.2±7.3 years).

RESULTS: Based on the obtained structural and functional data, and data from regional hemodynamics, a regression model was constructed that predicted the development of glaucoma.

CONCLUSION: Сonvincing data of the difference in the characteristics of regional hemodynamics were obtained depending on the diagnosis, in the following vessels: OA, CRA, choroid from the temporal side. At the same time, the blood flow velocity in the CRA and the choroid in conditions that threaten the development of glaucoma OG 

and unilateral PEG can act as a predictor of the transition from a healthy state to a glaucoma state and be regarded as a compensatory mechanism that prevents the development of glaucoma. Inclusion of regional hemodynamics
in the glaucoma prediction model allows diagnosing glaucoma with high accuracy (sensitivity and specificity up to 83.8%). The created probability calculator glaucoma allows you to diagnose glaucoma with an accuracy of 79.9%.

Current methods of intraocular pressure (IOP) measurement cannot always deliver reliable data. Therefore, creating a new objective tonometry method is a relevant objective.

PURPOSE: To develop a confocal optic system for cornea probing by polarized light. To explore the luminescence polarization, emitted by rabbit cornea ex vivo, induced by polarized radiation depending on IOP.

METHODS: An enucleated rabbit eye was fixated in the holder with the system of IOP setup and maintenance. The local photoluminescence of the cornea was initiated by polarized radiation of diode laser with 405-nm wavelength. Photoluminescence spectrums measurement was performed by confocal Raman microscopy. To measure the co- and cross-polarized photoluminescence components, a polarization filter was directed parallel or perpendicular to the polarization vector of excitation radiation. The photoluminescence spectrums were measured with IOP of 20, 40 and 60 mmHg.

RESULTS: The spectrums of polarization degree corresponding to IOP values of 20, 40 and 60 mmHg were obtained. IOP change in the range of 20-60 mmHg did not produce any significant change of luminescence polarization specters.

CONCLUSIONS: No reliable change of measured specters was detected during the IOP change.

The “classical” scheme of prescribing regimens to patients with newly diagnosed primary open-angle glaucoma (POAG) implies initial monotherapy treatment, which is practiced in patients with any stage of the disease. This in turn implies a consistent strengthening of regimes.
Thus, the “modern” clinical algorithm practically excludes the possibility of initial treatment with combined medicines, laser treatment or conventional surgery. At the same time, differentiated («stepwise») approache used in other disciplines makes it possible to achieve control over the disease with the use of the smallest, but sufficient amount of medicines (regimens), depending on the stage of treatment, intraocular pressure (IOP) compensation and stabilization of the glaucomatous optic neuropathy.

Significant research in the field of permissible IOP-level values, which against the background of the ongoing treatment would not lead to rapid negative morphofunctional changes of the visual analyzer, is still few. The analysis of the clinical and epidemiological results of the studies given in the review, the established hypotensive efficacy of different treatment regimens and the predicted terms of the active substance tolerance violation convincingly prove the feasibility of using differentiated schemes of initial treatment. «Stepwise» approach, including the choice
of monotherapy with the use of a prostaglandin analogues at the «start» of treatment in patients with a newly identified mild glaucoma, mandatory use of combinations (preferably fixed) in patients with moderate stage of the disease and a minimum of triple therapy with a predicted transition to rapid surgical treatment in patients with advanced stage is another rational variant of using a limited amount of resources with which we can achieve the final result.

PURPOSE: To identify visual functions dynamics in patients with primary open-angle glaucoma (POAG) with preserved visual functions and compensated intraocular pressure (IOP) after trophic modified laser coagulation (tMLC) and subsequent subconjunctive injection
of Retinalamin® to the laser burn sites with local vasoconstriction.

MATERIALS AND METHODS: The study included two groups: main (118 eyes) and control (40 eyes) with moderate and advanced stages of open-angle glaucoma and normalized IOP. Main group patients underwent tMLC followed by Retinalamin® injection, while control group patients’ treatment was limited solely to tMLC. All patients underwent a general examination, which consisted of the collection of symptoms, anamnesis vitae and morbi, and a comprehensive ophthalmological examination, including visometry, tonometry, biomicroophthalmoscopy and automated static perimetry using a central threshold test. The study was conducted before treatment, on the 5th day after tMLC, 1 month after tMLC and 5 months after tMLC. Trophic modified laser photocoagulation was carried out in two stages: the creation of zones of increased
permeability in the blood-ocular barrier (BOB) and the injection of Retinalamin® into this area.

RESULTS: In the study group, there was a significant improvement in visual fields parameters immediately after the treatment and long-term preservation of the effect after treatment. In the control group, visual functions improvement was achieved only immediately after treatment, and after one month the parameters practically did not differ from baseline. The trend of parameters’ return to baseline values was revealed in both groups, but in the control group this phenomenon was registered by the 1 month timepoint, while in the study group the effect lasted longer and the decrease was observed only 5 months after the treatment, indicating a long-term preservation of the positive treatment effect.

CONCLUSION: The method of subconjunctival Retinalamin® injection with local vasoconstriction at the laser burn sites (tMLC) showed an increase in local permeability of blood-ocular barrier for drug delivery, resulting in visual functions improvement. The obtained data suggest the efficacy, safety and promising use of tMLC in combination with Retinalamin® injection as a neuroretinoprotective therapy in patients
with compensated POAG and preserved visual functions.

