PURPOSE. To study the role of the choroid and lens in the development of primary anterior chamber angle closure.

MATERIAL AND METHODS. The study included 90 patients aged 47 to 80 years (30 with primary angle closure (PAC), 30 with suspected primary angle closure (PACs), and 30 in the control group) who underwent swept source optical coherence tomography (SS-OCT). The following parameters were analyzed: subfoveolar choroidal thickness (SFCT), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), lens vault (LV), iris curvature (ICurv) and iris thickness (IT750), angle opening distance (AOD500, AOD750), and trabecular-iris space area (TISA500, TISA750).

RESULTS. SFCT in PAC (341±59 µm) and PACs (340±51 µm) was higher than in the control group (257.0±37.0 µm, p<0.05). In PAC and PACs, the correlations of SFCT with age, AL, LV, ICurv, IT750 were revealed (p<0.05 for each), as well as correlations of LV with age, IOP, ACD, ICurv, IT750, AOD500, AOD750, TISA500, TISA750 were found (p<0.05 for each). The correlation of SFCT with IOP was determined only in PAC (p=-0.476; p=0.008).

CONCLUSION. The increase in the choroidal thickness in macula in both PACs and PAC compared with the controls, as well as the correlations of subfoveolar choroidal thickness with lens vault and iris parameters suggest the involvement of the choroid in the pathogenesis of primary angle closure disease (PACD). The correlations of lens vault with IOP, as well as the parameters of anterior chamber and iris indicate the prevailing role of the lens in the development of PACD and the need for its early replacement.

PURPOSE. To study possible biomarkers of proliferative diabetic retinopathy complicated by neovascular glaucoma and hemophthalmos located in the aqueous humor of the anterior chamber of the eye and the vitreous body, and to evaluate their role in the pathogenesis of pathological neovascularization in diabetes mellitus.

METHODS. Samples were taken from the anterior chamber aqueous humor of 7 patients with type 2 diabetes mellitus and operated neovascular glaucoma (Ahmed valve), as well as from the vitreous body of the same patients who underwent vitrectomy after drainage surgery due to long-term total hemophthalmos. The comparison group consisted of patients without diabetes mellitus, who also had aqueous humor samples taken from the anterior chamber of the eye and vitreous. Concentration of markers was assessed by multiplex immune analysis.

RESULTS. A significant increase in the levels of selected markers relative to the control group (patients without diabetes mellitus) was found in the aqueous humor of the anterior chamber and the vitreous body. The concentration of some cytokines differed significantly in the experimental and control groups suggesting the possibility of their evaluation for early detection of a more severe course of diabetic retinopathy.

CONCLUSION. The obtained results expand the knowledge about the pathogenesis of neovascular glaucoma and confirm the importance of further study of the immunological aspects of pathological neovascularization in diabetes mellitus. This allows us to take a fresh look at the role of biomarkers in the process and indicates their connection with the activation and support of the pathological chain of the process of new vessels formation.

PURPOSE. To compare the diagnostic effectiveness of two perimetric threshold strategies with frequency-doubling technology in patients with early primary open-angle glaucoma (POAG), the optical form of multiple sclerosis (MS) and papilledema in an open-label comparative clinical study.

MATERIAL AND METHODS. The study involved 78 patients (105 eyes) with optic neuropathies (ON). The patients were divided into 3 groups depending on the etiology of optic neuropathy: the first group included 30 patients (46 eyes) with early POAG aged 30 to 65 years (54.9±1.3); the second group included 26 patients (26 eyes) diagnosed with the optic form of MS (an episode of retrobulbar optic neuritis in the medical history) aged 22 to 44 years (33.7±6.5); the third group consisted of 22 patients (33 eyes) aged from 18 to 66 years (35.7±14.9) with papilledema caused in the majority of cases by various brain tumors (25 eyes or 75.7%). The fourth (control) group consisted of 60 healthy individuals (60 eyes) aged 20 to 65 years, who were divided into 2 equal subgroups – younger (24.8±4.4) and older (56.4±3.9).

