PURPOSE: To perform a detailed individual analysis of pathological parameters of the optic disc, peripapillary retina and macular ganglion cell complex in eyes with the disc area of 1.63–2.43 mm2 and different stages of glaucoma.

MATERIALS AND METHODS: The study included 64 patients (76 eyes) aged 63.3±8.7 years, among them 35 male and 29 female patients with stage I (35 eyes), stage II (21 eyes) and stage III (20 eyes) glaucoma. Tomographic parameters of the retina were measured with optical coherence tomography (OCT) and Heidelberg laser retinal tomography (HRT) using a modified program by V.A. Machekhin, with consideration of the individual disc size, regression analysis and color coding of pathological parameters of the optic disc and peripapillary retina.

RESULTS: Pathologically similar parameters that showed different relations between the tomographic results were divided into 3 subgroups: a) with equivalent results according to both methods; b) with the advantage of HRT method; c) with the advantage of OCT method.

CONCLUSIONS: Examination of the optic disc parameters and adjacent retina using both HRT and OCT methods complementing each other can help improve the understanding of the glaucomatous processes.

The large selection of drugs for reduction of intraocular pressure expands the possibilities of drug treatment of glaucoma. At the same time, it creates certain difficulties for doctors preparing a complex, multicomponent scheme of several names of drugs. The mobile application "GlauHint" was developed for doctors dealing with glaucoma treatment. It provides technical assistance in drawing up the correct drug therapy regimen. The application allows checking the treatment that the patient is receiving and making corrections to it, as well as comprising the right combination of drugs, excluding the coincidence of active substances of the same class.

PURPOSE: To present the results of the optimization of ab interno trabeculotomy technology in combined cataract and glaucoma surgery, developed at IRTC “Eye Microsurgery” Ekaterinburg Center.

MATERIALS AND METHODS: The study included a retrospective analysis of the results of three homogeneous groups of patients with various modifications of trabeculotomy as the technology developed from 2007 to 2020. The first group included 87 patients (100 eyes) with an extensive continuous dissection of the trabeculae from 90 to 120 degrees. The method was performed from the year 2009 to 2011. Results of at least five years were analyzed. The second group consisted of 82 patients (90 eyes) who had selective trabeculotomy performed. The method was developed in 2010. A dissection in length was not more than 40°. The cases from years 2011-2013 were analyzed for five years. The third group, consisting of 105 eyes of 96 patients, was operated since 2017 using the technology of microinvasive irrigation trabeculotomy. The length of the dissection of the scleral sinus did not exceed 3-5 degrees (1.5-2 mm). The hypotensive effect was evaluated for up to three years.

RESULTS: Analysis of the long-term results of three groups of patients showed the high efficiency of the used trabeculotomy modifications. Intraocular pressure decreased in the first group from 29±3.4 to 20±2.8 mm Hg (32%), from 26.2±2.7 to 18±2.4 mm Hg (31%) in the second, from 27.0±4.1 to 19.3±3.1 mm Hg (30%) in the third. Reducing the length of the dissection of the scleral sinus and ensuring the tightness of the corneal incisions made it possible to reduce the number of early postoperative complications by almost an order of magnitude (p< 0.01). A temporary decline in vision during the first days after surgery was detected in 32% patients of the first group, 14% of the second, and 3% of the third. The hypotensive effect (IOP< 21 mm Hg), despite a decrease in the length of the opening of the Schlemm canal, did not differ significantly in all analyzed groups 75%, 78%, 77% (p>0.05).

CONCLUSIONS: The developed ab interno trabeculotomy modifications in combined cataract and glaucoma surgery have been shown to be highly effective. Ensuring high tightness of corneal incisions significantly reduces the number of early hemorrhagic complications. Reducing the length of the opening of the scleral sinus to 1.5-2 mm does not affect the long-term functional and hypotensive effect but reduces the level of intraoperative and postoperative complications. The proposed modifications are effective, safe, cost-effective, and can be recommended for combined surgery of glaucoma and cataract.

PURPOSE: To evaluate the effects of laparoscopic surgery on intraocular pressure in the horizontal and Trendelenburg positions.

METHODS: A dynamic measurement of intraocular pressure was performed during laparoscopic abdominal surgery in 26 patients (52 eyes) without signs of ophthalmic diseases, mean age 50.4 years. The patients were divided into 2 groups according to the body position during surgery. Group 1 — horizontal position; 16 participants, mean age 50.9 years. Group 2 — Trendelenburg position (head below the legs); 10 participants, mean age 49.7 years. Measurements of intraocular pressure were made with a portable Icare® PRO tonometer. Measurements were performed the day before the intervention, 15 minutes before and 5 minutes after induction of anesthesia, 5 minutes after the start of insufflation, then every 10 minutes until the end of the surgery, and a week later. Pressure of the insufflation gas in the abdominal cavity was recorded synchronously with the measurement of intraocular pressure.

