PURPOSE: To evaluate the diagnostic value of morphometric, morphological and functional and parameters characterizing the state of the retina and optic nerve head (ONH) in patients with Alzheimer’s disease (stage of mild dementia) using computerized static perimetry and optical coherence tomography. METHODS: We examined 17 patients (34 eyes) with Alzheimer’s disease aged 59-82 years (mean age 71 years). All patients underwent a standard eye examination including visometry, computerized static perimetry on the visual field analyzer Humphrey Field Analiser II (HFA II) 750i (Germany) with the use of screening and threshold programs, biomicroscopy, ophthalmoscopy, Goldmann tonometry. Morphometric parameters of the optic nerve and the retina were assessed by optical coherence tomography (OCT) on the RTVue-100 (Optovue, USA). RESULTS: The study of the visual field in the threshold program 30-2 and 60-4 in patients with Alzheimer’s disease revealed the following patterns: a diffuse decrease in sensitivity, concentric arrangement of defects in the peripheral zone of the test visual field (central and peripheral), and a discrepancy between the results of research on threshold and screening programs. The study of morphometric parameters of the retina and optic nerve with OCT revealed diffuse thinning of the retina in patients with Alzheimer’s disease and an increase in the level of complex GCS volume global loss (GLV). CONCLUSION: The discrepancy between the results of visual field function study and morphometric parameters of the retina and optic nerve demonstrates low diagnostic value of the threshold study of computerized static perimetry in examining dementia patients with visual impairments, and can itself serve as a marker for dementia.

PURPOSE: Assessment of optic disc damage is an essential part of the ocular examination and differential diagnosis between the patient with ocular hypertension and pre-perimetric or perimetric glaucoma. The Stratus optic coherent tomograph (Carl Zeiss Meditec, Inc, Dublin, Calif) is still one of the most used optic nerve imaging technology throughout the world. Therefore, the development of methodology that enhances the utility of optic disc measurements with the Stratus OCT remains a relevant and meaningful goal. In an attempt to determine the optimal number of repeated measurements we investigated how the average of three sets of manually repeated measurements of retina nerve firer layer (RNFL) thickness would compare with a single set. METHODS: A total of 73 individuals (136 eyes) aged 55.3±15.2 years with ocular hypertensive (OHT), pre-peri-metric glaucoma or glaucoma were included in the final analysis. When the data was evaluated using a quadrant analysis we observed that 13.6% of the patients exhibited a clinically meaningful difference of 20% or more in the serial RNFL thickness measurements. RESULTS: The difference ranged from 9.3 to 32.7 microns and in 10 of the 12 quadrants the averaged measurement exceeded the initial measurement. Most of the differences demonstrated in this study occurred in the horizontal meridian and are probably a result of instinctive saccadic eye movements. A difference in the vertical meridian (superior and/or inferior quadrants) which is the more relevant meridian for changes in glaucoma was seen in only 3 patients (4.1%). CONCLUSIONS: One reliable RNFL measurement would be sufficient in most of these cases because in 95.9% of the cases the differences observed for the vertical meridian were less than 20%. Nevertheless, it is important to recognize that there can be more variability in the horizontal meridian and that in cases with visual loss encroaching on fixation serial measurements may be useful. At any rate, as with all ancillary tests, whenever a change is detected, it is wise to repeat the test to verify the results.

