PURPOSE. To study the tear levels of vascular endothelial growth factor (VEGF) in glaucoma and hypertensive disorders of pregnancy.

METHODS. The study included 44 participants: 7 pregnant women with an uncomplicated physiological pregnancy, 12 patients diagnosed with moderate (8 women) and severe (4 women) preeclampsia, 19 pregnant patients with stage I–II chronic arterial hypertension; the comparison group consisting of 6 patients with advanced primary open-angle glaucoma hospitalized for surgical treatment due to uncompensated intraocular pressure. After standard ophthalmologic and obstetric examinations, tear samples were collected using an original sampling technique for analysis.

RESULTS. Tear VEGF levels were significantly higher in the preeclampsia group, in pregnant women with chronic arterial hypertension, and in patients with glaucoma compared with those with physiological pregnancy. Moreover, the indicator was higher in preeclampsia than in arterial hypertension. No statistically significant differences were found when comparing the preeclampsia and glaucoma groups.

CONCLUSION. Tear VEGF levels are significantly elevated in preeclampsia and glaucoma. Tear VEGF level shows significant differences between physiological pregnancy and pregnancy complicated by chronic arterial hypertension. Investigation of tear VEGF levels appears promising for both ocular and systemic pathology.

Anterior segment mesenchymal dysgenesis comprises a broad group of phenotypically and genetically heterogeneous diseases that are frequently associated with the development of glaucoma in early childhood. One of the most common conditions within this group is Frank – Kamenetsky syndrome, which has an X-linked mode of inheritance and is characterized by distinctive abnormalities of the anterior segment of the eye, including features of goniodysgenesis. Identification of biological markers of the onset and manifestation of hydrodynamic disturbances remains an important challenge in ophthalmology.

PURPOSE. To identify phenotypic criteria for early-onset glaucoma in Frank – Kamenetsky syndrome.

METHODS. A comparative retrospective analysis of phenotypic features of Frank – Kamenetsky syndrome was performed in patients from two groups stratified according to the timing of glaucoma manifestation. Group 1 included 22 patients in whom elevated intraocular pressure (IOP) and the first signs of glaucoma were documented at the age of 5–10 years. Group 2 comprised 14 patients in whom persistent IOP elevation and signs of glaucomatous optic neuropathy were diagnosed after the age of 20 years.

RESULTS. Phenotypic criteria associated with early-onset glaucoma in patients with Frank – Kamenetsky syndrome included congenital non-progressive megalocornea (corneal diameter >12 mm), grade II–III goniodysgenesis, and iris stromal thickness <50 μm, indicating a combination of defects in the embryonic development of all mesenchymal tissue derivatives.

CONCLUSION. The abnormal phenotype of Frank – Kamenetsky syndrome can be readily distinguished from normal anatomy by the presence of specific and characteristic alterations of the iris and the anterior segment as a whole. At the same time, this disease demonstrates marked variability in the severity and range of clinical manifestations, as well as in the time of glaucoma onset. Differences in phenotypic expression of the abnormal genotype may lead to difficulties in interpreting the diagnosis and delayed identification of hydrodynamic disturbances and glaucomatous optic neuropathy.

PURPOSE. This study examined the relationship between Maklakov tonometry readings obtained using weights of different masses and biomechanically corrected intraocular pressure (IOP) values measured by pneumatic applanation tonometry in patients after various types of keratorefractive surgery (LASIK, FS-LASIK, and PRK).

METHODS. The study included 61 patients (121 eyes): a control group (n=31) and three postoperative groups – LASIK (n=26), FS-LASIK (n=32), and PRK (n=32). All patients underwent Maklakov tonometry using 5-, 10-, and 15-g weights. Using the Ocular Response Analyzer (ORA), corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal hysteresis (CH), corneal resistance factor (CRF), and the biomechanical stress coefficient (Kbs) were measured.

RESULTS. The strongest inverse correlations between Maklakov tonometry and IOPcc were observed in the PRK group (r=−0.80 and r=−0.91 for the 5- and 10-g weights, respectively), whereas in the LASIK group the maximum association was found with the 5-g weight (r=−0.85), weakening as the weight mass increased. In the FS-LASIK group, significant correlations were predominantly observed with the 10-g weight (r=−0.67). In the control group, the 10-g weight showed no correlation with any parameter, while the 5- and 15-g weights demonstrated moderate correlations with IOPcc, IOPg, CRF, and Kbs. Corneal hysteresis correlated significantly only with the 5-g weight in the PRK group (r=−0.491).

