Purpose: To determine the nature of the relationship between the localization of the fovea, the position of the papillary-macular bundle and individual morphofunctional characteristics of the eye in patients with different eye diseases.

Methods: The final protocol of work included the data of 33 people (17 women, 16 men, 46 eyes). The average age of patients was 78 (71; 81) years. All patients were divided into 3 groups: the first group consisted of 11 patients (16 eyes) with mild, moderate and advanced primary openangle glaucoma (POAG), the second — 13 patients (15 eyes) with early cataract, the third — 9 people (15 eyes) with the dry form of age-related macular degeneration (AMD). Morphometric characteristics of optic nerve head (ONH) and the retinal nerve fiber layer (RNFL), including the disk circumference measurement on the Elschnig’s ring and the papillomacular bundle (PMB) angle in relation to ONH was studied by optical coherence tomography using the Spectralis OCT device (“Heidelberg Engineering”, Germany). The data was statistically analyzed.

Results: The PMB angle relative to the location of the ONH in patients with glaucoma equaled -7.9 (-8.2; -6.8)°, in patients with cataract — -7.9 (-9.7; -6.3)° and patients with AMD — -7.9 (-8.0; -5.4)°. There was no statistically significant difference in the analysis of this parameter.

Conclusion: The position of fovea and the direction of PMB is a constant population value in patients with glaucoma, cataract or AMD. Foveal location is shifted, on average, 7.9° lower in relation to the conditional center of the ONH, which should be taken into account when analyzing the results of the RNFL study.

Purpose: To find out the need for various health services repeated delivery on the previously operated eye and evaluate their total cost in the surgical treatment of glaucoma.

Methods: The material for the study was taken from the database of the medical information system of the Orenburg branch of S. Fyodorov Eye Microsurgery Federal State Institution for the period of 2014-2017. Assessment of the change in the cost of medical services was carried out using automated process lists of surgical and laser treatment of glaucoma used in the Orenburg branch of S. Fyodorov Eye Microsurgery FSI by estimating the ratio of prevailing unit cost and the cost due to the application of the risk-oriented method.

Results: There is a significant amount of patients who need to undergo surgery of the previously operated eye — 12.75%. However, the number of re-surgery is uneven for various operations: laser glaucoma surgery — 8.55%, nonpenetrating glaucoma surgery — 17.60%, penetrating glaucoma surgery — 12.78%.

Conclusion: The use of the risk-based method of estimating the cost of medical care allows the medical institution to have a reserve of funds for re-intervention (1 time) at the presence of medical indications, but this increases the cost of initial medical intervention by 1.69% for penetrating surgery, by 8.47% — for non-penetrating surgery, by 21.18% — for antiglaucoma laser surgery.

Purpose: To study the effectiveness of various hypotensive regimens to determine the optimal tactics for managing patients with POAG.

Material and methods: The study included a total of 314 (628 eyes) patients with newly diagnosed POAG (stages I-III): 97 men (30.9%), and 217 women (69.1%). The average age was 65.8±2.04 years; 64.6±1.52 in male patienrs and 66.3±1.72 years in females. The following parameters were studied: age, anamnesis (concomitant somatic pathology), disease stages, IOP level at baseline and, 1, 3, 6, 12, 18 and 24 months after the start of hypotensive therapy, drug drug regimen and its changes.

Results: Over the entire study period, there was a regimen change from β-blockers monotherapy in 50.0% of mild POAG patients and 48.6% of moderate POAG patients, because they could not achieve “target pressure”. In 5.9% of moderate stage cases and 18.2% of advanced stage cases, disease progression into the next stage was recorded. Monotherapy with prostaglandin analogues (PA) was effective in patients with mild POAG. 24.7% of moderate glaucoma patients showed IOP level corresponding with the upper limit of the recommended range, despite a significant IOP decrease compared to baseline. In these cases the level the patients were prescribed an additional drug from another pharmacological group. PA monotherapy was not effective in patients with advanced glaucoma, leading to the disease progression into the terminal stage in 5 eyes. A combination of PA and β-blockers (BB) helped achieve the recommended IOP level in patients with mild and moderate POAG. The same regimen proved insufficient for patients with advanced glaucoma, leading to a disease progression. A fixed BB+PA combination regimen administration showed the same tendencies with a 20.8% progression rate in advanced glaucoma patients.

Conclusion: It is necessary to prescribe drugs (prostamides, prostaglandin analogues) that could provide a sufficient reduction of the IOP level and contribute to the longterm stabilization of the disease.