PURPOSE: To analyze molecular and immunological mechanisms of optic neuropathy development in patients with normal tension glaucoma. METHODS: We have been studying serologic indicators of autoantibodies (AB) in patients with normal tension glaucoma (NTG, n=31), which were compared to corresponding parameters in patients with primary open-angle glaucoma (POAG, n=30). The control group consisted of 25 somatically healthy individuals without ophthalmic pathology and clinical symptoms of systemic autoimmune diseases. For the immunological part of the research we used a wide range of antigens: ENO-1, MBP, NSE, Tβ4, α-crystallin, rhodopsin, GAPDH, actin, α-fodrin. The antibody formation in blood serum was determined with the use of the enzyme-linked immunosorbent assay (ELISA). Antibodies concentration in the blood serum was reflected in a spectrophotometric indicator measured in standard units of optical density. RESULTS: Systemic immune disorders in patients with both forms of glaucoma were revealed. In the NTG group the level of AB to rhodopsin decreased from 1.13±0.13 (Mean±SD) to 0.91±0.19 (p=0.00002, p <0.001), to α-fodrin - from 0.39±0.17 to 0.26±0.11 (p=0.00107, p <0.01), to ENO1 - from 0.56±0.19 to 0.28±0.09 (p<0.001), to actin - from 0.50±0.21 to 0.36±0.14 (p=0.00428, p <0.01) and NSE - from 0.37±0.08 to 0.29±0.10 (p=0.00201, p<0.01). At the same time AB levels to α-crystallin increased from 0.29±0.16 to 1.14±0.18 (p <0.001). Immune disorders in the POAG group were expressed by: the decrease of AB to ENO1 level from 0.56±0.19 to 0.36±0.14 (p<0.001), Tβ4 - from 0.23±0.11 to 0.16±0.03 (p=0.00205, p<0.01), actin - from 0.50±0.21 to 0.33±0.10 (p=0.00078, p<0.001) and of AB to α-fodrin - from 0.39±0.17 to 0.30±0.09 (p=0.01513, p<0.05). Meanwhile, AB levels increased in response to α-crystallin from 0.29±0.16 to 1.14±0.38 (p<0.001). The most significant differences in autoimmune indicators between NTG and POAG patients consisted in decrease of AB to rhodopsin level (reliability of intergroup distinctions p=0.00085, p<0.001) and the absence of changes in the levels of AB to Tβ4. In the NTG group we observed a more pronounced decrease in AB serologic indicators to ENO-1 (p<0.001), NSE (p=0.00201, p<0.01) and α-fodrin (p=0.00107, p<0.01), and in the POAG group - a more expressed decrease in AB to Tβ4 (p=0.00205, p<0.01) and actin (p<0.001). CONCLUSION: Complex disorders of immune and molecular homeostasis have been revealed in the NTG group. The study revealed a decreased production of AB to actin, α-fodrin, which are responsible for safety of the neuron cells cytoskeleton, AB to NSE and ENO-1, the markers of nerve cell damage, and to MBP - a marker of demyelination. AB to neuron differentiation antigens - ENO-1 and NSE - can be proposed as serologic markers of optic neuropathy immunodiagnostics in patients with NTG and POAG. Basic distinctions in targets of autoimmune aggression are found in patients with different forms of glaucoma: photoreceptor cells of the retina serve as a target of apoptosis in the NTG group, while in the POAG group the main target is represented by the retinal ganglion cells. Presumably, the target choice for autoimmune aggression in different forms of glaucoma is determined by the nature of the hemodynamic disorders that cause ischemia of either inner or outer layers of the retina.

PURPOSE: To compare CT and ocular blood flow (OBF) parameters in patients with primary open-angle glaucoma (POAG) and combined pathology of primary open-angle glaucoma and age-related macular degeneration (POAG+AMD). METHODS: 33 patients (age 69±4.7) with POAG+AMD, 31 with the same stage of POAG without AMD and 30 healthy individuals were included in the study. There was no difference between age and axial eye length in all study groups. CT of the fovea, average ganglion cell complex thickness (GCCavg), focal ganglion cell loss volume (FLV), global ganglion cell loss volume (GLV) and retinal nerve fiber layer thickness (RNFLT) were measured by means of optical coherence tomography (RTVue-100 OCT, Optovue, Inc., Fremont, CA). OBF was measured by Color Doppler Imaging (My Lab 70 Esaote). The statistical analysis included a comparison between CT, GCC, RNFLT and OBF parameters (SPSS Inc., Chicago, IL). A P value of <0.05 was considered statistically significant. RESULTS: Statistically significant CT reduction was revealed in POAG+AMD compared to POAG patients and the control group: 234.55±96.81 Mm, 294.56±95.3 Mm (p=0.003) and 308.9 Mm respectively. No statistically significant difference in the values of RNFL and GCCavg between glaucoma groups was found. Peak systolic velocity (PSV) in medial short posterior ciliary artery (mPCA) was reduced in POAG+AMD patients (7.61±5.35 cm/s) compared to the POAG group (12.81 ±2.62 cm/s; p=0.001). Both of the study groups revealed a correlation between CT and PSV in mPCA (0.4, p=0.005). CONCLUSION: The results demonstrate the significant role of the choroid and ocular blood flow in the development of a combined pathology of POAG and AMD. Both these medical conditions may have an adverse effect on each other.

