PURPOSE: To assess the possibility of applying the method of brain positron emission tomography in the study of neurocyte metabolism in glaucoma patients. METHODS: Patient D., born in 1935, with the diagnosis: OD - primary open-angle glaucoma II A; OS - primary open-angle glaucoma III A, underwent the following examination: visometry, refractometry, Maklakov tonometry, non-contact tonometry, biomicroscopy, gonioscopy, direct and indirect ophthalmoscopy, automated perimetry by means of "Tomey AP-2000" static perimeter, US. In addition to the ophthalmic examination, the patient underwent PET/CT scanning on the "Optima 560" tomography at the Ufa Nuclear Medicine Center. An hour before the scanning the patient received an intravenous injection of 18F-fluorodeoxyglucose (FDG) radiopharmaceutical. RESULTS: A reduction in the radiopharmaceutical accumulation in the orbital portion of the optic nerve, chiasm, lateral geniculate bodies, optic radiation and visual cortex was detected. The examination found that primary open-angle glaucoma was characterized by a specific nature of accumulation and distribution of FDG in the brain structures: uneven (heterogeneous) radiopharmaceutical accumulation and low glucose consumption in the pathological foci. CONCLUSION: Analyzing the data of the study, we found that neurodegenerative changes in the pathways of the visual analyzer were defined by glucose hypometabolism zones (mitochondrial dysfunction).

PURPOSE: Comparative analysis of the results of Mak-lakov tonometry (MT), Goldman applanation tonometry (GT) and Icare rebound tonometry (rt) in the following groups: «all patients», «low», «medium» and «high» IOP rate for the purpose of its proper interpretation, determination of unified correction coefficients and the points of application in the clinical practice. METHODS: In each of 294 cases (147 persons) IOP was measured by the above methods in the following order - RT, GT, MT. For a comparative analysis of measurement results and determination of correction factors Bland-Altman methods and simple regression analysis were applied. RESULTS: The difference in IOP level values in the «all patients» group: GT - MT was 4.6±1.9; GT - RT 1.9±2.9; MT - RT 6.7±2.7 mm Hg. In the groups of «average» and «low» standards IOP difference is comparable with the «all patients» group. The most significant difference was found in the range of «high» rate of IOP: GT - MT 5.6±2.1; GT - RT 2.49±3.5; MT - RT 8.0±3.6 mm Hg. The high value of the coefficient of determination (r²) MT and GT confirms the accuracy of data. The low value of r² when comparing the MT - RT and GT - RT indicates the approximate determination of IOP level by means of the Icare tonometer. CONCLUSION: Goldmann (P0) and Maklakov tonometry (Pt) are considered to be the tonometry benchmark. Alternative method of Icare rebound tonometry indicates the level of IOP, close to the level of true IOP, but has a large spread of deviations that cannot be attributed to the category of its precision. The significant dispersion in the measurement differences in range of «high» rate of IOP emphasizes the need to assess it in terms of «starting concepts», using only high-precision techniques. Icare tonometry is applicable for screening examinations (including pediatric), daily monitoring and self-control of IOP level, as well as in the general practice of «early» postoperative period, taking into account the use of identified correction factors.

PURPOSE: To compare the diagnostic value of regional blood flow indicators and choroidal thickness with other morphological and functional parameters in early glaucoma detection. METHODS: 30 normal eyes and 32 eyes with preperimetric glaucoma were analyzed in the present study. The thickness of the ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) and choroidal thickness (ChT) were measured using RTVue SD-OCT images. 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). As a measure of the parameter significance in early glaucoma detections, a value of the adjusted standardized statistic of the Wilcoxon-Mann-Whitney (z-value) and the area under the receiver operating characteristic (ROC) curve (AUC) were applied. RESULTS: The following parameters presented with the largest AUC score and highest z-values: the mean BFV in the vortex vein (AUC 1.0; z-value 5.35) and central retinal vein (0.85; 3.74), end diastolic BFV in the central retinal artery (0.73; 2.74) and temporal posterior ciliary arteries (0.71; 2.53), intraocular pressure (IOP) (0.74; -2.9), perimetric index Mean Deviation (MD) (0.72; 2.65), corneal hysteresis (CH) (0.69; 2.24), peripapillar ChT (0.69; -2.28), average GCC thickness (0.67; 2.05) and FLV (0.66; -1.86). CONCLUSIONS: The most informative clinical parameters in pre-perimetric glaucoma are blood flow indicators in vorticose veins, central retinal vein, central retinal artery and short posterior ciliary arteries, and the thickness of the peripapillary choroid, which indicates the role of hemoperfusion disorder in the progress of glaucoma and emphasizes the importance of ocular hemodynamic studies for early glaucoma detection.