CONCLUSION. After LASIK and PRK, Maklakov tonometry using a 5-g weight compares the best with biomechanically corrected IOP values, whereas after FS-LASIK the 10-g weight appears to be preferable. These findings underscore the need for individualized selection of weight mass when performing Maklakov tonometry in patients with altered corneal biomechanics.

PURPOSE. To develop a method for individualized prediction of the rate of progression in moderate and advanced primary open-angle glaucoma (POAG).

METHODS. The study included patients with confirmed moderate and advanced POAG who had been under observation for at least 36 months. Prediction of the rate of visual function loss was performed using modern machine learning methods, specifically Ranked PLS-DA, which is highly resistant to multicollinearity and allows for the ordered nature of classes to be taken into account. Two sets of input data were considered: a complete set of 34 variables and an optimized set of 20 variables, including demographic, functional, structural, and vascular indicators. For model optimization and validation, a test dataset was artificially generated using Procrustes Cross-Validation (PCV) method. Model performance was evaluated using specific metrics: sensitivity, specificity, total efficiency (TEFF), and area under the ROC curve (AUC).

RESULTS. The optimized set of variables improved model sensitivity (0.93 vs 0.78) while maintaining high specificity (0.78). Total efficiency on the test dataset was 0.77 for the reduced set, with an AUC of 0.9. The model not only distinguished patients with fast, moderate, and slow progression rates but also identified «borderline» cases requiring closer monitoring. Analysis of individual variable contributions revealed key predictors influencing prognostic accuracy: age, retinal nerve fiber layer thickness and ganglion cell complex thickness, peripapillary vessel density, and parafoveal retinal thickness. These findings underscore the importance of a comprehensive approach to assessing the risk of irreversible changes in visual functions.

CONCLUSION. The developed Ranked PLS-DA model demonstrated high effectiveness in stratifying patients with moderate and advanced glaucoma according to progression rate. The model may serve as a reliable basis for individualized monitoring and therapy in routine clinical practice.

PURPOSE. To evaluate corneal endothelial status in patients with primary open-angle glaucoma and complicated cataract undergoing combined micropulse transscleral cyclophotocoagulation (MP-CPC) and cataract phacoemulsification with intraocular lens implantation (PE+IOL).

METHODS. This prospective study included 62 patients with stage I–II primary open-angle glaucoma and complicated cataract who underwent surgical treatment. The study group comprised 33 patients who received combined intervention (MP-CPC+PE+IOL), while the control group included 32 patients who only underwent PE+IOL. Corneal endothelial status was assessed using the Tomey EM-3000 specular microscope preoperatively and at 1, 3, 6, and 12 months after surgery.

RESULTS. In both groups, a moderate decrease in endothelial cell density was observed during the early postoperative period, with the most pronounced reduction at 1 month (up to 11.8%), followed by stabilization. At 12 months, the mean endothelial cell loss was less than 10%, with no statistically significant differences between the groups (p>0.05). Best-corrected visual acuity improved significantly compared with baseline. No progression of glaucomatous damage was detected by perimetry and optical coherence tomography. The incidence of postoperative intraocular pressure elevation was comparable between the groups.

CONCLUSION. The combined use of MP-CPC and PE+IOL demonstrates a satisfactory safety profile and does not exert a significant negative effect on corneal endothelial status compared with isolated phacoemulsification. The obtained results support the feasibility of the combined approach in patients with concomitant ophthalmic pathology.

PURPOSE. To evaluate biometric parameters before and after micropulse cyclophotocoagulation (MP-CPC) used as an anti-glaucoma intervention in order to assess its feasibility within a two-stage treatment strategy for glaucoma and cataract.

METHODS. Micropulse cyclophotocoagulation was performed in 46 patients (46 eyes) with moderate and advanced primary open-angle glaucoma, among them six patients had a history of previous penetrating or nonpenetrating anti-glaucoma surgery. Patients were divided into two groups according to glaucoma stage: group 1 included 20 patients (20 eyes) with moderate glaucoma, and group 2 included 26 patients (26 eyes) with advanced glaucoma. Biometric parameters – axial length (AL), anterior chamber depth (ACD), and keratometric values – were measured using a noncontact optical biometer (IOLMaster 500, Zeiss AG, Germany). Measurements were obtained preoperatively and at 2 and 4 weeks after MP-CPC to assess changes over time.

