PURPOSE. To study the state of microcirculation in the peripapillary region of the optic nerve head (ONH) using an original method of objective assessment in the absence of the necessary licensed software.

METHODS. A total of 30 patients (30 eyes) were included. The main group consisted of patients with early (subgroup 1, 10 eyes) and advanced (subgroup 2, 10 eyes) stages of primary open-angle glaucoma (POAG), the control group — individuals without history of ophthalmic complications (10 eyes). The peripapillary region of the ONH was examined using optical coherence tomography angiography (OCT-A). An original script was written in Python language for assessment of the prevalence of the vascular bed on the scans, analyzing an array of elements with brightness data.

RESULTS. Subgroup 2 differed most from subgroup 1 in capillary deficiency in the superficial layer. Differences between the groups were found in the capillary network density in the superficial and deep vascular plexuses, in the superficial layer they were statistically significant (subgroup 1 — 27444.5±1372.2; subgroup 2 — 14126.5±706.3; control group — 45198.5±2259.9). Correlation analysis in advanced glaucoma confirmed almost complete atrophy of the superficial layer, which became almost "transparent" to the device.

CONCLUSION. The developed method, based on the capabilities of OCT-A and additional machine analysis, can be used in the complex diagnostics of POAG both to confirm the stage of the pathological process and to assess the effectiveness of the ongoing therapeutic measures. 

PURPOSE. To develop a personalized approach to selecting a treatment method for primary angle closure (PAC) based on a comparison of the predicted hypotensive effect of laser peripheral iridotomy (LPI) and lens extraction (LE).

METHODS. This prospective study included 60 patients (60 eyes) with PAC aged 41 to 80 years. LPI was performed on 30 eyes and LE on 30 eyes. All patients underwent swept-source optical coherence tomography (SS-OCT) of the anterior and posterior segments of the eye before and 1 month after treatment. A set of 37 clinical and anatomical parameters of each patient was evaluated. The hypotensive effect of the surgery was considered to be the magnitude of the decrease in intraocular pressure (IOP) after the intervention relative to the baseline. The principal component regression method was used to develop regression models predicting the hypotensive effect of treatment.

RESULTS. An innovative step-by-step algorithm for choosing a treatment method for PAC (LE or LPI) has been developed. The first step is to measure and take into account 4 clinical and anatomical parameters of the patient: gender, IOP, axial length of the eye (AL), and anterior chamber depth (ACD). The second step is to calculate the predicted difference in hypotensive effect (Ind_Short) using the formula Ind_Short=B0+B1·Gender+B2·IOP+B3·AL+B4·ACD, where B0=16.8; B1=-0.28; B2=0.24; B3=-0.65; B4=-2.36; male gender is 0 (zero) and female gender is 1. The third step is to compare the obtained result with zero: LPI is the preferred method if Ind_Short is less than 0, otherwise LE.

CONCLUSION. The developed step-by-step algorithm involving the use of machine learning methods allows a personalized approach to the treatment of primary angle closure.

PURPOSE. To evaluate the diagnostic effectiveness of questionnaires in combination with tonometry at the first stage of screening for early detection of glaucoma.

METHODS. The study analyzed a group of 640 people who applied for intraocular pressure (IOP) measurement. All subjects filled out a questionnaire aimed at identifying risk factors for glaucoma, and had non-contact tonometry (Reichert 7 CR) measurement taken. Of these, 238 people had normal IOP level and no risk factors. The remaining 402 people (with elevated IOP and/or risk factors — 4 points or more on the questionnaire) underwent a comprehensive examination, including tonometry using various methods, Pulsar perimetry, optical coherence tomography of the posterior segment of the eye with analysis of the ganglion cell complex, ophthalmologist's examination.