PURPOSE: To evaluate long term results of reverse meridional cyclodialysis (RMC) in decreasing intraocular pressure (IOP) in patients with different types of glaucoma.

METHODS: The study included twenty-one patients (21 eyes) who underwent RMC for different types of glaucoma. A specially designed cyclodialysis spatula was inserted through a clear corneal incision and ciliary body was gently detached from sclera creating a cleft of 2.5 mm wide and 6-6.5 mm deep. In 13 cases the patient had previously been operated for glaucoma, 3 patients had neovascular glaucoma, 8 patients had combined pathology and in 6 (29%) cases RMC was performed as an organ saving operation. There were also 3 (14%) patients with pain syndrome. Post-operative follow-up was > 2 years. IOP change, use of hypotensive medication(s), need for second surgery and postoperative complications were considered primary outcome measures. Success rates were evaluated using World Glaucoma Association’s guidelines. Results were statistically verified.

RESULTS: Mean baseline IOP was 30.2±7.2 mm Hg (95% coincidence interval (CI) — 27.0-33.5). At 2 years mean IOP decreased by 27.1±17.7% and was 20±1.4 mm Hg (95% CI —
19.2-20.8; p=0.0008). A direct correlation between IOP decrease and patency of cyclodialysis cleft was established. Use of hypotensive medication(s) prior to the operation was 2.6±0.9 (95% CI — 2.1-2.9), afterwards was reduced to 0.8±0.7 (95% CI — 0.4-1.2; p=2E-05). Total success was achieved in 67% cases (absolute success — in 24% (5/21), qualified — in 43% (9/21) cases. Failure rate was 33% (7/21) and in all such cases the underlying reason was cyclodialysis cleft closure. Hyphema, observed in 19% (4/21) cases, was the most common complication in early postoperative period. Two out of 3 eyes with pain syndrome were cured after RMC. All organ-saving operations were successful.

CONCLUSION: 1) There is a statistically significant decrease in IOP after ab interno RMC with patent cyclodialysis cleft in long term period.

PURPOSE: To study the efficacy of Proxofeline in patients with open-angle glaucoma and arterial hypertension.

METHODS: 32 patients (37 eyes) with mild and mode­rate open-angle glaucoma were included into the study. All patients underwent a complex ophtalmological exami­nation: visual acuity, perimetry, tonometry, tonography, gonioscopy and ophthalmoscopy before the treatment and 14 days after the treatment. All patients received Proxofeline instillation twice daily (in the morning and in the evening) and had blood pressure (BP) and heart rate measured 3 times a day.

RESULTS: After 14 days of Proxofeline instillations in­traocular pressure (IOP, P0) decreased to 14.8±1.8 mm Hg due to an increase in aqueous outflow facility (С) to 0.166±0.029 and the decrease of aqueous humor production (F) to 0.74±0.18. Becker coefficient normalization is caused by P0 decrease and aqueous humor retention reduc­tion. No changes in visual acuity, perimetric parameters or ophthalmoscopic findings were registered. A mild posi­tive IOP dynamics with a decrease by 1-2 mm Hg was note in 2 patients (7% of 28 patients). It might be due to a pro­nounced 3+/4+ anterior chamber angle pigmentation, as well as the presence of synechia that appeared after irido­cyclitis. Proxopheline instillations did not cause significant fluctuations in systemic blood pressure. No changes in pulse, systolic and diastolic pressure values were regis­tered in any patients.

CONCLUSION: Proxopheline is an effective drug for reducing IOP in patients with open-angle glaucoma. The hypotensive effect is achieved by increasing the outflow and reducing the production of aqueous humor. Additional research is needed to clarify Proxopheline efficacy in patients with secondary glaucoma caused by a pretrabecu­lar block and its influence on general hemodynamics.

The article is a review of Russian and foreign literature on the problem of angle-closure glaucoma with a plateau iris, methods of its diagnostics and treatment. More than 80 sources of Russian and foreign literature about the problems of diagnostics and treatment of angle-closure glaucoma (PACG) with a plateau iris were analyzed. There are differences in the classification of this disease in foreign practice, namely the differentiation of plateau iris configuration and plateau iris syndrome, which influences the choice of treatment. The analysis pointed out the specifics of diagnostics of this form of glaucoma. The prevailing majority of authors note that patients with PACG with plateau iris have an average depth of the anterior chamber. However, there are studies that prove the opposite. The review also reveals features of the structure and position of the ciliary body and its processes based on the results of anterior segment optical coherence tomography and ultrasonic biomicroscopy. As for the treatment methods, in case of PACG with a plateau iris, hypotensive medication cannot be considered the therapy of choice. Preference is given to laser and surgical methods of treatment. However, at present, there is no consensus on the most effective and safe methods leading to the anterior chamber angle opening and intraocular pressure level stabilization.

Glaucoma therapy is directed towards intraocular pressure stabilization. Pathological diurnal fluctuations of intraocular pressure (IOP), as well as its average value during 24 hours, is a significant risk factor or primary open-angle glaucoma (POAG) progression. Currently, a whole range pharmacologi­cal drugs is used for IOP correction. They differ in hypoten­sive effect degree, which, in turn, can depend on the time of administration. Tafluprost, a prostaglandin analogue, has a significant hypotensive effect and can effectively decrease diurnal IOP fluctuations amplitude in patients with POAG.