PURPOSE.To identify the relationship between the parameters of choroidal and retinal blood flow by optical coherence tomography (OCT) and OCT angiography (OCT-A), and the structural, hydrodynamic and systemic hemodynamic parameters in healthy adults.

METHODS.The study included 42 male subjects aged 54.43±4.1 years without signs of local or systemic pathologies. The following parameters were evaluated on the RTVue-XR tomograph (USA): structural and microcirculatory parameters of the optic disc (OD) — peripapillary retinal nerve fiber layer (pRLNF) and radial peripapillary capillary plexus (RPCP); the macula — thickness, superficial capillary plexus (SCP), deep vascular complex (DVC), foveolar avascular zone (FAZ); the choroid — thickness, structure. Blood pressure was determined using the Riva–Rocci method; tonometry — by the Maklakov method. The parameters of bidirectional corneal applanation were evaluated, and perfusion and tolerance pressure were calculated.

RESULTS.Negative correlations were revealed between intraocular pressure, pRNFL and capillary density of RCP (R= −0.58… −0.73); between choroid thickness, systemic blood flow, and tolerant pressure (R= −0.56… −0.72); between the thickness of the choroid and the volume of focal losses (FLV, %), as well as the OCT-A parameters of FAZ (area, perimeter, and density of foveolar vessels) (R= −0.45… −0.58). Positive correlations were found between perifoveal thickness (including ganglion complex) with the pRNFL (R=0.58–0.71), as well as with the thickness of the choroid (R=0.41–0.65). The confidence level was p≤0.001.

CONCLUSION. The relationship of retinal, choroidal, micro hemodynamics parameters by OCT (choroid thickness) and OCT-A (RCC) (HD Angio Disc 4.5 protocol); area, perimeter, and vascular density of FAZ (Angio Retina 3.0 protocol) with  the parameters of systemic blood flow in healthy subjects can likely be considered as hemodynamic biomarkers in the diagnosis, monitoring, and evaluation of treatment effectiveness of any intraocular vascular process (including glaucoma).

INTRODUCTION. Recently, posterior vitreous detachment (PVD) was suggested as a fundamental pathologic process in primary angle-closure glaucoma (PACG) in morphologically predisposed patients with anatomically narrow anterior chamber angle.

PURPOSE. To study the role of PVD in the development and clinical manifestation of PACG in anatomically predisposed eyes and to assess the capabilities of posterior segment optical coherence tomography (PS-OCT) in PACG diagnostics.

MATERIALS AND METHODS. Thirty eyes with newly diagnosed stage I-II PACG and thirty eyes predisposed to PACG (with narrow anterior chamber angle without glaucoma signs) were enrolled in the study. All patients underwent ophthalmological examination, Hyams test, ocular ultrasound (OU) and PS-OCT.

RESULTS. PVD with retrohyaloid space (RHS) formation was revealed in all PACG eyes. Positive Hyams test was in 86.67% eyes with PACG, and 13.33% were negative. All the eyes with PVD as a result of Hyams test experienced RHS enhancement correlating with IOP rise. Despite the negative results of Hyams test in some PACG eyes with PVD — glaucomatous optic neuropathy signs were present. Possible causes are discussed.

PVD with RHS formation was revealed in 53.33% predisposed to PACG eyes — all with positive result of Hyams test. The other 46.67% eyes predisposed to PACG had negative Hyams test, no PVD and no RHS.

CONCLUSION. Obtained results confirm a new theory of PACG etiopathogenesis suggesting PVD with PGS to be the essential mechanism of POAG development in morphologically predisposed eyes. PS-OCT appears to be crucial in PACG early diagnostics.

PURPOSE. To conduct a descriptive epidemiological study of glaucoma in the Far Eastern Federal District covering the years 2012 to 2019.

METHODS. The study uses data of the Federal Research Institute for Health Organization and Informatics (FRIHOI) covering the 2012–2019 time period, as well as data from the register of the Unified Interdepartmental Information and Statistical System (UIISS) and the Federal State Statistics Service (FSSS). Statistical data processing was carried out using Microsoft Excel 2019. Diagrams and a cartogram were built to visualize the obtained data. The reliability of the trend line was determined by the value of approximation. A trend is a tendency of changes in the studied time series. In this work, we used a linear approximation — a straight line that best describes the time course of incidence and prevalence. The significance of linear regression was checked using the F-test to determine the quality of the regression model. The coefficient of determination was also used to indicate the dependence of the variability of prevalence on time. A linear regression model was used to predict the prevalence of glaucoma in the Russian Federation and the Far Eastern Federal District; 91% of the total variability of prevalence in the Russian Federation is explained by a change in the time parameter, while 86% in the Far Eastern Federal District indicates a high accuracy of the selection of trend equations.

