PURPOSE: Investigation of nondestructive influence of pulse-periodic laser emission (wave length 1.56 μm) on microstructure changes in human sclera (in vitro), it's hydropermeability in rabbit sclera (in vivo) and also hypotensive effect in treatment of resistant form of primary open-angled glaucoma in preliminary clinical trials. METHODS: We used two types of ophthalmological laser devises: 1) diode laser ophthalmocoagulator «LAHTA-МILON» (St-Petersburg, Russia) with wave length 1.56 mμ, 2) diode laser ophthalmocoagulator OcuLight SLx («Iridex», USA) with wave length 0.83 mμ. Morphological investigation was carried out in 16 rabbit eyes by means of semifine section method and atom force microscopy (NаnoScope Veeco Instruments, cantilever Nanosensors ATEC-NC-50, USA). Clinical trials included 76 patients (76 eyes) aged 27-91 years (32 males and 44 females), who were divided into two groups depending on the used technology - traditional or original. RESULTS: Our study revealed laser-induced restructuring of the sclera and formation of submicron pores in collagen tissue promoting local increase of hydropermeability. The first-time presented clinical results prove the proposed laser technology capable of producing a stable hypotensive effect for the 12-month follow-up period. CONCLUSION: The new technology based on the thermomechanical effect of laser radiation on the microporous structure of the human sclera has an advantage over the acclaimed technologies of laser cyclodestruction applied in the treatment of resistant forms open-angled glaucoma.

PURPOSE: To study volumetric measurements of ocular hemodynamics in patients with myopia and primary open-angle glaucoma with statistically normal IOP on hypotensive medication. METHODS: The study included 326 eyes (206 patients) with myopia and glaucoma with IOP < 21 mmHg. All patients were divided into two groups depending on their age and axial length (AL) of the eye. Group 1 consisted of 132 eyes on hypotensive treatment with IOP exceeding their individual norm. Apart from standard ophthalmological examination all patients underwent flowmetry by means of Ocular Blood Flow Analyzer to determine the volumetric measurements of their ocular hemodynamics. RESULTS: The study revealed the volumetric blood flow in eyes with myopia and non-progressive glaucoma to be equal to or insignificantly differ from the calculated norm if actual IOP is inferior to or equals the individual ocular pressure norm. A statistically significant decrease in the volumetric blood flow was detected in eyes with myopia and progressive glaucoma if actual IOP exceeded the individual ocular pressure norm. The blood supply deficiency was significantly more pronounced if AL exceeded 25 mm. CONCLUSION: Patients on with myopia and glaucoma have shown a build-up in blood supply deficiency if their actual IOP on hypotensive medication exceeded the individual ocular pressure norm, as opposed to the patients whose actual IOP was compensated in relation to the individual norm. At the same time, the excess rate of IOP over the individual norm was lower than the blood supply deficiency, which leads us to believe, that the blood supply deficiency depends on both: the excess of IOP and the individual specifics of the vascular system in eyes with combined pathology (myopia and glaucoma).

PURPOSE: To determine the most important diagnostic criteria to distinguish the preperimetric glaucoma from the perimetric stage using complex analysis of structural, functional and ocular blood flow parameters. METHODS: 90 eyes, including 30 eyes with preperimetric glaucoma, 30 eyes with perimetric glaucoma and 30 normal eyes, were analyzed. The average thickness of the GCC, retinal nerve fiber layer thickness (avg. RNFLT) and choroidal thickness were measured using RTVue spectral-domain optical coherence tomography (SD-OCT). Perimetry - using Humphrey test («Carl Zeiss Meditec», Dublin, CA). Ocular blood flow velocity was measured by the color Doppler mapping («VOLUSON 730 ProSystem»). Intraocular pressure (lOPcc) and corneal hysteresis (CH) were determined using «Ocular Response Analyzer» (ORA). Standardized statistics (Z-value) of Wilcoxon - MannWhitney rank sum test and the area (S-ROC) under the receiver operating characteristic curve for logistic regression model was used to determine the most important diagnostic criteria in glaucoma. RESULTS: The difference between perimetric and preperimetric glaucoma could be characterized by 5 important diagnostic criteria: avg. RNFLT (S-ROC 0.93; z-value 5.75), PSD (0.91; -5.52), peripapillar choroidal thickness (0.7; 2.69), the end diastolic blood flow velocity in the medial posterior ciliary arteries (0.7; 2.55) and corneal hysteresis (0.68; 2.41). CONCLUSIONS: Five clinical parameters have been determined as the most important to distinguish the preperimetric glaucoma from the perimetric stage: avg. RNFLT, PSD, peripapillar choroidal thickness, the end diastolic blood flow velocity in the medial posterior ciliary arteries and corneal hysteresis. This data should be considered in glaucoma monitoring.

