PURPOSE: To study the morphological basis of a refraction shift that occurs after penetrating glaucoma surgery.

METHODS: The study included 45 patients with progressive primary open-angle glaucoma, who underwent trabeculectomy. We examined patients prior to surgery, one week, one month and three months after the surgery. The patients underwent visual acuity check, tonometry, measurements of biomechanical properties of the fibrous tunic of the eye, its axial length (AL), anterior chamber depth (ACD), lens thickness (LT) and pupil width. Refractometry and keratometry were also performed, including corneal curvature in steep and flat meridians (R1, R2), its average curvature (Ave), and the corneal cylinder.

RESULTS: Most of the significant changes occurred during the first week after surgery. Myopic shift continued to develop during the whole observation period: sphere increased from -0.2 [-1.19; 1.25] diopters to -0.68 [-2.61; -0.32] diopters by the third month. During the first week the cylinder increased from -0.54 diopters to -1.13 diopters, returning to previous condition by month 3 (-0.62 [-1.6; -0.28] diopters). Corneal cylinder value correlated with total astigmatism up to the end of the first month, then it increased again up to -1.13 [-1.81; -0.94] diopters by month 3. During all the observation period regular astigmatism prevailed, R1 and R2 changed in tandem, which complicated the analysis of corneal cylinder genesis. Intraocular pressure (IOP) decreased from 24.8 [21.2; 29.0] to 9.2 [4.95; 16.2] mm Hg during the first week, then it remained within the range of 10-17 mm Hg. Change of biomechanical properties (corneal hysteresis, corneal resistance factor) showed the decrease of the fibrous tunic inner tension, consequent to IOP compensation after surgery. AL decreased by 0.11 [0.06; 0.22] mm during the first week, then it showed an insignificant opposite trend. Simultaneously ACD decreased from 2.45 [2.23; 2.64] to 2.39 [1.95; 2.65] mm, also followed by a subsequent insignificant opposite trend. Pupil width during the first week increased from 3.03 [2.69; 3.38] to 3.63 [2.20; 4.06] mm; then the pupil resumed its diameter by half. The spherical component had a negative correlation with AL and ACD. Total astigmatism correlated with the corneal one. Its delta correlated with the delta of the corneal cylinder power and, more weakly, with the preoperative cylinder power.

CONCLUSION: A myopic shift with temporary astigmatism occurs after trabeculectomy. The refraction shift depends mostly on the biometric parameters of the eye. Induced astigmatism is mostly corneal in nature.

PURPOSE: Determination of key factors of non-compliance for treatment and duration of recommendations accomplishment in accordance with doctor’s instructions and associated with time from therapy start to its discontinuation (persistence) in patients with glaucoma by assessment of personal opinion of ophthalmologists with different amount of experience.

METHODS: 509 queries of medical professionals (631 doctors) from Russia and other 6 countries were included into the study. All doctors’ queries were grouped according to the duration of their work experience, place of work — depending on medical care type (ambulatory or inpatient) and by hospital propriety type (state or private). Data collection method: online survey. The significance of the 32 selected compliance factors was assessed by the ball system from 10 (maximum significant factor) to 1 (minimally significant factor). Analysis program Statistica 8.0 (StatSoft Inc., USA).

RESULTS: Data analysis allowed determining medium terms for continued application of recommended therapy depending on patients group. Persistency of low-compliant patients was considered a period of continued following of recommendations from 15 up to 27.5 days per year, high-compliant — 180-300 days per year. Doctors’ opinion depended on time in professional and place of work. Study results allowed recognizing percent’s of “low-compliant”, “mediumcompliant” and “high-compliant” patients. Following patients compliance factors were assessed as well: factors directly associated with treatment, factors, associated with patient’s condition, factors of behavioral compliance and social compliance. Moreover, trial results displayed difference in opinion of medical specialists depending on the duration of their work experience, place of work and clinic type.

CONCLUSION: Study groups divided by the amount of healthcare experience showed no difference in patients compliance apprehension. Percentage of low-compliant patients was 20 [10; 30] %; medium-compliant — 30 [20; 45] and high-compliant — 50 [30; 60]% in all groups. A longer duration of healthcare experience corresponded with higher persistence requirements. Low-compliant patients followed recommendations for up to 20 days per year [7; 60]; medium-compliant — for 90 [20; 200] and lowcompliant — 200 [40; 350]. Primary factors for non-compliancy in all groups were defined as follows: absence of motivation; complicated instillation regimen influencing daily activities; absence of contact with attending physician; low information level concerning condition; age; side effects; medication price; laziness; family history of glaucoma. Factors of behavioral compliance were considered the most important in all groups — 75%.

PURPOSE: To compare the biometric, biomechanic and keratorefractive shift after trabeculectomy and non-penetrative deep sclerectomy (NPDS).

