Purpose: To assess changes in the peripapillary retina and vessels of the arterial peripapillary circle of Zinn -Haller during the formation of glaucomatous optic neuropathy in patients with glaucoma associated with myopia.

Methods: We examined 26 patients (26 eyes) with a moderate stage of primary open-angle glaucoma on eyes with high myopia and 30 people (30 eyes) with uncomplicated myopia. Optical coherence tomography in angiography mode was included in the standard ophthalmologic examination.

Results: A rim area reduction (1.03±0.36 and 1.6±0.42; р=0.05) in patients with glaucoma develops against the background of choroid thinning, mainly in the lower (131.36±41.98 and 226.5±98.13; р=0.01) and nasal (57.63±9.81 and 216±122.4; р=0.0006) segments and is accompanied by an increase of the peripapillary atrophy area (1.94±0.5 and 1.05±0.15; р=0.005), which indicates the inconsistency

of trophic and metabolic processes. Changes in the vascular topography of the Zinn - Haller arterial circle (reduction of the density of small branches, exposure of large vessels with the formation of non-perfusion zones) in the area of peripapillary atrophy due to oscillations of the ophthalmic nerve should be considered as ischemia of the optic nerve head resulting from a disruption of the peripapillary blood flow with a choroidal blood supply.

Conclusion: Visualization and evaluation of dystrophic changes in the peripapillary retina and vascular topography of the Zinn - Haller arterial peripapillary circle can serve as the differential diagnostic criteria for glaucoma associated with myopia and be used to monitor the course of the glaucoma process.

Intrachamber anesthesia is an effective method used in cataract phacoemulsification and is practically devoid of complications. A serious disadvantage of this method is the toxic effect of the anesthetic on the posterior corneal epithelium.

Purpose: To study a 0.75% ropivacaine solution safety for the posterior epithelium of the cornea, retina, ciliary body of the rabbit eyes in the experiment.

Methods: During experiment 1, 20 rabbits (40 eyes) were injected intracamerally with a 0.75% ropivacaine solution, 1% lidocaine solution, and saline solution as a control. We dynamically evaluated the eye globe structures using biomicroscopy, ophthalmoscopy, pachymetry and specular microscopy. Experiment 2 included 14 rabbits (28 eyes). In the course of experiment 2, several rabbits (7 eyes) were intracamerally injected with 0.75% ropivacaine solution. Other animals (7 eyes) had the solution administered intracamerally and intravitreally. Control group underwent intracameral and intravitreal injections of saline solution. Biomicroscopy and ophthalmoscopy were performed. On the 7th day, the eye globes were enucleated and examined morphologically.

RESULTS: During experiment 1 biomicroscopy and ophthalmoscopy did not detect any inflammatory, toxic and allergic changes. Pachymetry and mirror microscopy showed no statistically relevant changes in central corneal thickness and corneal endothelium cell count correspondingly. Experiment 2 revealed biomicroscopical and ophthalmo-scopical inflammatory changes in the ciliary body on the first day after intracameral and intravitreal injections of 0.75% ropivacaine solution and saline. By day 7 the manifestations ceased. Histological study of intraocular structures detected no changes after ropivacaine solution injection.

CONCLUSION: The experiments proved the safety of intracameral and intravitreal 0.75% ropivacaine solution injections for the rabbit intraocular structures.

Aim: To develop a high-sensitivity method of localized dynamic thermographic evaluation of the face skin surface and to assess the correlation between thermal parameters and current indicators of glaucoma-associated damage.

Methods: 69 glaucoma patients (138 eyes) and 52 healthy volunteers (104 eyes) were enlisted in the study. All subjects underwent dynamic infrared thermography following an algorithm developed by our research group and conducted in a special room with optimal parameters of the environment. Cold test applicator was applied to the area of the inferior margin of the zygomatic bone for 20 s, then infrared images of this area were captured every 20 s for the following 5 min. Temperature recovery curve for all patients was plotted based on the acquired data. The sum of received curves' deviations from a theoretical “ideal" temperature recovery curve constituted the cumulative temperature difference coefficient - 1ДТ.

Results: Mean cumulative temperature difference 8.32+4.65° for glaucoma patients and 6.09+3.54° for healthy volunteers. Difference between groups was statistically significant (p<0.05). A statistically significant correlation was also observed between glaucoma stage and 1ДТ: its value decreased with glaucoma progression. Additionally, topical antiglaucoma therapy, as well as its absence, influenced 1ДТ. Use of prostaglandin analogs, beta-adrenergic blockers, carbonic anhydrase inhibitors caused the increase of 1ДТ to a level corresponding to an earlier glaucoma stage.

