PURPOSE. To compare the anatomical and functional effectiveness of lensectomy (LE) and laser peripheral iridotomy (LPI) in patients with primary anterior chamber angle closure.

METHODS. This prospective study included 120 patients aged 41 to 80 years (60 eyes — primary angle closure (PAC), 30 — primary angle closure suspects (PACs), 30 eyes — without ophthalmic pathology). 30 PAC eyes were treated using LE with intraocular lens implantation, and 30 eyes with LPI. All subjects underwent swept source optical coherence tomography (SS-OCT). The following parameters were analyzed: spherical equivalent (SE), uncorrected and corrected distance visual acuity, intraocular pressure (IOP), Shaffer grade of angle opening, lens opacity, goniosyne chiae, choroidal thickness in the macular region, axial length (AL) of the eye, anterior chamber depth (ACD), lens vault (LV), iris curvature (ICurv), iris thickness at 750 µm from scleral spur (IT750), angle opening distance (AOD500, AOD750), iridotrabecular space area (TISA500, TISA750). Along with standard descriptive statistics methods, machine learning methods were used, including Data Driven Soft Independent Modelling of Class Analogies (DD-SIMCA).

RESULTS. Every third eye with PAC had reached control group values after LE (DD-SIMCA specificity 0.67), which was not the case after LPI (DD-SIMCA specificity 1.0) with the probability of getting into the control group estimated as 0.01. After LE, all parameters of the anterior chamber angle did not significantly differ from the norm (p>0.05 for all), while ACD, ICurv even exceeded the norm (p=0.000). After LPI, there was a deepening of the ACD (from 2.34±0.28 mm to 2.36±0.280 mm, p=0.000) and a decrease in LV (from 0.864±0.120 µm to 0.843±0.110 µm, p=0.000), however, the result comparable to control was achieved only in ICurv (p=1.000). After LE in PAC, all parameters, including uncorrected visual acuity, SE, ACD, LV, iris profile, Shaffer grade of angle opening, and AOD500, AOD750, TISA500, TISA750 parameters in the superior and inferior sectors had advantages over those in PACs without treatment (p<0.05). After LPI, an improvement in a number of pa rameters was also achieved compared to LPI: ICurv, Shaffer grade of angle opening, AOD500, AOD750, TISA500, TISA750 in the superior sectors and AOD500 in the inferior sector (p><0.05).

CONCLUSION. The effectiveness of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. Both treatments, especially LE, improve these parameters compared to PACs. Lens extraction is the treatment of choice at the early stages of primary angle closure.

PURPOSE. Comparative assessment of the spectrofluorimetric parameters of the limbus area in patients with primary open-angle glaucoma (POAG) receiving various molecules of prostaglandin analogues topically.

METHODS. The study included 129 patients (129 eyes) with newly diagnosed primary open-angle glaucoma who were randomized into four groups depending on the prostaglandin analogue they used for one month. The control group consisted of patients who were prescribed a non-selective beta-blocker (timolol). Patients underwent a comprehensive ophthalmological examination and spectrofluorimetric study of the limbus area.

RESULTS. In all studied groups, the achieved hypotensive effect after one month of instillations was 30.6–34.5% of the baseline intraocular pressure (IOP) level. Stabilization of glaucomatous optic neuropathy was determined in all study groups regardless of the stage of POAG with varying degrees of significance. The most pronounced ischemic effect on the limbus area was recorded in patients with moderate POAG using travoprost (increase in fluorescence intensity of 0.14; p=0.018), advanced POAG — using bimatoprost (increase in fluorescence intensity of 0.141; p<0.0001). Latanoprost had a lesser effect on ischemia of the limbal area — increase in fluorescence intensity of 0.124 (p=0.043) and 0.104 (p<0.001) in moderate and advanced stages, respectively. In the control group in all examined patients the difference in fluorescence indices was insignificant, which may indicate a minimal effect of timolol on ischemia of the limbus area.

CONCLUSION. Spectrofluorometric indicators of the limbal area reflect the ischemic effect of all molecules within the prostaglandin analogue class, while the use of beta-blockers causes a minimal effect on ischemia. The use of any prostaglandin analogues in patients with advanced POAG leads to more pronounced ischemia of the limbal area than in eyes with moderate stage, which suggests a greater tendency to scarring of the filtering bleb after hypotensive interventions.

PURPOSE. To study the factors affecting the results of intraocular pressure (IOP) measurement by different ocular tonometry methods.

MATERIAL AND METHODS. The study involved 72 patients (128 eyes) aged 22 to 86 years. IOP was measured in all patients using Corvis ST tonometer, Topcon ST-800 pneumotonometer, iCare IC 100 portable tonometer, and Maklakov applanation tonometer. The results of IOP measurements were analyzed depending on the following factors: age, gender, presence of glaucoma or suspicion for glaucoma, presence of refractive errors, axial length of the eye, thickness of the cornea.

RESULTS. The greatest difference in IOP values was observed between the Maklakov method (tonometric IOP) and iCare IC 100 device (true IOP). In some cases (9–22%), tonometric IOP obtained using the Maklakov method was equal or lower than the values obtained with other methods.