RESULTS. The hypotensive effect was achieved in all cases from the first day after MP-CPC and averaged 14.0±0.48 mm Hg in group 1 and 15.1±0.59 mm Hg in group 2. Axial length measurements obtained at 2 and 4 weeks after MP-CPC showed no significant changes. Mean AL values were 23.2±1.23 mm in group 1 and 23.6±1.31 mm in group 2 (p>0.05).No tendency toward shallowing or deepening of the anterior chamber was observed. In group 1, mean ACD values were 3.03±0.22 mm at both 2 and 4 weeks. In group 2, mean ACD values were 2.98±0.36 mm at both time points. The refractive power of the steep and flat corneal meridians, as well as the axis of the steep meridian, remained unchanged in all study groups (p>0.05).

CONCLUSION. MP-CPC provides a pronounced hypotensive effect while exerting minimal influence on ocular biometric parameters. The stability of biometric measurements eliminates the need for repeat biometry or revision of intraocular lens power calculations after MP-CPC, thereby improving the efficiency of surgical management in patients with concomitant glaucoma and cataract.

Patients with glaucoma exhibit elevated levels of prionflammatory cytokines and growth factors, as well as cellular infiltration of the ocular surface tissues, which is associated with long-term use of topical hypotensive medications, particularly those containing preservatives. An additional contributing factor is filtering surgery itself, which leads to an increase in proinflammatory cells and biologically active substances in the already altered conjunctiva. The resulting excessive and prolonged inflammatory response promotes the development of early subconjunctival fibrosis, causing obstruction of filtration pathways and subsequent elevation of intraocular pressure. Therefore, postoperative management after trabeculectomy requires careful control of inflammation. Despite low bioavailability and rapid elimination, which necessitate frequent and prolonged use in the postoperative period, topical anti-inflammatory agents remain the cornerstone for preventing these complications. These limitations highlight the need to search for more effective alternatives and to refine existing therapeutic strategies. This review presents current data on the pharmacokinetics, safety profile, and clinical use of triamcinolone acetonide in ophthalmology and analyzes its potential as a promising agent for improving long-term outcomes of filtering surgery due to its sustained anti-inflammatory action.

Normal-tension glaucoma is a progressive optic neuropathy characterized by thinning of the peripapillary retinal nerve fiber layer and the development of typical visual field defects, open anterior chamber angle, and intraocular pressure levels that do not exceed the statistically normal range. The course of this disease differs from that of hypertensive glaucoma by the presence of more localized and deeper defects of light sensitivity, as well as by a higher rate of progression.

The management of normal-tension glaucoma (medical, laser, or surgical) is aimed at reducing intraocular pressure and achieving target levels at which further loss of visual function can be halted. A distinctive feature of the therapeutic approach to this form of glaucoma is the need for lower target intraocular pressure values, which, in combination with the high rate of disease progression, necessitates a more rapid transition to surgical treatment. The challenge of normal-tension glaucoma lies in its diagnostic features, clinical manifestations, and treatment strategies, all of which require a differentiated and personalized approach.

This literature review analyzes current data on the morphological and functional differences between normaltension glaucoma and typical primary open-angle glaucoma, evaluates the effectiveness of various pharmacological classes of hypotensive medications, and examines modern trends in the surgical management of this disease.

Normal-tension glaucoma (NTG) is one of the most difficult forms of glaucoma to diagnose, as intraocular pressure remains within the normal range and diffuse retinal light sensitivity does not change until the advanced stages of the disease.

Timely diagnosis of NTG requires careful assessment of risk factors for disease development. One of the most significant risk factors is heredity. The majority of NTG cases have a complex genetic basis caused by the combined effects of multiple genes, although efforts to identify specific gene mutations characteristic of this form of glaucoma are ongoing.

Vascular pathology represents a major risk factor for NTG development. Peripheral vasospasm, cerebral atherosclerosis, alterations in blood rheological properties, endothelial dysfunction, systemic hypertension or hypotension contribute to the progression of glaucomatous optic neuropathy. Nocturnal arterial hypotension is a particularly important factor in NTG pathogenesis. NTG is frequently associated with Flammer syndrome, Raynaud syndrome, and migraine. Significant changes in NTG are detected in the superficial vascular plexus of the macular region of the retina, which may indicate a key role of the vascular factor in the development of this disease. NTG is a multifactorial, genetically determined disorder, and careful assessment of risk factors for its development and progression is required for timely diagnosis.