Conclusion: Data acquired in this study indicate that extraocular dynamic thermography of facial skin surface may be a reliable method of evaluating pathologic microvascular changes characteristic to glaucoma.

Purpose: To evaluate the clinical efficacy of antihypertensive drugs in the treatment of posttraumatic hypertension and glaucoma.

Methods: The retrospective study was carried out in Regional Clinical Hospital N 3 in Chelyabinsk. Posttraumatic eye hypertension was detected in 76 patients: 65 (85.5%) men and 11 (14.5%) women, the average age was 49±12.7 years. Blunt trauma of the eye globe occurred in 55 (72.3%) patients, open globe injuries were registered in 21 (27.7%). Рatients were prescribed with eye drops: timolol 0.5%, brin-zolamide 1%, fixed combination: brinzolamide 1% + timolol 0.5% and systemic acetazolamide 250 mg orally 2-3 times daily for the course of 3-5 days. The changes of intraocular pressure (IOP) and visual functions were evaluated in assessing the effectiveness of treatment.

Results: Baseline IOP level was 25-43 mm Hg. Medical reduction of IOP was achieved in 56% of patients, mostly after the administration of a brinzolamide 1% + timolol 0.5% fixed combination, or when combined with acetazolamide orally (68%).

The IOP decreased in 6.07% patients after brinzolamide 1% administration, in 7.67% patients after a fixed combination of brinzolamide 1% with thymolol 0.5% and 16.78% patients after brinzolamide in combination with beta-blockers and systemic carbonic anhydrase inhibitors. In case of insufficient effectiveness of conservative therapy - 39 (51%) patients underwent various surgical procedures.

Conclusion: IOP increase after an eye globe injury may have a transient nature and may be controlled by conservative therapy or its combination with various types of eye surgery. The most statistically significant decrease of IOP in post-traumatic hypertension and glaucoma can be achieved using a brinzolamide 1% + timolol 0.5% fixed combination simultaneously with systemic carbonic anhydrase inhibitors.

Purpose: To study the efficacy and safety of Bimoptic® (bimatoprost 0.03%, "Rompharm Company") as the initial monotherapy in early and advanced stages of primary open-angle glaucoma.

Methods: In 2018, clinics in 23 cities of Russia recruited 178 patients (294 eyes) with newly diagnosed primary open-angle glaucoma with uncompensated IOP (84 men, 94 women, average age - 64.3 years). The mild stage was diagnosed in 72, moderate - in 222 eyes. Tonometry was performed using a Maklakov 10 g tonometer. All patients after standard ophthalmologic examination were prescribed bimatoprost 0.03% 1 time per day. Tonometry was performed before the study, and on the months 1, 2, and 3.

Results: Initial IOP equaled 26.2+3.4 mmHg. On the month 1 IOP decreased by 25.6% to 19.5+2,5 mmHg (p<0.0001). On the month 2 IOP was 18,5 mmHg (29.4% decrease, p<0.0001), on the month 3 - 18.1 mmHg (31% decrease, p<0.0001).

On the month 1, IOP was compensated in 94% of all patients, on month 2 - in 98%, on month 3 - in 99% patients.

Bimatoprost was tolerated well. The most common adverse effect was conjunctival hyperemia (4.5% of all patients).

Conclusion: Bimatoprost allows compensating IOP as monotherapy in patients with early and advanced stages of primary open-angle glaucoma.

Purpose: To evaluate the efficacy and safety of Bimatoprost 0.03% (bimatan) treatment for patients with newly diagnosed open-angle glaucoma (POAG) I-II stages as the first line drug.

Methods: 64 eyes of 46 patients (26 men, 20 women) with newly diagnosed POAG I-II stages were included into the study. The average age of the men was 61.3 years, women - 65 years. The study comprised 31 patients (67.4% of 46 patients) with early glaucoma changes (mild, moderate) and 15 patients (32.6% of 46 patients) with advanced glaucoma changes. The patient's non-corrected visual acuity varied from 0.2 to 0.8. Prior to treatment all patients underwent a complex ophtalmological examination: visual acuity, perimetry, tomometry, tonography, gonioscopy and ophthalmoscopy. The examination in 14 days after treatment included of visual acuity, tonometry, tonography and in 3 months after treatment - visual acuity, perimetry, tomometry, tonography, gonioscopy and ophthalmoscopy.

