PURPOSE: A comparative analysis of morphological changes in the central part of the visual analyzer (lateral geniculate nucleus (LGN) and the visual cortex) in patients with glaucoma and Alzheimer’s disease. MATERIALS: Morphological material included brains of 7 patients: 2 patients with Alzheimer’s disease, 1 patient with glaucoma and 4 control patients without neurological and ophthalmic pathology. Nissl staining and Bilshovsky staining were applied to the autopsy material. A comparative analysis of the area sizes of the neurons and their nuclei as well as and the nuclear-cytoplasmic ratio in the LGN and the visual cortex in patients with glaucoma and Alzheimer’s disease was performed using morphometry software. Immunocytochemistry staining for-amyloid and tau-protein in the LGN and the cerebral cortex was perfomed in patients with glaucoma and Alzheimer’s disease. RESULTS: A marked reduction in the area size of neurons associated with Alzheimer’s disease and glaucoma was observed in all studied areas in comparison with the control group. Cross-sectional area of the nucleus in patients with Alzheimer’s disease on the contrary was substantially increased in the magnocellular and parvocellular layers and not significantly different from the control group in the visual cortex. No difference was found in the area size of the nuclei in the magnocellular layers of glaucoma patients compared to the control group, while in the parvocellular layers and the visual cortex their size was smaller. Immunocytochemistry analysis confirmed the presence of p-amyloid and tau- protein in the LGN and the cerebral cortex in glaucoma and Alzheimer’s disease. CONCLUSIONS: Morphological changes observed in visual centers in Alzheimer’s disease and glaucoma indicate transsynaptic distribution of the pathological process in the central nervous system structures.

PURPOSE: The search and identification of factor revealing the hemodynamic disturbances in magistral ocular and orbital blood vessels in endocrine ophthalmopathy (EOP) increasing the risk of the optic neuropathy development. METHODS: 86 patients with EOP were examined. EOP was associated with Graves' disease (GD, n=72, 144 orbits) and autoimmune thyroiditis (AIT, n=14, 28 orbits). All patients were examined by an ophthalmologist and an endo-crinologist. The diagnostic of GD and AIT was based on the medical history, examination, the level of thyroid hormones (free T4, free T3), thyroid-stimulating hormone (TSH), rTSH antibodies and thyroid sonography. Normal range for TSH levels was 0.25-3.5 mlU/l; free Т4 - 9.0-20.0 pmol/L; free ТЗ - 4.26-8.1 pmol/L. Patients with EOP were evaluated using the EUGOGO protocol. Every orbit was assessed separately. Ophthalmic examination included patients history and clinical assessment of EOP. All patients underwent similar eye examination (visometry, perimetry, biomicroscopy, tono-metry, ophthalmoscopy, Hertel exophthalmometry). Orbit pathology was verified by multispiral computed tomography. Orbit echography was carried out for all patients. Eyeball, retrobulbar space and magistral vessels were the anatomic objects of investigation. Blood flow was examined by ultrasound diagnostic system Voluson 730 PRO («Kretz», Austria) in regimen of triplexic screening (B-regimen, CDK in combination with impulse value dopplrography). Hemodynamic indices were analysed in a. ophthalmica, a. et v. retinae centralis, a. ciliaris posterior brevis et longae. Thyroid dysfunction type, endocrine disease duration, patient's age, orbital inflammation and the compressive factor were considered as factors of hemodynamic orbit disturbances. RESULTS: Different hemodynamic disturbances were present in all patients with EOP (100%). Statistic correlative analysis showed, that thyroid dysfunction is one of the most important factors, determining hemodynamic disturbances of orbit blood flow. The severity of these disturbances depended on the type of thyroid dysfunction. The obtained data showed that the age of the patient and the duration of the endocrine disease is the important factor of the hemodynamic disturbances of orbit blood flow in EOP. The age (over 50) and the duration of the disease result in hemodynamic disturbances, reaching the value of «chronic eye ischemic syndrome». The intensity of autoimmune inflammation was revealed to determine the depth of hemodynamic disturbances in orbit. At the same time the severity of EOP reflected intraorbital pressure that may cause hemodynamic disturbances changing the blood flow in the orbit. CONCLUSION: Factors determining the character of hemo-dynamic disturbances in main vessels of the eye and orbit in EOP are found and identified such as thyroid dysfunction type, orbital inflammation intensity, compressive factor, endocrine disease duration and the age of the patient.

