PURPOSE: To determine individual clinical and epidemiological characteristics of the disease in patients with primary open-angle glaucoma (POAG) and to establish its relationship with adherence to treatment.
MATERIALS AND METHODS: The analytical, multicenter, combined study involved 1 092 subjects (2 184 eyes) with different forms of glaucoma (general group) were selected using a survey, followed by their clinical and epidemiological analysis.
RESULTS: When verifying the diagnosis, eyes with POAG prevailed in the main group (from 89.6 to 92% of all eyes). The average age in the main group at the final examination was 66 (63; 69) years, the duration of the disease was on average 3 years. The number of eyes with the initial stage of glaucoma decreased in 3 years by 17.5-19.1%, and the number of eyes with advanced and severe stages of the disease increased by 10.4-12.9% and 5.1-5.2%, respectively. The hypotensive regimen was changed at the average tonometric intraocular pressure of 24 (23; 26) mm Hg (regardless of the disease stage). When estimating the comorbidity of the main group, the most common concomitant somatic pathology was hypertension. Today, prostaglandin analogues are prescribed in 34.6-36.3% of all cases for all stages of glaucoma. The leading complaint of patients according to the survey was the cost of treatment. In addition, the influence of the organization's pharmacist on the choice of the purchased drug was revealed. However, attending physician remains the main source of information about the disease for patients (92.2%).
CONCLUSION: It was found that POAG predictably prevails in Russia, and its diagnosis still comes with a delay. The causes of treatment failures should be recognized as late diagnosis, incorrect treatment of patients with newly diagnosed condition, and the same treatment regimens for paired eyes with different stages of POAG, as well as social and behavioral factors of patient compliance.

PURPOSE: To assess the hypotensive effectiveness, frequency and nature of intra- and postoperative complications in patients with various clinical manifestations of refractory glaucoma.
MATERIALS AND METHODS: The study included 196 patients (196 eyes) with various forms, stages and clinical manifestations of glaucoma. There were 142 patients with primary glaucoma, among them 120 with open-angle glaucoma and 22 with angle-closure glaucoma. Among the patients with primary glaucoma, 85 had pseudophakia (77 with openangle and 8 with angle-closure forms); 57 had a native lens (43 with open-angle and 14 with angle-closure forms of the disease). Secondary glaucoma was presented mainly by patients with neovascular (21) and postuveal (16) glaucoma. The intraocular pressure (IOP) level in the group as a whole ranged from 16 to 50 mm Hg (on average 30.1±2.6 mm Hg). In all presented cases of surgical intervention, the Glautex drainage was used, which is a bioresorbable composite biomaterial based on polylactic acid (polylactide) and polyethylene glycol (manufactured by “HiBiTech”, Russia). Standard methods of patient examination were used.
RESULTS: In patients with POAG, the IOP averaged 13.7± 4.7 mm Hg one week after surgery and 16.1±3 mm Hg 12 months after surgery. The absolute success of the operation was noted in 71 patients with POAG (59.2%); the relative hypotensive effect — in 85.8%. In primary angle-closure glaucoma, the same indicators were 47.6 and 61.1%, respectively. In the group of patients with neovascular and postuveal glaucoma, the hypotensive effect was as expected lower and amounted to 42.8 and 50.0%, respectively. The restart of therapy at different periods of observation was done in 78.3%. Complications, their frequency and nature, noted by us in the operated patients, could be attributed to those typical for fistulizing operations in refractory glaucoma. The most common complication was ciliochoroidal detachment, which was seen in all groups, but percentage-wise was more common in patients with PACG, neovascular and postuveal glaucoma.
CONCLUSION: Composite drainage based on polylactic acid (polylactide) and polyethylene glycol (glautex) is an effective and safe solution to the issue of surgical treatment of glaucoma. The antihypertensive effectiveness of the Glautex drainage implant depends on the severity of the glaucomatous process and the timeliness of the surgical intervention. The frequency and nature of complications depends on the degree of refractoriness of glaucoma, initial clinical characteristics of the process, and patients' multimorbidity.