All patients received instillation of Bimatoprost 0.03% (Bimatan) once daily in the evening at 8 p.m. Adverse reactions were reported at every step.

Results: After 14 days of Bimatoprost 0.03% instillations intraocular pressure (P0) level decreased from 17.2+3.1 to 13.9+1.8 mm Hg due to an increase in outflow facility (C) from 0.081+0.042 mm³/min/mm Hg to 0.198+0.044 mm³/min/mm Hg and the suppression of aqueous humor production (F) from 0.91+0.18 to 0.78+0.12 mm3/min (p<0,05). There were no significant changes in the hydrodynamic indicators after 3 months of treatment (p>0.05).

IOP reduced to the individual tolerance level due to bimatoprost 0.03% instillation in 100% of cases (64 eyes).

Conclusion: Bimatoprost 0.03% is an effective and safe drug for reducing IOP in patients with primary open-angle glaucoma I-II stages. The hypotensive effect is achieved by increasing the outflow of aqueous humor and the suppression of aqueous humor production. This agent is characterized by minor topical adverse reactions. Bimatoprost 0.03% may be recommended for POAG treatment to reduce IOP as the first line drug.

Purpose: To define the features of glaucoma progression, considering the analysis of treatment approaches (regimens) in patients with primary open-angle glaucoma.

Methods: The multicenter clinical cohort study was performed during Nov 2015 - Jan 2018 in 30 clinical bases of 6 countries. Data of 155 primary open-angle glaucoma patients (247 eyes) was included. Anamnesis, intraocular pressure (IOP) by the moment of the first treatment regimen as well as the administered treatment were analyzed retrospectively. IOP (baseline and 5 more measurements each 6 months) was analyzed prospectively. During the automated perimetry analysis, mean deviation of light sensitivity (MD) and its pattern standard deviation (PSD) were analyzed. IOP, MD, PSD data dynamics in the prospective part was described by y=kx+b equation, where b was a constant, an average parameter rate, and k - the coefficient of line slope, describing the trend of parameter increase/ decrease during the 2.5 year follow-up.

Results: No statistically significant difference in age and anamnesis between men and women was found. Mild glaucoma stage was found in 192 eyes (77.73%), moderate -in 40 (16.19%), advanced - in 15 (6.08%). Glaucoma duration in patients with different disease stages by the moment of study beginning was comparable and averaged 5.7 (3.9; 8.6) years.

Throughout the average follow-up period of 8 years mild stage did not progress in 135 (70.31%) of 192 eyes, turned into moderate stage in 45 eyes (23.44%), into advanced -in 8 eyes (4.17%) and into terminal - in 4 eyes (2.08%). During the average follow-up period of 8.45 years moderate

glaucoma stage remained stable in 17 of 40 eyes (42.50%), turned into advanced in 19 eyes (47.50%), into terminal -in 4 eyes (10.00%). In turn, existing advanced glaucoma remained stable in 11 eyes (73.33%) and progressed into terminal in 4 eyes (26.67%) during 7.6 years of follow-up.

Generally, the only manageable criteria of glaucoma treatment and lack of optic neuropathy progression is adhering to the recommended IOP level its and timely correction according to disease stage.

IOP difference in dependence of glaucoma stage by the moment of disease diagnostics was statistically significant (p<0.001; H=43.965): the higher the glaucoma stage, the higher IOP level by the time of diagnosis verification. However, no statistically significant IOP difference in dependence of glaucoma stage was found after prescribing the first treatment regimen (р=0.238; H=2.875).

Target IOP was reached only in patients with mild glaucoma, in 75% of moderate stage patients IOP was >19.5 mmHg, and in 75% of advanced stage patients on the first treatment regimen IOP was >20 mmHg. By the moment of prospective part start, no statistically significant IOP difference depending on glaucoma stage were found (р=0.924; H=0.479).

By the final visit a statistically significant IOP difference in dependence of glaucoma stage was found (p=0.050; H=7.807). The more advanced glaucoma stage the patient had, the lower IOP was achieved. Since the start of the prospective part, a more aggressive treatment was observed in order to reach the lowest individually possible IOP, using accessible treatment options.

A slow disease progression tendency was revealed during 2.5 years of study by static automated perimetry in each glaucoma stage group and on the whole: MD changed from -3.27 (-7.98; -1.37) to -4.08 (-10.33; -1.95), PSD from 3.14 (2; 5.79) to 3.56 (2.14; 6.31) dB.