PURPOSE: To evaluate the role of cytokines IL-17, IL-6, TGF-B1 and TGF-B3 in the immune response in patients with primary open-angle glaucoma (POAG). METHODS: Using specific ELISA test systems «R&D Diagnostics Inc.» (USA), we investigated blood serum and tear fluid of 110 subjects (80 POAG patients and 30 healthy subjects). Mean age was 57.0±3.2 years (78 years in women and 37 - in men). From 42 patients diagnosed with glaucoma, 38 had advanced and terminal stages. Patients were subdivided into 2 subgroups: with POAG only and POAG combined with chronic pathology (hypertensive disease, type 2 diabetes, myopia). RESULTS: All patients demonstrated high levels of IL-17, IL-6 and low levels of TGF-B1 and TGF-B3 in blood serum and lacrimal fluid. The study revealed varied changes in inves- tigated biological fluids. Thus, IL-6 production was higher in the systemic circulation compared to the local, while the production of IL-17, on the contrary, was higher in the lacrimal fluid. Anterior chamber examination also revealed high local hypercytokinemia (IL-6, IL-17). Reduced concentration of the TGF-B cytokine group may be associated either with its utilization during hyperergic inflammatory reactions or with insufficient response. Similar immunological changes were also observed in the combined pathology subgroup (POAG with hypertension, type 2 diabetes, myopia) due to the similarity in the pathogeneses of these diseases: genetic, vascular, neuroendocrine.

PURPOSE: Russian glaucoma epidemiological studies are scattered and not always objective, since they are based on the outcomes of the annual reports provided by the primary care ophthalmologists. Taking into account the significant staff shortages, these data may not fully reflect the true epidemiological situation. A similar situation exists in the studied region, which defined the purpose of the present work: to identify the key epidemiological characteristics in long-term morbidity of glaucoma in Irkutsk region to improve the system of clinical examination. METHODS: 300.000 medical records of patients referred to the Irkutsk branch of Sv. Fyodorov Eye Microsurgery Institute between 1992 and 2013 diagnosed with glaucoma were processed. Epidemiological evaluation of the data was based on the analysis of primary morbidity with a further characteristic of the disease stages. The results of the study were processed using conventional parametric and nonparametric statistical analysis. The obtained absolute values were transferred to intensive parameters using the following formula: A/Bx1000=intensive index, where A is the number of patients with newly diagnosed glaucoma, B - the number of patients referred to the Irkutsk branch of Sv. Fyodorov Eye Microsurgery Institute during a one year period. Due to the fact that 80% of glaucoma patients living in the Irkutsk region undergo the primary examination in the Irkutsk branch of Sv. Fyodorov Eye Microsurgery Institute of Russian Ministry of Health, the data were extrapolated to the epidemiological situation in the entire region. RESULTS: The incidence of glaucoma increased from 45.2 to 140.6 per 1,000 patients. We noted an increasing detection rate of preclinical stages of glaucoma. At the same time, the detection rate of advanced stages of glaucoma remained stable. Four periods during which the incidence increase exceeded the expected results were identified. These periods correspond to widespread application of new diagnostic technologies and realization of additional organizational arrangements in this area. CONCLUSION: The results of the study allowed estimating the epidemiological situation on glaucoma and identifying the main regularities of its development. This information can be used in predicting the major trends in the prevalence of glaucoma for better preventive healthcare management decisions.

