PURPOSE: To optimize priority treatment regimens using retrospective analysis of treatment approaches in patients with primary open-angle glaucoma (POAG) in routine clinical practice.

METHODS: The final protocols of the combined analytical research and clinical multicenter cohort studies conducted in the period from July 2014 to January 2018 at 30 scientific and clinical bases of 6 (six) countries. 2 223 people;
men — 810, women — 1 413 (2900 eyes), with POAG stages I-III were included in the study. The average age of all patients at the time of inclusion in the study was 64.39±0.64 years. The following indicators were included in the research protocols: the age of patients, the stage of POAG, the time of diagnosis verification, mean deviation (MD) and pattern standard deviation (PSD) at the time of diagnosis verification, treatment regimens, duration
of hypotensive effect and hypotensive efficacy.

RESULTS:Statistically significant differences in the levels of intraocular pressure (IOP) at the time of diagnosis verification in patients with different stages of glaucoma were established: patients with advanced stages of POAG had an IOP level higher than patients with the mild stage of the disease. The average level of IOP at the time of diagnosis verification for mild glaucoma was 26 (24.0; 28.0) mm Hg, for moderate 29 (27.0; 32.0) mm Hg, for advanced 31 (28.0; 34.0) mm Hg. The most commonly used regimens were monotherapies with betablockers (BB) 26.6% and prostaglandin analogues (PG) 24.6%. The combination of these drugs prescribed in 17.9% of cases. Hypotensive efficacy (-5.70 mm Hg) and regimen duration (1.6±0.16 years) of BB monotherapy was weaker than PG monotherapy (-6.35 mm Hg) and (2.16±0.16 years). The antihypertensive efficacy of the combined treatment of PG+BB (-6.56 mm Hg) was comparable to PG monotherapy (-6.35 mm Hg), and the duration of combined therapy was shorter than monotherapy (2.00±0,24 years and 2.16±0.16 years, respectively). Laser treatment provided additional hypotensive effect in combination with local combined therapy. Surgical treatments (STE and NPGS) demonstrated maximum hypotensive efficacy (-11.86 mm Hg and -13.38 mm Hg, respectively). Practitioners begin treatment of POAG with monotherapy at an average age of 62.34±1.1 years and with an average anamnesis of 0.06±0 years. Surgery is performed in younger patients (65.42±1.44 years) with a anamnesis 3.40±0.60 years, the maximal topical hypotensive therapy is used in patients with older age 71.03±2.45 years and a longer anamnesis (4.01±1.07 years) of the disease.

CONCLUSION: The established differences of IOP level at the time of diagnosis verification may be used as a prognostic criterion for POAG. A stepwise approach is most reasonable in patients with POAG. Start with PG, the transition to combination therapy and laser treatment with further surgery will guarantee target IOP and preserve the patient’s visual functions.

Primary open-angle glaucoma is a chronic optic neuropathy, which often requires a lifelong treatment. Patient compliance, adherence to therapy and persistence play a vital role in improving the outcomes by reducing morbidity and the economic consequences that are associated with disease progression.

PURPOSE: To assess the role of Xalatan use in modern conservative drug therapy of glaucoma process.

METHODS: A non-clinical, epidemiological, single-step study was conducted by interviewing 231 outpatient ophthalmologists in 19 cities of the Russian Federation. RESULTS: Data analysis allowed us to conclude that Xalatan presently is one of the leading prostaglandin ana logues prescribed by ophthalmologists on the territory
of the Russian Federation.

CONCLUSION: After assessing the number of cases of insufficient Xalatan efficacy, we could conclude that doctors are highly satisfied with the treatment results. At the same time, the frequency of choosing Xalatan as the first line drug, second line drug, as well as total percentage of patients receiving Xalatan, and the number of patients who had to cancel Xalatan due to lack of effectiveness did not depend on the doctor’s experience, which indicates that doctors were highly aware of Xalatan.

The lack of full knowledge of the causes and all links of glaucoma pathogenesis forces us to recognize an increased level of intraocular pressure (IOP) as one of the main risk factors for glaucoma development. That is why glaucoma treatment is based on IOP level reduction to values that hold no danger of provoking visual functions decrease. Among the reasons for ocular hypertension development, the least studied are the conditions in which pressure increases in the system of episcleral veins. In differential-diagnostic search the idiopathic elevated episcleral venous pressure syndrome (Radius-Maumenee) fills a special place. This condition is an exclusion diagnosis in the absence of other significant pathology. Currently, in foreign literature one can find single clinical cases describing this condition. In this clinical case, a patient with secondary glaucoma of the right eye resulting from a long monocular idiopathic elevated episcleral venous pressure is presented. The peculiarity of this patient’s management was the intolerance of most hypotensive drugs, which affected the treatment tactics.

PURPOSE: To assess the possibility of glaucoma compensation and stabilization in patients with a combination of primary open-angle glaucoma (POAG) and axial myopia on 0.2% brimonidine as part of combination glaucoma therapy.

METHODS: We conducted a clinical results analysis of a 1-year treatment program of 30 patients with a combination of non-compensated POAG and axial myopia. All patients underwent an ophthalmologic examination that was sufficient to verify the diagnosis, as well as an analysis of the morphometric parameters of the retina and optic nerve using Cirrus HD OCT 4000. 0.2% brimonidine instillation was added to the treatment 2 times day as part of the hypotensive treatment.