PURPOSE: Comparative evaluation of the hypotensive effect and tolerability of two drugs — bimatoprost 0.03% (Bimatan) and latanoprost 0.005% (Xalatan) — when used as the treatment of choice in patients with stage I-II primary open-angle glaucoma (POAG).
MATERIALS AND METHODS: The action of latanoprost 0.005% (Xalatan) was studied for 3 months on cases of 51 patients with POAG (59 eyes), among which 17 males with average age of 65.2 years, and 34 females with average age of 64.1 years. All patients suffered from newly diagnosed primary open-angle glaucoma: stage I — 29 patients (56.9% of 51 patients), stage II — 22 patients (43.1% of 51 patients). The degree of width of the anterior chamber angle according to the Schaffer classification was 3-4, the degree of pigmentation of the angle according to A.P. Nesterov — 1-2. Visual acuity of the study patients ranged from 0.4 to 0.8 without correction.
Treatment outcomes of the latanoprost study are compared with a previous study of bimatoprost 0.03% (Bimatan) used for 3 months in the treatment of 46 patients (64 eyes) with POAG. The bimatoprost study included 26 males with the average age of 61.3 years and 20 females with the average age of 65 years; among them, 31 (67.4% of 46 patients) with stage I glaucoma and 15 (32.6% of 46 patients) with stage II glaucoma. The degree of width of the anterior chamber angle according to the Schaffer classification was 3-4, the degree of pigmentation of the angle according to A.P. Nesterov — 1-2. Visual acuity of the patients varied from 0.2 to 0.8 without correction.
All patients underwent a comprehensive ophthalmological examination, which included visometry, ophthalmoscopy and gonioscopy, computerized perimetry, tonometry, and tonography. The drugs were applied daily, 1 drop into the affected eye at 8 p.m. daily. The follow-up tonography, as well as assessment of changes with visometry and computerized perimetry was carried out 3 months after the start of daily systemic therapy.
RESULTS: After 3 months of 0.03% bimatoprost instillations, IOP has decreased from 17.2±3.1 to 13.8±1.6 mm Hg, mainly due to an increase in the ease of aqueous humor outflow from 0.081±0.042 to 0.198±0.038 mm3/min/mm Hg, as well as a tendency towards decrease in the production of aqueous humor from 0.91±0.18 to 0.76±0.11 mm³/min (p<0.05). Becker’s coefficient has decreased from 161.9±36.1 to 63.1±9.3 due to the decrease in P₀ and reduced retention of aqueous humor.
After 3 months of 0.005% latanoprost instillations, IOP has decreased from 21.5±2.3 to 18.4±1.7 mm Hg due to an increase in the ease of aqueous humor outflow from 0.097±0.064 to 0.201±0.043 mm³/min/mm Hg. Becker's coefficient has decreased from 159.7±37.4 to 60.1±10.5. No significant decrease in the production of aqueous humor was noted (p>0.05).
The use of bimatoprost caused the following side effects: 2 patients (4.35% of 46 patients) felt burning sensation in the eye after instillations, 6 patients (13% of 46 patients) had mild conjunctival hyperemia. Thus, 8 patients (17.4% of 46 patients) experienced unwanted side effects. The systematic use of latanoprost 0.005% caused fewer side effects: 2 patients (3.9% of 51 patients) experienced a burning sensation in the eye after instillation.
None of the patients had to discontinue the use of the drugs due to these side effects.
CONCLUSION: Prostaglandin F2α analogs are known to have pronounced and long-term hypotensive effect due to facilitation of the outflow of intraocular fluid. The comparative study of the effectiveness of bimatoprost and latanoprost shows that despite them both belonging to the same group, there are certain differences in the degree of their hypotensive effect and in the mechanism of action: bimatoprost reduces intraocular pressure by facilitating the outflow and reducing the production of intraocular fluid, which provides it with certain advantages over latanoprost. Thus, the pronounced hypotensive effect of bimatoprost is realized through simultaneous action on two components of the pathogenesis of ophthalmic hypertension. For the moment, both bimatoprost and latanoprost are undoubtedly the first choice drugs for the treatment of patients with early and advanced glaucoma.