RESULTS. At the stage of pre-medical tonometry, IOP of 21 mm Hg and below was recorded in 216 people (53.7%), 22–28 mm Hg — in 139 (34.5%), 29 mm Hg and above — in 47 (11.6%). During a comprehensive examination, IOP up to 21 mm Hg was detected in 151 people (37.5%), 22–28 mm Hg — in 214 (53.2%), 29 mm Hg and above — in 37 (9.2%). Of the 402 examined, glaucoma was diagnosed in 178 patients (44.1%), glaucoma/ocular hypertension was suspected in 139 (34.5%), and in 85 (21.1%) no glaucomaspecific data was found. At the same time, among 186 people with elevated IOP without risk factors, glaucoma was detected in 30.5% of cases, and glaucoma/ocular hypertension was suspected in 14.9% of cases. In total, of the 640 people who applied to the pre-medical tonometry measurement, glaucoma was detected in 178 (27.8%), and glaucoma/ocular hypertension was suspected in 139 (21.7%). Early glaucoma was detected in 94 cases (52.8%), moderate glaucoma in 63 (35.5%), and advanced glaucoma in 21 (11.7%). No cases of advanced glaucoma were detected among those selected for a comprehensive examination based on the results of the questionnaire.

CONCLUSION. The use of questionnaires in addition to pre-medical tonometry increased the detection rate of glaucoma from 30.5% to 44.4%, and the group of patients with suspected glaucoma/ocular hypertension increased from 14.9% to 34.3%.

PURPOSE. To evaluate the hypotensive efficacy of a single instillation of brimonidine 0.15% Purit or a fixed combination of brimonidine 0.2% and timolol 0.5% (FCBT) in various forms of glaucoma and ocular hypertension (OH).

METHODS. Brimonidine 0.15% or FCBT was instilled in 285 eyes with uncompensated glaucoma and OH. Brimonidine 0.15% was instilled in patients with OH, early and moderate glaucoma, initially moderately elevated IOP (b), newly diagnosed pathology without previous therapy. FCBT was instilled in patients with initially high IOP (c), advanced and terminal stages, who were on therapy. The hypotensive effect was evaluated after 20 minutes. The mean age of the patients was 64.94±0.952 years. Women were predominant in the study group — 62.5%, men comprised 37.5%.

RESULTS. The maximum efficacy was observed in the age group of 60–79 years and over 80 — 27.30±1.1% and 32.46±0.9%. The greatest hypotensive effect was observed in angle-closure glaucoma — 31.69±3.5%. In newly diagnosed glaucoma, intraocular pressure (IOP) decreased by 24.95±1.14%; when added to previous mono- and combination therapy, the decrease was 27.48±2.0% and 25.88±2.7% (p=0.64). In the early and moderate stages, the decrease was 23.68±1.6%, 26.8±2.3%, respectively. The maximum effect (30.64±2.25%) was observed in the advanced stage. At more than 30 mm Hg, the decrease was more than 30%. The hypotensive effect of FCBT was twice that of brimonidine — 22.5±0.97% and 33.27±1.43%, respectively (p<0.001). With an initial IOP of more than 30 mm Hg and the use of brimonidine 0.15%, a decrease of 21.32±1.0% was achieved; with the use of FCBT — 35±1.55%.

CONCLUSION. We recommend using brimonidine 0.15% or FCBT for elevated IOP in all types of glaucoma and OH: brimonidine 0.15% when the initial IOP is less than 30 mm Hg, and FCBT — when it is more than 30 mm Hg. The use of both drugs is most effective in people over 60 years of age. Brimonidine 0.15% can be recommended as a starting therapy for early glaucoma and OH with an initial IOP of less than 30 mm Hg. In case of IOP more than 30 mm Hg, advanced or angleclosure glaucoma, or glaucoma uncompensated while on therapy, it is preferable to prescribe FCBT due to its greater hypotensive effect.

PURPOSE. To evaluate the efficacy of drainage surgery in primary juvenile open-angle glaucoma.

METHODS. The study included 16 patients with glaucoma, they were examined at the East Sight Recovery eye care center. The mean age was 40.2±13.5 years. All patients underwent a standard ophthalmological examination, including additional methods in dynamics. All patients underwent non-penetrating deep sclerectomy (NPDS) with Xenoplast drainage. In two cases, a combined procedure was performed: NPDS and phacoemulsification with intraocular lens implantation (Phaco+IOL). Within a year after surgery, all patients underwent YAG laser goniopuncture of the Descemet's membrane (Descemet's goniopuncture; DGP).

RESULTS. There were no complications in the postoperative period in any of the studied cases, target IOP level was achieved in the long-term postoperative period, and the number of hypotensive drugs used was reduced to 1–3.

CONCLUSIONS. NPDS with Xenoplast drainage in young patients with a diagnosis of primary juvenile open-angle glaucoma is highly effective and leads to stabilization of IOP and structural and functional parameters of the ONH in a long-term (3–5 years).

