PURPOSE. To explore the potential for predicting the hypotensive effectiveness of glaucoma surgeries based on the parameters of the filtering bleb (FB) measured using optical coherence tomography (OCT).

METHODS. The study included 15 patients (15 eyes) with uncontrolled primary open-angle glaucoma, who underwent standard glaucoma surgery: sinus trabeculectomy with basal iridectomy. Objective assessment of the FB was performed using OCT on postoperative day 2, and then at 7 days, 1 month, and 3 months after surgery. Based on the OCT scans, a three-dimensional model of the FB was constructed, and its volume was calculated.

RESULTS. In 3 patients, by the end of the observation period, the FB volume was less than 5.7 mm³, which was associated with an unsuccessful surgical outcome and an increase in intraocular pressure (IOP) to 22.1±3.2 mm Hg. These patients were prescribed hypotensive therapy to achieve target IOP levels. In the other 12 patients, the IOP remained below 14 mm Hg throughout the observation period, with an average IOP of 11.7±2.3 mm Hg. The FB in these patients was diffuse, and its volume exceeded 5.7 mm³. The successful outcome of the surgery allowed for these patients to avoid the need for additional hypotensive therapy.

CONCLUSION. Long-term success of glaucoma surgery can be predicted using the threshold filtering bleb volume of 5.7 mm³.

PURPOSE. To compare the changes in morphometric parameters of the optic nerve head (ONH) following intravitreal injections (IVI) of aflibercept in patients with natural and artificial lenses.

METHODS. The study included 60 patients, divided into two groups: the control group, consisting of 30 patients with natural lenses, and the main group, consisting of 30 patients with intraocular lenses. All patients underwent three aflibercept IVIs at 4-week intervals, followed by a treat-and-extend regimen for one year. Intraocular pressure (IOP) was measured with the iCare Pro tonometer before IVI, and 1 minute and 60 minutes after IVI. All patients underwent optical coherence tomography (OCT) of the ONH, using radial (star-shaped) scans. Horizontal slices of the ONH were analyzed.

RESULTS. By the end of the observation period, both groups had received a comparable number of IVIs. The average IOP increase 1 minute after IVI exceeded 15 mm Hg compared to baseline in both groups. In the control group, one year after treatment, an increase in optic disc cup width was observed, with the median increasing by 15 μm (p<0.001). The median cup depth increased by 8 μm (p<0.001). In the main group, cup width also increased, with a median increase of 6 μm (p<0.001), and cup depth increased by 4 μm (p<0.001). These changes were statistically more pronounced in the control group compared to the main group. In both groups, the Bruch’s membrane opening diameter and the distance to the anterior surface of the lamina cribrosa did not significantly change throughout the observation period.

CONCLUSION. A series of acute IOP elevations due to repeated IVIs over the course of a year is associated with an increase in the width and depth of optic disc cup, which is more pronounced in patients with natural lenses.

PURPOSE. To study the ability of ophthalmologists to provide patients with glaucoma with comprehensive information regarding the nature of the disease, its progression, prognosis, monitoring, treatment, and prevention in real clinical practice.

METHODS. The study was conducted by surveying 377 ophthalmologists across 53 regions of the Russian Federation. The majority (79.6%) of respondents worked in outpatient clinics, 13% combined inpatient and outpatient care, and 7.4% worked exclusively in hospitals. Most respondents (96.6%) were practicing clinicians, 2.9% had combined roles, and 0.5% were academic faculty.

RESULTS. A total of 91.2% of respondents reported being able to assess a glaucoma patient’s knowledge of their disease during a consultation. Additionally, 65.8% of ophthalmologists stated that they were able to provide detailed information on the goals and methods of medical therapy to patients and their families during consultations. Furthermore, 39.8% recommended that patients keep a self-monitoring diary when feasible. A similar percentage of respondents (40.3% and 40.6%) believed that treatment plans should be discussed either with the patient alone or with both the patient and their spouse. The most preferred educational tool among ophthalmologists was a brochure containing recommendations. Moreover, 87.5% believed that treatment prognosis was the most interesting topic for patients, 75.1% considered the patient's education level to be the most important factor influencing their attitude towards treatment, and 76.4% felt that establishing regular follow-up intervals facilitated more effective therapy. According to the ophthalmologists, 75.5% of patients understood that glaucoma treatment is lifelong. The ophthalmologists estimated that, on average, 49.8% of patients visited their doctor at least once every three months.

CONCLUSION. The majority of ophthalmologists support the idea of providing glaucoma patients with information about their disease, its treatment, and lifestyle modifications beyond regular consultations. They are also willing to participate directly in educational activities. A new model of interaction between physicians and the patient community is emerging, which aims to engage more glaucoma patients in educational and motivational programs.

PURPOSE. To evaluate the effectiveness of micropulse laser cyclophotocoagulation (mCPC) in patients with secondary glaucoma associated with post-burn and terminal dystrophic corneal leukomas.

METHODS. Twelve patients (12 eyes) with corneal leukomas and secondary glaucoma underwent mCPC. The mean age of the patients was 44±6.5 years, including 8 men and 4 women. All patients exhibited elevated intraocular pressure (IOP), ranging from Tpalp "+" to Tpalp "++," despite being on maximum combination hypotensive therapy. Visual acuity for all patients was 1/∞ light perception with correct projection (proectia lucis certa).

