PURPOSE: To determine the effect of the drug-induced stress-relief tests on the corneal biomechanical properties in patients with newly diagnosed glaucoma. METHODS: The study included 68 patients (119 eyes) with newly diagnosed glaucoma. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) were obtained using an ocular response analyzer (ORA) before and after the instillation of eye drops (Arutimol 0.5%, Cosopt, Azopt) for 49 eyes of 27 patients with normaltension glaucoma (NTG), 70 eyes of 41 patients with primary open-angle glaucoma (POAG). Tolerable intraocular pressure (tIOP) was determined on a Blood Flow Analyzer (Paradigm, USA). RESULTS: Drug-induced stress-relief tests with different drugs caused statistically significant changes in corneal biomechanical properties of the eye: after a significant decrease in IOPcc and IOPg corneal resistance factor (CRF) decreased and corneal hysteresis (CH) increased. CONCLUSION: When IOPg was used as a reference as opposed to IOPcc obtained on Ocular Response Analyzer, 34.7% eyes were be incorrectly qualified as normal-tension glaucoma (NTG). That proves the lower corneal resistance in NTG patients and can lead to underestimation of the true IOP level. Additional research of tIOP by Blood Flow Analyzer confirmed the NTG diagnosis in these patients.

PURPOSE: The study of UBM capacity in drainage structures control after surgical treatment of neovascular glaucoma. METHODS: The study included 80 patients (80 eyes) with neovascular glaucoma. The mean age of the patients was 60.7±1.9. All patients were divided into two groups depending on the surgical technique: group I (main group) included 40 patients after a deep sclerectomy with xenocollagen drainage implantation (DSE with XDI), group II (control group) - 40 patients after standard deep sclerectomy (DSE). All study subjects underwent standard ophthalmological examination as well as ultrasound biomicroscopy (UBM) (“Paradigm Model P60™ UBM”, USA). The following parameters: filtration bleb - height, area, volume; scleral flap - thickness; intracleral cavity - height, area, volume and anterior chamber depth, anterior chamber angle were measured with the help of ultrasound biomicroscopy. RESULTS: Ultrasound biomicroscopic study helped identify the morphological components of each structure respon sible for postoperative drainage function of the eye after deep sclerectomy with implantation of xenocollagenic drainage in patients with neovascular glaucoma. UBM data research of the anterior segment of the eye in early and long-term follow-up revealed that the proposed modified method of deep sclerectomy with xenocollagen drainage implantation allows forming new constructed ways for intraocular fluid outflow from the anterior chamber in supraciliar, sub-Tenon’s space and subconjuctival spaces. This leads to unobstructed filtration of intraocular fluid and helps prevent scarring of the operation zone. CONCLUSION: Using the ultrasound biomicroscopy in patients with neovascular glaucoma allows monitoring the condition of the drainage system of the eye in the postoperative period in order to ensure the prevention of the postoperative hypertension.

The pathogenesis of glaucomatous optic neuropathy is still debated. Ocular blood flow (OBF) in glaucoma patients is generally reduced, particularly in patients with progression of damage in spite of a normal IOP. However, the question of whether this OBF reduction is only secondary to the damage or whether it is a primary causal factor has remained open for a long time. In this review, we try to explain why vascular dysregulation contributes to glaucomatous damage. In people with primary vascular dysregulation, the autoregulation of ocular perfusion is disturbed. Therefore, fluctuations in intraocular pressure (IOP) or blood pressure lead to an unstable oxygen supply. This in turn increases oxidative stress, particularly in the mitochondria of the optic nerve head (ONH). The simultaneous activation of the astrocytes leads to altered gene expression, which contributes to both tissue remodeling in the ONH and the death of retinal ganglion cells. The activated astrocytes produce more metalloproteinase degrading the extracellular matrix. This results in a remodeling of the extracellular matrix, which is basic component of ONH excavation.

