Original article is published in: Frontiers in Bioscience, Landmark, 20, 892–901, January 1, 2015

Glaucoma is the main cause of irreversible blindness worldwide. This disease is characterized by apoptosis of retinal ganglion cells (RGC) and visual field loss that seems to be related to elevated intraocular pressure (IOP). Several lines of evidences have implicated the crucial role of mitochondrial dysfunction in the pathogenesis of glaucoma. Increased mitochondrial oxidative stress in RGC may underlie or contribute to susceptibility of RGC to apoptosis. In our work we (i) designed a rabbit model of chronic, moderately elevated IOP for studying glaucoma and (ii) demonstrated efficacy of mitochondria-targeted antioxidant SkQ1 as a tool to reverse several traits of experimental glaucoma induced by a series of injections of hydroxypropylmethylcellulose (HPMC) to the anterior chamber of the rabbit eye. It is shown that 6 months instillations of drops of 0.2.5–5 µM solution of SkQ1 normalize IOP and eye hydrodynamics and abolish an increase in lens thickness that accompanies glaucoma.

Original article is published in: Frontiers in Bioscience, Landmark, 20, 892–901, January 1, 2015

Glaucoma is the main cause of irreversible blindness worldwide. This disease is characterized by apoptosis of retinal ganglion cells (RGC) and visual field loss that seems to be related to elevated intraocular pressure (IOP). Several lines of evidences have implicated the crucial role of mitochondrial dysfunction in the pathogenesis of glaucoma. Increased mitochondrial oxidative stress in RGC may underlie or contribute to susceptibility of RGC to apoptosis. In our work we (i) designed a rabbit model of chronic, moderately elevated IOP for studying glaucoma and (ii) demonstrated efficacy of mitochondria-targeted antioxidant SkQ1 as a tool to reverse several traits of experimental glaucoma induced by a series of injections of hydroxypropylmethylcellulose (HPMC) to the anterior chamber of the rabbit eye. It is shown that 6 months instillations of drops of 0.2.5–5 µM solution of SkQ1 normalize IOP and eye hydrodynamics and abolish an increase in lens thickness that accompanies glaucoma.

PURPOSE. To evaluate the structural changes in the corneal nerve fibers (CNF) in patients with primary open-angle glaucoma (POAG) who have recovered from the coronavirus infection (COVID-19).

METHODS. The study examined 66 patients (132 eyes), who were divided into the main group with stage I–III POAG (38 patients, 76 eyes) and the control group of healthy volunteers (28 patients, 56 eyes). The groups were divided into subgroups based on the history of coronavirus infection. All patients underwent confocal microscopy of the cornea and analysis of the subbasal layer of corneal nerve fibers using special software (programs Liner 1.2.S and Liner Calculate).

RESULTS. Analysis of confocal images of patients who recovered from COVID-19 showed significant differences with healthy individuals with no distinctions in their medical history (p=0.02). The group with POAG showed pronounced changes in corneal nerve fibers compared with the control group (p<0.01). When comparing the indicators between the subgroups of the main group, no significant differences were found. A positive correlation was found between the severity of changes in the subbasal nerve plexus, and the stage of glaucoma and the duration of the glaucomatous process since the time of diagnosis. CONCLUSION. The study revealed the effect of coronavirus infection on the state of the subbasal layer of corneal nerve fibers in healthy individuals without visible ophthalmic pathologies. The neurodegenerative effect of glaucoma on the nerve tissue of the cornea has been proven. The relationship between the stage of glaucoma and the duration of glaucoma optic neuropathy, and the severity of pathological changes on confocal images of the patients was revealed. However, it was not possible to diagnose the effect of coronavirus infection on corneal nerve fibers of patients with POAG due to the presence of pronounced glaucomatous changes in them.><0.01). When comparing the indicators between the subgroups of the main group, no significant differences were found. A positive correlation was found between the severity of changes in the subbasal nerve plexus, and the stage of glaucoma and the duration of the glaucomatous process since the time of diagnosis.

CONCLUSION. The study revealed the effect of coronavirus infection on the state of the subbasal layer of corneal nerve fibers in healthy individuals without visible ophthalmic pathologies. The neurodegenerative effect of glaucoma on the nerve tissue of the cornea has been proven. The relationship between the stage of glaucoma and the duration of glaucoma optic neuropathy, and the severity of pathological changes on confocal images of the patients was revealed. However, it was not possible to diagnose the effect of coronavirus infection on corneal nerve fibers of patients with POAG due to the presence of pronounced glaucomatous changes in them.

PURPOSE. To create a predictive algorithm for identifying the risk of increased intraocular pressure (IOP) after phacoemulsification (PE) in patients with primary open-angle glaucoma (POAG), and to assess its effectiveness.

METHODS. The analysis of 132 eyes of patients with POAG with normalized IOP, which underwent PE, was carried out. During the observation period lasting up to 18 months after PE, 28 eyes (21%) showed an increase in IOP from 24 to 32 mm Hg. These patients made up the 1st group; the 2nd group consisted of 104 patients without elevated IOP at the indicated time. A comparative analysis of risk factors for increased IOP was carried out, which included the initial clinical and morphological characteristics of the anterior segment of the eyes, stages of POAG, methods of preoperative normalization of IOP.

RESULTS. Significant differences were revealed in the eyes of the 1st group in terms of the frequency of a combination of pseudoexfoliative syndrome (PES), rigid pupil, degree IV nucleus density, degree I lens subluxation (p<0.01), frequency of advanced stage of glaucoma, anterior chamber depth, lens thickness, duration of antihypertensive therapy (p<0.01). The method of logistic regression and ROC analysis was used to create and verify a predictive algorithm for identifying the risk of postoperative increase in IOP after PE based on these identified factors.

