PURPOSE: To compare the level of scleral collagen crosslinking with structural functional parameters in patients with different stages of primary open-angle glaucoma (POAG). METHODS: 75 patients aged 50-91 with different stages of POAG were examined. All patients, planned for antiglaucomatous surgery (nonpenetrating deep sclerectomy) were divided into three age groups: 21 patients aged 50-59, 22 patients aged 60-69 and 32 patients aged 70 or older. 19 eyes had stage I of glaucoma, 24 eyes had stage II, 32 eyes had stage III. Subjective and objective structural functional eye parameters were evaluated before and after operation. In all cases scleral samples were taken during the surgery. To estimate the collagen cross-linking level, we used differential scanning calorimetry (Phoenix DSC 204, “Netzsch", Germany) and analyzed scleral thermograms. RESULTS: Patients with rigid sclera, i.e. with high temperature of denaturation (Tm) had lower values of the average integral index of photosensitivity level (MD) and total parameters of threshold sensitivity, but more expressed changes in value and degree of local defects (sLV). The highest correlation factor of Tm and morphometric parameters of the optic disk were observed with horizontal integral parameter and the neuroretinal rim. In the 50-59 years group, a significantly higher positive index of correlation (Tm) with functional structural state of the glaucomatous eye was detected with regard to the whole set of patients. The correlation between Tm and perimetry index, between Tm and neuroretinal rim value (r=0.85, p<0.015 and r=0.73, p<0.009 respectively) was received. In the 60-69 group, a significantly higher positive index of correlation Tm with IOP level before and after operation (r=0.55, p<0.05; r=0.58, p<0.05) and corneal hysteresis (r=-0.77, p<0.048) was observed. CONCLUSION: The development of glaucoma in relatively young age is characterized by higher correlation (in comparison with glaucoma in older patients) of denaturation temperature with functional structural state of glaucomatous eye, especially with the perimetry index and the neuroretinal rim value.

PURPOSE: Comparative analysis of the biomechanical parameters of the fibrous tunic of the eyeball and extracellular matrix (ECM) characteristics in patients with suspected POAG, early-stage POAG and healthy elderly people, as well as control groups of various ages. METHODS: The study included 60 people aged 21 to 74 years. The first group consisted of 16 healthy young adults (n=16; mean age 26.3±5 years; “young" control group), the second group included 17 healthy elderly subjects (n=17; 69.2±4 years “age" control group) with no signs of ophthalmological pathology. The third group consisted of 17 people with suspected POAG (n=17; mean age 68.2±6 years; with IOP above 21 mm Hg for three consecutive measurements (average central corneal thickness) and absence of visual field defects on the threshold perimetry test). The fourth group consisted of 10 patients with early-stage POAG (n=10; mean age 67.6±5 years; lesion of one or both eyes). Therapy was discontinued 2 weeks prior to the study. Ophthalmic examination included both the standard (visometry, tonometry, biomicroscopy, gonioscopy, automatic static perimetry) and additional methods (laser scanning tomography). Investigation of the fibrous tunic biomechanical parameters was conducted using the Ocular Response Analyzer (ORA) («Reichert», USA). All subjects underwent lab tests. The content of the regulation of extracellular matrix factors, MMP-9 and TIMP-4, in the serum and tear fluid was determined by enzyme linked immunosorbent assay (ELISA; diagnostic test systems Bender MedSystems® («eBiosciences», Austria; «R & D Diagnostics Inc.», US). We investigated 60 tear fluid samples and 60 serum samples. Statistical processing was made in the SPSS program 17.0 (SPSS, Inc., Chicago, IL). Two independent groups were compared with the use of nonparametric U-test Mann-Whitney test. Correlation analysis was performed using the Spearman test (r). Differences were considered statistically significant at p <0.05. RESULTS: The results showed that elderly age, suspected POAG, and the early-stage of POAG were associated with a set of changes in the cornea-scleral capsule and more or less expressed changes in the ECM regulation system both on local and systemic levels. Thus, the data obtained from the bi-directional applanation tonometry showed a reduction of viscoelastic properties of fibrous tunic associated with age and the development of the early-stage of POAG: the correlation between the age and corneal hysteresis (CH) (significant decrease with age), CH and changes in the early-stage of POAG (similar dynamics). In the study of MMP-9 and TIMP 4 content a significant increase in TIMP-4 level in tear fluid was detected in the 2-nd group compared to the 1-st (p=0.0001). This tendency to a progressive increase of tear fluid TIMP 4 was observed in patients with suspected of POAG and early-stage of POAG. Pair correlations analysis revealed a statistically significant strong inverse relationship between CH and TIMP-4 level in the tear fluid (r=-0,510; p=0,01). It was found that physiological aging was associated with a significant rise of TIMP-4 on local level (p=0.0001), whereas patients suspected of POAG had an increased MMP-9 production on systemic level. CH and CH/corneal resistance factor (CRF) decreased with age, and in initial POAG. We also revealed a significant correlation between the CH and TIMP-4 levels in tear fluid (r=-0,510; p=0,01), which suggests the presence of age associated cornea-scleral capsule restructuring resulting in an increase of its stiffness. Significant increase of the systemic level of MMP-9 may play a key role in the launch of pathological changes in the cornea-scleral capsule of the eye and be one of the major factors leading to the development of POAG.