PURPOSE: To evaluate and compare the intraocular pressure changes in patients with initial and advanced stages of open-angle glaucoma (POAG) when using the study drug bimatoprost 0.03% and the comparison drug travoprost 0.004%, as well as to assess the effect of these drugs on the ocular surface.
METHODS: The study involved 81 patients (137 eyes), 48 women and 23 men, with a mean age of 63 years. Patients of the first group (36 patients, 69 eyes) received 0.03% bimatoprost for 3 months. Patients of the second group (35 patients, 68 eyes) received 0.004% travoprost for 3 months.
RESULTS: According to tonometry data, a hypotensive effect was observed in both groups. Regardless of the method of tonometry, intraocular pressure was lower in the group of patients receiving 0.03% bimatoprost (p<0.001).
In both groups, the state of the anterior segment of the eye was affected in the form of increased hyperemia and an increase in spot staining of the cornea and conjunctiva with fluorescein according to the Oxford scale. However, there was no significant differences between the action of 0.03% bimatoprost and 0.004% travoprost drugs.
CONCLUSION: The hypotensive effect of bimatoprost 0.03% was better than travoprost 0.004%. Both drugs had an effect on the ocular surface. The incidence of adverse events in the group of patients treated with bimatoprost did not exceed similar results for travoprost.

PURPOSE: To study the structure and dynamics of the trends of glaucoma-related disability recorded from initial medico-social examinations of the adult population in the Republic of Bashkortostan during 2014-2019.
METHODS: The study consisted of retrospective comparative analysis of the official annual statistical data of the Federal State Institution "Main Bureau of Medical and Social Expertise in the Republic of Bashkortostan" for a six-year period from 2014 to 2019. The paper assesses the dynamics of glaucoma-related disability trends.
RESULTS: In the Republic of Bashkortostan in 2014, the primary disability due to diseases of the eye and its adnexa was 1.98 per 10 thousand population, in 2019 — 1.27. The primary disability for glaucoma among the adult population in 2014 was 0.79 per 10 thousand population, in 2019 — 0.51. In 2019, the proportion of people who were first recognized as disabled due to primary open-angle glaucoma was 86.4%, angle-closure glaucoma — 6.3%, secondary glaucoma — 7.3%. The share of men was 57.3%, women — 42.7%.
CONCLUSION: In the Republic of Bashkortostan in 2014- 2019, a decreasing trend was observed in the indicators of primary disability due to diseases of the eye and its adnexa by 1.57 times, as well as a decrease in the level of primary disability due to glaucoma among the adult population by 35.5%, including the share of persons with group I disability. Analysis of the glaucoma-related disability trends recorded during initial medico-social examinations of the adult population indicates the need for annual follow-up monitoring of patients in risk groups and strengthening measures for the early detection of glaucoma.

Today the only available treatment option for patients with primary open-angle glaucoma is lowering intraocular pressure with medication, laser or surgical procedures. However, besides the mechanical factor, pathogenesis of glaucoma also involves the vascular factor, which in the future may become a new treatment target for slowing chronic neurodegeneration. Optical coherence tomography angiography (OCT-A) is a relatively new method for studying the microcirculation in the retina and optic nerve head. It has many advantages over other methods used for studying ocular blood flow including non-invasiveness, reproducibility and repeatability of results. Glaucoma is known to affect the hemodynamic parameters of the optic nerve head, peripapillary retina and macular region. This review analyzes available data on the effects of glaucoma surgeries and, consequently, induced hypotension on OCT-A parameters of microcirculation in the macular region.

The article analyzes literature data on the use of modern antiangiogenic drugs in the treatment of neovascular glaucoma (NVG) presenting information on the mechanisms of action of inhibitors of vascular endothelial growth factor (VEGF) as adjuvant therapy in NVG, as well as the clinical effectiveness of these drugs in modulating the activity of ocular tissue healing processes after surgical treatment of glaucoma.
The article also considers the results of studies on the use of VEGF inhibitors bevacizumab, ranibizumab, and aflibercept by different routes of administration. Usage of these drugs is indicated to require taking into account the contraindications, as well as the possibility of side effects associated with the intravitreal route of drug administration. The effects of anti-VEGF drugs in the treatment of NVG have been noted to be temporary and last 4–6 weeks, so the result of using a combination of these drugs and standard methods of treating the disease is assumed to be more pronounced and lasting.