Standard and non-standard perimetry was performed on all subjects during a comprehensive ophthalmic examination using the Humphrey 745i Visual Field Analyzer II (HFA II, «24-2» threshold strategy) (Germany-USA) and the author's own modification of Frequency Doubling Technology (FDT) Perimetry, in the form of 2 threshold strategies: the well-known «FDT-16» and the new «FDT-64».

RESULTS. Both the «FDT-16» and the «FDT-64» threshold strategies were more effective in diagnosing glaucomatous optic neuropathy (GON), as confirmed by the higher sensitivity of their results to two criteria — the number of identified scotomas (n of scotomas n≥2), and the number of scotoma clusters in patients with POAG (88 and 100%; 95 and 83%, respectively) compared with those in patients with MS (61 and 76%; 85 and 54%, respectively) and papilledema (51 and 78%; 88 and 70%, respectively). The specificity of the «FDT-16» and «FDT-64» threshold strategies was significantly higher than the specificity of Humphrey perimetry (100, 80 and 63%, respectively).

CONCLUSION. Both perimetric threshold strategies with frequency-doubling technology were found to be the most effective in detecting GON. This confirms that they are more sensitive in patients with early POAG when compared with the sensitivity in patients with MS and papilledema. The level of specificity of both FDT perimetry strategies far exceeds the level of specificity of Humphrey perimetry data, which indicates the advantage of FDT perimetry in separating healthy people from patients with ON, and not only of glaucoma genesis.

The article describes a clinical case of the formation of a choroidal cavern (CC) in a patient with glaucoma. CC are associated with degenerative diseases of the retina, which is likely associated with dysfunction of the choriocapillaries and impaired retinal supply. Most often, СС are the outcome of pachychoroidal conditions and age-related macular degeneration. Patient D., 63 years old, with previously diagnosed primary open-angled glaucoma in the right eye, complained of a gradual decrease in visual acuity in that eye for several years. According to the examination, the cause of vision acuity decrease was determined as partial atrophy of the retinal layers associated with CC in the superior nasal part of the perifovea and fovea. Presumably, based on signs of a pachychoroidal state in both eyes of the patient, the formed CC is the outcome of chronic central serous chorioretinopathy: focal thickening of the choroid, vasodilatation of the Haller's layer, thinning of the choriocapillaris layer, the presence of pachychoroidal pigment epitheliopathy in the left eye. CC is the marker of choriocapillary blood flow deficiency, which is an unfavorable prognostic factor for the development of glaucoma — proved by glaucoma optic neuropathy being more advanced in the eye with CC compared to the contralateral eye.

PURPOSE. To evaluate the potential impact of herpesvirus infection (carriage) on early postoperative outcomes of antiglaucoma surgeries.

MATERIAL AND METHODS. The study included 95 patients with stage I, II and III primary open-angle glaucoma (POAG), with indications for surgical treatment. The patients were divided into the main group (group 1, 31 patient) and the control group (group 2, 64 patients). The groups were formed on the basis of information obtained from the anamnesis about a transferred herpes simplex virus of any localization (as a rule, it was labial, oral-facial herpes and its skin manifestation). The indication for surgical treatment was the absence of persistent normalization of intraocular pressure and a decrease in visual functions. Depending on the clinical situation, patients underwent one of the two types of surgical interventions: trabeculectomy and non-penetrating deep sclerectomy. Analysis of postoperative complications was performed on day 7 after surgery.

RESULTS. The most frequent complications in the early postoperative period were ciliochoroidal detachment, hyphema, increased intraocular pressure, shallow anterior chamber syndrome, excessive vascularization in the surgery site, clinical signs of conjunctival-scleral and sclerascleral scarring. On day 7 after antiglaucoma surgery, the IOP level was 9.1±0.8 mm Hg on average in the groups. IOP was 1–2 mm Hg higher in case of non-penetrating surgery. In the same patients, normalization of IOP by the same date was obtained in 63.15% of cases, which required goniopuncture; needling was indicated and performed in 84.2% of patients. Ciliochoroidal detachment was diagnosed in both groups with the same frequency: 9.7 and 9.4%, respectively. Presence of minor hyphema was observed only after trabeculectomy, in 16.1 and 10.9% of cases, respectively.