Purpose: Develop clinical and functional algorithms for the diagnosis, monitoring and treatment of progressive myopia in children based on the establishment of patterns between accommodative disorders, intraocular pressure (IOP) and changes in the biomechanical properties of the sclera.

Methods: There was performed a study of 153 patients with myopia after scleroplasty (153 eyes). The patients’ age is from 5 to 17 years old (average age is 13.4±2.5 years). The observation period was 3 years. The maximum stabilizing effect of scleroplasty was observed one year after surgery.

Results: 3 years after scleroplasty, the progression of myopia was detected in 36 eyes (23.5%). The combination of accommodation weakness, constantly redundant tension of accommodation (CRTA) and IOP values in the range of 18 to 23 mm Hg indicates the presence of ophthalmic- hypertensive syndrome of overstretching accommodation and the progression of myopia.

Conclusion: The use of 0.005% Latanoprost solution (Prolatan) in the complex treatment of patients with myopia leads to IOP level normalization, increase of corneal hysteresis and rigidity index of corneoscleral tunic, as well as increase in the coefficient of accommodative response and decrease in the coefficient of the ciliary body microfluctuations.

Purpose: To study the role of Octopus computer visual field indices in assessing the stages of the glaucomatous process. Successful treatment of primary open-angle glaucoma (POAG) largely depends on the possibility of reliable control of its effectiveness. The system of POAG early detection and monitoring has significant problems: insufficient clinical coverage of the population, poor quality of patients’ examination at the outpatient level. Standard automated perimetry (SAP) is the golden standard in glaucoma diagnosis and is suitable for a life-long clinical examination of POAG patients. Currently, ophthalmologists do not fully use all the features of this method to determine the stages of POAG.

Methods: The study included 150 patients with POAG (284 eyes). According to the results of the study in 102 patients with POAG (193 eyes), exclusion criteria that affect the reliability of SAP indicators were identified The results were evaluated in 48 patients (91 eyes) with POAG diagnosed at least 2 years prior. This group included 27 women (56.3%) and 21 men (43.7%), the average age of patients was 64±10.2 (σ=0.036). The control group consisted of 26 people (52 eyes) — 16 women (61.5%) and 10 men (38.5%). The average age of these subjects was 61±9.0 years. (σ=0.030). All patients underwent a study of the central visual field on the Octopus-101 perimeter (Switzerland), G2 program (glaucomatous test).

Results: The corrected loss variance index (СLV) of the Octopus computer visual field analyzer is the most important for determining of the stage of glaucoma. The СLV index less than 8 dB is found in patients without glaucoma. The CLV index interval from 8.1 dB to 19.0 dB corresponds to stage I of POAG, from 19.1 dB to 36.0 dB — to stage II of POAG and the CLV index value of more than 36.1 dB corresponds to stage III of POAG.

Conclusion: Glaucoma stage of can be determined not only by the location and depth of the central visual field loss but also based on the evaluation of statistical indicators available in a number of models of automated perimeters. Based on that, we propose a screening method for glaucoma stage assessment in outpatient clinic conditions.

Purpose: To estimate the number of Langerhans cells (LC) in the cornea in primary open-angle glaucoma (POAG) at various stages of the disease.

Methods: The study included 129 patients. The main group — 102 patients (204 eyes) aged from 42 to 83 years (62.5±2.4 years) — diagnosed with POAG stage I-IV. The control group consisted of 27 ophthalmologically healthy volunteers (54 eyes) with a normal level of IOP and no signs of POAG aged 54 to 76 years (65.9±1.4 years). The patients underwent visometry, biomicroscopy of the anterior segment of the eye, ophthalmoscopy, gonioscopy, Pascal contour tonometry, optical coherence tomography (OCT) (Zeiss Stratus 3000) and corneal confocal microscopy (CMR) (HRT III, with Rostock Cornea Modul).

Results: The average number of LC in patients with glaucoma amounted to 144±21 cells/mm2. It was higher than in the norm group, the difference was statistically significant (p=0.0002). The study revealed an increase in the number of LC associated with the development of glaucoma. A significant positive correlation of the amount of LC in the nerve fiber layer with the stage of the disease (R=0.23, p<0.05) was also found, as well as a negative correlation with the anisotropy coefficient of the directivity of the corneal nerve fibers in the POAG group (R= -0.29, p<0.001). Intereye asymmetry was investigated, which was found to be the higher, the greater the difference in the stages of POAG between paired eyes. With the value of the indicator of interocular asymmetry LC, equal to 19.68%, the sensitivity and specificity of the proposed indicator for the diagnosis of POAG were 94.1 and 66.6%, respectively. Thus, the values of the interocular asymmetry LC indicator above 19.68% are considered pathological.

