PURPOSE. To study the correlations between the immunological data and the indicators of electroretinography (ERG) and optical coherence tomography (OCT) in patients with advanced stages of primary open-angle glaucoma (POAG).

METHODS. Previously, we conducted a multimodal study of patients with advanced stages of glaucoma involving ERG, morphometric and immunological studies. In this new study we performed a correlation analysis of the immunological and morphofunctional data of patients with advanced stages of POAG. The study included 35 patients (35 eyes), among them 19 women and 16 men, who were divided into two groups: group 1 — stage II POAG (12 patients, 12 eyes), and group 2 — stage III POAG (23 patients, 23 eyes). The average age of the subjects was 64.2±6.5 years. Intraocular pressure was compensated in all study patients. The Pearson's correlation coefficient was used to calculate the linear relationship between continuous features.

RESULTS. In the subgroup with stage II POAG significant correlations of moderate strength (according to the Chaddock scale) were found between the parameters of pattern ERG (PERG) and photopic negative response (PhNR) and the level of VEGF-A in the blood serum (BS), EGF in the tear fluid (TF) and aqueous humor (AH); strong correlations — for the concentrations of EGF and TGF-β2 in the AH. In group 2, moderate correlations between PERG and PhNR parameters and the level of IL-1RA in the TF were found, as well as moderate correlation of TGF-β2 expression in the AH with PnHR amplitude from the baseline. In patients with stage II glaucoma, the levels of MIP-1β/CCL4 in the TF, IL-1RA in the intraocular fluid correlated with the thickness of the retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (GCL), while the EGF in the TF and AH correlated with RNFL thickness. In the group with stage III POAG, correlations of moderate strength were found for the expression level of TNF-α, IL-8/CXCL8 in the TF and RNFL thickness, and strong correlations — for the level of IP-10/CXCL10, HGF/SF, TGF-β2 in AH and the thickness of RNFL and GCL.

CONCLUSION. Comparison of ERG, OCT findings and the level of cytokines of various biological effects in the BS, TF and AH confirmed the high informativeness of PERG and PhNR indicators and immunological data as markers of advanced stages of POAG, and allow EGF to be considered as the most promising pathogenetically oriented immunological marker of II and III stages of glaucoma.

PURPOSE. To determine the role of extracellular matrix (ECM), transforming growth factor β (TGF-β) and matrix metalloproteinase 9 (MMP-9) in the mechanisms of filtering bleb formation after non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).

METHODS. The study consisted of prospective examination of 65 patients with POAG operated by the NPDS method. Three groups were formed: group 1 — optimal hypotensive effect of NPDS (21 patients); group 2 — relative hypotensive effect (23 people); group 3 — absence of hypotensive effect (21 patients). During the postoperative period, the condition of the intraocular fluid outflow pathways was evaluated with ultra biomicroscopy, optical coherence tomography, level of intraocular pressure, as well as the concentrations of TGF-β and MMR-9 in the tear and aqueous humor.

RESULTS. The anterior chamber aqueous humor was found to contain TGF-β in all patients with glaucoma. Group 1 was noted to have minimal initial TGF-β concentrations in the tear and aqueous humor, high MMR-9 level in the pre- and postoperative period. Sparse extracellular matrix was the substrate for the filtering blebs. Group 2 was revealed to have elevated initial concentrations of TGF-β in the tear and aqueous humor, extremely high level of MMP-9 in the aqueous humor, accumulation of MMP-9 in the tear after 2 weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early period, loci of rigid ECM were visualized in the filtering blebs, but functional outflow pathways were successfully formed by month two after additional therapy. Group 3 was established to have maximum TGF-β concentrations and low MMP-9 concentrations in the anterior chamber aqueous humor, a decrease in tear MMP-9 after two weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early postoperative period, the filtering blebs were based on rigid ECM, by month two there was scar deformation of the outflow pathways.