PURPOSE: To investigate the effect of cerebral blood flow on ocular haemodynamics in control subjects and in patients with primary open-angle glaucoma (POAG), depending on the age and dynamics of glaucoma process. METHODS: Blood filling of cerebral and ocular vessels was investigated with the use of rheoencephalography and rheoophthalmography in 115 patients with POAG and in 31 subjects of the control group with no signs of glaucoma, including 33 patients (66 eyes) with non-progressive glaucoma and 82 patients (164 eyes) with progressive POAG. The age range was 50-89 years. Intraocular pressure in all subjects was between 19-21mm Hg. Cerebral hemodynamics was analyzed by the intensity of blood vessel pulse in the cerebral vessels (rheographic index), by the maximum speed of blood during the periods of rapid and slow blood flow, as well as the dicrotic and diastolic indices. Intraocular perfusion was analyzed by the following parameters: largest pulse volume, time of rapid and slow blood flow in ocular vessels, Kedrov’s pulse volume and Yantchu rheographic coefficient. RESULTS: Control group members aged 70-79 and 80-89 showed a significant decrease of blood filling of cerebral and ocular vessels (p=0.02). In patients’ age groups 50-59 and 60-69, with nonprogressive course of POAG no significant decrease of hemodynamics of cerebral and ocular vessels has been revealed as compared to the control group (p=0.02). In age groups of 70-79, 80-89 there was a decrease in blood flow speed in cerebral and ocular vessels. In patients with progressive glaucoma a significant decrease in cerebral and ocular hemodynamics parameters has been revealed starting at the age of 50-59 with further deterioration in the following age groups: 60-69, 70-79, 80-89 (p=0.02). CONCLUSION: A correlation between ocular blood supply and cerebral hemodynamics has been established. A more prominent correlation is detected in patients with progressive course of POAG (p=0.01, r=0.97).

PURPOSE: Dynamic measurement of visual functions in patients with primary open-angle glaucoma (POAG) with achieved target pressure during a one-year observation. METHODS: 57 patients (102 eyes) with POAG were observed for a year. Uncorrected visual acuity, best corrected visual acuity, threshold static perimetry, kinetic quantitative perimetry were quantitatively estimated in all the patients. Intraocular pressure (IOP) compensation was assessed according to the National Glaucoma Guidelines with regard to glaucoma stage. Target pressure was achieved in all the patients. All data was statistically analyzed. RESULTS: Uncorrected visual acuity and best corrected visual acuity stayed stable in patients with POAG stage I during the whole observation period, while in patients with POAG stages II-III a statistically verified decrease of uncorrected visual acuity was discovered. We hadn’t observed changes in central vision parameters in patients with POAG stage I in the majority of cases, while 32.9 and 52.9% of patients with POAG stages II-III revealed a visual acuity loss during the year of observation despite the fact that the target pressure was achieved. Retinal sensitivity in the central area stayed stable in the majority (55.6-70.7% depending on the stage and period of observation) of glaucoma patients during the year of dynamic observation. An improvement of threshold static perimetry results was noticed in 32.3-66.7% of cases. Summarized field of vision was measured at eight principle meridians, and it was considered to be the most informative method of studying the peripheral vision. Verified visual field reduction (test-object square = 1 mm²) was noticed in patients with all stages of POAG. Decrease of peripheral vision was observed in 48.1-61.8% cases (depending on the stage and period of observation) even though the target IOP values had been achieved. IOP stabilization with achieved target pressure values was preserved in the majority of cases (81.0-100%, statistically significant interrelation with the stage of glaucoma and observation period was not found). However, in some cases after 6-12 months a subcompensation of IOP was detected (0% in patients with I stage of POAG, 16% and 11.8% - in patients with II and III stage of POAG correspondingly by the end of one-year observation period). Strong statistically significant correlations were found for all parameters of central and peripheral vision and stages of glaucoma at each term of observation. A significant negative correlation was found between glycemia level and dynamics of IOP compensation. Highly significant negative correlations were found between the central and peripheral vision parameters, IOP compensation and anterior chamber angle pigmentation. CONCLUSION: Despite an adequate background therapy, a high degree of compliance and achieved target pressure, negative dynamics in visual functions take place in the majority of patients with POAG. Peripheral visual field reduction (testobject square = 1 mm²) was found in the majority of cases, while summarized sensitivity and depth of suppression within the scotoma in the central visual field area stayed almost the same. Within a year a patient with the I stage of POAG in average loses 52 degrees of peripheral visual field (test-object square = 1 mm²); reduction in visual acuity doesn’t occur; reduction in visual acuity in patients with the II stage of POAG amounts to 0.08, loss of peripheral visual field amounts to 60 degrees, in patients with the III stage of POAG corresponding changes amount to 0.1 and 85 degrees respectively. Negative correlations between the patient’s age, glycemia, anterior chamber angle pigmentation and visual functions dynamics as well as the dynamics of IOP compensation were revealed.