PURPOSE: To identify changes in the parameters of the anterior segment of the eye and uveoscleral outflow indicators in patients with primary glaucoma during cataract phacoemulsification surgery. METHODS: The study included 153 patients (153 eyes) with cataract and primary open-angle glaucoma. All patients were divided into three groups: 51 patients (51 eyes) with cataract without glaucoma (first group), 51 patients (51 eyes) with cataract and the initial stage of primary open-angle glaucoma (second group), 51 patients (51 eyes) with cataract and advanced stages of primary open-angle glaucoma (third group). Before and after surgery patients underwent pneumotonometry, tonography with vacuum compression (unit Glau-Test60) and were examined by means of Pentacam anterior segment analyzer (Oculus). All patients underwent cataract phacoemulsification with implantation of a posterior chamber intraocular lens. The observation period duration was 6 months. RESULTS: Cataract phacoemulsification with intraocular lens implantation decreases IOP. More pronounced hypotensive effect can be noted in patients with an advanced stage glaucoma and patients not suffering from glaucoma. Topographic relations of the anterior segment structures undergo more changes after the operation in the eyes of patients with advanced-stage glaucoma. The post-surgical uveoscleral outflow increase in the presence of trabecular outflow block is more expressed in patients with initial stage of glaucoma and in patients without glaucoma. The share of uveoscleral pathway in the intraocular fluid outflow both before and after surgery is prevalent in patients with advanced-stage of glaucoma. CONCLUSION: The hypotensive effect of cataract phacoemulsification in patients with primary glaucoma is due to topographical changes in the structures of the anterior segment of the eye and possibly to increasing uveoscleral outflow of intraocular fluid.

PURPOSE: To explore the correlations between quality of life indicators, visual functions and intraocular pressure level in patients with primary open-angle glaucoma. METHODS: The material for this study was gathered in the course of a comprehensive examination and treatment of 213 people between 2010 and 2014. The main group consisted of 112 patients with primary open-angle glaucoma, 36 patients with suspected glaucoma and 35 patients with primary angle-closure glaucoma. The control group consisted of 30 healthy volunteers without ophthalmic pathology. The age of patients with glaucoma averaged 62.9±0.6 years, of healthy individuals - 62.2±1.1 years. All patients underwent a complete ophthalmic examination. To assess the quality of life of patients we used the NEI-VFQ-25 medical questionnaire. NEI-VFQ-25 questionnaire was designed for ophthalmology and consisted of 23 questions, divided into 11 scales. After signing an informed consent for participation in the study, patients filled the questionnaire forms themselves. Statistic analysis was performed using the Statistica 8.0 computer software (Statsoft, Inc., USA). The differences and correlations with p<0.05 were considered statistically significant. RESULTS: Total score of all the indicators featured in the NEI-VFQ-25 questionnaire in patients with glaucoma was significantly lower than in healthy individuals (723 and 943±5.2±4.5; p<0.001). It was found that in all types of primary glaucoma QOL was significantly lower than in healthy individuals, where the average score was 943±4.5 (p<0.001). The average score of quality of life (theoretically possible maximum - 1100) was as follows: primary open-angle glaucoma - 717±5.5, suspected glaucoma - 774±6.3, primary angle-closure glaucoma - 778±5.8. The calculation of the Spearman's rank correlation coefficient (rho) of average visual acuity and perimetry data with different NEI-VFQ-25 scales profiles in patients with POAG showed different levels of correlation between these indices, which ranged from r=0.25 to r=0.49. When calculating the total sum of scores for all scales of the questionnaire we revealed the dependence of QOL on the stage of the disease. When calculating coefficient rho between visual acuity and stages of POAG an inverse average correlation was established (r=-0.51, p<0.001), we also revealed the presence of a weak inverse correlation between the scales of «mental health» «peripheral vision» and POAG stage (r=-0.40 and r=-0.44, respectively; p<0.05). This shows deterioration of vision and subjective self-assessment of mental health depending on the stage of the disease. CONCLUSION: Deterioration of visual function due to primary open-angle glaucoma: decreased visual acuity, visual field loss adversely affect the condition of the quality of life of patients. A statistically significant correlation was established between the perimeter and visometric patient data and indicators of the NEI-VFQ-25 questionnaire scales in primary open-angle glaucoma (r=0.25-0.49), as well as an inverse average correlation (r=-0.51) between visual acuity and stages of POAG, and a weak inverse correlation between stages of primary open-angle glaucoma and the «mental Health» (r=-0.40) and «peripheral vision» (r=-0.44) scales.