CONCLUSION. The important conditions for the formation of functional filtering blebs after NPDS are the structural organization of temporary ECM of the filtering blebs in the early postoperative period and the timely degradation of ECM components with predominant concentration of MMR-9 over TGF-β.

PURPOSE. To evaluate the capabilities of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with early stages of glaucoma.

METHODS. The study included 38 patients with early stages of primary open-angle glaucoma who underwent MP-TSCPC with SUPRA 810 (“Quantel Medical”, France) as primary surgical treatment. The follow-up period averaged 17±11 months (from 6 to 30 months). The Kaplan-Meier scale was used to assess the cumulative success of laser treatment.

RESULTS. The postoperative period was uneventful. One month after MP-TSCPC a  significant hypotensive  effect was  observed,  averaging  41.5%  from  the  baseline.  After 6 months, the hypotensive effect continued to  persist  and averaged 36.1%. By 12 months, the hypotensive effect remained stable, IOP averaged 16.0±3.5 mm Hg, which was 31% from the baseline. No changes in best corrected visual acuity (BCVA) were detected during the observation period. Target intraocular pressure (IOP) was achieved in all cases. Optical coherence tomography and perimetry findings remained stable or improved.

CONCLUSION. MP-TSCPC in patients  with  early  stages  of glaucoma leads to a pronounced stable hypotensive  effect during the follow-up period, averaging 31%  (from  20% to 50%). An improvement in the quality of life was noted due to the cease or reduction in the number of instillations. Monitoring of patients continues in order to develop practical recommendations for the indications and regimens of MP-TSCPC in the early stages of glaucoma.

PURPOSE. To determine the types of reaction to pilocarpine in patients with low-tension glaucoma (LTG) and study the nature of fluid outflow along the main pathways in different types of reaction to pilocarpine.

METHODS. The observation group included 21 people (42 eyes) with LTG aged 51 to 80 years (average age 68±9.8 years). The criteria for inclusion in the study were emmetropic refraction and no previous laser and surgical interventions on the examined eye. The anterior chamber angle corresponded to medium–wide or wide according to the classification by A.P. Nesterov. The initial stage of LTG was established in 16 eyes, developed stage — 12 eyes, advanced stage — 14 eyes.

The examination was carried out both in patients with newly diagnosed glaucoma and in patients with previously established diagnosis who received hypotensive drug therapy; in the latter case the patients were recommended to cease instillations of hypotensive drugs 10–14 days prior to the examination.

RESULTS. Among the studied LTG patients, positive pilocarpine test was registered in 5 eyes (12%), negative — in 6 eyes (14%), and paradoxical — in 31 eyes (74%).

The obtained data revealed no statistically significant differences in the initial values of anterior chamber depth, lens thickness and axial eye length between patients with paradoxical and positive reactions to pilocarpine. Therefore, there are no anatomical prerequisites for the development of a particular type of reaction to the pilocarpine test in the studied eyes.

The ease of outflow coefficient (EOC) for the drainage pathway is significantly reduced in patients with positive reaction to pilocarpine, which in absolute numbers approaches normal values. In these patients the drainage outflow reserves are preserved.

In persons with paradoxical reaction to pilocarpine, EOC for the drainage pathway is significantly reduced and is low in absolute numbers. Deterioration of the outflow along the uveoscleral pathway in pilocarpine instillations leads to elevated intraocular pressure.

CONCLUSION. The majority of patients with low-tension glaucoma have a paradoxical reaction to the pilocarpine test. The sufficiently high sensitivity of the sample allows recommending it as a diagnostic test for this type of glaucoma.

Different types of reaction to pilocarpine in patients with low-tension glaucoma are associated with the intensity of intraocular fluid outflow over the drainage and uveoscleral pathways.

PURPOSE. To compare the course of the early postoperative period after Ahmed valve implantation in patients with neovascular glaucoma of diabetic and post-thrombotic genesis with and without anti-VEGF therapy.