PURPOSE: To find out the expected duration of the disease and age of patients with different primary open-angle glaucoma changes. METHODS: The study protocol included data from 120 patients (50 males (41.7%), 70 females (58.3%)); 189 eyes; 102 right eyes; 87 left eyes). The first study group (28 patients, 44 eyes) comprised patients with suspected glaucoma. The second group (53 patients, 84 eyes) consisted of patients with early glaucoma changes. The third group (21 patients, 33 eyes) included patients with advanced glaucoma changes. The forth group (18 patients, 28 eyes) comprised patients with terminal glaucoma. The mean age of the patients was 61.6 (58.4; 66.9) years at the time of diagnosis and 66.9 (63.4; 72.8) years at the endpoint visit in 2013. In all cases the diagnosis was made according to the differential diagnosis system and was proved by special diagnostic techniques. The database included data from 3 qualified examinations as well as tonometry and static automatic perimetry results. RESULTS: The expected mean age of the patients at the moment of total vision loss was 75.1 years. The period, during which patients developed blindness, was limited to 6.1 years. Mean age of the patients at the time of possible glaucoma development was 59.58 (56.14; 64.36) years. The disease itself could have developed within -3.24 (-5.38; -1.2) years prior to the diagnosis. CONCLUSION: Glaucoma diagnostic research should be focused on the age group of 55-60 years. The degree of IOP-lowering in patients with advanced glaucoma changes does not correspond with the Russian glaucoma society recommendations, which determines further progression of the disease.

PURPOSE: Investigation of neuroprotective efficacy of Ronocite in complex treatment of patients with primary open-angle glaucoma (POAG) with normal intraocular pressure (IOP) level based on clinical and functional evaluation of ophthalmological indices. METHODS: Sixty patients (38 women and 22 men) aged 60.75±12.83 years with POAG stages I-III have been examined. The duration of the disease varied from 6 months to 10 years, 3.1±0.6 years on average. All the patients were divided into 2 groups: the main group and the control group. The control group included 28 patients (47 eyes) who received a traditional treatment scheme. The main group (32 patients, 58 eyes) was treated with traditional therapy combined with Ronocite. All patients underwent the following examinations: best corrected visual acuity definition, biomicroscopy, goniosco-py, automated static perimetry on the Humphrey visual field analyzer (HFA II 740), tonography, eyeground examination with VOLK lens, optic coherent tomography (OCT), definition of electrical sensitivity threshold and optic nerve lability by phosphene, compliance monitoring. RESULTS: Good local and systemic Ronocite tolerance was noted through all periods of investigation. The use of the recommended scheme in the treatment of POAG patients demonstrated a reliable improvement in visual acuity up to 20/250-20/100 (0.08-0.2), which is 4 times higher than in patients treated with the generally accepted scheme. The patients of the main group showed a reliable improvement of fusion of flickering phosphenes (FFP indices): up to 14.5% at I stage, 13.9% - II stage in the main group, and 2.7 and 2.4% respectively in the control group. Ronocite provided a more marked neuroprotective effect in POAG patients, rendering an effective protection of the nervous tissue and delaying apoptosis. Along with the improvement of clinical and functional indices of the eye, we have noted an improvement of the general state, attention and working ability of the patients too. CONCLUSION: Analysis of the obtained results indicated a good clinical effect of Ronocite (Citicoline) in conservative treatment of POAG patients with compensated IOP. This drug may be recommended as an adjunctive to neuroprotective therapy of primary open-angle glaucoma.