Conclusion: The detected increase in the number of LC in the nerve fiber layer indicates the presence of an inflammatory process in the eye, which may well be autoimmune. And it may be the root cause of open-angle glaucoma, lead to pathological glaucomatous scleropathy with damage to the drainage apparatus of the eye and a corresponding increase in IOP level. It also causes a characteristic clinical course in the form of a chronic, bilateral, low-intensity process. In this sense, the neurodegenerative processes in the anterior and posterior segments of the eye are pathogenetically uniform.

Purpose: Analysis of somatic pathology and its correction according to the intraocular pressure (IOP) level in elderly and senile patients with glaucoma.

Methods: The study included 256 patients (512 eyes) with newly diagnosed POAG stage I-III, 78 (30.5%) men and 178 (69.5%) women. The average patient age was 64.7±1.97 years. The study protocol combined the following indicators: age, anamnesis (concomitant somatic pathology and its correction), stages of the disease, IOP level at baseline, 2 weeks, 1 month, 3 months, 6 months and a year after the start of hyportensive therapy, hypotensive drug regimen and its changes.

Results: Patients with POAG in 93.8% of cases had concomitant somatic diseases. Cardiovascular pathology was registered in 232 (90.6%) patients. The majority of patients received combination therapy (188 people, 72.9%), the remaining patients received monotherapy (70 people, 27.1%), which was mainly represented by i-ACE (41.4%) and ARB (32.9% of all monotherapy). For the treatment of glaucoma, β-blockers (75.4%) were the first choice drugs. Prostaglandin analogs (PA) were administered in 17.8% of cases. Patients with β-blockers monotherapy in 57.8% of cases retained this regimen a year after administration. It should be noted that the level of IOP reduction was more promineny than stated in the instructions of the drugs. At the same time, for the correction of cardiovascular pathology, monotherapy in the form of i-ACE and ARB was received in 18.4% of cases. In 33.3% of cases, patients received a combination of BAB with TD, ARB, AK. In 17.2% of cases, patients received antiplatelet agents.

Conclusion: The question of the interaction of drugs for glaucoma and other diseases treatment is relevant throughout the patient’s life to achieve stabilization of the glaucomatous process, eliminate or reduce their side effects and increase adherence to the prescribed therapy.

Purpose: To evaluate the efficiency of Oсuhyl C moisturizing ophthalmic solution in patients with dry eye syndrome (DES) and primary glaucoma.

Methods: The study included 26 patients (47 eyes) with different stages of primary open-angle glaucoma, mean age 68.62±1.76 years. Duration of instillation of hypotensive eye drops with preservatives ranged from 1 year to 35 years. Intraocular pressure (IOP) was compensated prior to the examination. Subjective DES signs assessment included a three-point scale questionnaire: 0 points — no sign, 1 point — periodic occurrence, 2 points — constant presence. The following functional tests were performed in all the patients: the Norn test for the stability of the precorneal tear film, the Shirmer test for assessing the level of total tear production. Examinations were carried out prior to drug administration and after 4 and 8 weeks of its use (sodium hyaluronate 0.12% 1 drop 3 times a day after 10 min after antihypertensive drugs).

Results: All patients noted good tolerability of the drug and no significant side effects. Feeling of a foreign body, dryness and eye redness were significantly decreased after the drug instillations. The initial total tear production on average was 8.94±1.12 mm, after 8 weeks it increased to 11.55±1.01 (p<0.1). The time of the precorneal tear film rupture increased significantly from 8.21±0.31 seconds to 15.06±0.61 (p<0.001).

Conclusion: Ocuhyl C has a positive effect on reducing DES symptoms in patients with primary glaucoma and a long-term use of antihypertensive therapy with preservatives, and can be recommended for clinical use.

Purposes: 1. To reveal the morphophysiological features of the elastic structures of the fibrous tunic of the eye in age-related ophthalmohypertension (AOH) and openangle glaucoma (OAG). 2. Show new features of dynamic differential diagnosis by means of modernized techniques of pnevmomagistral ORA and Corvis ST for accurate and objective differentiation between AOH and OAG.