RESULTS. On the first postoperative day, IOP was reduced to Tpalp "+" in 4 patients and to Tpalp "N" in 8 patients. Hypotensive therapy was continued based on individual indications throughout the observation period. By day 7, IOP had decreased to Tpalp "N" in all patients and remained stable throughout the follow-up period. Visual acuity in all cases remained unchanged from the preoperative level. Ultrasound biomicroscopy (UBM) revealed that the mean ciliary body thickness (CBT) before surgery was 0.56±0.11 mm. On the first postoperative day, CBT increased by an average of 20.1% due to pronounced edema caused by hydration from the inflammatory response, with a gradual return to baseline by the 1-month follow-up. At 6 months, no statistically significant difference in CBT from the preoperative thickness was observed, with a mean CBT of 0.50±0.12 mm.

CONCLUSIONS. Micropulse cyclophotocoagulation can be an effective treatment for secondary glaucoma in patients with post-burn and terminal dystrophic corneal leukomas. This technique reduces the risk of intraoperative and postoperative complications due to its non-invasive nature and low surgical trauma. The procedure can be repeated if IOP increases, and gentle laser parameters can help preserve visual potential.

PURPOSE. To evaluate the potential of corneal topography analysis in assessment of the precorneal tear film stability.

METHODS. The study included two groups of randomly selected participants: patients receiving topical hypotensive therapy, and patients with newly diagnosed primary open-angle glaucoma (POAG) who had underwent selective laser trabeculoplasty (SLT). All study participants underwent measurement of tear break-up time (TBUT) and meibomian gland dysfunction. The CSO Sirius+ topographer with software designed for diagnosing dry eye syndrome was used.

RESULTS. Patients who had been on topical therapy for various durations (ranging from 3 months to 10 years) demonstrated significant evidence of reduced TBUT, indicating the presence of dry eye syndrome. In contrast, patients who underwent SLT without receiving medication had TBUT values within normal limits.

CONCLUSION. Preliminary results of this comparative study on the use of corneal topography used for diagnosing dry eye syndrome in evaluation of tear film stability demonstrated the informative value and advantages of this method compared to conventional techniques (Schirmer’s test, Norn’s test).

PURPOSE. To examine the professional preferences of surgeons that influence the selection of drainage devices in glaucoma surgery.

METHODS. The working hypothesis suggested that the choice of drainage for glaucoma surgery may be influenced by subjective criteria, i.e., the "professional preferences" of ophthalmic surgeons. The study involved a descriptive cross-sectional retrospective survey of 21 ophthalmic surgeons from 8 different clinics who practice drainage surgery for glaucoma. They were asked to subjectively choose the optimal method from the commonly used drainage implants in Russia. Respondents answered standardized open-ended questions. Some questions focused on surgeons' attitudes toward different drainage implants used in Russia (resorbable, partially resorbable, and non-resorbable types).

RESULTS. The resorbable drainage Glautex TDA (by HiBiTech LLC) was selected as the drainage of choice by 6 (28.5%) surgeons. The partially resorbable MP drainage (by OOO Makmedi) and the resorbable drainage Xenoplast (by OOO Transkontakt) were chosen by 3 (14%) surgeons each. Ahmed valve was preferred by 4 (19%), Ex-PRESS shunt by 2 (9.5%), and autologous implants by 2 (9.5%): autologous sclera by 1 (4.8%) and anterior lens capsule by 1 (4.8%).

CONCLUSION. The most commonly chosen drainage device was Glautex, but 71.5% of the surgeons had other preferences. The working hypothesis was confirmed. The survey results should be considered personal preferences, not a medical consensus on the problem of glaucoma surgery. A comparative, objective analysis of the advantages of one drainage over another based on this simple survey is not possible, as the method does not provide reliable primary results. The surveyed surgeons currently do not have a consensus on the optimal drainage device for glaucoma surgery. Their practices differ significantly, and they did not report reliable data on long-term surgical outcomes. The perspectives and preferences expressed could only be obtained through an anonymized survey.

Choriocapillaris dropout within the beta zone of peripapillary choroidal atrophy is a significant marker in glaucoma diagnosis. This marker is associated with retinal nerve fiber layer thinning, retinal ganglion cell loss, and visual field deterioration. This review highlights data showing a correlation between choriocapillaris blood flow and the progression of glaucomatous optic neuropathy, suggesting that choriocapillaris dropout serves as a vital biomarker for glaucoma progression, and provides literature evidence on how choriocapillaris blood flow changes relate to glaucoma treatment.

According to established data, intraocular pressure (IOP) level is a substantiated risk factor for the development and progression of primary open-angle glaucoma. However, the progression of glaucoma despite achieving the 'controlled' IOP, as measured by traditional one- or two-time tonometry, has confirmed the possibility of other IOP characteristics that prevent the stabilization of the glaucomatous process.
The review summarizes commonly used and describes newly emerging techniques for IOP monitoring, and analyzes studies that refute and confirm the presence of correlations between IOP fluctuations and the progression of glaucomatous optic neuropathy. An assessment of traditional and prospective data on the qualitative and quantitative indicators of IOP allows the conclusion that its most informative characteristic is fluctuation. A concept is formed where the main goal is to dampen modulations in IOP levels and achieve consistently 'stable' values, in contrast to routine quantitative reduction in IOP. This, in turn, determines the nature of disease progression and allows for the optimization of primary open-angle glaucoma treatment regimens.