PURPOSE: To develop the methods of treatment and prevention of secondary «dry eye» in patients with primary open-angle glaucoma. METHODS: The study involved 50 patients (100 eyes): 20 men, 30 women aged 46 to 85 years (mean age 65.5±9.6 years) with primary glaucoma. Glaucoma duration varied from 1.5 to 17 years. The patients administered the following hypotensive drops: Betoptik, Azopt, Arutimol, Xalatan, Travotan, Alfagan, Taflotan, Dorzopt as monotherapy or a combination of two or three of them. All patients underwent a clinical examination, Schirmer test, Norn test, vital staining with lissamine green and fluorescein, impression cytology, osmolarimetry (Tearlab Corp, USA) tearscopy, confocal microscopy («Confoscan-4», Nidek (Japan). The functional state of the meibomian glands and passability of its canaliculi were determined by the presence of lipids in the imprints of the palpebral intermarginal space on Millipore® filter after its OsO4-vapor staining (RF patent number 2.373.832). The digital image of the interference pattern of the lipid layer was analyzed by computer software «Lacrima». Follow-up period was 3 years. RESULTS: The signs of the «dry eye» syndrome were detected in 70.6% (76 eyes). Of these, 23.6% of patients (18 eyes) had meibomian gland dysfunction confirmed by Norn tests - 9.7±0.1. The most common complaint was the ocular pain sensation. The result of Schirmer test (20.7±0.8 mm) allows us to conclude the presence of hypersecretion as the initial manifestation of «dry eye». No increased tear osmolarity (average was 290.2±13.1 mOsm/l) was shown. The main changes pertained to the condition of the lipid layer of the tear film: an irregular thickness with normal thickness limited only to some small areas. Conjunctiva impression cytology showed a significant (from single to total absence of the field of view) reduction in the number of goblet cells and revealed pronounced degenerative changes in the epithelium. Confocal microscopy revealed a cytotoxic effect on the cornea (the front of desquamated epithelial corneal edema, stroke and intermittent crimp in subbasal neural plexus. When prescribing treatment for the «dry eye» associated with primary glaucoma, it is important to correct the defects of the lipid layer of the tear film using Systanebalance instillations. Adjuvant reparative agents may be presented by Korneregel, Sisteyn gel or Vit A Pos administered overnight. According to our data, these drugs should be used for a long time, depending on results of confocal microscopy of the cornea. For inflammatory process management we used the spectacle frame «Blephasteam» in combination with the drug Restasis. CONCLUSION: We have developed an algorithm of dry eye treatment in glaucoma patients, which allowed to optimize the state of the ocular surface and ensure the stability of the functional parameters for the entire period of observation.

PURPOSE: to study the causes of late diagnosis and clinical features of glaucoma in the North-eastern region of the Arabian Peninsula on the example of Kuwait country. METHODS: 620 patients with glaucoma, who sought medical help in Kuwait Oil Company Ahmadi Hospital, were included in the study. They underwent standard ophthalmic examination (subjective visometry with Snellen chart, computer perimetry, gonioscopy, refractometry, biomicroscopy, ophthalmoscopy, Goldmann tonometry) and filled out a specially designed questionnaire. The obtained data were statistically processed and analyzed. RESULTS: Among the reasons of late glaucoma diagnosisthat we selected the leading role belonged to the lack of symptoms, especially in the early stages of disease. By the degree of significance the risk factors of severe glaucoma were located as follows: age, climatic and geographic region of residence, type of glaucoma, the degree of urbanization. The level of intraocular pressure and detection of late (III, IV) stages of glaucoma were increased in the older age groups, which is consistent with the global statistics. A comparative analysis of intraocular pressure in flatland patients (95% CI 25.39±0.24 mm Hg) and coastal patients (95% CI 21.87±0.19 mm Hg) with the Student's T test showed with a high significance (p<0.001) a higher IOP in the flatland region as a whole and in specific subgroups by gender, degree of urbanization and type of glaucoma. The analysis of the dependence of glaucoma stages on the region of residence using Pearson's Chi-squared test revealed a significantly (р=0.005) more severe open angle glaucoma in the flatland region compared to the coastal. In the inhabitants of the flatland area, citizen's intraocular pressure was significantly higher than that of rural residents, while the inhabitants of the coastal area showed no significant difference in IOP in similar groups. Intraocular pressure for citizen residents in the flatland were (95% CI 25.66±0.37 mm Hg), while for rural residents at the same region - (95% CI 25.16±0.3 mm Hg). Student's T test showed significant (р=0.037) difference in these groups. CONCLUSION: Asymptomatic early stages of glaucoma are the leading cause of its late detection in Kuwait. Local climatic and geographic factors play a significant role in the epidemiology of glaucoma in the region. The data can be used to develop measures to prevent blindness from glaucoma in this country.

