PURPOSE: To analyze the factors influencing the motivation for a long-term treatment in elderly and senile patients with glaucoma and to propose ways of increasing its level.

METHODS: A survey of patients with POAG was conducted to identify factors influencing motivation for treatment. Various models of therapeutic training were proposed: an independent study of proposed special literature (subgroup A), a lecture course on glaucoma (subgroup B), and individual in-depth consultation of a patient with glaucoma (subgroup C). The study of motivation for treatment was carried out at baseline — before conducting the therapeutic training, and then 1 month and 6 months after its completion. 366 patients with stage I-IV primary open-angle glaucoma who were treated in the Regional Ophthalmological Hospital took part in the survey and therapeutic training. During the study the patients were divided into 3 groups: Group I — 104 patients of middle age (45-59 years old), with 44 (42.3%) men and 60 (57.7%) women, Group II — 164 people of the elderly age group (60-74 years old), with 66 (40.2%) men and 98 (59.8%) women; Group III — 98 senile patients (75 years and older) — 36 (36.7%) men and 62 (63.3%) women.

RESULTS: The study helped determine the main cause for the lack of motivation for treatment, which turned out to be the underestimation of the treatment importance and the dangerous consequences of the disease. This mostly happens due to the following reasons: an asymptomatic disease (55.2%), a low level of awareness of the disease (51.9%), lack of a visible effect from the prescribed therapy (50.8%), adverse effects (47.5%), forgetfulness (36%), lack of confidence that the treatment can actually help (23.5%), lack of empathy and insufficient attention from the attending physician (63.4%), etc. When comparing the three proposed therapeutic training models, the best results were noted with an individual in-depth counselling: the level of motivation remained stable up to 6 months after the counselling was finished.

CONCLUSION: “Low” and “below average” levels of motivation for treatment are common for primary open-angle glaucoma patients. Our proposed model of therapeutic training has increased the level of motivation for treating in POAG patients, especially in the elderly and senile age groups. 

PURPOSE: To compare the diagnostic accuracy of structural parameters, vessel density (VD) measured by optical coherence tomography angiography (OCTA), and electrophysiological testing in primary open-angle glaucoma (POAG) diagnosis.

METHODS: 35 healthy participants and 90 POAG patients underwent the measurement of whole image en face (wi) VD in the disc/peripapillary region and macula, as well as the assessment of the retinal nerve fiber layer (RNFL), average thickness of ganglion cell complex (GCC), pattern electroretinograms and pattern visual evoked potentials. The area under the receiver operating characteristic curve (AUC) was assessed for each parameter to differentiate early POAG from healthy eyes and conduct a differential diagnosis between the POAG stages.

RESULTS: To distinguish early POAG from healthy eyes, the parameters with the highest AUC were detected: P50 amplitude of transient pattern electroretinogram, 1° (AUC 0.93, p=0.002), P1 component of steady-state pattern electroretinogram (AUC 0.92, p=0.003), P100 amplitude of pattern visual evoked potential, 1° (AUC 0.84, p=0.013), wiVD macula superficial (AUC 0.80, p=0.001), wiVD Disc (AUC 0.74, p=0.016), GCC (AUC 0.74, p=0.016) and to distinguish early POAG from the moderate to advanced POAG: inferotemporal peripapillary VD (AUC 0.94, p<0.0001) and focal loss volume of GCC (AUC 0.92, p<0,001).

CONCLUSIONS: Our results demonstrate the importance of measuring the microcirculation parameters in the macular area along with PERGs and PVEPs for the early detection of glaucoma. VD in the inferotemporal sector of the peripapillary retina and focal loss volume of GCC are important for monitoring of the disease. The inclusion of OCTA, PERGs and PVEPs in glaucoma diagnostics may improve its early detection and monitoring. 

 PURPOSE: To conduct a comparative analysis of clinical and functional parameters in patients with primary openangle glaucoma (POAG), pseudoexfoliation glaucoma (PEG) and pseudoexfoliation syndrome (PES), to justify angio-OCT expedience in diagnostics and monitoring.

METHODS: The study included 121 patients (121 eyes). Group 1 consisted of 29 patients (29 eyes) diagnosed with stage I PEG. Group 2 included 32 patients (32 eyes) diagnosed with stage I POAG. Group 3 consisted of 31 patients (31 eyes) with pseudoexfoliative syndrome signs. Group 4 (control) consisted of 28 people (28 eyes) without significant ophthalmopathology. Patients underwent standard ophthalmologic examination, tonography, gonioscopy, pachymetry, tonometry, perimetry, optical coherent angiography of the optic disc. All patients underwent 3 examinations: at baseline, 6 and 12 months after.

