PURPOSE. To evaluate the morphological features of implantation of a new intrascleral implant (ISI) made of polymethyl methacrylate in an ex vivo experiment.

METHODS. The ex vivo experiment was conducted on scleral fragments obtained from the equatorial region of the eyes of cadaveric donors aged 40–60 years. The study group included eight scleral fragments in which the ISI was implanted during simulated glaucoma surgery (GS), while the control group consisted of eight scleral fragments subjected to GS without implantation. Organotypic cultivation was performed in a standard medium under normothermic conditions for 6 months. At 14, 30, 90, and 180 days, two fragments from each group were removed from the culture for scanning electron microscopy and immunohistochemical analysis.

RESULTS. Morphological findings demonstrated that the presence of the investigated ISI in cadaveric sclera did not induce an active proliferative cellular response throughout the entire observation period (up to 6 months).

CONCLUSION. The developed polymethyl methacrylate ISI shows promise for further clinical trials in glaucoma surgery.

PURPOSE. To study the total protein and α2-macroglobulin (α2-MG) levels in the lacrimal fluid (LF) of patients with primary open-angle glaucoma (POAG) depending on age, glaucoma stage, intra-ocular pressure (IOP) levels and after trabeculectomy.

METHODS. Analysis of the total protein (mg/ml) and α2-MG (nmol/min×ml) levels in LF was performed in 46 patients with POAG stages I–IV before and 7 days after sinus trabeculectomy.

RESULTS. The level of total protein in LF in patients with POAG before surgery was 2.23±0.13 mg/ml. A trend toward a decrease with age (r=0.32) and an increase with glaucoma progression (r=0.39) was observed: stage I — 1.80±0.14 mg/ml, stage II — 1.96±0.18 mg/ml, stage III — 2.81±0.23 mg/ml. After sinus trabeculectomy, IOP decreased from 23.5±6.1 to 14.6±4.2 mm Hg. The decrease in the total protein level was 0.05 mg/ml (from 2.23±0.13 to 2.18±0.24 mg/ml), with a correlation coefficient of 0.24. The preoperative α2-MG level was 0.46±0.07 nmol/min×ml, with no significant correlation with glaucoma stage (r=0.03) or IOP level (r=–0.26). A correlation with patient age was identified (r=0.64). Analysis of α2-MG levels in relation to IOP changes over time demonstrated an inverse correlation between IOP and α2-MG levels before and after surgery: a decrease in IOP was accompanied by a non-significant increase in α2-MG of 0.13 nmol/min×ml (from 0.46±0.07 to 0.60±0.12 nmol/min×ml), r=0.29.

CONCLUSION. The level of total protein in LF is an important parameter in POAG, correlating with patient age and glaucoma stage. No significant correlation of α2-MG level in LF with glaucoma stage or IOP was observed. Surgical IOP reduction was associated with a decrease in total protein level and an increase in α2-MG level, both demonstrating weak correlations.

Recurrence of sustained intraocular pressure (IOP) elevation occurs in 15% to 35% of cases after glaucoma surgery (GS). The choice of optimal management strategy and timing for repeat GS remains an important and insufficiently studied issue.

PURPOSE. To study the range of opinions and clinical approaches among ophthalmologists in Russia regarding repeat glaucoma surgery in patients with primary openangle glaucoma (POAG).

METHODS. This study consisted of a survey conducted among 606 ophthalmologists from various regions of Russia. Among them, 432 (71%) worked in outpatient clinics, 96 (16%) in hospitals, and 78 (13%) combined both settings. The study used descriptive statistics and comparison of proportions between groups with assessment of statistical significance (p-values).

RESULTS. The vast majority of respondents (77.2% of outpatient physicians and 81.7% of hospital physicians) regularly (weekly, monthly, or quarterly) encounter patients requiring repeat GS.

Significant differences in clinical approaches were identified: 46.9% of hospital surgeons were ready to refer patients for repeat surgery within 1.5 to 6 months, whereas only 33.1% of outpatient physicians supported this strategy (p=0.005). In cases of disease destabilization, 46.9% of hospital physicians favor the "prefer repeat surgery" approach, while outpatient physicians more often (42.1%) opted for "prefer prolonged medical therapy" (p=0.0005). While 98.95% of hospital doctors consider stabilization without therapy as a criterion for complete success of antiglaucoma surgery, 6.2% to 8.9% of physicians from other groups also regarded stabilization with hypotensive medications as a successful outcome.