PURPOSE: To study the von Willebrand factor (vWF) level and platelet aggregation in primary open-angle glaucoma (POAG). METHODS: Ophthalmic examination, color doppler imaging of ocular blood flow, plasma level of vWF, spontaneous and induced platelet aggregation were performed in 67 patients with high pressure glaucoma (HPG), 41 patient with normal tension glaucoma (NTG) and 38 control subjects. The statistical analysis included standard methods of variation statistics. The threshold P value for statistical significance was 0.05. RESULTS: The mean level of vWF was increased in HPG (113.25±24.31%, р=0.009) and NTG (106.85±21.02%, р=0.012) in comparison with control group (93.86±17.13%), platelet aggregation was increased in all glaucoma patients (while in the control group adrenalin-induced aggregation was 49.71±15.96% and ristocetin-induced aggregation was 53.56±8.80%, in HPG it was 63.34±20.42%, р=0.043, and 79.45±28.63%, р=0.01; in NTG 62.3±11.53%, р=0.047, and 68.98±12.42%, р=0.022, correspondingly). Patients with endothelial dysfunction (with increased level of vWF) had reduced diastolic and mean velocity of blood flow in central retinal artery, posterior short and long ciliary arteries in comparison with patients without endothelial dysfunction in HPG and NTG. CONCLUSION: The obtained results indicate the importance of endothelial dysfunction and platelet hemostasis in POAG pathogenesis.

PURPOSE: To assess the efficacy and safety of Duoprost in the treatment of patients with primary open-angle glaucoma (POAG) in an open prospective clinical trial. METHODS: The study included 60 patients (78 eyes) aged from 43 to 89 years (mean age 74 years) predominantly with mild and moderate stages of POAG. Patients were divided into three groups depending on the course of disease and prestudy therapy. Group I included 20 patients (28 eyes) with newly revealed POAG; group II consisted of 20 patients (26 eyes) with insufficient IOP compensation on monotherapy with one of the following: β-adrenergic blockers, carbonic anhydrase inhibitors, prostaglandins; group III included 20 patients (24 eyes) with normalized ocular tonus treated with a combination of β-adrenergic blockers with prostaglandins. Study parameters registration was started a month after the switch from the previous therapy to Duoprost which was instilled in one or two eyes once a day for 6 months. Variables dynamics were assessed at baseline examination and in 1, 3 and 6 months after the start of Duoprost hypotensive therapy. Patient examination included a standard ophthalmic assessment as well as static perimetry performed on Humphrey Visual Field Analyzer II (HFA II) 750i (Germany) and confocal laser scanning ophthalmoscopy (HRT III). Blood pressure, heart and respiratory rate were registered in dynamic. RESULTS: All patients demonstrated high drug tolerance throughout the whole follow-up period. No changes in cardiovascular and bronchopulmonary systems were observed. Patients of groups I and II demonstrated a decrease in IOP to 9.1 mm Hg (32.8%) and 7.8 mm Hg (30.8%) correspondently when treated with Duoprost, р<0.05. The IOP compensation was accompanied by a statistically insignificant improvement of perimetritic and morphometric parameters. No positive dynamic in IOP or any morpho-functional variables was revealed in patients of group III. CONCLUSION: Duoprost is a well-tolerated, safe pharmaceutical agent with a sufficient and quite prolonged hypotensive properties and a positive impact on the ocular nerve and the retina, enhancing their morpho-functional condition. It does not act as systemic agent and is comfortable for patients.

PURPOSE: To assess therapeutic efficacy and tolerability profile of Alphagan P 0.15% either as a monotherapeutic replacement of previously used hypotensive agents or for medical therapy enhancement in treating patients with primary open-angle glaucoma (POAG) in an open-lable randomized controlled clinical trial. METHODS: The study included 123 patients (146 eyes) with verified POAG diagnosis. All patients were divided into three groups: group 1 included 34 patients (38 eyes) with newly diagnosed glaucoma; group 2 consisted of 41 patient (48 eyes) with compensated IOP, who previously received local hypotensive monodrugs from other pharmacological groups; group 3 included 48 patients (60 eyes), who had Alphagan P added to intensify the hypotensive effect of current instillation regimen. All patients underwent standard ophthalmological examination, including visometry, static computer perimetry, biomicoscopy, ophthalmoscopy, gonioscopy and pachymetry. Corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated IOP value (IOPg), corneal hysteresis value (CH) and corneal resistance factor (CRF) were determined by means of dynamic bi-directional corneal applanation. The follow-up period lasted 6 months. RESULTS: The study demonstrated a pronounced hypotensive effect of Alphagan P in treatment of POAG patients as a monotherapy, when switching to it from previously administered eyedrops and in intensifying current instillation regimen. Therapeutic efficacy amounted to 71.0%, 66.6% and 51.3% in groups 1, 2 and 3 correspondingly. The number of local adverse effects (9.8%). Keeping in mind that α-adrenergic agonists tend to affect blood pressure (BP) and heart rate, one should be cautious of administering them simultaneously with cardiac glycosides. CONCLUSION: Alphagan P showed its efficacy both as mono- and combined therapy in treating patients with primary open-angle glaucoma, not only decreasing IOP, but also helping maintain visual functions throughout the follow-up period.