PURPOSE: the study of the dynamics of primary and repeated disability due to glaucoma in the adult population of the Altai Territory for the 2004-2013 period. METHODS: We analyzed the data provided by the Central Bureau of Medical and Social Expertise of the Altai Territory over the 2004-2013 period. The analysis was conducted for three age groups of the adult population according to the criteria of the №7-social security form. RESULTS: Among the causes of primary and repeated disability in adults in the Altai region the class of eye and adnexa diseases held the 9-10th ranking places. Glaucoma consistently ranked first in the nosological structure of primary disability (PD) due to eye diseases. In case of repeated disability (RD) within the analyzed time span glaucoma moved from the third to the first place, thus increasing its share in causes of repeated disability due to diseases of the eye and adnexa by a factor of 2.1. The population of primarily disabled due to glaucoma was equally formed by male and female patients, from both urban and rural population, mostly presented by elderly patients with I and II disability groups. The III disability group prevailed among young and middle-aged patients. The contingent of repeatedly disabled due to glaucoma was formed mainly by the elderly patients of I and II disability groups, coming equally from the urban and rural population, with twice as many men as women. CONCLUSION: The specifics of primary and repeated disability due to the diseases of the eye and adnexa over a 10-year period were defined. Glaucoma ranked first in both groups. The intensive index of primary disability due to glaucoma increased from 0.7 per 10 000 of the adult population in 2004 to 1.1 in 2005 (by 57%) with a further decrease to 0.4 by 2013 (by 63.6%). The level of repeated disability due to glaucoma increased from 0.6 per 10,000 adult population in 2004 to 0.9 in 2012-2013 (by 50%).

PURPOSE: To evaluate effectiveness of Kumar's 2nd generation stainless steel spiral Schlemm's canal expander (SCE) in decreasing intraocular pressure (IOP) in patients with primary open-angle glaucoma (OAG) refractory to previous penetrating and non-penetrating glaucoma surgeries. METHODS: Nine consecutive patients (9 eyes) having failed filters (failed trabeculectomy - 6 cases, failed deep sclerectomy - 2 cases and failed selective laser trabeculoplasty - 1 case), who's IOP was insufficiently controlled, were operated upon. A 2.5-3.0 mm long stainless steel spiral 2nd generation SCE made from 0.04mm thick medical grade stainless steel wire, having outer diameter of 0.2 mm and inner lumen diameter of 0.12 mm was implanted into Schlemm's canal (SC) ab externo. Two patients (2 eyes) with coexisting cataract and glaucoma underwent a combined procedure. Patients were evaluated daily during hospital stay, after 1 week, and at 1, 3, 6 and 12 months after surgery. IOP was considered a primary outcome measure. Secondary outcome measures were as follows: the number of glaucoma medications pre- and postoperatively and complications. A paired t-test was used for IOP and medication analysis. Decrease in IOP >20% or IOP from 6 to 18 mmHg without medication was considered a complete success, with medication - partial success. Failure was declared if the patient had IOP < 6 mmHg or > 18 or reduction in IOP was <20% after 3 months and if patient needed a subsequent filtering surgery. Success rates were evaluated at each follow-up visit after 3 months after surgery. Statistical analysis was performed using MS office application - Excel 2007 at each follow-up visit taking into account the change in the number of patients. Results were considered significant with p<0.05. RESULTS: Mean (mean+standard deviation (SD)) preoperative IOP was 25.2+5.5 mmHg. At each follow-up a decrease in mean IOP was observed, resulting in 12.5+3.9 mmHg (p=.00003) at 6 months and 12.9+1.4 mmHg (p=.00009) at 12 months. This represents a reduction in IOP from baseline of 49.4+17.4 and 44.2+9.8% at 6 and 12 months respectively. Mean number of used medications decreased from baseline 2.4+1.0 to 1.4+1.0 (p=0.05) and 1.0+1.0 (p=0.03) at 6 and 12 months respectively. Complete and partial success were observed in 2 and 6 cases (n=9) at 3 months, in 2 and 7 cases (n=9) at 6 months and 2 and 3 cases (n=5) at 12 months. There was only 1 case at 3 months, who fulfilled the failure criteria. There were no failure cases at 6 and 12 months. Intraoperative microperforation of trabecular meshwork (TM) in areas other than exposed part of SC occurred in 1 case. In 7 cases the device could be inserted completely into SC lumen. In 2 cases the caudal end (0.5 mm) of the device was left in the exposed part of SC. In the early post-operative period a bleb was noticed in 3 cases at 1 week and in 1 case at 1 and 3 months each. Complications like device dislocation, inflammation at the implantation site, devices' erosion through TM, loss of device were nil. YAG laser trabeculopucture was not required in any of the cases. CONCLUSION: Kumar's 2nd generation SCE is effective in decreasing IOP in patients with primary OAG refractory to previous penetrating and non-penetrating glaucoma surgeries. Use of medications is significantly reduced after implantation of this device.