RESULTS: Adding 0.2% brimonidine to the course of treatment in patients with POAG and axial myopia allowed achieving IOP compensation and reducing the initial IOP level by 25.3-29.9%. No statistically significant changes in visual acuity and perimetry data were registered during the year of observation. There were no changes in OCT parameters, which demonstrated a stable condition of the optic disc and retina during the treatment course.

CONCLUSION: The use of 0.2% brimonidine as part of combination glaucoma therapy in patients with POAG and axial myopia is expedient and effective.

The article shows evidence of the undifferentiated connective tissue dysplasia influence on the development of keratoconus and pathological changes of the optic nerve and retina.

PURPOSE: Comparative study of morphometric parameters of the optic nerve and retina variations in patients with keratoconus, depending on the presence of undifferentiated connective tissue dysplasia.

METHODS: 186 patients with verified keratoconus diagnosis (186 eyes) underwent optical coherence tomography of the posterior segment of the eye. The results were used to subdivide the patients into 3 clinical groups. A comparative analysis of the morphometric indices of the optic nerve and retina was conducted in all groups. Group 1 included 40 patients (40 eyes) with expressed changes in morphometric parameters of the optic nerve and retina. Group 2 consisted of 50 patients (50 eyes) with insignificant deviations from the average values. The comparison group comprised 96 patients (96 eyes) without any morphological changes of the fundus, according to optical coherence tomography.

RESULTS: Group 1 patients showed a statistically significant decrease of the average thickness of retinal nerve fiber layer compared to patients of the other groups (80.15±1.29 vs. 91.70±1.09 and 95.50±0.81, respectively) (1-2 p≤0.0001; 1-3 p≤0.0001; 2-3 p=0.003). Retinal nerve fiber layer thickness in separate segments (SNIT) in group 1 patients also significantly thinner. The analysis also identified significant differences in the volume of optic disc cup and rim area. No significant differences in average and vertical cup/disk ratio between patients of different clinical groups have been identified. Group 1 patients on average had a smaller optic disc than Group 2 and comparison group patients, (1.712±0.059 µm against 1.825±0.047 and 1.966±0.036 µm, respectively) (1-2 p=0.04; 1-3 p=0.0001; 2-3 p=0.01).

CONCLUSIONS: Currently undifferentiated connective tissue dysplasia presents a widely overlooked risk factor of keratoconus development and pathological changes of optic disc and retina. Patients with keratoconus combined with connective tissue dysplasia, apart from the «gold» standard of treatment, require both neuroprotective and collagen stabilizing therapy as well as a close medical monitoring.

Postoperative excessive scarring of the eye tissue at the surgical site is known to be the main reason of postoperative IOP increase. This review presents an analysis of local and foreign literature on the problem of excessive scarring management in glaucoma surgery by means of anti-metabolites (5-fluorouracil and mitomycin C).
It gives an evaluation of their practical efficacy and presents various methods of their application and particular complications. The article also recounts alternatives to anti-metabolites and steroids as well as current means of affecting the process of excessive scarring. The author concludes that currently antimetabolites and, in a lesser degree, steroids present the only viable clinical possibilities of an effective postoperative drug correction of excessive scarring.

The literature review provides the information on loading and unloading stress tests, which could be useful for early glaucoma diagnosis in absence of its regular clinical signs. The mechanism of tests for primary angle closure glaucoma diagnosis and risk of intraocular pressure (IOP) elevation in anterior chamber angle closure diagnosis is emphasized. The development history and clinical acceptance is described. Considering the undulating way of IOP elevation in primary angle closure glaucoma, the stress tests for latent disease diagnosis are of high importance. This enables us to discover the risk of glaucomatous optic nerve progression early and prevent it (at first, to perform the laser iridectomy).

The features and mechanisms of most common loading stress tests are given, including the Hyams prone test, based on provocation of pupillary and angular block development and IOP elevation while supervised by physician. The unloading tests, based on pilocarpine, acetazolamide and glycerascorbate, based on the opposite mechanism and utilized when loading stress tests are considered dangerous, are also described.

Laparoscopic surgery has an undoubtable advantage over classical abdominal surgery with large incisions. Hence the constant increase of the laparoscopic surgery share in abdominal surgery throughout the world. Laparoscopic surgery is also characterized by a temporary increase of intra-abdominal pressure, absent in classical surgery.

Changes in cardiovascular, respiratory and renal systems associated with the said increase of intra-abdominal pressure have been studied, but there is only a small amount of works devoted to the study of visual system in same circumstances.
A connection between intra-abdominal pressure changes and fluctuations in intraocular pressure has been mentioned in several studies, but the results presented in different studies are contradictory and have a debatable character.

This literature review presents a modern view of the concept of intra-abdominal pressure, the causes of its change, as well as the effect of these changes on the human body and particularly on the organ of vision.

Cataract and glaucoma are the leading causes of vision impairment and loss, and their combination requires a personalized approach to treatment. Phacoemulsification is the most widespread operation in ophthalmology, and apart from cataract removal, it may decrease the intraocular pressure in patients with mild glaucoma. However, combined or subsequent phacoemulsification and glaucoma surgery increase surgical trauma with consequent scarring of the new outflow path and intraocular pressure decompensation.
This treatment plan is most frequently used; however, it requires additional research of the optimal time interval between operations. New microinvasive glaucoma surgery devices allow for minimizing surgical trauma in cases of both separate implantation and being combined with phacoemulsification; however, this is a relatively new class of devices, requiring further study of its long-term hypotensive efficacy.