PURPOSE: To evaluate the safety and effectiveness of Schlemm's canal (SC) dilation with stainless steel spiral Schlemm's canal expander (SCE) in decreasing intraocular pressure (IOP) in patients with open angle glaucoma (OAG). MATERIAL AND METHODS: Eighteen consecutive patients (18 eyes) with OAG, who's IOP was insufficiently controlled by their current ocular hypotensive medications were operated upon. A 4-5 mm long SCE made from 0.05 mm thick medical grade stainless steel wire was implanted into the SC lumen ab externo. In 6 cases with coexisting pathology a combined two site procedure - phacoemulsification with implantation of an intraocular lens (IOL) and SCE implantation was performed. Primary outcome measure was IOP change, secondary - number of glaucoma medications pre-and postoperatively and complications. A paired t-test was used for IOP and medication analysis. Decrease in IOP >25% or IOP 18 mm Hg or less without medication was considered a complete success, with medication - partial success. Failure was considered if the patient needed subsequent filtering surgery. Results were significant with p<0.05. Mean postoperative follow-up was 9.5±2.7 months. RESULTS: Mean preoperative IOP was 25.8±6.2 mm Hg (95% CI 22.7-28.9), mean number of medications - 2.4±0.8 (95% CI 2.2-2.6). At each follow-up a decrease in mean IOP was observed, resulting in 11.9±3.0 mm Hg (95% CI 11.513.1) at 6 months (p=0.000000008) and 12.3±2.5 mm Hg (n=10; 95% CI 11.2-12.6) at 12 months (p=0.00000001). This represents a reduction in IOP from baseline of 51.7±19.0% (95% CI 47.2-56.2) at 6 months and 49.8±15.3% (95% CI 45.0-54.6) at 12 months. Mean number of medications use decreased to 0.6±1.1 (95% CI 0.3-0.9; p=0.0000002) and 0.9±1.3 (95% CI 0.5-1.3; p=0.004) at 6 and 12 months respectively. Complete and partial success were observed in 13 and 5 cases at 6 months and 6 and 4 cases at 12 months (n=10). Intraoperatively, microperforation of trabecular meshwork (TM) in areas other than exposed part of SC occurred in 3 out of 18 cases. Postoperatively, not a single case of inflammation at insertion site, of hypotony, or shallow chamber was observed. Gonioscopically the device was in SC in all, except 2 cases, where one end of the device was lying in anterior chamber without contact with intraocular structures. Some blood was observed in SC at the device site in 3 cases, which cleared spontaneously after 3-4 days. There was 1 case with raised IOP after operation, which required Nd-YAG laser trabeculopuncture and one glaucoma medication. There were no failure cases. CONCLUSION: Six months and one year results of SCE insertion in surgical management of OAG show significant reduction in IOP from the baseline and in hypotensive medications use.

PURPOSE: To compare the long-term effectiveness of pseudoexfoliative glaucoma (PEG) treatment with a fixed combination (FC) brinzolamide/timolol vs. latanoprost by a comprehensive assessment of structural and functional changes, as well as indicators of arterial ocular blood flow. METHODS: We observed 42 patients with PEG who received FC brinzolamide/timolol (22 patients) 2 times daily or latanoprost once a day (20 patients). The groups were homogeneous for age (66.05±1.241 in brinzolamide/ timolol group and 63.8±2.09 in latanoprost group, p=0.36) and glaucoma stages (MD -6.43±1.51 dB in brinzolamide/ timolol group and -8.02±2.08 dB in latanoprost group, p=0.54), intraocular pressure (IOP) levels were also comparable (19.59±0.79 mm Hg in brinzolamide/timolol group and 19.94±0.88 mm Hg in latanoprost group, p=0.77). The functional and morphometric parameters, studied by means of standard automated perimetry and spectral optical coherence tomography, and ocular blood flow parameters, measured by color Doppler Imaging with impulse Doppler sonography, were subjected to a comparative evaluation. Follow up period was 10.5±0.363 month. RESULTS: A significant IOP reduction, compared with baseline was observed in both groups: 11% from baseline in brinzolamide/timolol group (p=0.005) and 12.5% from baseline in latanoprost group (p=0.011). MD was improved in brinzolamide/timolol group: by 1.2±0.37 dB (p=0.003). No statistically significant difference in RNFL, GlV and GCC was obtained in both groups during the follow up period. However, by the end of 12 months a significant increase of FLV was noted in latanoprost group (p=0.04). By the end of the observation period patients treated with brinzol-amide/timolol showed an increase in diastolic blood flow in the ophthalmic artery (p=0.044) and systolic blood flow in the lateral posterior short ciliary artery (p=0.011). CONCLUSION: FC brinzolamide/timolol and latanoprost demonstrate a significant hypotensive efficacy in PEG, however FC brinzolamide/timolol unlike latanoprost provides stabilization of glaucomatous optic neuropathy, as evidenced by the preservation of visual function and morpho-metric parameters of the retina and optic nerve, as well as an improved arterial ocular blood flow.