PURPOSE: To compare the efficacy of glaucoma surgery with placement of a metallic glaucoma drainage device into the anterior chamber angle with that of standard trabeculectomy for the treatment of refractory glaucoma. METHODS: 108 patients (109 eyes) diagnosed with refractory glaucoma were included into the study. All patients were divided into 2 groups: 55 patients (56 eyes) underwent glaucoma surgery with placement of a metallic glaucoma drainage device into the anterior chamber angle, while 53 control group patients (53 eyes) underwent standard trabeculectomy. Mean intraocular pressure (IOP) at baseline was 34±5.8 mm Hg and 30.3±4.1 mm Hg in the main and in the control group respectively. Pain was felt by 44.6% (25/56) of the main group and by 26.4% (14/53) of the control group patients. Assessment criteria in both groups were as follows: IOP levels, the need for additional hypotensive medication and repeated surgery, relief from pain, and early and late post-operative complications. Follow-up period lasted 3 years. RESULTS: In the main group, absolute success after surgery was achieved in 71.4% of cases (40/56), qualified success - in 21.4% of cases (12/56), failure - in 7.2% (4/56) of cases. The respective outcomes in the control group were 28.3% (15/53), 49.1% (26/53) and 22.6% (12/53). Both groups showed a statistically significant decrease in IOP compared to the pre-surgery levels: by 45.3% and 41.6% in the main and the control group respectively (р=0.01). Hypotensive effect persisted significantly longer in the main group than in the control group (р=0.03). Use of mean number of hypotensive medications decreased from 2.9±0.3 to 1.3±0.4 in the main group and from 2.9±0.3 to 1.7±0.5 in the control group (p=0.02). The need for repeated glaucoma surgery was statistically significantly higher (p=0.02) in the control group (22.6% of cases; 12/53) than in the main group (7.2%; 4/56). Relief from pain was achieved in 92% of the main groups cases (23/25) and in 64.3% of those in the control group (9/14); the difference was statistically significant (p=0.04). The number of intraoperative, early and late post-surgery complications was significantly higher in the control than in the main group (р=0.01). CONCLUSION: Glaucoma surgery with placement of a metallic glaucoma drainage device provides the greatest and the most stable IOP reduction, relief from pain and a low rate of post-operative complications.

PURPOSE: Evaluate the influence of concomitant glaucoma on the ultra-thin Descemet’s stripping automated endothelial keratoplasty (UTDSAEK) outcome. METHODS: 64 patients (67 eyes) with bullous keratopathy underwent UTDSAEK. The average age of the patients was 71.7±5.4 years. The average preoperative visual acuity equaled 0.04±0.04. 19 patients (19 eyes) had a history of glaucoma (stages II-III). 45 patients (48 eyes) didn’t have glaucoma. Bullous keratopathy was detected in 47 of the studied eyes, Fuchs dystrophy - in 20. Prior to the operation mean intraocular pressure (Р₀) in eyes with glaucoma was 13±2.3 mmHg, in eyes without glaucoma - 14±3.1 mmHg. Intraocular pressure before and after the operation was measured by Tonopen-XL tonometer. RESULTS: In 1 year after endothelial keratoplasty mean IOP for patients with concomitant glaucoma was higher than before surgery and equaled 16±2.8 mmHg (p<0.05). Patients who didn’t have a history of glaucoma didn’t manifest any essential difference IOP before and after the operation with mean IOP of 15±2.1 mmHg. Patients with concomitant glaucoma had greater percentage of postoperative corneal endothelial cells loss after 1, 2 and 3 years compared to patients without a history of glaucoma (48 vs 40%, 55 vs 49%, 63 vs 55% respectively). In 3 years after keratoplasty graft failure reached 42% for eyes with concomitant glaucoma and 8% for eyes without glaucoma history. CONCLUSION: The probability of elevated intraocular pressure in the long-term period after endothelial keratoplasty is higher for patients with bullous keratopathy and concomitant glaucoma. Concomitant glaucoma can affect the results of UTDSAEK, increasing the risk of graft failure because of higher rate of endothelial cells loss.