RESULTS: Angio-OCT data comparison showed that morphometric parameters of the optic disc and microhemodynamics indices differed significantly between all the studied groups. Patients’ examination a year after revealed a negative dynamics of the optic disc parameters in some patients, with the most significant changes observed in PEG patients. To identify the diagnostic significance of the optic disc morphological parameters, the parameters of the peripapillary zone and the macular area, a comparative study of angioOCT data was conducted. Scatterplots with regression equations were also constructed based on data obtained during the second and the third follow-up examinations.

CONCLUSION: The study results showed that morphometric indices and optic disc perfusion indices differ significantly both in healthy patients as compared to POAG patients, and in patients with different types of glaucoma. The conducted correlation analysis showed that morphometric indices dynamics correlate with microcirculation indicators in glaucoma patients. Retinal ganglion cells apoptosis and optic nerve fiber degradation was most prominent in PEG patients. Correlation analysis showed that the optic disc microcirculation indicators, specifically the perfusion density and vascular density, were the most significant criteria indicating the pathological process progression. Therefore they may be used as reliable markers  of the pathological process.

PURPOSE: To determine the effectiveness of primary open-angle glaucoma (POAG)  treatment based on the assess-ment of hypotensive regimens used to achieve "target" intraocular pressure (IOP) depending on the clinical stage of the disease.

METHODS: Analytical multicenter study was conducted based on the results of a survey of 51 ophthalmologists. Each specialist solved 18 tasks, determining the "target" level of IOP, hypotensive regimen and further tactics de-pending on preset parameters.

RESULTS: “Target” values for stage I of POAG was 22 mm Hg; 20 mm Hg — for stage II of POAG; 18 mm Hg — for stage III of POAG. “Convenient” target values equaled 19.2±0.26 mm Hg for stage I; 19.02±0.23 mm Hg — for stage II and 17.35± 0.21 mm Hg for stage III. “Inconvenient” values, i.e. requiring  changing or enhancing therapy, were 23.98±0.38 mm Hg for stage I; 23.63±0.29 mm Hg — for II; 22.86±0.28 — for stage III. “Extremely inconvenient” values and the indication for surgery were 27.2±0.45 mm Hg for stage I; 26.14±0.34 mm Hg for stage II and 25.97±0.42 mm Hg — for stage III. The therapy changed if IOP was increased by 9% in stage I, 20% in II and 22% in stage III; the transition to surgery was made if the increase reached 23% in patients with stage I, 30% in II and 39% in stage III of POAG. The average transition period from drug therapy to surgery was 4 years.

CONCLUSION: The achievement of "target" IOP was ensured by the use of severe hypotensive regimens that included up to 3-4 drugs. Perhaps this is an additional argument for further improvement of POAG treatment algorithms, justifying an earlier and more active use of surgical methods of IOP correction. However, a high level of evidence base practice of their efficacy and safety must be provided.

 

PURPOSE: To evaluate the safety criteria of femtolaser impact during femtosecond laser–assisted cataract phacoemulsification on the filtration zone after microinvasive non-penetrating deep sclerotomy based on ultrasound bio- microscopy data.

MATERIALS AND METHODS: 12 patients (15 eyes) with operated primary open-angle glaucoma, 7 women and 5 men, were kept under observation. The average age of the patients was 64±11 years. Femtosecond laser–assisted cataract phacoemulsification was performed 6-12 months after microinvasive non-penetrating deep sclerectomy. In addition to standard research methods all patients underwent ultrasound biomicroscopy prior to surgery. The femtolaser stage of the surgery was performed using FEMTO LDV Z8 device («Ziemer», Switzerland). Ultrasonic cataract phacoemulsification was performed using Centurion VisionSystem («Alcon», USA) according to the standard phaco-chop technique. Ultrasonic biomicroscopy follow-up was performed 1 day and 1 month after the operation.

RESULTS: Study results indicate the need to include ultrasound biomicroscopy into the list of mandatory diag nostic research methods for patients with previously operated glaucoma prior to femtosecond laser–assisted cataract surgery. To ensure a safe performing of femtolaser cataract surgery in patients after microinvasive non-penetrating deep sclerectomy, one has to take into account a combination of such features as the preservation of the linear profile of the trabeculodecemetic membrane, the absence of its dense adhesions with surrounding tissues, and the presence of an intrascleral cavity with a height of 0.25 mm and above. Failure to respect these conditions when using femtosecond laser technology can lead to adverse changes of the newly formed drainage system.