PURPOSE: We assessed visual outcome in patients with and without glaucoma, who underwent multifocal Lentis MPlus lens implantation. METHODS: 78 patients (100 eyes) aged over 50 years without concomitant glaucoma and 20 patients (24 eyes) with early stages of glaucoma were implanted with the «Lentis MPlus» IOL. Each subject underwent preoperative examination to determine near and distance visual acuity and best corrected visual acuity. Postoperative examination included measurement of best corrected and uncorrected near (33 cm) and distance visual acuity along with the intermediate visual acuity using the near chart (60 cm). Monitoring of patients was carried out for one year. RESULTS: Patients showed quite high distance and near vision acuity on the third day postoperatively. In 1 year uncorrected visual acuity of two thirds of the patients was 0.8-1.0. 25% of the patients required distance vision correction of -0.5 - -0.75 D with the near vision acuity of 0.9-1.0. Near vision acuity of all patients 1 year postoperatively was above 0.5. Vision 0.4 at an average distance was observed in 100% of patients, and 0.5 in 78% of patients. Postoperative results in patients with glaucoma were comparable to the control group. CONCLUSION: Multifocal «Lentis MPlus» lens implantation provides high distance visual acuity and convenient intermediate and near vision. Lens implantation in patients with cataract on the background of glaucoma allows to achieve high functional results.

The effect of the tonometer contact surface shape on the accuracy of measuring the true and tonometric pressures is analyzed. Possible modifications of the tonometry method, which can not only make the intraocular pressure measurement more accurate but also enable us to estimate parameters characterizing the elastic properties of the corneal and scleral eye segments, Ec and Es, are discussed. The tonometers with flat (Maklakov's method) and convex (convex-tonometry) contact surfaces are taken as examples. It is shown that the pressure measurement accuracy can be increased substantially with increase in the accuracy of the tonometer contact area radius measurement and if the individual Ec and Es values are attained from independent measurements. Possible measurement modification methods which make it possible to estimate together the individual values of the intraocular pressure and the parameters Ec and Es that separately characterize the elastic properties of the cornea and the scleral segment. The tonometry modification consists in measuring within each examination the intraocular pressure by the standard method using successively both tonometers considered, of two different weights each (four measurements). The complication of the measurement procedure is justified not only by the possibility to increase the intraocular pressure measurement accuracy but also by the possibility to simultaneously estimate the individual elastic characteristics of the cornea and the scleral segment, which may be important for diagnostics and therapeutic efficacy control.

This literature review presents an analysis of diagnostic methods for neurodegenerative changes in the visual analyzer pathways in patients with primary open-angle glaucoma. The majority of patients with long duration glaucoma even with normalized intraocular pressure present with progressive deterioration of visual functions. According to recent reports of glaucomatous damage is not limited to retinal ganglion cells, but extends over the entire visual pathway: retina, optic nerve, optic chiasm, optic tract, lateral geniculate nucleus, optic radiation and the cerebral cortex. The article presents the results of primary open-angle glaucoma patients' examination with standard magnetic resonance imaging, functional magnetic resonance imaging and diffusion tensor imaging. The results of morphological studies, which confirm the degenerative changes identified through noninvasive methods, are also presented. Recent years saw an increasing frequency of scientific work in which primary open-angle glaucoma was treated as a neurodegenerative disease, along with such diseases as Alzheimer's disease. This review recounts the facts that unite these diseases. A full understanding of retrobulbar glaucomatous damage may allow for more effective primary open-angle glaucoma diagnostics and contribute to the discovery of new therapeutic strategies for the protection of the optic nerve.

Over the last thirty years a few original antihypertensive drugs with different mechanisms of action have been developed and introduced in glaucoma practice. Today almost all of these drugs have several analogs. The problem of the generic drug interchangeability with the original is relevant to every practicing ophthalmologist. On one hand, the pharmaceutical and pharmacokinetic equivalence of the original and the generic drug is a requirement for the realization of the generic on the market, on the other hand - pharmaceutical trials are not conducted for the generic drugs is not generic clinical trials conducted so there is scientifically no proven data on their therapeutic efficiency and safety. Due to the development of pharmaceutical market of glaucoma drugs analogues and the absence of uniform requirements to their quality, safety and efficacy in Russia, the practitioner needs to have current data on their therapeutic equivalence. Our review analyzes the domestic publications of the past five years on the efficacy and safety of glaucoma drugs analogues. The results of the antihypertensive effectiveness of generics in monotherapy and in their combined use are also presented.

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.