CONCLUSION. The survey results revealed significant discrepancies between outpatient and hospital ophthalmologists in the management of patients with failed initial GS, particularly regarding the timing of repeat surgery and the choice between surgical and medical strategies. These findings highlight the absence of unified standards and underscore the need for the development of standardized clinical guidelines for managing this complex patient population to improve long-term functional outcomes.

PURPOSE. To evaluate the accuracy and repeatability of intraocular pressure (IOP) measurements using a transpalpebral tonometer compared to corneal-compensated intraocular pressure.

METHODS. The study included 50 healthy subjects and the same number of glaucoma patients. Transpalpebral measurements were performed using the Tonotest tonometer (AO Yelatomskiy priborniy zavod, Russia), cornealcompensated IOP was measured using the Ocular Response Analyzer (Reichert Inc., USA). Five consecutive transpalpebral measurements were obtained for each eye, followed by a repeat measurement after returning the device to its initial position.

RESULTS. The age of subjects in first group was (M±σ) 21.54±2.82 years; 21 men and 29 women. The age of the patients in the glaucoma group was 66.34±13.53 years; 17 men and 33 women.

When comparing transpalpebral measurements with corneal-compensated IOP using the Bland–Altman method, the mean measurement error (bias) was -0.36 mm Hg. The upper (ULOA) and lower (LLOA) limits of 95% agreement were +7.77 and –8.49 mm Hg, respectively. A significant (p<0.001) difference was also found between the measurement error in the group of healthy volunteers and patients with glaucoma. Comparison of the initial and repeated transpalpebral measurements demonstrated their good agreement. The mean bias was –0.64 mm Hg. ULOA and LLOA were +0.77 and –2.06 mm Hg, respectively.

Regression analysis of sequential transpalpebral measurements revealed a trend toward decreased results, with each subsequent measurement being, on average, 0.19 mm Hg lower than the previous one (confidence interval 0.02–0.38 mm Hg).

CONCLUSION. Transpalpebral tonometry is not a suitable replacement for corneal IOP measurement methods in the initial diagnosis of glaucoma due to substantial measurement error. However, despite these limitations, it is highly valuable for screening and follow-up due to its advantages, such as high repeatability, noninvasiveness, and technical simplicity.

PURPOSE. To identify clinical and epidemiological features of the course of primary open-angle glaucoma (POAG) in patients with a verified family history of the disease.

METHODS. This work is part of a multicenter study conducted across six clinical sites in different regions of the Russian Federation. The analysis included data from 134 individuals (134 eyes), of whom 51 (38%) were men and 83 (62%) were women. Group 1 (60 patients, 60 eyes) comprised individuals with sporadic glaucoma, while group 2 (56 patients, 56 eyes) included patients with hereditary glaucoma. The control group consisted of 18 healthy subjects (18 eyes). The mean age of all participants was 68.1 (62.6; 72.4) years. Standard and specialized glaucoma examinations were performed.

RESULTS. The mean age at POAG diagnosis in patients with sporadic glaucoma was 64.5 (59; 67.9) years, whereas in patients with a burdened family history it was 5.9 years younger, amounting to 58.6 (54.6; 61.5) years. Statistically significant differences between groups 1 and 2 were found in the mean thickness of the ganglion cell complex — 26 (24; 28) µm and 25 (22; 27.5) µm, respectively; lamina cribrosa depth — 450.5 (360; 585) µm and 512.5 (437; 631) µm; Bruch’s membrane to inner limiting membrane distance — 198.5 (163.5; 265.5) µm and 155.5 (110; 225.5) µm; and macular retinal thickness — 274.5 (261; 286) µm and 262 (246.5; 273) µm. Patients with a burdened family history were significantly less satisfied with their current condition (63.96 points) compared to the patients with sporadic POAG (83.51 points).

CONCLUSION. Preventive screening in individuals with a burdened family history should be initiated at an earlier age. Optical coherence tomography should be regarded as one of the most sensitive diagnostic tools, particularly at early disease stages. Patients with a hereditary burden should also be advised to seek psychological counseling to improve their psycho-emotional status.

PURPOSE. To study the incidence and characteristics of ciliochoroidal detachment (CCD) at different time points following minimally invasive glaucoma surgery in patients with primary open-angle glaucoma (POAG).