PURPOSE: The study of epidemiological characteristics and condition of dispensary observation of patients with primary open-angle glaucoma in the Tyumen region with use of the Register of glaucoma patients. METHODS: In 2010 we assessed the dispensary observation of glaucoma patients over a period of 1999 and 2009. Out-patient medical records of 400 glaucoma patients of Tyumen region were studied retrospectively. The observation design included 5 visits, during which all patients underwent standard ophthalmological examination: visometry, tonometry with Maklakov tonometer, perimetry, ophthalmoscopy, gonioscopy. In the Regional ophthalmic dispensary an automated information system «Register of glaucoma patients of Tyumen region» was created (certificate No. 2011618588 registered 31.10.2011). RESULTS: In the course of glaucoma diagnostics stage I of glaucoma was detected in 76%, II - 13%, III - 8%, IV - 3%. Beta-blockers were used for glaucoma treatment in 79%. The surgical treatment of glaucoma was performed in 19.4%. «Register of glaucoma patients of Tyumen region» contains 7 646 records, 5 156 women (66%) and 2 513 men (33%). The Register includes patients in need of medical supervision in the Regional ophthalmologic dispensary: 1 624 patients with suspected glaucoma (21%), 360 monocular glaucoma patients (4.7%%), and patients with decompensated glaucoma, in need of rehabilitation actions (surgery, laser treatment, selection of hypotensive therapy) - 2 960 people (39%). CONCLUSION: The risk of vision loss from glaucoma is directly dependent on the duration of the disease. 7% of patients lose their vision (stage IV glaucoma) during the first 10 years. In most cases, beta-blockers are chosen for the local treatment of glaucoma. The use of the Register allows improving the quality of dispensary observation of glaucoma patients, as well as performing an analysis of the treatment methods and their effectiveness.

PURPOSE: To study association of some antioxidant defense genes polymorphisms with pseudoexfoliative glaucoma (PXG). METHODS: 224 patients with PXG and 152 healthy controls were genotyped through polymerase chain reaction and restriction fragment length techniques for 3 antioxidant system genes polymorphisms: P1I105V of the glutathione S-transferase P1 (GSTP1), T718C of the glutathione peroxidase (GPX4) and Pro187Ser of the quinone oxidoreductase type 1 (NQO1). RESULTS: Presence of mutant allele Val105 of GSTP1 was associated with increased risk of PXG (OR=1.76, 95%CI 1.272.42). Val105Val genotype in PXG patients was determined four times more often than in control subjects (p<0.001) and was associated with increased risk of PXG (OR=1.57, 95%CI 1.03-2.37). CC genotype of GPX4 was associated with increased risk of «early» onset PXG (x²=4.65, р=0.03; OR=1.88, 95% CI 1.06-3.36). Val105Val genotype of GSTP1 presented a risk factor for both, «early» (x2=5.88, р=0.02; OR=3.53, 95% CI 1.21-10.35) and «late» (x2=15.46, р<0.0001; OR=5.69, 95% CI 2.29-14.15) onset of the disease. Genotype Ile105Ile of GSTP1 was determined as an anti-risk factor for «late» onset group of PXG (x2=5.00, р=0.03; OR=1.68, 95% CI 1.06-2.64). CONCLUSION: The corellation of polymorphisms of some antioxidant genes with PXG has been studied for the first time in Central Russian population. Polymorphic variants of GSTP1 и GPX4 were determined as genetic markers of PXG. The study results confirm the important role of the genes of antioxidant system in determining susceptibility to PXG, and may help in «risk» group formation.