Results of the correlation analysis confirmed the high correlation of the IOP values obtained with Topcon CT-800, iCare IC 100 and Corvis. On the other hand, IOP values obtained with the Maklakov method had lower correlation dependence with IOP values obtained using other tono metry methods. The strongest correlation of IOP and corneal thickness was observed when using Topcon CT-800. The IOP value obtained with the Maklakov method had the lowest correlation dependence with corneal thickness.

CONCLUSION. The lowest correlation dependence of Mak lakov IOP measurements with IOP values obtained using Topcon CT-800, iCare IC 100 and Corvis indicates that the reliability of the Maklakov method significantly depends on the compliance with the examination technique.

PURPOSE. To study the diagnostic effectiveness of an improved software version of the well-known authors' modification of Frequency Doubling Technology (FDT) perimetry by comparing it with the previous software version and standard automated perimetry on the same contingent of healthy individuals and patients with primary open-angle glaucoma (POAG).

METHODS. The study included 56 patients (105 eyes) (mean age 61±13.2 years) with POAG. Patients were divided into three groups depending on the stage of glaucoma: group 1 — early stage (39 eyes), group 2 — moderate (25 eyes), and group 3 — advanced (9 eyes) stage. The fourth (control) group included 32 eyes of 16 healthy people (average age 48.2±6.2 years). All study subjects underwent standard automated perimetry (SAP) on the Humphrey III visual field analyzer and non-standard perimetry in the form of our own modification of FDT perimetry and its improved software version — FDT VR version based on the new portable automatic perimeter "Stimulus" (OOO Total Vizhen, Russia). The optic nerve disc was evaluated on the Heidelberg Retina Tomograph 3.

RESULTS. The software version of the authors' modification of FDT perimetry has been improved for liquid crystal monitors and adapted to the portable perimeter "Stimulus". When comparing diagnostic effectiveness, both variants of FDT perimetry are not inferior to SAP in sensitivity (87.6; 87.8 and 86.7%, respectively), and in terms of specificity (98.2; 98.1 and 84.4%, respectively) they are superior. A strong (r=0.99988) and reliable (p<0.05) correlation was found between the average values of light sensitivity for both variants of FDT perimetry.

CONCLUSION. The introduction of FDT perimetry based on the new portable automatic perimeter "Stimulus" into widespread ophthalmological practice can contribute to improving the effectiveness of screening and early diagnosis of glaucoma.

PURPOSE. Comparative evaluation of anti-hypertensive effectiveness of tafluprost 0.0015% (Taflotan), and a fixed-combination of benzolamide 1% and timolol maleate 0.5% (Azarga) preparation in an experimental animal model with artificially induced steroidal ophthalmic hypertension.

METHODS. The study experiments were performed on 30 sexually mature Chinchilla rabbits (60 eyes) with steroid-induced glaucoma modeled by ocular instillations of dexamethasone.

The animals were divided into 3 groups each consisting of 10 rabbits. The first group was the controls that were divided into two subgroups; they were instilled dexamethasone 0.1% two drops per day into the right eye (the left eye remained as control) for 20 days in subgroup 1, and for 30 days in subgroup 2.

The animals in group 2 received Azarga, group 3 — Taflotan. Animals of group 2 and 3 were divided into three subgroups: in subgroup 1 the animals were instilled the studied drugs for 10 days, in subgroup 2 — for 20 days, in subgroup 3 — for 30 days.

RESULTS. Both drugs reduced the intraocular pressure down to the reference range, i.e. 18–25 mm Hg. Animals that received instillations of Taflotan achieved the refe rence range values after 10 days, while the animals receiving Azarga — after 20 days.

CONCLUSIONS. Under the conditions of steroidal ophthalmic hypertension, instillations of both Azarga and Taflotan yield satisfactory results in terms of IOP reduction. The use of Taflotan allowed achieving the reference range values after 10 days, Azarga — after 20 days. Taking into account the ease of administration of Taflotan, it can be recommended as the most convenient and effective drug in terms of reducing intraocular pressure.

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.

PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.

METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.

RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.

CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

PURPOSE. The study aimed to evaluate the antihypertensive effectiveness and the condition of the ocular surface in patients with glaucoma during monotherapy with the drug Traviolan® (travaprost 0.05%).

METHODS. This longitudinal, randomized, prospective study included 27 patients (59.6% women, 40.4% men; mean age 64.1±6.4) with uncompensated primary open-angle glaucoma in early and moderate stages receiving mono-therapy with β-blockers or carbonic anhydrase inhibitors. This was a longitudinal, randomized, prospective, observational study. All patients underwent a complete ophthalmological examination and assessment of dry eye symptoms using a questionnaire (Ocular Surface Disease Index, OSDI). An objective assessment of the condition of the ocular surface was carried out using the Sirius corneal topography device, which is used for assessment of tear film breakup time (TBUT). All patients were re-examined after 12 weeks.