PURPOSE. To investigate the clinical and statistical characteristics of primary open-angle glaucoma (POAG) in patients with age-related cataract (ARC) in the Khabarovsk territory of the Russian Federation.

METHODS. The study examined a total of 231 patients (462 eyes), including 113 men and 118 women aged from 55 to 88 years (average 71 years) with ARC and POAG of different stages.

RESULTS. Stage II glaucoma was detected in the maximum number of eyes with ARC, while stages I and III were less common. In 31 eyes (6.7%), there was a terminal stage of POAG. Moreover, only 10 eyes had previously been operated on for glaucoma. The most widely used drugs in patients with stages I and II POAG are prostaglandin analogues, while in stages III and IV — various combinations of hypotensive drugs.

CONCLUSION. Among all studied eyes, 320 (69.2%) (except for stage IV) did not have target intraocular pressure indicators established by the Federal Clinical Recommendations. In regard to the used drug therapy, it should be noted that in 183 eyes (36.9%) two or more hypotensive drugs were prescribed.

PURPOSE. To compare the hypotensive effectiveness of Glauteks and HealaFlow drainage implants in non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).

METHODS. The study included 56 patients (56 eyes), of them 19 had moderate POAG and 37 had advanced POAG. The intraocular pressure (IOP) level was 27.8±3.6 mm Hg on the hypotensive regimen. Glauteks drainage impalnt was used in the first group (27 eyes), HealaFlow drainage implant — in the second group (29 eyes).

RESULTS. On the 1st day after surgery the IOP was 13.3±1.8 mm  Hg in the 1st group, and 13.6±1.7 mm  Hg in the 2nd group. After 3 months, the average IOP level was 15.6±1.4 mm Hg in the 1st group, and 15.9±1.6 mm Hg in the 2nd group. All patients underwent a planned Descemet's goniopuncture at 3 months. After one year, the IOP level in the 1st group amounted to 17.3±1.7 mm Hg (IOP normalization achieved in 96% of eyes), with 67% of the eyes not requiring hypotensive therapy. In the 2nd group — 18.0±1.8 mm  Hg (IOP normalization achieved in 93% of eyes), with 62% of the eyes not requiring hypotensive therapy. After two years, 25 patients of the 1st group had normalized IOP and was 18.2±1.5 mm  Hg, of them 30% did not use hypotensive therapy. In the 2nd group, 27 eyes had IOP of 18.3±1.7 mm Hg, of which 28% did not require hypotensive therapy. Over the 2 years of follow-up, reoperations were required in 11% of eyes in the 1st group and in 14% of eyes in the 2nd group.

CONCLUSION. The use of biodegradable Glautex and HealaFlow drainage devices in NPDS allowed achieving persistent normalization of IOP in the vast majority of patients with POAG — 89% and 86%, respectively — within 2 years of follow-up.

PURPOSE. To create a model of uveitis in conditions of experimental glaucoma and to study various immunological blood parameters.

METHODS. The experiment was conducted on 24 sexually mature Chinchilla rabbits, divided into 2 groups. In group I (16 eyes), steroid glaucoma was modeled. To create the model, the animals were instilled with 1 drop of 0.1% dexamethasone 2 times a day for 30 days. In group II, sensitization with normal horse serum (NHS) was performed in addition to experimental steroid glaucoma modeling (16 rabbits). To create a model of uveitis, a resolving dose of NHS was injected into the right eye of the animals of group II (16 eyes). The right eye (16 eyes) constituted subgroup 1, the left eye (16 eyes) — subgroup 2 (control). Blood was taken from the ear vein of all animals. Sample 1 consisted of specimens from animals in group I, samples 2 and 3 — specimens from animals in group II after sensitization and after uveitis development, respectively.

RESULTS. Clinical picture of uveitis was observed in the right eye 3 days after injecting the resolving intravitreal dose. The following changes were noted in samples 2 and 3, respectively: the leukocyte content increased by 95.9% (p<0.001) and 90.8% (p<0.001); the neutrophil content decreased by 22% (p=0.417) and increased by 105.8% (p<0.001), total hemolytic complement capacity decreased by 84.4% (p<0.001) and 84.3% (p<0.001), the number of circulating immune complexes decreased by 99.1% (p<0.001) and 96.9% (p<0.001), the number of T-lymphocytes increased by 120.5% (p<0.001) and 116.8% (p<0.001), and B-lymphocytes — by 93.0% (p<0.001) in both samples, IgE — by 5.3 times (p<0.001) and 6.5 times (p<0.001).