PURPOSE: To evaluate safety and effectiveness of Schlemm's canal expander (SCE) in management of open-angle glaucoma (OAG) in cataract patients. METHODS: A total of 9 cases (9 eyes) having visually significant cataract and insufficiently controlled by their current ocular hypotensive medication(s) glaucoma were operated upon. There were 5 cases of pseudoexfoliation syndrome, rigid pupils and weakening of Zinn's ligaments resulting in instability of native lens and requiring implantation of a capsule tension ring (CTR) into the capsular bag to stabilize it. A one-stage combined surgery - phacoemulsification with in-the-bag implantation of a foldable acrylic hydrophilic intraocular lens (IOL) and implantation of SCE in Schlemm's canal (SC) was performed in all cases. A 4-5 mm long SCE made from 0.05mm thick medical grade vanadium stainless steel wire was implanted into the SC lumen by ab externo approach. Primary outcome measure was intraocular pressure (IOP) change, secondary - number of glaucoma medications pre- and postoperatively and complications. A paired t-test was used for IOP and medication analysis. 25% decrease in IOP or IOP of 18 mm Hg or less without medication was considered a complete success, with medication - partial success. The need for subsequent filtering surgery was qualified as failure. Success was evaluated on the basis of Kaplan-Meier cumulative probability at each follow-up visit. Results were considered statistically significant with p<0.05. Minimum postoperative follow-up was 18 months. RESULTS: Out of 9 operated cases a total of 7 cases (7 eyes) were included for analysis. 1 patient who died of natural causes 3 months after the surgery and another case with incomplete follow up were excluded from the study. Mean preoperative IOP was 26.1+4.6 mm Hg (range: 19.0-30.9; 95% CI 22.7-29.5) and mean number of preoperative medications was 2.1+0.4 (range: 2-3; 95% CI 1.9-2.4). At each follow-up a decrease in mean IOP was observed, resulting in 11.3+3.0 mmHg (range: 7.1-15.3; CI 9.1-13.5) at 18 months (p=0.0000015). This represents a reduction of 56.3+11.6% from the baseline IOP. A reduction in glaucoma medications use was observed at each follow up visit and was 0.9+1.2 (range: 0-3; 95% CI 0.0-1.8) at 18 months (p=0.016). Complete and partial success was observed in 4 and 3 cases at the 18-month point, respectively. Microperforation of the trabecular meshwork (TM) in areas other than the exposed part of SC occurred in 1 case. In 5 cases the device could be pushed into SC completely. In 2 cases one end (0.5 to 1.0 mm in length) of the device was left in the exposed part of SC. No specific complications related to the device were noted. A filtration bleb was noticed in 5 cases on day one, 2 cases at 1 week and 1 case at 1 month. At 3 months and afterwards no filtration bleb was noticed in any of the cases. In 1 case laser capsulotomy for secondary cataract was performed to restore vision. Goniosco-pically the device was in the lumen of the SC in all cases except the case with intra-operative microperforation, where one end of the device was lying in the anterior chamber (AC) without any contact with intraocular structures. CONCLUSION: Eighteen months results of the SCE implantation in surgical management of OAG in cataract patients show significant reduction in IOP from the baseline and in hypotensive medication(s) use.

PURPOSE: The analysis of the results of deep sclerectomy with xenocollagen drainage implantation in patients with neovascular glaucoma during dynamic observation process. METHODS: The study included 80 patients (80 eyes) with neovascular glaucoma. 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. All patients underwent a standard eye examination including visometry, perimetry, tonometry, tonography, biomicroscopy, gonioscopy, ophthalmoscopy, A-, B- scan («А/В 3D-OTI Scan 2000», Canada), ultrasound biomicroscopy («Paradigm Model P60™ UBM», USA). RESULTS: There was a significant difference in the persistence of post-operative hypotensive effect in the two studied groups. IOP decompensation rate in the control group exceed that in the study group (15 vs 3%, respectively) in long-term follow-up. Statistically significant positive changes in the visual functions were noted in the main group within 1 month after surgery, which remained stable during the 12 months of the observation period. The scarring of the filtration area was the main cause of glaucoma relapse in patients of the control group. CONCLUSION: According to the observation data, there was a statistically significant improvement in clinical and functional indicators in patients of the main group, which remained stable during late postoperative period, as compared to the control group. Using the modified operation technique with xenocollagen drainage implantation in the treatment of neovascular glaucoma promotes the stabilization of the clinical and functional results.