CONCLUSION. The developed predictive algorithm showed high sensitivity and specificity of 82%, making it useful for predicting an increase in IOP after PE in patients with POAG.

PURPOSE. To analyze the effects of intravitreal injections of prolonged corticosteroids (Ozurdex®) on intraocular pressure (IOP).

METHODS. The study involved 330 patients (142 men, 188 women aged 54.5 (40 to 63) years who received 399 intravitreal injections (IVI) of Ozurdex®. Patients were divided into two main groups: 1st group consisted of 184 (55.7%) patients who did not use antihypertensive therapy before or after IVI of Ozurdex®; 2nd group consisted of 146 (44.3%) patients who used hypotensive drugs before IVI, or immediately after IVI of Ozurdex®. Two subgroups were formed according to main concomitant disease: 1st subgroup — 167 (50.6%) patients with retinal vein occlusion (RVO); 2nd subgroup — 163 (49.4%) patients with diabetic retinopathy (DR). The IOP level was measured before IVI, the next day, and one month after drug administration. In cases of ophthalmic hypertension, local carbonic anhydrase inhibitors were used as monotherapy, or in combination with beta-blockers.

RESULTS. An increase in IOP observed in 44% of cases after the first injection was stabilized by medications: in 80.7% with the help of monotherapy, in 19.3% — with combined antihypertensive therapy. In 100% of cases, patients with hypertension and history of laser coagulation did not require IOP correction by a drug combination. The mean IOP values tended to decrease in all patients (p<0.01). Cataract was diagnosed in 69% of cases, phacoemulsification after the first IVI was performed in 9%, and after the second injection — in 19% of cases. There is a more frequent occurrence of ophthalmic hypertension in patients with RVO. The correlation coefficient between the IOP level before and after treatment was r=0.148 in patients with RVO and r=−0.0221 in patients with DR, respectively. There was no statistical relationship between the development of ophthalmic hypertension and the number of Ozurdex® injections received.

CONCLUSION. The rise in intraocular pressure after intravitreal introduction of the Ozurdex® implant is diagnosed 17% more often in patients with RVO. IOP increased more often after the first injection, while there was no correlation between hypertension and the number of Ozurdex® injections. In 8.5% of cases, combination therapy was required. In half of patients with ophthalmic hypertension, the IOP has compensated independently within 3–15 months after IVI.

PURPOSE. To reveal the features of the clinical course of uveal melanoma with elevated intraocular pressure (IOP).

METHODS. The study retrospectively analyses case histories of 84 patients who received radical (liquidation) surgical treatment (enucleation or exenteration) for stage T3–T4 uveal melanoma in the ophthalmology department of MONIKI from 2015 to 2020.

RESULTS. The patients admitted for liquidation therapy of uveal melanoma had a stage T3 tumor (80–95%) and stage T4 tumor (4–5%). In almost a third of patients (in 25 out of 84 patients), an increase in IOP from 30 to 50 mm Hg (in average 37.57 mm Hg) was detected during the initial ophthalmologist visit. Two patients underwent antiglaucoma surgery in medical institutions at the place of residence. The waiting time from the appearance of first complaints to admission for treatment at an ophthalmic-oncologist ranged from 1 month to 18 months (median 3.5 months). Due to the late detection of uveal melanoma, four patients were referred to an ophthalmic-oncologist only after cataract phacoemulsification. The diagnosis of uveal melanoma was confirmed by histological examination of the enucleated eye. It is worth noting that pigmented forms of melanoma were detected in all patients with elevated IOP.

CONCLUSION. The initial examination of a patient with elevated IOP should involve special attention to possible intraocular tumors. Particular attention should be paid to the local expansion of the epibulbar vessels, delimited darkening of the sclera during transillumination, unusual pigmentation of the iris and anterior chamber angle. A thorough examination of the paired eye is of great importance. It is advisable for all patients with newly diagnosed glaucoma to undergo an ultrasound examination of the eye, and if indicated — ultrasound biometry of the anterior segment of the eye.

PURPOSE. Comparative study of the efficacy and safety of the reproduced travoprost drug (generic) TravoprostOptic and the original drug (Travatan) in patients with primary open-angle glaucoma receiving mono- or combination therapy.

METHODS. A non-randomized prospective crossover study included 60 patients (60 eyes) with a diagnosis of stage I or II primary open-angle glaucoma, compensated by hypotensive therapy — monotherapy with the original travoprost drug (group 1, n=30), or combination therapy with the original travoprost drug (group 2, n=30). At the screening visit after the examination, the original travoprost was replaced by Travoprost-Optic in all patients. Efficacy was studied based on an assessment of the dynamics of intraocular pressure values, safety — based on an analysis of the severity of the main adverse effects of therapy using a special questionnaire before and 4 weeks after replacing the travoprost drug separately in each group.

RESULTS. In group 1 and group 2, the initial average level of intraocular pressure was 14.3±2.3 mm Hg and 16.2±1.1 mm Hg, respectively. In 4 weeks after replacing the original travoprost drug with Travoprost-Optic, there was no statistically significant dynamics of the indicator values in the groups — 13.7±2.7 mm Hg and 16.0±2.4 mm Hg, respectively. There were no significant differences in the severity of the adverse effects of antihypertensive therapy such as irritation, itching, lacrimation, foreign body sensation and dry eye.

CONCLUSION. The generic drug Travoprost-Optic, in comparison with the original travoprost, has a comparable efficacy and safety profile, as well as higher economic availability, and can be considered as an alternative.