PURPOSE: The purpose of the research is to study glaucoma prevalence in the Republic of Bashkortostan (RB) over the 20-year period (1999-2018 years).

METHODS: This research was conducted using the data from statistic annual reports of ophthalmologists from various cities and regions of RB, the Ufa Eye Research Institute with assistance from the Head Office of Medical and Social Examination Service in RB.

RESULTS: In 2018 there were 33 727 people with glaucoma in RB (81.5% with primary open-angle glaucoma — POAG). 73.8% of them were over the age of 60 and 83.3% patients had mild or moderate glaucoma. During periodic health examination there were 1.2% patients with suspected glaucoma and 0.6% with an established diagnosis. During the period from 1999 to 2018 there was a 112.8% increase in patients registered in dispensaries, a 77.4% increase in prevalence and morbidity from POAG, while there was a decreasing trend in the number of blind people and people primary identified as disabled associated with glaucoma.

CONCLUSION: The 20-year period analysis (1999-2018) showed that there was more than a two-fold increase in the number of officially registered patients with glaucoma in the Republic of Bashkortostan: from 15 852 to 33 727. But despite the progressive growth of glaucoma incidence, particularly primary open-angle glaucoma (from 9.3 to 16.5 per 10 000 people over the age of 40) there was a 30% reduction in blindness prevalence over the last 9 years (since 2010) — from 17.3 to 13.0 and a 37% reduction in absolute number of people with glaucoma-related disability — from 346 to 218. It was a complex result of high level of check-ups and periodic health examinations in Republic followed by an increasing number of identifications of patients with early glaucoma, active and wide use of topical medicines and a persistently high surgical activity.

PURPOSE: To study the efficacy of ranibizumab intravitreal injections in patients with macular edema due to retinal vein occlusion and primary glaucoma.

MATERIALS AND METHODS: The study group included 61 patients with macular edema due to retinal vein occlusion. 27 (44%) patients with macular edema had primary open-angle glaucoma (POAG): 11 (41%) of 27 patients were diagnosed stage I POAG, other 16 (59%) — with stage II. The remaining 34 (56%) of 61 patients with macular edema without POAG comprised a comparison group. All patients underwent a standard ophthalmic examination, spectral optical coherence tomography of the macular zone and the optic nerve head prior to treatment and after the intravitreal injections. We performed ranibizumab intravitreal injections according to the standard protocol. A statistical analysis was conducted.

RESULTS: Patients of both study groups showed a significant increase of the best corrected visual acuity compared to baseline and a decrease of both foveal thickness and volume, without a statistically significant difference between groups after intravitreal injections of ranibizumab. We did not register a significant increase in the level of intraocular pressure from baseline, or a decrease of optic nerve head parameters after intravitreal injections of ranibizumab.

CONCLUSION: Intravitreal injections of ranibizumab are an effective and safe treatment for macular edema in patients with retinal vein occlusion and POAG.

OBJECTIVE: To assess the accuracy of Maklakov intraocular pressure imprints measurement by doctors and artificial intelligence.

MATERIALS AND METHODS: Two pairs of tonograms were prepared, obtained by a Maklakov tonometer with a load of 10.0 g. The tonograms were labeled anonymously, using a measuring ruler devised by prof. B.L. Polyak for 4 Maklakov tonometers. In total, 57 ophthalmologists took part in the work. A total of 40 prints were chosen based on there quality. The same prints were photographed by a Xiaomi mi smartphone camera 40 times with a different level of illumination and a different angle of rotation relative to the normal of the lens focal plane. Received photos in jpg format were analyzed by http://ai-tonometry.com algorithms and processed by the Contrast Limited Adaptive Histogram Equalization (CLAHE) algorithm to extract sharper boundaries, and then translated into binary matrices (matrices consisting of “0” and “1”).

RESULTS: An imprint with a maximum number of measurements of 40 and a collegially accepted reliable tonometric level of 17 mmHg was measured in the middle range of 16.48±2.7 16.0 (15.0; 17) mmHg by doctors, and 17.0±1.1 17.0 (16.0; 17.0) mmHg by the neural network. At the same time, the range of imprint diameter measurements by the neural network was almost three times smaller, than human measurements.