Methods: Theoretical analysis and clinical trials results of the author’s method of differential Express-diagnostics between AOH and OAG based on the criteria of «rigidity» and «fluctuation of the sclera».

Results: There is a practical possibility of using the upgraded rapid diagnosis with the help of pneumatic analyzers ORA and Corvis ST in the conditions of polyclinic network for a reasonable and objective choice of the method of AOH prevention and OAG treatment, as well as their differential diagnostics,. This allows you to instantly, accurately and numerically identify the elderly patient abnormality of the current IOP level according to the level of IOP in his youth and belonging to the corresponding IOP zone. Also, according to the measured current levels of rigidity and fluctuation of sclera, it is possible to reliably differentiate AOH from OAG, as well as identify the level of decrease in the functional ability of the fibrous membrane of the eye (FME) to the fluctuation necessary to maintain the normal circulation of watery moisture and eye volume.

Conclusion: The principal role in the mechanisms of IOP level formation is played by rigidity and micro fluctuation of the sclera. With age, IOP increases due to the fact that the rigidity of the FME gradually increases. From the standpoint of physiology, AOH is useful and necessary for the eye to maintain normal metabolic processes, even in old age. Not knowing patient’s IOP level in his youth, the doctor often cannot reliably determine the abnormality or normality of the current IOP value. But the pathological level of rigidity of FME in OAG is always significantly higher than the normal level of its rigidity in AOH, and the level of fluctuation of the sclera on the contrary, respectively, falls markedly. This allows you to objectively separate the AOH from the OAG. In case of AOH or OAG, it is necessary to restore the functions of sclera, which will be physiologically and pathogenetically justified preventive or therapeutic effect.

The prevalence of glaucoma in the world today is extremely high: according to different authors total prevalence number reach as high as 66 to 105 million people. It accounts for about 29% in the structure of causes of irreversible blindness and visual impaireness. The only effective way to treat glaucoma, regardless of its type, is to reduce and stabilize intraocular pressure at an individually safe level. In most cases, this can be achieved by the appointment of local antihypertensive therapy. The need for daily and often lifelong adherence to hypotensive drops makes the problem of drug choice extremely important. The presence of systemic diseases, their therapy and the interaction of drugs received by the patient should all be taken into account. Local hypotensive drugs are often embedded into the daily regimen of patients’ systemic medications. Up to 80% of the active substances of ophthalmic drugs are absorbed systematically, while avoiding the primary stages of metabolism. Antiglaucoma drugs can cause serious side effects: symptomatic bradycardia, various violations of cardiac muscle conductivity, orthostatic hypotension, syncope, dyspepsia, exacerbation of chronic diseases of the liver and kidneys, etc. In the present work we considered all currently used groups of local hypotensive drugs: prostaglandin analogues, selective and non-selective β-blockers, carbonic anhydrase inhibitors, α-adrenoceptor agonists, parasympathomimetics. The article describes the pharmacological groups of drugs, the mechanisms of intraocular pressure reduction, systemic absorption and utilization of each group of drugs, possible local and systemic adverse reactions — the most significant information that must be taken into account in the selection and appointment of a drug to each patient. The review presents data on the most common concomitant diseases in patients with primary open-angle glaucoma, the specifics of local and general exposure to antiglaucoma drugs, as well as the information on the possible drug interactions of local antihypertensive drugs and systemic medicines.

Despite the rare incidence of childhood glaucoma in the routine practice of an ophthalmologist, the status of a disabling disease dictates the need to treat this group of patients as carefully and warily as possible. Difficulties with the diagnosis, the choice of the optimal treatment algorithm and the subsequent tactics of monitoring patients with pediatric glaucoma necessitated detailed coverage of this pathology with the accumulation and systematization of data from various sources. The review combines the concepts of etiology, pathogenesis, classification, and also focuses on diagnostic criteria and therapeutic approaches in the management of patients with pediatric glaucoma. The current data on the genetics of the disease are detailed, the underlying mechanisms for the development of glaucoma in children are highlighted, and various classification systems are also reviewed. International criteria for diagnosis are also included. Attention is drawn to the importance of choosing a pathogenetically substantiated surgical technique. The importance of timely verification of the diagnosis and promptly initiated treatment is emphasized. Despite the aggressiveness and refractory nature of the disease, it is possible, with promptly and adequately taken measures, to maintain sufficiently high visual functions for the patient to continue an independent lifestyle.