METHODS. Among 4 513 patients who underwent surgery for POAG between 2020 and 2024, 75 patients (75 eyes; 1.7%) with postoperative CCD were selected. The mean age was 73.5±8.8 years. Two groups were formed: group 1 (54 patients) with CCD developing within the first 3 days after glaucoma surgery, and group 2 (21 patients) with CCD developing later than 3 days postoperatively.

RESULTS. CCD developed more frequently within the first 3 days after glaucoma surgery (54 vs 21 eyes). Early CCD occurred more often in men (38 vs 16), whereas no sex differences were observed in late CCD. No significant differences between groups were found in mean age, ocular morphometric parameters, POAG stages, structure of somatic pathology, glaucoma duration, baseline and postoperative intraocular pressure, or the number and classes of medications used. Late CCD occurred more frequently after cyclophotocoagulation (19% vs 1.9%, p=0.031). Early CCD showed no characteristic features regarding the prevalence of subchoroidal fluid, whereas late CCD was typically limited to 1–2 quadrants (81%).

CONCLUSION. The identified differences in the development of CCD depending on the time period after glaucoma surgery have clinical relevance for its timely diagnosis and treatment.

PURPOSE. To evaluate the clinical effectiveness of combined mechanical trabecular peeling and phacoemulsification (PE) in patients with primary open-angle glaucoma (POAG) and complicated cataract.

METHODS. The study included 72 patients (72 eyes) with POAG and complicated cataract (46 women, 26 men). Early stage POAG was present in 52 (72.2%) eyes, and moderate stage POAG in 20 (27.7%) eyes.

Patients were divided into two groups. In the main group (37 patients, 37 eyes), subjects underwent mechanical trabecular peeling combined with phacoemulsification and intraocular lens (IOL) implantation. The control group (35 patients, 35 eyes) underwent isolated phacoemulsification with IOL implantation.

Baseline intraocular pressure (IOP) measured by Maklakov tonometry was 23 [19; 24] mm Hg in the main group and 23 [21.0; 25.0] mm Hg in the control group (p=0.553). The number of hypotensive medications used preoperatively was 2 [0; 4] in the main group and 2 [0; 3] in the control group (p=0.135). The follow-up period was 12 months.

RESULTS. At 12 months, IOP in the main group was 18.0 [18.0; 20.0] mm Hg with complete discontinuation of hypotensive therapy. In the control group, IOP was 20.0 [19.5; 22.5] mm Hg, with additional hypotensive therapy required in 9% of cases. The reduction in IOP from baseline was 15.37% in the main group and 11.46% in the control group (p=0.031). A significant difference between groups was observed in the ease of outflow coefficient (p=0.007).

CONCLUSION. The developed combined technique of phacoemulsification with mechanical trabecular peeling results in a 15.37% reduction in IOP from baseline at 12 months postoperatively, exceeding the hypotensive effect of isolated PE. The method is associated with a minimal risk of complications and may be recommended for the treatment of patients with early and moderate POAG and complicated cataract.

PURPOSE. To identify signs of choroidal detachment (CD) in the late postoperative period using optical coherence tomography (OCT).

METHODS. Patient L. was admitted with the diagnosis «advanced open-angle glaucoma with elevated intraocular pressure, complicated cataract, and epiretinal fibrosis OD. Anophthalmos on the left». Visual acuity in the right eye was 0.5 sc; IOP (P₀) was 30 mm Hg. The patient underwent sinus trabeculectomy with implantation of a Repergel A1 drainage device and prophylactic posterior scleral trephination in the right eye. A hyphema occupying approximately onehalf of the anterior chamber volume was observed during the first postoperative week. Subsequently, hyphema washout was performed, followed by phacoemulsification with intraocular lens implantation.

RESULTS. Four months after surgery, the patient presented with decreased vision in the right eye (visual acuity 0.2 sph +1.5 = 0.3); P₀ 7 mm Hg. OCT of the retinal periphery revealed flat CD with a height of 390 µm, accompanied by folds of the retinal pigment epithelium and neuroepithelium at the base of the detachment. OCT of the macular region showed deformation of the macular interface, cystoid spaces, folding of the pigment epithelium and neuroepithelium, and localized neurosensory detachment. Three days later, posterior scleral trephination was performed. One week postoperatively, OCT of the retinal periphery demonstrated complete reattachment of the choroid. Persistent macular edema was an indication for intravitreal implantation of dexamethasone 0.7 mg implant. Two weeks after the treatment, visual acuity improved to 0.7 sc, and IOP increased to 16 mm Hg.