METHODS: 45 patients after trabeculectomy and 45 patients after NPDS were included into the study. The patients were examined prior to surgery, one week, one month and three months after the surgery. Patients underwent tonometry and measurements of corneal biomehanic properties, axial length (AL), anterior chamber depth (ACD), lens thickness and pupil width. Keratorefractometry was performed to define refractive data and corneal curvature in the steep meridian (R1), flat meridian (R2), the average curvature (Ave), and the corneal cylinder.

RESULTS: The changes of intraocular pressure, biomechanical and refractive properties after trabeculectomy and NPDE were comparable. The following parameters were statistically different between two groups: during the first week — ACD (2.39 [1.95; 2.65] mm after trabeculectomy, 2.62 [2.33; 2.89] mm after NPDE); by the end of the first month — ACD (2.42 [2.24; 2.70] mm after trabeculectomy, 3.11 [2.68; 3.17] mm after NPDE), AL (23.70 [22.70; 24.11] mm after trabeculectomy, 25.11 [23.95; 26.25] mm after NPDE), R1 (7.53 [7.36; 7.70] mm after trabeculectomy, 7.93 [7.89; 8.05] mm after NPDE), and average curvity (7.47 [7.27; 7.65] mm after trabeculectomy, 7.88 [7.60; 7.92] mm after NPDE). No significant intergroup differences were noted by the end of the third month of follow-up. It is also worth noting, that a correlation between refraction shift with astigmatism development and corneal resistance change was observed in the NPDE group.

CONCLUSION: Significant differences between eyes after trabeculectomy and NPDE can be found in ACD values one week post-surgery and in ACD, AL and cornea curvature by the end of the first month. Refraction shift and astigmatism development after NPDE depends on the initial biomechanical properties of the cornea.

PURPOSE: The analysis of new cohesive and adhesive OVDs (Kogevisk and Adgevisk, "Solopharm") influence on the intraocular pressure (IOP) level in early postoperative period after phacoemulsification.

METHODS: The clinical study was based on an assessment of the clinical and functional state of 60 patients (60 eyes), which were divided into 2 groups depending on ophthalmic viscoelastic device (OVD) used during the operation of phacoemulsification (Softshell technology): in Group I (30 patients, 30 eyes) Adgevisk was introduced for tissue protection, and Kogevisk — to create volume; in Group II (30 patients, 30 eyes), Viscoat was used to protect tissues and Amvisk Plus was used to create volume. During the postoperative period, all patients received standard anti-inflammatory therapy. There were no statistically significant differences in average patient age, operation field, preoperative intraocular pressure (IOP), and preoperative central corneal thickness (CCT) between the two groups. Prior to the surgery and in the postoperative period (after 30 minutes, 2 hours, 1 day, 7 days) the level of IOP was measured, and one day and one week after the surgery we measured CCT values and endothelial cells density (ECD). The duration of the operation and the amount of fluid required during each operation were also assessed.

RESULTS: Each patient showed a transient increase in IOP level, reaching its maximum 2 hours after the operation. There was no statistically significant difference in the severity of transient ophthalmic hypertension between the two groups, as well as between CCT and ECD values. There was no significant difference in the time of surgery between the groups. No complications were observed during the intraocular lens implantation in the two groups.

CONCLUSION: The investigated OVDs Adgevisk and Kogevisk showed ease of use, safety, and the absence of adverse effects. Post-surgical changes in the IOP level after the use of Adgevisk and Kogevisk were comparable with those after other OVDs use. The reduced cost of the new OVDs presents an additional advantage.

PURPOSE: To study the distribution of intraocular pressure (IOP) obtained by Maklakov tonometry in different age groups.

METHODS: The study evaluated Caucasians without glaucoma aged 45-75. The participants underwent Maklakov tonometry with a 10 g tonometer at 09:00-12:00 with subsequent imprint evaluation by means of NesterovEgorov scale, measurements of central corneal thickness (CCT) and visual acuity. All the participants were divided into 3 groups by age: Group 1 consisted of participants aged 45-55, Group 2 comprised the ones aged 56-65, Group 3 included patients aged 66-75.

RESULTS: In total 791 person were enrolled; 1 429 of 1 499 eyes (95.3%) were accepted into the study. IOP in Group I was 16.1±3.3 mmHg in Group 1; 16.3±3.3 in Group 2; 16.2±3.5 mmHg in Group 3. CCT in Group 1 was 545.7±14.6 μm; 545.3±15.4 μm in Group 2; 544.7±14.6 μm in Group 3. Visual acuity was 0.93±0.13 in Group 1; 0.89±0.15 in Group 2; 0.81±0.18 in Group 3. Average IOP in men was 16.4±3.3 mmHg, in women 16.5±3.3 mmHg. Age, vision acuity, CCT and IOP were within the normal distribution; IOP and CCT had no significant differences between the age groups. The measured parameters showed no significant intercorrelation. We found no significant difference between IOP in men and women.

CONCLUSION: In a healthy population CCT and IOP values fall within a normal distribution and do not change significantly with age. IOP does not depend on sex. Average IOP in the studied population is 16.2±3.4 mmHg, average CCT is 545.3±15.1 μm.