CONCLUSION. Results of this study, firstly, do not indicate that HSV activates in response to surgical intervention; secondly, in patients who had been infected with it previously, only a tendency for the number of most common intra- and postoperative complications to increase was noted. The obtained results are insufficient for an unambiguous answer to the question posed in this study, which indicates the need for further research.

PURPOSE. To improve the effectiveness of primary angle closure glaucoma (PACG) treatment in the initial stage in patients with hyperopia.

MATERIAL AND METHODS. The study observed 18 patients (36 eyes) with the initial stage of PACG who also had low (8 subjects, 16 eyes) or moderate (10 subjects, 20 eyes) hyperopia. Study patients were divided into two groups: the main group — 12 patients (24 eyes) aged 43–67 years (mean age 55.6±1.1 years); the control group — 6 patients (12 eyes) aged 48–60 years (mean age 56.4±2.4 years). Prescribed treatment in the main group: selection and application of universal progressive correction, then laser iridecotomy (LIE) and management without pilocarpine instillations. Prescribed treatment in the control group: selection and application of monofocal correction for near vision, then LIE and instillations of 1% pilocarpine solution 3 times a day. All patients underwent visometry with correction, refractometry, ophthalmoscopy, tonometry, tonography, gonio-scopy, optical coherence tomography of the anterior eye segment, ultrasound biometry. Indicators of hydrodynamics and parameters of the anterior chamber were recorded before using spectacles correction, after the start of correction, after LIE, and 1 month after the start of all therapeutic measures.

RESULTS. The use of progressive spectacle correction led to a significant decrease of true intraocular pressure (IOP) (p<0.001), an improvement of aqueous humor outflow (p<0.05) and an increase in the size of anterior chamber angle (p<0.001). Performing LIE in patients of the main group did not significantly change these indicators. The results obtained in this group made it possible to abandon the use of pilocarpine. In patients of the control group, the improvement in aqueous humor outflow (p<0.001) and increase in the size of anterior chamber angle (p<0.002) were more significant after LIE than after prescription of adequate monofocal correction for near vision (p<0.02–0.05 and p<0.2, respectively).

CONCLUSION. The use of progressive spectacle correction in patients with hyperopia and initial stage of PACG before LIE leads to normalization of hydrodynamic parameters and an increase in the magnitude of anterior chamber angle without the use of miotic drugs. Prescription of progressive spectacle correction is advisable in these patients as a part of the complex of therapeutic measures aimed at normalizing ocular hydrodynamics.

PURPOSE. To study the opinion of ophthalmologists about the usefulness of training programs presented on the continuing medical education (CME) web portal, their significance and impact on the process of obtaining knowledge in modern conditions, when the scene is dominated by hybrid forms of education.

MATERIAL AND METHODS. This study was multicenter scientific and analytical selective cross-sectional observational in design and was conducted in the period from June to September 2021; it was based on the data obtained by an online survey among Russian ophthalmologists with varying records and/or work experience, employed at institutions of different forms of ownership. The prepared questionnaire included two groups of questions: general statistical data and special questions related to the topic "glaucoma".

RESULTS. The study involved 1113 clinically practicing ophthalmologists (88%), with an average medical experience of 18 (0; 50) years, without medical category (35%), and have a polyclinic as their main place of work (77%). According to the survey results, 46% of respondents give a high assessment of the content of educational programs, 35% — negative. When choosing therapeutic and diagnostic tactics, doctors prefer their own clinical experience (36.4%), while the main source of knowledge today is the CME training courses (30.8%). According to respondents, the target level of intraocular pressure is achieved in clinical practice in around 71% of cases, which is facilitated by the comprehensive approach to treatment (47%). At the same time, according to the majority of specialists (71%), only 25% of patients achieve target intraocular pressure.

CONCLUSION. Representativeness of the sample is beyond doubt. Registration on the CME web portal, in general, does not depend on work experience, attitude to educational organizations, or place of work. With increase in work experience, there is an increase in the number of positive responses characterizing the information completeness of the CME training courses (from 39.7% to 61.8%). CME programs in the field of glaucoma and comorbid ophthalmic pathologies require adaptation taking into account personal skill levels of ophthalmologists.