CONCLUSION. OCT enables identification of signs of flat CD and its complications. OCT of the retinal periphery visualizes a slit-like cavity of ciliochoroidal detachment with hyporeflective content, allows measurement of detachment height, and facilitates dynamic monitoring of choroidal effusion resorption and treatment outcomes. OCT of the macular region reveals secondary signs of hypotony-related CD, including folds of the retinal pigment epithelium and neuroepithelium, neurosensory detachment, and cystoid macular edema.

Primary open-angle glaucoma (POAG) is considered a latediagnosed disease due to its prolonged latent period preceding clinical manifestations. Existing diagnostic methods typically detect glaucomatous changes only after the loss of more than 40% of optic nerve fibers. This review discusses approaches to the early diagnosis of glaucoma at the preclinical stage. Particular emphasis is placed on the relevance of identifying biomarkers of neuroinflammation that lead to apoptosis of retinal ganglion cells. The article analyzes data on the activity of autoimmune inflammation markers, including neuron-specific enolase, S100 protein family, myelin basic protein, cytokines, and neurotrophins, as well as their potential application in the early diagnosis of glaucoma. The glial responses and biomarkers described in the review require further in-depth investigation and systematization of current knowledge. Studying the neurochemical processes that occur at the preclinical stage of glaucoma may enable the identification of specific biomarkers of disease onset and open prospects for rapid and convenient POAG screening.

Glaucomatous optic neuropathy (GON) in primary openangle glaucoma (POAG), including normal-tension glaucoma (NTG), is a multifactorial disease in which vascular mechanisms play a significant role. This article reviews current Russian and international literature on the vascular theory of GON. Impaired autoregulation of ocular blood flow, vasospasm, endothelial dysfunction with increased production of endothelin-1, reduced levels of nitric oxide and alterations in its metabolism may contribute to glaucomatous damage to the optic nerve even at normal intraocular pressure levels. The review examines the role of ocular perfusion pressure, hemorheological properties of blood, and systemic hemodynamics, including blood pressure variability, as potentially significant risk factors for the development and progression of GON. Several studies confirm reduced ocular blood flow and the presence of microvascular disturbances in patients with NTG independent of intraocular pressure. The paper also discusses changes in blood viscosity, aggregation of formed elements and their impact on microcirculation in ocular structures. The study concludes that there is a high likelihood of vascular involvement in the pathogenesis of GON, emphasizing the need for a comprehensive approach to the diagnosis and management of patients with POAG.

This review provides a comprehensive overview of the evolution of transscleral technologies employing physical factors in the treatment of glaucoma. The article addresses the effectiveness, safety, and future prospects of various transscleral approaches, including cyclodiathermy, cryodestruction, xenon coagulation of the ciliary body, ultrasound cyclocoagulation and cyclodestruction, pneumocyclodestruction, electrical pulse stimulation of the ciliary body, YAG laser cyclodestruction, diode laser cyclophotocoagulation of the pars plicata of the ciliary body, transscleral thermotherapy, endoscopic laser cyclophotocoagulation with transscleral access, transscleral selective laser trabeculoplasty, as well as transscleral laser technologies targeting the pars plana of the ciliary body (micropulse cyclophotocoagulation, laser activation of scleral hydraulic permeability).

Primary open-angle glaucoma in young adults is a relevant clinical and diagnostic challenge in modern ophthalmology due to its atypical course, high variability of intraocular pressure, and limited sensitivity of standard diagnostic methods at early stages. Despite the relatively low prevalence of glaucoma in this age group, early disease onset is associated with a prolonged course, a high risk of progression, and significant socioeconomic consequences.
This review analyzes current understanding of the epidemiology, pathogenesis, and clinical features of primary open-angle glaucoma in young adults (18–44 years), and considers the role of genetic factors, systemic connective tissue disorders, biomechanical vulnerability of the eye, myopic refraction, and vascular mechanisms in the development and progression of the glaucomatous process.
A comprehensive multidisciplinary approach, taking into account structural-biomechanical and systemic factors, is essential for early detection, risk stratification, and personalized management of young patients.