Elevated intraocular pressure (IOP) is the only modifiable risk factor for glaucoma development and progression. Glaucoma therapy prior to surgical treatment may consist in the instillation of many hypotensive drugs for a long time. The best of them have the greatest hypotensive effect with a minimum frequency of instillation. The fixed combination of bimatoprost and timolol is currently the most effective among the known drugs. The addition of local carbonic anhydrase inhibitors, in particular, brinzolamide, to this regimen can be considered the maximum glaucoma therapy with optimal tolerance. This review will attempt to summarize relevant data on the most effective anti-glaucoma drugs, in particular, on a fixed combination of bimatoprost and timolol, and brinzolamide. Among other things, the timeliness of surgical treatment at the maximum glaucoma therapy will be investigated.

Currently, topical hypotensive therapy is the main means of glaucoma treatment. Frequently, the achievement of the target level of ocular pressure is possible only with the simultaneous use of several topical hypotensive drugs. A complex instillation regimen and a high incidence of adverse effects contribute to compliance reduction. All this leads to therapy efficacy decrease and the disease progression. The use of fixed combinations can simplify the instillation regimen during the day and reduce the incidence of adverse effects. The use of fixed combinations of prostaglandin analogues and timolol maleate allows us to achieve a more pronounced hypotensive effect with a single instillation of the drug during the day. In this review, we will try to summarize current data on the fixed combination of latanoprost and timolol maleate (FCLT), its pharmacological effects and hypotensive effectiveness, compared to other antihypertensive drugs and their combinations.

Primary open-angle glaucoma as a chronic progressive neuropathy, characterized by functional and structural changes in the optic nerve, is one of the main causes of blindness and disability. With a general prevalence of 3% in the population of patients with diabetes mellitus, the risk of its development increases by 1.4 times and increases with the duration of the disease. The role of glycemia level as an important risk factor for the development and progression of the disease is shown. Similar pathogenetic mechanisms of the development of the disease define them as neurodegenerative, with determining mechanisms for the development of cellular apoptosis associated with excessive release of glutamate, the formation of reactive oxygen species, end products of glycation and oxidation of lipids, with mitochondrial disorders. The theory of “Brain diabetes” considers glaucoma to be a type 4 diabetes. In this case, the role of compensation for carbohydrate metabolism in the absence of which insulin resistance exacerbates transsynaptic neurodegeneration becomes crucial. The central theory of insulin resistance in patients with diabetes explains the mechanisms of glaucoma due to impaired trabecular outflow, vascular changes (amyloid angiopathy) and glial activation. The use of metformin and insulin reduces the risk of development and the severity of the progression of the glaucoma process. A study of the structural and angiographic parameters of optical coherence tomography showed a similar decrease in the volume of the ganglion cell complex, the average thickness of the retinal nerve fiber layer, and the peripapillary density of the capillary layer in patients with glaucoma and diabetes. Their comorbid course is accompanied by pronounced structural and functional changes due to the neurodegenerative process, which determines the variants of their progress, the risk of early progression and severe loss of visual function. Patients with glaucoma in the presence of diabetes should be closely monitored by specialists, be informed about the risks and the need for both adequate glycemic control and the monitoring of functional and structural changes in the optic nerve and retina.

Neovascular glaucoma is a severe pathology of the eye, which is difficult to treat. It is characterized by rapid progression, high intraocular pressure (IOP) level, severe pain and an acute decrease in visual acuity. Its most common causes include diabetic retinopathy and ischemic central retinal vein occlusion. The endothelial vascular cells respond to a specific stimulus (tissular hypoxia) and secrete proangiogenic factors. The most significant is VEGF. The resulting imbalance between pro- and antiangiogenic factors produces neovascularization of the eye tissues. Panretinal photocoagulation and anti-VEGF therapy are used to reduce iris neovascularization and reduce the complications of surgical treatment. Currently, surgical methods such as trabeculectomy and tubular drainage implantation are used to treat neovascular glaucoma. An alternative to surgical interventions is presented by cyclodestructive procedures. Transscleral diode-laser micropulse cyclophotocoagulation is the latest technology, characterized by the absence of a pronounced damaging effect on tissues and a small number of complications.

Glaucoma is one of the main diseases leading to visual impairment and blindness. At present, drainage device surgery is the most effective way to normalize the intraocular pressure and preserve visual functions. Depending on the material, the following types of drainage devices are distinguished: collagen-based; metal-based; synthetic polymerbased and biopolymer-based. This paper described the main characteristics of these types of drainage devices and provides data on their use in clinical ophthalmic practice. Data analysis led us to believe that due to the imperfection of the materials a dense connective tissue capsule forms around the implant, obliterating the newly created outflow pathways of the intraocular fluid. A wide selection of drainage devices existing at present indicates the absence of material around which scar tissue would not form. At present synthetic drainage device from natural polymers shows optimal properties. They combine the advantages of all groups: greater resistance compared to natural polymers, high biocompatibility, physiological transport of intraocular fluid. However, they do not yet answer all the necessary criteria, requiring further scientific research in this direction.