PURPOSE: Study of the state of the corneal structural components in primary open-angle glaucoma patients on travoprost with the preservative benzalkonium chloride who later switch to the instillation travoprost with preservative polyquad. METHODS: The study included 32 patients (48 eyes) aged 55 to 72 years with primary open-angle glaucoma stage I or II, receiving the drug travoprost containing belzalkonium chloride. This drug has been replaced by travoprost with polyquad, in the same mode of instillation. Along with the standard ophthalmologic examination, patients underwent laser scanning confocal imaging of the cornea. As a result of layer-by-layer confocal laser scanning, we received a series of scans of the cornea with the possibility of observation of each individual layer. Morphology and density of the epithelial and endothelial cells were evaluated, as well as the morphology of the corneal stroma. RESULTS: 8 of the 19 patients presented fewer complaints against foreign body sensation under the eyelids, visual discomfort and idiopathic eye redness after 3 months of instillation travoprost with polyquad, while 11 presented no such complaints at all. After 3 months of using travoprost with polyquad the total number of cells of the corneal epithelium increased from 4723+310 to 6231+415 cells/mm², in 9 cases corneal epithelial edema decreased, while in 39 of 48 eyes no signs of edema were revealed. The switch to travoprost with polyquad helped reduce the number of keratocytes with bright nuclei and visualized cytoplasmic processes in the surface layers. A statistically non-significant increase in the density of keratocytes in the anterior stroma was observed due to changes in antihypertensive therapy with an average of 634+133 to 987+208 cells/mm². After applying travoprost with polyquad endothelial cells were well visualized due to epithelium edema reduction and had a hexagonal shape. CONCLUSION: Obtained data showed histomorphological changes in the corneal tissue appearance, associated with long term medicinal therapy with prostaglandin analogue (travoprost with benzalkonium chloride), and the improvement in the state of epithelial front layers and corneal stroma in primary open angle glaucoma patients with a less toxic replacement preservative (travoprost with polyquad).

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 sclera and cornea form the fibrous tunic of the eye which resists external and internal actions and maintains the shape of the eyeball. The functioning of these tunics is associated with their structural and biomechanical properties. Age-related changes of these properties affect protective and supporting functions of the sclera and cornea thus being direct or indirect cause of many ocular disorders. Structural changes of the fibrous tunic of the eye primarily consist in the disorientation of collagen, elastin, and proteoglycan fibers which are the basis of corneal and scleral stroma. Fibrils are disoriented, the number of cross-link bridges increases. Structural changes of ocular connective tissue affect its functionality, i.e., viscoelastic properties of the cornea and sclera. According to the foreign authors, a common tendency of age-related changes of the fibrous tunic of the eye is its stiffening and decrease in viscoelastic properties.

Due to anatomical specifics associated with axial myopia, primary open-angle glaucoma diagnostics in myopic eyes may present difficulties. This review aims to analyze the results of glaucoma diagnostic methods in patients with axial myopia. We emphasized the specifics of functional and anatomical changes occurring separately in axial myopia, glaucoma, as well as in their combination. The results of tonometry, automated static perimetry, short-wavelength perimetry, measuring macular pigment optical density, optical coherence tomography data - thickness of the ganglion cell complex, retinal nerve fiber layer, the parameters of the optic nerve head and choroidal thickness. Analysis of published data shows that differential diagnosis of glaucoma in patients with axial myopia should be complex and requires a deep and extended examination of this group of patients. Developing standards for diagnosis and monitoring of glaucoma process in axial myopia would be advantageous, since the variety of data and various publications, as well as inconsistent representations of the typical signs of glaucoma in patients with myopia leads to difficulty of diagnosis, late diagnosis and reducing the effectiveness of monitoring of the glaucomatous process in this group of patients.

PURPOSE: To study the reaction of the soft tissues of the optic nerve head and peripapillary choroidal vessels to compression by the increased IOP. METHODS: The study was performed on 10 healthy volunteers (20 eyes) aged 30 to 62 years (mean age 48 + 10.4 years). An increase in the IOP level was caused the by an extraocular compression. OCT was performed on the Spectralis OCT retinotomograph (Heidelberg Engineering, Germany) before and during the compression. We investigated changes in Bruch's membrane opening diameter, cup width, cup depth and lamina cribrosa depth in response to increased IOP. Also we measured diameter of large peripapillary choroidal and retinal vessels. RESULTS: Changes in almost of all the parameters of ONH except the Bruch's membrane opening diameter and the lamina cribrosa depth manifested in response to an increase of the IOP to 36 mm. It was noted that the cup width increase was more pronounced than the increase in cup depth under the influence of elevated IOP. In cases with IOP elevation to 28 mmHg all parameters of the cup remained unchanged, except for the minimum thickness of the ONH (MRW) in the inferior-temporal and inferiornasal sectors. Acute increased IOP was accompanied by a decrease in diameter of the main vessel of ONH and choroidal vessels at the peripapillary region. CONCLUSION: Obtained results suggest that damage to the nerve fibers in glaucoma may occur not only within the lamina cribrosa, but also in the prelaminar part of the optic nerve head. We introduce a new concept of lateral compressive deformation of the prelaminar part of the optic nerve head under the influence of elevated IOP. This concept can explain some phenomena of the glaucomatous process, which are not completely clear within the traditional paradigm, such as the development of perimetric symptoms towards from the periphery to the center of visual fields with the progression of glaucoma, the appearance of hemorrhages on the edge of the optic nerve, atrophy not only of the neural tissue, but also of the glial and capillary tissues in the prelaminar part of the optic nerve in glaucoma. Further research in this direction can supplement and clarify our understanding of the pathogenesis of glaucoma.