CONCLUSION. The obtained model of uveitis in conditions of experimental glaucoma will allow a more detailed study of the important links of the pathological process in the eye, and to extrapolate the obtained data to clinical practice in order to improve the effectiveness and safety of pathogenetically oriented treatment.

Primary open-angle glaucoma (POAG) is a multifactorial, progressive disease, which pathogenesis is not completely understood. This review analyzes studies that confirm the relationship between emotional state, mental characteristics, and the morphological-functional state of the central nervous system with the development and progression of POAG. The psychopathological disorders are shown to be inevitable in such chronic neurodegenerative diseases as Alzheimer's disease and glaucoma. The article presents data confirming that cognitive indicators correlate with the thickness of the retinal ganglion cell layer. Retinal ganglion cells can be considered a marker not only for glaucoma, but also for cerebral neurodegeneration, cognitive impairment, anxiety and depression levels. Optical coherence tomography of the retina can be used as a method for early detection of cognitive impairment and neurodegenerative processes in the brain. It is confirmed that patients with open-angle glaucoma need a comprehensive neurological and neuropsychological examination for early identification of cognitive disorders and timely prescription of psychotherapeutic treatment. The article also emphasizes the need for psychotherapeutic support due to the prevalence of depression, dementia, and sleep disturbances among glaucoma patients.

Currently, trabeculectomy in combination with antimetabolites remains the operation of choice in the treatment of both primary and secondary forms of glaucoma, despite the proven side effects and contradictory long-term hypotensive results. At the same time, methods and technologies of glaucoma surgeries are constantly developing, and with the advent of drainage devices (DD), the possibilities for achieving the necessary hypotensive effect and preserving visual functions have significantly improved, even in prognostically unfavorable clinical situations. Drainage devices are used to improve the outflow of intraocular fluid, reduce intraocular pressure and stabilize glaucomatous optic neuropathy. With the expansion of indications for DD implantation in clinical practice, it is important for specialists to know all the advantages and disadvantages of different types of drainage systems, possible complications and methods of their prevention. This review systematizes literature data on the types of DD, indications and nuances of implantation, postoperative IOP level and duration of hypotensive effect, comparative effectiveness, characteristic complications of early and late postoperative periods (hyperfiltration, hypotension, tube extrusion and exposure, trophic defects, cicatricial transformations of tissues around the drainage platform, endothelial dysfunction of the cornea), as well as methods of their prevention and treatment.

Primary open-angle glaucoma (POAG) is a chronic optic neuropathy characterized by the loss of ganglion cells and the development of specific changes in the optic nerve head (ONH). Identification of structural glaucomatous changes is necessary both to verify the diagnosis and to determine the effectiveness of antihypertensive therapy.

Currently there are several devices used in clinical practice that allow for an objective morphometric analysis: confocal laser scanning ophthalmoscopy (Heidelberg retinotomography, HRT), scanning laser polarimetry (SLP, GDx), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).

These devices have different examination principles and differ in their diagnostic possibilities for detecting structural changes and identifying the trends in glaucoma patients.

Studies in recent years have shown an increase in the prevalence of systemic diseases, some of which may be independent risk factors for the development and progression of glaucoma. Metabolic syndrome (MetS) is currently one of the leading public health problems in the world. Some studies indicate a relationship between MetS and its individual components (in particular, insulin resistance, hyperglycemia, impaired homeostasis, and systemic arterial hypertension) with an increase in intraocular pressure (IOP), ocular hypertension, and the development of primary open-angle glaucoma (POAG). However, no unambiguous conclusions about the role of MetS in the pathogenesis of glaucoma has been established due to the insufficient number of scientific studies on this topic, the differences in their methodology, and the contradictory results. Further research is needed to determine the role and place of MetS in the occurrence and development of POAG, and the prospects for the practical application of this knowledge.

This review presents literature data on the effect of MetS and its individual components on IOP, occurrence and development of glaucoma and several other ophthalmic diseases