METHODS. This study included patients with refractory neovascular glaucoma of diabetic and post-thrombotic genesis who were indicated for Ahmed valve implantation. Some patients underwent intravitreal administration of ranibizumab 4–14 days prior to implantation. A total of 39 eyes from 39 patients were included in the study and divided into 2 groups: group 1 (n=20) — patients with refractory neovascular glaucoma of diabetic and post-thrombotic genesis with Ahmed valve implantation without prior anti-VEGF therapy; group 2 (n=19) — patients with refractory neo-vascular glaucoma of diabetic and post-thrombotic genesis with anti-VEGF therapy before Ahmed valve implantation. The following parameters were assessed: best corrected visual acuity (BCVA), intraocular pressure (IOP) before and after the intervention, and the course of the early post-operative period.

RESULTS. In the group with prior intravitreal administration of ranibizumab, the incidence of hyphema was significantly reduced due to regression of the newly formed vessels. The study showed the best functional outcomes are achieved with the use of preparation therapy with anti-VEGF before Ahmed valve implantation: increase of corrected visual acuity by 34%, stabilization of initially elevated IOP by 100%. The baseline IOP of 29.9±6.6 mm Hg decreased to 9.7±3.6 mm Hg (p<0.05). The better visual results can be attributed to the reduced incidence of hyphema as a result of preoperative anti-VEGF therapy, which simplifies the surgical procedure. In addition, preoperative intravitreal injection of ranibizumab (IVI) improved best corrected visual acuity by relieving macular edema. Our study shows that the combination of Ahmed valve implantation and intravitreal injection of an anti-VEGF agent is successful in the early follow-up period, but fails to persist: an increase in IOP to almost 21 mm Hg was seen in both groups by the end of one-year follow-up, and visual acuity regressed in group 2.

CONCLUSION. The use of anti-VEGF agent prior to Ahmed valve implantation provides better functional outcomes in the early postoperative period. Intravitreal administration of ranibizumab prior to Ahmed valve implantation minimizes the number of hemorrhagic complications in the early postoperative period and reduces the length of hospital stay. Within one year after surgery, patients experienced regression of visual acuity, as well as an increase in intraocular hypertension following the reactivation of iris neovascularization.

Objective: to evaluate the possibilities of transscleral micropulse cyclophotocoagulation (MP-TSCPC) in patients with early stages of glaucoma.

Material and methods. 38 patients with early stages of primary open-angle glaucoma underwent MP-TSCPC as the primary procedure. For the operation, modified laser parameters were used on the SUPRA 810 device (Quantel Medical, France). The follow-up period averaged 17±11 months (from 6 to 30 months). The Kaplan-Meier scale was used to assess the cumulative success of laser treatment after surgery.

Results. The postoperative period was uneventful. A month after the MP-TSCPC,  was noted hypotensive effect averaged 41.5% . After 6 month hypotensive effect continued to persist and averaged 36,1%. By 12 months follow-up, a stable hypotensive effect remained, IOP averaged 16.0±3.5 mm Hg, averaged 31%. No changes in BCVA were detected during the observation period. IOP reduction was achieved in all cases. The parameters of the state of the ONH (OСT, perimetry) remained stable, or their improvement.

Conclusion. MP- TSCPC in patients with early stages of glaucoma leads to a pronounced stable hypotensive effect during the follow up period, averaged 31% (up20% to50%). An improvement in the quality of life was noted due to the refusal or reduction in the number of instillations. To develop practical recommendations on the indications and regimens of MP-TSCPC in the early stages of glaucoma, further monitoring of patients is carried out.

Key words: open angle glaucoma, early-stage glaucoma; intraocular pressure; micropulse cyclophotocoagulation.

According to the results of various studies, in up to 50% cases after cataract phacoemulsification patients with glaucoma experience ophthalmic hypertension on the first day. This occurs due to the mechanical retention of aqueous humor in the anterior chamber. Temporary decrease in the function of the eye drainage system is explained by pigment particles, viscoelastic, erythrocytes, protein  cells,  product  of postoperative inflammation and lens particles obstructing the trabecula. In the long-term period after phacoemulsification in glaucoma patients there is a decrease in  the intraocular pressure in up to 74% of cases.