Open-angle glaucoma is a chronic progressive optic neuropathy characterized by morphological changes in the optic nerve head and retinal nerve fibers layer in the absence of other eye diseases.

Regular medical check-ups are necessary to assess the progression of glaucoma, to correct the treatment regimen or prescribe surgical interventions, to control the stabilization of the glaucoma process and to preserve visual functions for longer period. When planning the number of monitoring visits, it is necessary to carefully study the prognostic risk factors, since they are statistically associated with the development and progression of glaucoma. Closer observation of patients with glaucoma reduces the risk of irreversible changes in the organ of vision.

Patient compliance is of particular importance in the progression of glaucoma. The adherence rate in the treatment of glaucoma is relatively lower compared to other chronic diseases that require lifelong treatment.

Currently, there is no effective model of regular checkups for glaucoma patients, therefore this direction requires improvement and development, both in the standards and timing of patient examination, and in the use of remote methods of glaucoma control. The disadvantage of the current medical check-ups routine is the lack of individual approach to patients, lack of equipment in the offices of regional ophthalmologists, and lack of specialized glaucoma offices.

The tense epidemiological situation during the Covid-19 pandemic, gave understanding that while in-person consultations and remote consultations (telemedicine) cannot replace each other, a combination of these methods is cost-effective, can reduce the uneven distribution of ophthalmic resources, reduce the burden on the doctor and the rate of misdiagnosis. The situation was aggravated by the closure of ophthalmological hospitals and an increase in the waiting time for consultation in higher specialized medical institutions, which probably entails an increase in patients with progression of the glaucomatous process and the economic burden on both the state and the patients themselves.

Telemedicine should be gradually introduced into everyday practice, for which it is advisable to create a single database of glaucoma patients to track the glaucomatous process.

PURPOSE. To study the role of the choroid and lens in the development of primary anterior chamber angle closure.

MATERIAL AND METHODS. The study included 90 patients aged 47 to 80 (30 with primary angle closure (PAC), 30 with suspected primary angle closure (PACs), and 30 in the control group) who underwent swept source optical coherence tomography (SS-OCT). The following parameters were analyzed: subfoveolar choroidal thickness (SFCT), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), lens vault (LV), iris curvature (ICurv) and iris thickness (IT750), angle opening distance (AOD500, AOD750), and iridotrabecular space (TISA500, TISA750).

RESULTS. SFCT in PAC (341±59 µm) and PACs (340±51 µm) was higher than in the control group (257.0±37.0 µm, p<0.05). In PAC and PACs, the correlations of SFCT with age, AL, LV, ICurv, IT750 were revealed (all p<0.05). Also, in PAC and PACs, the correlations of LV with age, IOP, ACD, ICurv, IT750, AOD500, AOD750, TISA500, TISA750 were found (all p<0.05). Only in PAC the correlation of SFCT with IOP was determined (p=-0.476; p=0.008).

CONCLUSION. The increase in the choroidal thickness in macula compared with the control in both PACs and PAC, as well as the correlations of subfoveolar choroidal thickness with lens vault and iris parameters, suggest the involvement of the choroid in the pathogenesis of primary angle closure disease (PACD). The correlations of lens vault with IOP, the anterior chamber parameters and iris indicate the prevailing role of the lens in the development of PACD and the need for its early replacement.

The annually growing number of children and adults suffering from visual impairments necessitates new approaches to the diagnosis and treatment of eye pathologies. The most common pathologies leading to vision loss are cataract, age-related macular degeneration, glaucoma, diabetic retinopathy and high myopia. They result in pathological processes that lead to patient disability (temporary or permanent) and a decrease in the quality of live.

This fact emphasizes the need to implement and introduce into the ophthalmological practice new approaches to the treatment of diseases using modern medications, new technical means and equipment. However, when conducting a practical study, a number of problems arise: the organizational problem (including the problem of finding and implementing new treatment methods), ethical and financial problems that impede the proper use of the obtained results despite their promise, and specifically the difficulties arising in the organization of studies (development of study design, including the choice of medical institution, selection of an appropriate group of patients, their preparation in order to implement the necessary continuity in therapy and staged observation at certain time intervals).