RESULTS: Significant decrease of intraocular pressure was observed after the induction of anesthesia. In the horizontal po-sition mean decrease was 3.8 mm Hg, in the Trendelenburg position it was 3.71 mm Hg. Later, during surgery, it grew in both groups. Correlation coefficient between the duration of the surgery and the IOP level in the horizontal position was 0.224 (p=0.008); in the Trendelenburg position — 0.744 (p<0,001). Significant excess of the initial IOP level in the horizontal position — at 55 minutes (p=0.0222), and in the Trendelenburg tilt at 25 minutes (p=0.0284). Positive correlation was found between pressure in the abdominal cavity and intraocular pressure in the horizontal position, correlation coefficient 0.529 (p<0.0001). Relationship between them was weak In Trendelenburg tilt, correlation coefficient -0.168 (p=0.184). One week later, IOP was at the initial level.

CONCLUSION: Trendelenburg tilt and increase in laparoscopic surgery duration lead to ophthalmic hypertension. The levels of intra-abdominal pressure during surgery have a mild effect on IOP. The correlations revealed in the study suggest limiting the duration of laparoscopic surgery and Trendelenburg position in patients with existing ophthalmic hypertension or glaucoma.

MATERIALS AND METHODS: 35 patients (35 eyes) with open-angle glaucoma were examined 1, 7 days, and 1-3-6 months after minimally invasive sinustrabeculectomy using the infrared camera Тesto 875-2i with SuperResolution technology and telephoto lens 9×7°. The bleb area and temperature were evaluated With IRSoft and Universal Desktop Ruler software. Intraocular pressure (corneal compensated) (IOPcc) was measured with Ocular Response Analyzer® (ORA). Investigation protocol included 2 groups. Group 1 — 15 patients (15 eyes) with moderate glaucoma. Group 2 — 20 patients (20 eyes) with advanced glaucoma. All patients went through glaucoma surgery, microinvasive sinustrabeculectomy. Management and recurrent examinations were carried on the first day and 7 days after glaucoma surgery; then 1, 3 and 6 months after surgery.

RESULTS: The IOP level was significantly lowered in all patients in all terms of management in comparison with the baseline IOP level. High statistical correlation was determined in patients of 1 group between IOPcc and the index of temperature difference between the filtering bleb (Tfb) and surrounding conjunctiva temperatures (Tsc), in all management terms after surgery (in 1, 3, 6 months) with correlation coefficient of >0.7. In group 2 statistical correlation was determined between IOPcc and index of temperature difference between filtering bleb and surrounding conjunctiva temperatures (Δ Тsc – Тfb) at 1 week, 1 and 3 months after surgery. The same correlation coefficient was determined between filtering bleb temperature and Δ Тsc – Тfb at 6 months after surgery.

CONCLUSION: Thermography is a safe and noninvasive method that credibly detects temperature elevation in surgery zone, indicates IOP level raise and can predict the beginning of filtering bleb scarring. This method shows the necessity of needling procedure in different terms after surgical treatment and allows to control its effectiveness.

PURPOSE: To evaluate the efficacy and safety of the Nd:YAG 1.44 μm laser cataract extraction and intraocular lens implantation in eyes with coexisting primary openangle glaucoma.

MATERIALS AND METHODS: 137 glaucomatous eyes had Nd:YAG laser cataract extraction surgery (study group) or ultrasound phacoemulsification (control group). Intraocular pressure and visual functions were evaluated postoperatively.

RESULTS: Among patients with primary open-angle glaucoma, the number of cases of early ocular hypertension was less after laser cataract extraction (23.5% of eyes) than the number of cases of ocular hypertension after conventional phacoemulsification (40.0%, p<0.05). Furthermore, patients with primary open-angle glaucoma after laser cataract extraction had a better response to the intraocular pressure lowering therapy and shorter visual recovery period compared with those who had phacoemulsification.

CONCLUSION: Laser cataract extraction (Nd:YAG, 1.44 μm) is a safe and preferable method for cataract surgery in glaucomatous eyes.

Despite certain progress in the medical and surgical treatment of glaucoma, the prevalence of this disease in modern society continues to grow. It is necessary to search for additional and effective methods of glaucoma management in the progression of the disease. One of these non-drug treatment methods is reflexotherapy. This type of treatment can be an effective and cost-effective method used to improve the overall condition, as well as reduce intraocular pressure and pharmacological load on the patient. The review of research papers shows that the results of treatment of patients with glaucoma by acupuncture are ambiguous and contradictory and require further, more detailed study of the effectiveness of acupuncture in the treatment of patients with glaucomatous optic neuropathy.

Clinical and population-based studies have shown that moderate and high myopia is associated with an increased risk of primary open-angle glaucoma (POAG), normal pressure glaucoma, and ophthalmic hypertension. The combination of these eye pathologies amplifies the risk of decreased vision and can lead to blindness. In eyes with myopia, false overdiagnosis or underdiagnosis are common when specific differences between glaucoma and myopic changes are not taken into account. Therefore, it is necessary to develop standards for the diagnosis and monitoring of the glaucoma process in patients with axial myopia, especially considering that the diversity of data, as well as the inconsistency of ideas about the typical signs of glaucoma in patients with myopia, make it difficult to diagnose, and can result in late detection and decrease in the effectiveness of observation of this group of patients. This review analyzes the results of various diagnostic methods for glaucoma in patients with axial myopia, and pays special attention to functional and anatomical changes in axial myopia and glaucoma.