RESULTS. Intraocular pressure was significantly reduced at all study visits and amounted to 5.9±2.8 mm Hg at week

12 (25.9%). There was a significant reduction in symptoms of dry eye, irritation, itching, and foreign body sensation (p<0.05 for each parameter). A significant improvement was also noted in terms of the condition of the ocular surface, and in most patients the symptom complex was classified as mild dry eye syndrome (p<0.05). Additionally, there was also a significant improvement in the OSDI score (p<0.05) with a mean of 17.95±5.35 points. The tear film breakup time by the end of observation increased by 4.1±2.3 sec and amounted to 7.4±3.1 sec.

CONCLUSION. The drug Traviolan® has high antihypertensive effectiveness and good tolerability, and improves the condition of the ocular surface.

Development of primary open-angle glaucoma (POAG) in older patients is associated with a high risk of its refractoriness, which contributes to the progression of the pathological process possibly leading to a severe disabling complication — blindness. Concomitant pathology also makes a significant contribution to the course of primary open-angle glaucoma and requires a careful approach to diagnosis and management. POAG is a multifactorial pathology, so the treatment plan should take into account both genetic predisposition and general somatic pathology, as well as the socio-economic background. Studying the interaction of these factors contributes to a better understanding of the causes and processes that result in the refractory form of POAG. Specifically, the most common pathologies of the cardiovascular system that affect the course of POAG are arterial hypertension (AH) or hypotension, coronary heart disease (CHD), dyscirculatory encephalopathy (DE). In addition, the course of the disease is significantly affected by diabetes mellitus (DM), neurodegenerative pathologies, and smoking. These findings have been confirmed in a number of international multicenter studies. Certain social factors, however, are of particular importance due to mutually exclusive published findings. Notably, the socioeconomic status of patients (for example, the presence or absence of higher education) also plays an important role in the diagnosis and progression of the disease. Detailed consideration of these factors is extremely important for a better understanding of the disease and, consequently, the improvement of the quality of life of patients.

Glaucoma surgery is the most effective way to achieve target levels of intraocular pressure. However, it has significant advantages and disadvantages. The main disadvantage is the temporary nature of its hypotensive effect. The onset of surgical failure can occur at various times after the intervention. A correct assessment of the operation timing and risk factors for excessive scarring, as well as correct perioperative therapy, can prolong the effectiveness of the surgery and reduce the number of repeat operations.

With a wide choice of surgical treatment methods, trabeculectomy remains the most frequently performed intervention. Its effect is better understood and can be considered more controllable. If the surgical treatment of glaucoma is ineffective, it is possible to prescribe a "restart" therapy, activate previously formed outflow tracts, and perform a second intervention. The development of needling technology makes it possible to delay repeat interventions, prolonging the hypotensive effect of the initial operation.

Excessive fibrosis and scarring of newly created aqueous humor outflow pathways, mainly at the level of the intrascleral canal and filtering bleb, is a significant disadvantage of the so-called bleb-dependent antiglaucoma surgery. Taking into account the fact that aqueous humor, which flows evenly through the non-healing fistula under the hermetically sutured conjunctiva, is the forming substrate for the newly created outflow pathways, its composition also plays an important role in the body's response to surgical trauma. A large number of publications reliably demonstrate an increase in the concentration of various biologically active molecules in the aqueous humor of the anterior chamber of glaucoma patients. These are transforming growth factor β (TGF-β), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), interleukins IL-6 and IL-8, etc., which concentration in cases of unsuccessful outcome of trabeculectomy was significantly increased compared to patients who underwent successful surgeries. In addition, it has been established that an imbalance of various matrix metalloproteinase pools, fibroblast activation, wound infiltration by neutrophils and macrophages, which in turn express a significant amount of pro-inflammatory cytokines and growth factors, contribute to the prolongation of inflammation and fibrosis. An important condition for the removal of aqueous humor from the filtering bleb area is the postoperative activation of conjunctival lymphatic angiogenesis, which suppression may be associated with prolonged inflammation or the active use of cytostatics. This literature review presents the complexities of the pathophysiological mechanisms of postoperative healing and the formation of newly created aqueous humor outflow pathways after antiglaucoma operations. At the same time, the question remains open about the effect of initial changes not only on the tissues of the ocular surface, but also in the aqueous humor of the anterior chamber, as well as the general condition of patients on the outcome of the operation.

The purpose of this review is to present modern literature data on the pathophysiological mechanisms of the wound healing process and the features of postoperative healing regulation after antiglaucoma surgery.

Nowadays methods of standard and non-standard computerized perimetry using stationary devices are widely used in functional screening of glaucoma. The information about new portable devices for perimetry has appeared in foreign literature in recent years, describing such advantages as economic availability, autonomy and mobility, which open up new possibilities for their use. New possibilities include cloud storage of data, the use of telemedicine technologies, artificial intelligence, examination of patients with disabilities, including those who are bedridden, as well as examination outside of medical institutions. All of this can allow glaucoma patients to receive ophthalmic care when in-person visits are unavailable, including social distancing needed during a pandemic or quarantine. This review of the literature describes the latest portable devices and applications for perimetry, attempts to classify them according to similar parameters, and assesses their advantages and disadvantages, as well as the prospects for their use in functional screening of glaucoma.