Cyclodialysis was proposed in 1905 by Leopold Heine and actively criticized by his contemporaries, but later received a worldwide recognition in the field of open-angle and aphakic glaucoma surgery. A number of modifications has been proposed, including the combination with other hypotensive surgeries as well as the implantation of various drainage systems, fabrics and materials into the cyclodialys cleft. The effect of this surgical procedure can be attributed to the increase in uveoscleral outflow and the reduction of intraocular fluid production. Currently, cyclodialysis gave way to laser trabeculoplasty and trabeculectomy. However, cyclodialysis modifications are still used in surgical treatment of refractory glaucoma in combination with other surgeries, including cataract extraction.

For many years people have studied the structure of the eye. This article is devoted to the changes in the structure of the cornea in patients with primary open-angle glaucoma. With the advent of modern technology, which allows the in vivo study of individual structures of the eye, significant changes in the endothelium of the cornea were found in patients with primary glaucoma. In recent years, more attention was being paid to the interrelation of the pathogenesis of glaucoma with the biomechanics of the eye. Therefore, the review gave consideration to such aspects as biomechanical, biochemical features of the structure of the cornea in normal and pathological changes related to primary glaucoma. The cornea is a highly sensitive tunic of the eye. In various pathological conditions of the eye its sensitivity can be greatly reduced or completely disappear, so its definition can be very informative. This article provides information about the condition and the sensitivity changes of the cornea in patients with primary open-angle glaucoma. A decrease in tear production leading to the development of the dry eye syndrome was noted to be a side effect of all hypotensive drops which contain preservative agents. A literature review regarding this question is also provided. This article also presents data about the morphological changes of the cornea related to primary glaucoma according to confocal microscopy.

Choroidal effusion - a complication that accompanies decompression eye surgery and inflammatory eye disease. The development of this phenomenon is due to the peculiarities of anatomy and physiology of choroid and sclera. An important role in the etiology of choroidal effusion also plays a violation of eye pressure gradients, causing the circulation of intraocular fluid. The survey provides the classification of pathological conditions leading to the development of choroidal effusion, and its clinical manifestations. Authors describe the features of differential diagnosis of choroidal detachment, hemorrhage and retinal detachment. The survey list preventive measures, as well as the principles of medical and surgical treatment.

This part of the article discusses present mainline therapy for glaucoma, lowering the eye pressure: daily eye drops, laser treatment to the angle, or various forms of surgery. Though each method works, they all have their own advantages and downsides. Choice of the starting treatment largely depends on the form of glaucoma and should be a mutual decision of both the doctor and the patient. Eyedrops are the most widespread beginning treatment and can be enough for many patients. Their strong points are that they usually don’t do permanent damage to the eye, they work as indicated the majority of the time and, in case of necessity are easily switched to something else, mostly without any ill effects. The two weak points are: side effects and adherence problems. Side effects vary from temporary to lasting and serious, that can force about 10% of patients to stop regular instillations. The second problem with taking drops is adherence: patients forgetting to take them or not taking them as prescribed. As for laser angle treatment, its good points are that it is nearly impossible to hurt vision or the eye when done properly, and, having laser treatment doesn’t prevent a person from later using other treatments to lower eye pressure if the laser doesn’t work. It’s painless, takes only eyedrop anesthesia, takes about 15 minutes to do, and vision is nearly normal immediately. It’s biggest problem is that laser angle treatment often isn’t powerful enough. It works best for those with uncomplicated or primary glaucoma, and probably shouldn’t be tried in those with secondary glaucoma. The main upside of glaucoma surgery is a reasonable success at lowering pressure. As for the risks of surgery, they can be grouped into the bothersome, such as a gritty sensation and the dangerous, such as overly low pressure potentially aggravating vision, infections and risk of cataract development. Further details are given on hypotensive drop instillations. According to the studies conducted over the last years, patients instill from 20% to 75% of the prescribed medicine. Possible reasons for the adherence problems are numbered. The importance of having an iron-clad reminder system is emphasized, for example, wrist watch alarms going off every day or every 12 hours, relatives reminding to take drops, making instillation schedules, linking the instillations to something in daily routine and keeping the medicine in plain sight. The article dwells on the doctor-patient collaboration when taking the drops, gives tips for the doctors that could help increase the adherence and finally the 13 ways the patient can get glaucoma eye drops into the eye, while being effective at lowering eye pressure and saving money are enumerated in details.