CONCLUSION: Femtosecond laser–assisted cataract surgery for patients who previously underwent microinvasive non-penetrating deep sclerotomy (MNSE) is a safe and effective technology when performed after a preliminary selection of patients based on filtration zone ultrasound biomicroscopy (UBM).

PURPOSE: 1. To show new possibilities of differential Express diagnostics for reliable and objective discernment between age-related eye hypertension (AEH) and OAG using pneumatic analyzers ORA or Corvis ST according to the testing methodology developed by the authors. 2. To determine the specifics of changes in IOP level and functional ability of the sclera to microfluctuations of the eye volume after volumetric intraocular interventions.

METHODS: A theoretical analysis and the results of clinical trials of the author's method of AEH and OAG differential Express-diagnostics by the criteria of "rigidity" and "scleral fluctuation".

RESULTS: There is a practical possibility of using the upgraded rapid diagnosis by means of ORA and Corvis ST pneumatic analyzers for a reliable differentiation between AEH and OAG as well as the optimal choice of AEH prevention and OAG treatment methods in the conditions of polyclinic network. This makes it possible to accurately and quantitatively identify current IOP level abnormality and the normal IOP range in an elderly patient according to his IOP level in his youth. Moreover, according to the measured current levels of scleral rigidity and fluctuation, it is possible to reliably discern AEH and OAG and identify the degree of the decrease in the fibrous tunic functional ability to fluctua- tion necessary to maintain the normal circulation of watery moisture and eye volume.

CONCLUSION: Rigidity and micro fluctuation of the sclera play the principal role in the mechanisms of IOP level formation. IOP increases with age due to a corresponding age-related increase in fibrous tunic rigidity. From the standpoint of physiology, AEH is useful and necessary for the eye to maintain normal metabolic processes, even in old age. The lack of information concerning patient’s IOP level in his youth often hinders an adequate assessment of current IOP level normality. Pathological scleral rigidity level in OAG patients is always significantly higher than the normal rigidity level in AEH patients. Meanwhile, scleral fluctuation level shows the opposite trend. Both patterns allow for an objective differentiation between AEH and OAG. Restoring scleral functions in AEH and OAG patients may be physiologically and pathogenetically justified for both preventive and therapeutic effects.

Glaucoma is a socially significant disease. It is one of the leading causes of visual impairment and blindness. Along with cataract surgery, glaucoma treatment determines the basic surgical potential of any surgical facility. A high preva-lence, frequent combination of primary open-angle glaucoma and cataract, as well as their negative impact on the visual functions of the eye remain relevant and important problems. In this regard, special attention should be paid to the choice of active management tactics for patients withthis pathology. This review covers different approaches to surgical treatment of combined pathology of glaucoma and cataract. A comparative assessment of their efficacy and safety was carried out, and statistics on postoperative complications and long-term results of surgical treatment was gathered.

Today glaucoma is the leading cause of irreversible blindness. Intraocular pressure level is the only directly influenced factor which can stop visual function deterioration and prevent visual loss. Generally, IOP reduction starts with topical therapy, which can adversely affect the ocular surface and impair the prognosis of possible future surgery. Long-term medical therapy leads to irreversible changes of the ocular surface and induces chronic inflammation, which promotes scarring of the newly created outflow pathways. This in turn may hinder and ultimately block the outflow from the anterior chamber. It was found that the use of preservative free eyedrops for less than 6 months does not influence the outcomes of glaucoma filtration surgery. Therefore, when prescribing local hypotensive therapy, we should remember, that the use of large number of different drops worsen the prognosis of the possible future surgery. Preservative free eyedrops and early surgery should be preferred, especially in patients with a long life expectancy.

The article recaps the aspects of the formation, development and reform of the ophthalmological service of the Republic of Tajikistan, highlights the main stages of its development, which include: the emergence and establishment of the service, years of active struggle with trachoma, systematization and profiling of the ophthalmological institutions of the country, the beginning of the microsurgical era in ophthalmology. After the “second birth of the ophthalmologic service” in the post-conflict period, its development during the period of the state independence of Tajikistan required colossal work to restructure and re-equip all parts of the service, to actively work on staff training, taking into account the need for high-tech medical care. In 2011, a new, sixth stage of development began — the “century of high technologies in medicine”, including the application of innovative approaches to the detection and treatment of eye diseases, as well as the introduction of modern technologies and medicines. Thus, along with the traditions established over the past years, the accumulated experience in the treatment and diagnosis of the most complex diseases in ophthalmology, and the inclusion of new developing measures allow us to hope that the new model of patient care will improve the performance of visual functions and reduce still high disability rates of visual impairment in the country.