A decrease in the density of endothelial cells in these patients occurs as a result of fluctuation of intraocular pressure, prolonged application of hypotensive drops, surgical intervention and presence of drainage devices after antiglaucoma surgery. This leads to the increase of inflammatory reaction of the cornea in the form of edema of up to 16.9% after cataract phacoemulsification.

Phacoemulsification also provides a significant hypotensive effect (up to 34%) and is a preventive measure for  an acute attack in patients with angle-closure glaucoma. However, the state of acute glaucoma attack leads to difficulties in phacoemulsification in the form of high intraocular pressure, corneal edema and small chamber. Cataract extraction under such circumstances causes an increase in postoperative corneal edema and eye inflammation of up to 22.85%.

The trends of recent years regarding the surgical treatment of the visual organ and its appendages are to minimize tissue traumatization during surgical manipulations, reduce their duration, as well as achieve the best possible outcome from the points of view of the doctor and the patient at minimal economic costs. Currently, the leading vector in glaucoma treatment remains the achievement of the target level of intraocular pressure (IOP). Taking into account the projected increase in the number of patients with glaucoma, conducting justified surgical treatment will remain relevant in the future. Its present state prompts the creation of new drugs, new means of their delivery, and surgical techniques with improved safety profile while achieving effective IOP reduction. In this regard, the trends in the development of surgical treatment of glaucoma have shifted towards procedures with minimal trauma to the eye tissues — minimally invasive glaucoma surgery (MIGS). The article discusses modern varieties of MIGS, theoretical and practical aspects of their application (effectiveness and safety profile), as well as prospects of their use.

The review is devoted to the genetic nature of congenital glaucoma (CG) and presents clinical and genetic forms of hereditary glaucoma and single nucleotide polymorphisms identified by genome-wide association studies (GWAS). Glaucoma is a genetically heterogeneous disease, and patients with the same clinical diagnosis often have different molecular causes. The role of mutations in the CYP1B1 gene has been proven in the pathogenesis of hydrophthalmos; the MYOC gene — in juvenile open-angle glaucoma; the PAX6 gene — in aniridia; mutations in the PITX2, FOXC1 genes have been identified in Axenfeld-Rieger anomaly/syndrome. It has been established that 4–43% of patients with open-angle glaucoma have a family history of a mutation in the MYOC, OPTN or TBK1 genes. Genetic studies of glaucoma are the first steps to developing a new generation of personalized treatments. The article describes the key features of the pathogenesis of various genetic forms of glaucoma and the possible course of its therapy. However, gene therapy requires further study of both long-term effects and efficacy. Molecular genetic diagnosis of glaucoma allows for personalized genetic counseling of family members with consideration of the genetic risks.

Primary open-angle glaucoma (POAG) is one of the most significant medico-social problems in the modern society. The development of its refractoriness aggravates the pathological process and inevitably leads to blindness. Despite the fact that this form accounts for up  to  80%  of all glaucoma cases, the problem of POAG refractoriness has not been considered in sufficient detail in either Russian or foreign sources. The article presents an overview of the main ophthalmic factors that contribute to changes in various structures of the eyeball and accelerate the formation of refractory forms of POAG. One of the reasons for that is a genetic predisposition to the  development of POAG.  It is worth noting that in 60% of patients with    a family history of glaucoma, the risk of developing POAG increases by 10 times (among the first-degree relatives).

Additional factors in the development of the refractory form of POAG are the reactive syndrome and during laser surgery. It is important to emphasize that the risk of development and progression of POAG in patients with     a hereditary predisposition is much higher, while indicating a number of therapeutic measures may lead to drug resistance. Genotyping is a promising scientific and practical direction of research, allowing prediction of the pharmacological response to a particular drug and individual selection of the appropriate therapy according to the patient's genotype. This approach could help prevent a number of complications and improve the accuracy of disease prognosis.