CONCLUSION: The artificial intelligence-based mobile application allows for a high-quality monitoring of intraocular pressure and rejects prints of unsatisfactory quality, which may potentially reduce the number of patients with glaucoma progression.

PURPOSE: Qualitative and quantitative analyses of glaucoma patients’ examination efficiency in the conditions of the outpatient link of glaucoma department.

MATERIALS AND METHODS: Out-patient and statistical patient cards, annual reports from 2012 till 2019.

RESULTS: 34 677 patients were consulted from 2012 till 2019; a total of 12 267 first time addressing patients comprised 35.4% of the total number of patients. 5 115 people with glaucoma diagnosis (41.7%) were taken under observation for this period.

CONCLUSION. 1. Dispensary supervision of glaucoma patients in the outpatient link of the glaucoma department promotes a delay of glaucoma progression and visual functions stabilization.

2. The continuity between outpatient clinic doctors and the Republican glaucoma department promotes glaucoma detection at the early stages of its development. It gives better chances to the follow-up observation and timely treatment of the patient.

3. Collective cumulative measures for the population enlightenment via mass media promote an increase of glaucoma awareness that in turn stimulates an early admission of patients to specialists.

PURPOSE: To study and compare the prognostic capabilities of the Lowe coefficient and the Shirshikov axial coefficient in the eyes with an anatomical predisposition to the development of primary angle-closure glaucoma (PACG).

MATERIALS AND METHODS: We examined 135 patients (201 eyes) with a first-time diagnosis of PACG. Prior to the treatment we measured biometric parameters of the eyes and used them to calculate the prognostic Lowe coefficient and Shirshikov axial coefficient. A comparison of these coefficients’ informativeness was conducted.

RESULTS: It has been confirmed that the predisposition to PACG is the result of a combination of anatomical parameters involved in the development of hydrodynamic blocks, and not the clinical influence of any single parameter. According to the authors of the coefficients, in the eyes of those predisposed to PACG development, Lowe coefficient usually equals ≤0.2, while Shirshikov axial coefficient reaches ≥10. According to the calculation results, the average value of Lowe coefficient was 0.21±0.02≤0.2, while Shirshikov axial coefficient was 15.79±3.05≥10. When comparing the data, it was established that the reliability of the Shirshikov axial coefficient in predicting PACG was significantly higher (2.44 times; DI 2.06; 2.90) than that of Lowe coefficient.

CONCLUSION: The informativeness of the Shirshikov axial coefficient (poorly known among ophthalmologists) for predicting PACG turned out to be higher than that of the Lowe coefficient, which gives reason to recommend its wider use in clinical practice.

Glaucoma is the main cause of irreversible blindness worldwide, the treatment of which is based on reducing intraocular pressure to tolerant values. Despite the development of medication and laser methods, surgery remains the most effective means of glaucoma treatment, while trabeculectomy remains the golden standard of surgery. However, postoperative scarring remains a critical determinant of long-term bleb survival and IOP control after drainage surgery. Antimetabolites, such as mitomycin C and 5-fluorouracil, have been used to increase the survival time of filtration surgeries by preventing bleb fibrosis and scarring. Mitomycin C is activated via enzymatic reduction into metabolites that inhibit cell replication by inhibiting DNA synthesis, RNA transcription, and protein synthesis. In tissue culture, MMC induces apoptosis of tenon fibroblasts. MMC blocks cell division, which in turn inhibits fibroblast proliferation and enhances bleb formation and function.

This review includes a literature analysis on the use of antimetabolites in glaucoma surgery. Based on the data and literary sources of recent years, a general understanding of the mechanism of action of MMS and the need for its use in the course of AGO, but exclusively with low doses and short exposure times, has been achieved, which will reduce the frequency of complications associated with excessive filtration, but at the same time prevent the development of excessive scarring.