The article analyzes the experience of cellular technology application in the treatment of retinal degenerative diseases. Experimental studies proved the ability of stem cells for self-renewal, migration, integration and subsequent differentiation into most types of retinal nerve cells, including photoreceptors. The article describes the experience of application and complications arising from the application of the following types of stem cells: retinal pigment epithelium cells, neural stem cells, mesenchymal stem cells, bone marrow cells, cord blood stem cells, induced pluripotent stem cells. Main mechanisms of cells action are discussed, namely replacement therapy and paracrine effect. The article marks the role of stem cells in the induction of angiogenesis, suppressing the local inflammatory response and apoptosis. In conclusion, the author describes the use of hematopoietic stem cells of human umbilical cord blood for restoring visual impairment in patients with normotensive glaucoma.

Glaucoma is a chronic optic neuropathy, characterized by ganglion cell loss and specific changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL). Early glaucoma detection plays an important role in preventing permanent structural damage development and irreversible vision loss. Glaucoma diagnostics is based on examination of structural damage to the optic nerve and visual functions evaluation. The results of ONH and RNFL clinical evaluation are subjective and can vary to a great extent. As a result, much recent research has been devoted to developing additional objective diagnostic methods, such as the use of confocal scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography for evaluating the OHN status. In order to provide early detection of visual field defects some researchers consider the possibility of replacing standard automated perimetry (SAP) with the selective automated perimetry, that includes the short-wavelength automated perimetry (SWAP) and frequency-doubling technology perimetry (FDt). This article presents a review of modern methods available for glaucoma diagnostics with emphasis on their clinical use.

The operating principle of most tonometers is based on producing a physical impact on the cornea and measuring the response, which depends not only on the intraocular fluid pressure, but also the properties of the fibrous tunic of the eye. Over the last few decades refractive surgery has gained a discernible progress. Keratorefractive surgery induces expressed to various extents alterations in corneal structure, thickness and curvature radius of the anterior and posterior corneal surfaces. The most substantial of such changes are often associated with radial keratotomy - a widespread operation in the 1980-90s. It was performed on eyes with refractive abnormalities that were already associated with certain deviations in the fibrous tunic structure, while myopia itself is considered to be a risk factor for the development of glaucoma. In the present day most patients who underwent radial keratotomy have reached mature or elderly age, when the risk of glaucoma development is increased. Patients who undergo modern keratorefractive surgery nowadays might face the same problems in the future. Intraocular pressure (IOP) in glaucoma is equally a risk factor, the sole treatment target and an essential monitoring element. This determines the actuality of a detailed evaluation of how keratorefractive surgery influences the ocular tonometry measurements. The perspectives of increasing the informative value of IOP measurement after keratorefractive surgery pertain to the appliance of modern tonometry methods: non-applanation tonometry (dynamic contour and rebound tonometry) and the methods that take into account biomechanical specifics of the fibrous tunic (bidirectional applanation tonometry with the definition of the corneal-compensated IOP). Non-applanation methods should be preferred after the radial keratotomy.

Being diagnosed with glaucoma tends to permanently change one's daily activities, but it is important for every patient to realize that glaucoma can be managed and generally kept from changing his life. The first part of the article explains what everyday personal habits - such as aerobic exercise - might be useful for glaucoma patients, which of them to avoid (Valsalva maneuver, weight lifting etc.) and which have no effect on glaucoma whatsoever (diet, alcohol consumption, caffeine intake, reading and watching TV). The second part of the article focuses on the importance of low vision rehabilitation services and understanding what treatments, practical aids, technology and training it has to offer. One of the two main options of the low vision rehabilitation is using special equipment to improve visual function, choice and variety of which is vast (lenses, special filters, cell phone technology, magnifiers with LED lights, video magnification, software, etc). Alternative approach is using adaptive strategies and techniques and “low-tech" solutions. The author also reminds that psychological counseling and treatment may be in question in some cases, since glaucoma patients with substantial vision loss are prone to depression. The difference in life with glaucoma is often one's ability to adapt, and incorporating devices and adaptive strategies in to daily life might help with that.