The problem of cataract treatment in patients with coexisting glaucoma attracts attention of ophthalmologists for many years. Most of them prefer combined surgery in these cases. Antiglaucomatous component of such treatment - non-penetrating deep sclerotomy (NPDS) has less complications and Femtosecond laser assistance can decrease the trauma of phacoemulsification. PURPOSE: The purpose of this work was to evaluate the effectiveness and safety of femtoassisted phacoemulsification with NPDS in cases of glaucoma and cataract combination. MATERIALS AND METHODS: All the patients were divided to groups according to the procedure performed: 1) phacoemulsification (269 eyes, 213 patients); 2) femtoassisted phacoemulsification (461 eyes, 320 patients); 3) phacoemulsification with NPDS and Xenoplast drainage implantation (11 eyes, 7 patients); 4) femtoassisted phacoemulsification with NPDS and Xenoplast drainage implantation (53 eyes, 42 patients). RESULTS: Vision acuity before operation in average was: 1 group - 0.13; 2 group - 0.23; 3 group - 0.24; 4 - 0.14. 1 months after operation it was 0.67; 0.72; 0.66 and 0.68 correspondingly. IOP in first two groups 1 day after the surgery was identical. Femtolaser assistance in all cases decreased the intraocular working time. There were no cases of hemorrhage intraoperative complications. In groups of combined surgery IOP normalized by 5-10 day after the surgery. CONCLUSIONS:Combined phacoemulsification and NPDS with Xenoplast implantation is safe and effective procedure. Femtoassistance in cataract surgery can decrease intraocular operation time and doesn't lead to intraoperative and postoperative complications increase.

Today there are many hypotensive surgical interventions intended to activate the uveoscleral outflow of aqueous humour. Their technique has changed due to the development of understanding of morphology and physiology. The primary concept of creating a fistula between the anterior chamber and suprachoroidal space transformed into combined surgical procedures based on filtering and non-penetrating techniques. Such surgical operations were often used for treating severe forms of glaucoma. In the course of non-penetrating glaucoma surgery development, combinations of non-penetrating deep sclerectomy with surgical activation of uveoscleral outflow were proposed. Most frequently it is carried out by implanting various drainages. Draining devices with one end implanted under the scleral flap into the anterior chamber and the other end - through a sclera incision into suprachoroidal space were recently developed. This appears to be the modern embodiment of the idea of combining filtering surgery with suprachoroidal space draining. In modern surgery cyclodialysis has also developed - a number of draining devices are implanted from anterior chamber into suprachoroidal space creating a direct pathway between these expanses. Mechanism of action of hypoten-sive surgical interventions and some aspects of histotopog-raphy are also discussed in the article.

This literature review depicts various tonometry methods (Maklakov, elastotonometry, Goldmann tonometry, tonometry by means of Ocular Response Analyzer (ORA) and ICare). The efficacy and accuracy characteristics of different intraocular pressure measuring methods are presented. The article sums up current research on the interdependence of the intraocular pressure and central cornea thickness, the influence of visco-elastic characteristics of the fibrous membrane of the eye on results of some tonometry methods, the correlation of biomechanical indices and interrelation of corneal hysteresis, corneal resistance factor and intraocular pressure. The review describes various stress tests (mydriatic test, Wurgaft compression tonometry test, Heims position test, Krasnov orthoclinostatic test, corticosteroid provocative testing by B. Becker, W. Mills etc.) and stress-relief tests (pilocarpine and epinephrine tests, determining individual tolerant intraocular pressure) used in early diagnostics of glaucoma and the history of their development and practical application.

The review focuses on key pharmacotherapeutic characteristics of selective adrenoceptor agonists, including their receptor selectivity, IOP-lowering mechanism of action and potential neuroprotective activities. As well, comparison of efficacy and safety profiles of brimonidine and other anti-glaucoma drugs is made.

The first part of the article aims to give a patient a general idea of glaucoma as a complex disease. It provides a comprehensible description of eye's anatomy, histology and physiological processes. It also explains pathological processes associated with glaucoma, why a patient is prone to take no notice of the changes and what symptoms to look out for. Stating that all forms of glaucoma are related to some degree to the pressure inside the eye, the article dwells further on the concept of intraocular pressure, its normal ranges and what happens if they are exceeded. The second part describes the various types of glaucoma and how they differ. The author emphasizes that there are almost no life-style choices that are known to be big factors in leading to either form of glaucoma. The most important things that determine glaucoma risk are how the eye was built and how it responds to changes in its environment, because the death of ganglion cells in both open-angle and angle closure glaucoma results partly from weaknesses in the tissues around them and partly from defects in the ganglion cells themselves as well as under-responses or over-responses in the normal defense mechanisms. The article explicates the idea of contributing risk factors and considers the contributing risk factors for open-angle glaucoma. Main contributing factors of open angle glaucoma - such as age, elevated eye pressure, ethnicity, hereditary background, myopia, low blood pressure, exfoliation and pigment dispersion - are specified and given further explanation. Controversial risk factors (corneal thickness, heart disease, anti-cardiolipin antibodies, migraine and Raynaud's phenomenon) as well as things that do not present risk of glaucoma development, contrary to common opinion (gender, diabetes, hypertension, diet and alcohol) are also listed.