Selective laser trabeculoplasty (SLT) is a relatively new method of intraocular pressure lowering in patients with primary open-angle glaucoma (POAG). The main advantages of SLT are its safety and effectiveness. Laser methods are considered to be the second line of glaucoma treatment worldwide. Hyportensive drugs are usually used as the initial method for glaucoma patients. It is common knowledge that preservatives and active components of eye drops usually cause adverse effects. This problem is especially relevant in patients with POAG due to the need for lifelong therapy starting from the moment of proving the diagnosis. In addition, the mechanisms of interaction between antiglaucoma drugs and medications for extraocular diseases remain unclear. Therefore, the question of initial SLT in patients with newly diagnosed POAG remains essentially important. In our review we compared the methods of selective laser trabeculoplasty and drug therapy in glaucoma treatment, analyzing available information regarding indications, contraindications, complications and effectiveness of the methods, patients’ quality of life and economic aspects.

This article discusses the effect of prolonged instillations of ophthalmic antihypertensive drops on the ocular surface tissue, as one of the pathogenetic factors contributing to the occurrence of artifical or secondary dry eye syndrome (DES). It is known that the vast majority of antiglaucoma drops contain a preservative for the prevention of bacterial contamination of the vial: prolonging the shelf life of drops, the preservative prevents biodegradation and preserves the effectiveness of the drug, allowing you to use a convenient and safe bottle.The most common preservative, to date, is still benzalkonium chloride (BAK). But another thing is known: even at a minimum concentration, ВАК is able to have a cytotoxic effect on all structures of the eye surface. Even at a minimal concentration, BАК is capable of exerting a cytotoxic effect on all structures of the ocular surface. It is possible to reduce the toxic effects of the preservative on the ocular surface and stop the symptoms of DES using tear replacement therapy. The artificial tears replacement therapy proposed in the article is non-preservative, and the active substances that make up the preparations have proven effectiveness in the treatment and prevention of ocular surface xerosis.

In recent years, the stock of therapeutic agents for glaucoma treatment has been supplemented with new effective drugs. Despite this, only timely surgical intervention creates the conditions for the preservation of visual functions in patients with primary open-angle glaucoma. Surgical and laser interventions are the most frequently performed operations in primary glaucoma. But the risk of complications that lead to treatment efficacy decrease remains an important factor. Excessive scarring of the newly created intraocular fluid outflow pathways is one of the most frequent postoperative complications, which in 15-45% of cases leads to intraocular pressure level increase at different timepoints after surgery. Postoperative periods in different patients may have significant differences, despite a comparable clinical picture prior to the surgery.

Developing the criteria for predicting postoperative course, frequency and nature of complications, as well as a set of measures to prevent and eliminate the causes that lead to glaucoma surgery failure is a question of the utmost importance. Possible causes include chronic herpesvirus infection, whose role in glaucoma surgery outcome has not been sufficiently studied.

The majority of hypotensive antiglaucoma drugs, designed for intraocular pressure (IOP) decrease, contain a preservative. A lifelong use of eyedrops provides the conditions for its accumulation with realization of its side effects. One of the most common preservatives is benzalkonium chloride — a quaternary ammonium compound with detergent properties. Its constant exposition on the eye surface can lead to functional and organic alterations of eye tissues, affecting both the quality of life and glaucoma progression with concomitant disease development.

As it is impossible to create an “ideal preservative”, active against the pathogen microorganisms, but that leaves the eye tissues intact — and taking into account a low prevalence and amount of studies of other, more harmless preservatives, an issue of non-preservative hypotensive glaucoma treatment is relevant. Complete absence of a preservative in the eyedrops can dramatically improve the treatment adherence and quality of life.

By now, there is a lot of data confirming better tolerance of non-preservative drugs, compared to the ones that contain preservative. Meanwhile, preservative-free therapy has also its drawbacks, with the most important of the bigger drug cost and absence of long-term tolerance studies.

The article is dedicated to a new stage in the study of glaucoma. It describes clinical signs of hypothalamic hypertension. It refers to the biographical data of Professor G.Y. Chernyavsky, head of the glaucoma department (1962-1980) of the Helmholtz Moscow Research Institute of Eye Diseases. His role in the organization of a new scientific school is demonstrated.