The bleb is the functional part of trabeculectomy, and the part that largely determines long-term success, failure, and complications. In many studies authors have described bleb appearance after glaucoma surgery in terms of recognized patterns of bleb appearance such as cystic, encysted, flat, and diffuse, usually in conjunction with a global vascularity assessment. Article describes all proposed bleb grading systems: the old ones (Kronfeld, Migdal, Hitchings, Vesti, Lederer and Shingleton), the most popular (Wuerzburg bleb classification score, Indiana bleb appearance grading scale, Moorfields bleb grading system). Also analyzed the modern concepts of bleb morphology using ultrasound biomicroscopy, optical coherence tomography, thermography and digital methods for assessing hyperemia level. In conclusion, the author tried to determine the role of each classification. Which characteristics are to be used as a descriptive, and which of them can predict the duration of the hypotensive effect of the surgery.

The review presents clinical and pharmacological aspects of treating glaucoma patients with cardiovascular diseases and current epidemiology of cardiovascular diseases in Russian Federation. It discusses the most widespread cardiovascular diseases and medications for their treatment (organic nitrates, systemic beta-blockers etc.). The article describes the effects of anti-glaucoma medications (beta-blockers, alpha2-adrenoceptor agonists, prostaglandins, carbonic anhydrase inhibitors) on cardiovascular system (heart rate, blood pressure) and the course of treatment of cardiovascular diseases, including cardiovascular mortality. Authors enumerate the main absolute and relative contraindications to different groups of anti-glaucoma medications: prominent forms of cardiovascular pathology (atrioventricular block II-III degree, decompensation of chronic heart failure, marked bradycardia). The impact of the medications for cardiovascular diseases (antihypertensive drugs, organic nitrates, antiplatelet medications) on intraocular pressure and the course of glaucoma is also described in the review. It emphasizes the necessity of developing a rational systemic antihypertensive regimen to avoid the episodes of nocturnal arterial hypotension that promote the progression of glaucoma. The article also presents examples of possible clinically significant drug-drug interactions in patients with combined pathology. The authors provide recommendations on improving treatment efficiency and pharmacotherapeutic safety in patients with glaucoma in combination with cardiovascular diseases.

The article deals with the facts confirming the author’s concept that genetically determined accommodation weakness may serve as a trigger of primary glaucoma. It is anatomically determined by a “tight” anterior segment of the eyeball. In these cases at a certain period of life (most frequently - presbyopic) the distance between the equator of the crystalline lens and ciliary body becomes less than that of the age norm. Ligaments of Zinn are sagging more than usual, the effect of the ciliary muscle on the crystalline lens becomes rather weak and accommodation volume decreases dramatically (more than in healthy eyes). In case of excessive accommodation weakness the body triggers compensatory reactions to create comfortable conditions for the accommodation apparatus to function. Such an attention to accommodation is connected with the fact that in the process of evolution it played a primary role in human survival as a species (scanning the danger on various distances). The body can trigger various compensatory reactions implemented as primary stages of different eye diseases. In every case the brain estimates what kind of reaction (e.g. disease) will be the most advantageous ergonomically. In other words, what kind of pathological process will result in restoration of accommodation function of the eye with the least loss of energy. The analysis of clinical signs of retinal vein thrombosis (frequent association with primary glaucoma, identical correlation of patients with “mild” and malignant course - 2/3 and 1/3, occurrence of afferent papillary defect) gives the basis to suggest that accommodation weakness may be a trigger of retinal vein thrombosis. Analytically drawn conclusion assumes that an effective method of treating retinal vein thrombosis may be equivalent to that of glaucoma: a surgical thinning of the sclera in the projection of the ciliary body. It enables the eye to restore the accommodation function and stabilize the pathological process in the retina.