Patients with mild stage remained stable during the 2.5              years follow-up with negative MD trend of 6 months -0.09 (-0.27; 0.08) dB, in case of MD decrease of -0.86 (-1.24; -0.44) dB per 6 months the transition to the following stage occured. Moderate stage patients showed a positive tendency with the stage being stable for 2.5 years. Progression to the following stage occurred in cases of a -1.42 (-1.58; -0.82) dB dynamics per 6 months. Advanced stage remained stable if the dynamics measurements did not exceed -0.25 (-0.61; -0.09) dB per 6 months, and progressed to terminal if it reached -0.85 (-1.79; -0.73) dB per 6 months. Retinal light sensitivity loss accelerates with stage progression, however, there is no trend of PSD acceleration with the stage increase.

By the time of glaucoma diagnosis verification 90.3% patients fell into one of 5 following regimens: beta-blockers (BB - 43.7%), prostaglandin analogues (PA - 27.1%), carbonic anhydrase inhibitors (CAI - 3.2%), beta-blockers and prostaglandin analogues combination (BB+PA - 12.1%), beta-blockers and carbonic anhydrase inhibitors combination (BB+CAI - 4%). Laser and surgical treatment amounted to 5.2%. The use of these “top-5" hypotensive regimens lead to IOP level decrease to 20.5 (18; 23) - 23.5 (22; 25) mm Hg irrespective of the disease stage.

By the moment of prospective study start, the amount of treatment regimens combinations increased to 31; the most popular being beta-blockers (BB)+prostaglandin analogues (PG), PG, BB+PG+carbonic anhydrase inhibitors (CAI), BB, BB+ICA (72.3%). Laser and surgery treatment amounted to 24.3%.

By the end of the study 40 different variants of treatment were used. The most popular regimens didn't change (BB+PG+CAI, BB+PG, PG, BB+CAI), BB was replaced by surgical intervention at the top of the list.

PG and BB were used during mild stage glaucoma, and PG use caused the slightest light sensitivity loss among there hypotensive drugs. CAIs were added in more advanced stages, enforcing the PG and BB therapy. BB use showed the most prominent negative trend. Combined BB+PG therapy was followed by a 2.85-times slower disease progression than BB monotherapy.

The higher was the baseline IOP, the more changes of treatment regimens were tried. PSD trend does not show the dependence of treatment regimens amount.

Conclusion: Starting treatment helped reach target IOP only in patients with mild glaucoma, in 75% of moderate stage patients IOP exceeded 19.5 mm Hg, in 75% patients with advanced stage IOP exceeded 20 mm Hg. The progressing negative MD trend increased with the disease stage (-0.14; -0.26; -0.46).

By the moment of glaucoma diagnosis verification 90.3% prescriptions consisted of five main regimens (BB, PG, BB+PG, BB+CAI, CAI). BB monotherapy caused the most prominent MD negative trend during 2.5 years of follow-up (-0.4). The best trends were showed by PG (-0.07), PG+BB (-0.14), BB+CAI (-0.14).

Regimen change provided extra IOP decrease (IOP trend change from 0 to -2.5), however the disease progression still occurs (trend change from -0.18 to -0.81), which may bear witness both to the starting therapy inefficacy and 'programmed' disease progress.

Purpose: 1. To identify the reasons for the relatively low reliability of the traditional «IOP level» criterion for the diagnosis of age-related ocular hypertension (AOG) and open-angle glaucoma (OAG).

2. To show the absolute practical advantages and the need for a gradual transition in the field of evidence-based medicine from the traditional criterion «level of IOP» to modern functional criteria: «rigidity» and «scleral fluctuation», determined by dynamic rapid diagnosis.

Methods: Theoretical analysis and results of our own clinical trials of traditional and new econometric methods of AOG and OAG diagnostics based on the following criteria: IOP, rigidity and fluctuation.

Results: ORA pneumoanalyzer can be used in rapid diagnostics in the conditions of polyclinic network for reasonable and objective choice of AOG and OAG prevention and treatment methods, as well as their differential diagnosis. It allows for an instant, accurate and numerical identification of the elderly patient's current IOP level abnormality as compared to his «younger» IOP levels, and its correspondence to normal IOP range. Also, according to the measured current levels of sclera rigidity and fluctuation, it is possible to reliably estimate the decrease in the functional ability of the fibrous tunic of the eye (FTE) in relation to the fluctuation necessary to maintain the normal circulation of intraocular fluid and the volume of the eye.