RESULTS. According to the study, in the 2012–2019 years there was a significant increase in the incidence of glaucoma in the Primorsky Krai (PK) amounting to 8%. Over the observed period, a significant increase in the prevalence of glaucoma is noted in the Republic of Buryatia (6.9%), and in the Magadan Region (5%). At the same time, the highest incidence and prevalence of glaucoma was noted in the Republic of Sakha (Yakutia) — 105.4 cases and 1551.6 cases per 100 000 population. The expected prevalence of glaucoma in the Russian Federation (RF) in 2020 is 895–999.7 per 100 000 population, in 2021 — 908–1020.2; in the Far Eastern Federal District (FEFD) in 2020 — 783.7–961.3 per 100 000 population, in 2021 — 799.5–989.8. The largest proportion of glaucoma was found among the population of the Magadan Region (16%) and Yakutia (13.8%), the smallest in the Amur Region (5%) and the Chukotka Autonomous Okrug (5.7%).

CONCLUSION. The dynamics of glaucoma incidence in the Far Eastern Federal District is uneven, which corresponds to the epidemiological situation in the Russian Federation as a whole. But the prevalence and proportion of glaucoma in the structure of diseases of the eye and adnexa in the FEFD are characterized by negative dynamics in comparison with country-wide. At the same time, even within the regions of the FEFD, the incidence and prevalence of glaucoma is mosaic, which predisposes to studying the influence of factors on glaucoma incidence.

PURPOSE. To determine individual clinical and epidemiological characteristics of the disease in patients with primary openangle glaucoma (POAG) and to establish its relationship with adherence to treatment.

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 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 presents a 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" recorded during the six-year period from 2014 to 2019 and assesses the glaucoma-related disability trends.

RESULTS. In the Republic of Bashkortostan in 2014, the rate of reassessed disability due to glaucoma was 0.79 per 10 thousand population, in 2019 — 0.56. The share of young individuals reassessed as disabled in 2019 was 3.9%, middle aged — 11.8%, above working age — 84.3%. The share of patients with group I disability in 2019 was 40.6%, with group II disability — 33.6%, group III — 25.8%.

CONCLUSION. Based on the results of the performed analysis, in the Republic of Bashkortostan from 2014 to 2019 there was a decrease in indicators of reassessed disability due to glaucoma from 0.79 in 2014 to 0.56 per 10 thousand people in 2019. Repeated medical and social examinations carried out during the specified period showed an increase in the share of young people (from 18 to 44 years old) by 1.1%, as well as patients with group I disability by 16.8%.

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.

Glaucoma is a socially significant disease and ranks first among the causes of visual impairment and blindness. Glaucoma is a chronic disease with progressive course, and the entire treatment and diagnostic process is associated with the need for constant monitoring of the structural and functional components of the visual system to assess the progression of glaucomatous optic neuropathy. With adequately chosen treatment tactics, it is possible to stabilize the glaucomatous process and successfully reverse the structural and functional changes thanks to the links between functional defects of the visual fields and topographic damage in the optic nerve with the stage of the disease. This statement emphasizes the need to choose the correct treatment tactics, as well as to closely monitor the structural and functional characteristics of patients with glaucoma. In this regard, the issue of studying the safety and effectiveness of various glaucoma surgeries depending on observation time remains relevant. 

At present, the problem of treating optic neuritis is becoming increasingly relevant due to growing incidence of this pathology among the young, significantly affecting their quality of life. High rate of disability outcomes (28%) connected with the development of optic nerve atrophy leading to irreversible changes in the visual functions accounts for high social value of this disease.

The development of optic neuritis is known to happen very quickly in some cases, and in this regard all the performed methods of treatment should be urgent, aimed at increasing the treatment efficiency and preventing the irreversible complications due to the late and sometimes incorrect diagnosis.

There are currently no reasonably effective treatments of optic nerve neuritis because generally, the therapy is etiopathogenesis-targeted, depending on the revealed cause of the disease, which in practice can rarely be established.

The article reviews various methods of conservative and surgical treatment of optic neuritis and describes our experience of employing a drainage surgery technique with the use of allogeneic spongy biomaterial commonly used for complicated glaucoma.

One of the priority directions in the development of medical science is activities associated with patenting and licensing. The review analyzes the inventions of new treatment methods of various forms of glaucoma among patents issued in the last 7 years. The search for new approaches to treating the disease continues despite the numerous known methods. The article describes promising medical, laser, microinvasive, surgical and combined methods for the treatment of glaucoma from the 123 new patents issued in the Russian Federation. Novel innovations are presented with design schemes.

The review will be useful to a wide audience. Young specialists can invent, patent, and license their own original method of glaucoma treatment. Surgeons can expand their routine by introducing new technical elements from different methods, testing its effectiveness and safety in everyday practice.