Conclusion: Scleral rigidity and micro-fluctuations play a fundamental role in the mechanisms of the IOP level formation. With age, both FTE rigidity and consequently IOP level tend to increase. Physiologically, AOG can play a necessary role in maintaining normal metabolic processes even in old age. If a patient's IOP level in his youth is unknown, the doctor often cannot adequately assess the abnormality of the current IOP values. In the meantime, pathological FTE rigidity in OAG patients is always significantly higher than the normal rigidity level in AOG. On the contrary, scleral fluctuations tend to correspondingly decrease. This allows for an adequate AOG and OAG differential diagnostics. In both AOG and OAG, it is necessary to restore the scleral functions, which can account for physiologically and patho-genically justified preventive or therapeutic effects.

The review considers possible treatment tactics for patients with open-angle glaucoma and coexisting cataract. Combined treatment is recommended in the case of subcompensation of intraocular pressure (IOP) and a significant decrease in visual functions, because it allows achieving a more pronounced hypotensive effect, versus the phacoemulsification alone. The advantage of one-step intervention lies in the optimization of economic, social, psychological aspects, and shortening the patient's period of rehabilitation. In recent years, the methods of minimally invasive glaucoma surgery (MIGS) have become most relevant and common. The safety and technical simplicity of MIGS procedures, as well as their success in combination with phacoemulsification, ensured a widespread dissemination of these interventions. According to a number of scientific studies, the implementation of MIGS-technologies simultaneously with phacoemulsification contributes to the achievement of optimal results. The review considers the main groups of MIGS methods, presents the results of clinical studies devoted to their effectiveness. It presents the data on the efficacy of combined MIGS technologies with phacoemulsification and MIGS methods alone. There is a great interest in studying modern microinvasive methods of laser treatment in the combined treatment of patients with POAG and cataract. These operations have a minimal damaging effect on the trabecular tissue and have a pathogenetic orientation. The development of microinvasive-combined methods of treatment of POAG and complicated cataract remains an actual and promising direction.

Glaucoma is a chronic progressive optic neuropathy, characterized by changes in the optic nerve head (cup) and ganglion cell complex (GCC) loss that lead to field of vision defects. In some patients GCC loss progresses despite intraocular pressure (IOP) level normalization. Today neuroprotection is one of the most promising trends in glaucoma treatment. It is directed at GCC loss prevention in patients with normal-tension glaucoma. Neuroprotection can be direct or indirect, depending on the nature of damaging factors and counteraction mechanisms. Indirect neuroprotection includes IOP level decrease and hemodynamics improvement. Direct neuroprotection can be primary and secondary. Such pharmaceutical groups as NMDA-receptor antagonists and calcium-channel blockers have a direct neuroprotective action. They protect retinal neurons and optic nerve head fibers by blocking the main ischemic cell damage factors and moderate ischemia-associated increase of lipid peroxidation products, free radicals and calcium ions concentration. Secondary neuroprotection drugs influence the delayed neuronal death mechanisms. They include Ginkgo biloba, antioxidants, neurotrophic drugs (Brimonodone, Betaxolol, carbonic anhydrase inhibitors, prostaglandin analogues) and peptide bioregulators. IOP level decrease still remains the main means of glaucoma treatment. One of the questions of considerable substance in IOP lowering achievement is the elaboration of alternative methods aimed at further progression prevention. Based on the latest research, neuroprotective medicine shows promise in GCC loss prevention despite the actual IOP level. This article presents information on a wide range of neuroprotective drugs used in complex glaucoma treatment.

Glaucoma is a group of chronic diseases leading to irreversible vision loss. The choice of treatment strategy for glaucoma is determined by the clinical manifestations of the disease, risk factors and rates of progression. Achieving "target pressure" helps slow the progression of the disease and improve the quality of life for patients. Efficiency, the low incidence of instillation per day, and the absence of systemic side effects are important factors for patient compliance. In the arsenal of doctors there are several groups of antihypertensive drugs, each of which has its own advantages and disadvantages. In the case of the ineffectiveness of starting monotherapy, it is possible to prescribe a combination of two or even three antihypertensive drugs. More often, prostaglandin analogue drugs are prescribed as starting monotherapy. Bimatoprost, being a prostamide, is included in this group, but differs in its pharmacochemical properties and effectiveness from typical prostaglandins. This review is devoted to the experience of using bimatoprost, in particular its pharmacochemical properties, efficacy and safety in comparison with other drugs and combinations.