INTRODUCTION. Correction of myopia and myopic astigmatism with LASIK, FS-LASIK, and photorefractive keratectomy (PRK) affects the biomechanical properties of the cornea, leading to distorted applanation tonometry readings. Filatov–Kalfa elastotonometry and bidirectional pneumatic applanation using the Ocular Response Analyzer (ORA) assess different components of the biomechanical response, and correlations between these methods after corneal refractive surgery remain insufficiently studied. P

URPOSE. To evaluate how Filatov–Kalfa elastotonometry findings reflect corneal biomechanical properties measured with ORA in patients after corneal refractive correction of myopia and myopic astigmatism.

METHODS. The study included 61 patients (121 eyes): the control group consisted of 31 eyes without a history of corneal refractive surgery, and the study group comprised 90 eyes divided into three subgroups after LASIK, FS-LASIK, and PRK. Elastotonometry was performed using 5, 7.5, and 15 g weights, along with Maklakov tonometry (10 g), noncontact pneumotonometry (NCT), and ORA assessment with measurement of corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated intraocular pressure (IOPg), corneal hysteresis (CH), corneal resistance factor (CRF), and the biomechanical stress coefficient (Kbs). ΔIOP7.5/5 (corneal component), ΔIOP10/5 (corneoscleral component), ΔIOP15/10 (scleral component), and ΔIOP15/5 were calculated; Spearman correlation analysis was performed (p < 0.05).

RESULTS. In the control group, significant correlations of ORA parameters, except Kbs, were found only with the corneal component (ΔIOP7.5/5). After LASIK, most IOP and biomechanical parameters, including IOPg, CH, CRF, and NCT, showed moderate correlations with the total elastotonometric rise ΔIOP15/5. In the FS-LASIK group, the main ORA and pneumotonometry parameters showed the strongest associations with the corneoscleral component ΔIOP10/5. After PRK, IOPcc, IOPg, CH, CRF, and Kbs were most strongly associated with the scleral and total components (ΔIOP15/10 and ΔIOP15/5).

CONCLUSION. Correlations between Filatov–Kalfa elastotonometry results and ORA measurements differ substantially after LASIK, FS-LASIK, and PRK, reflecting the procedure-specific effects of these techniques on corneal biomechanical properties. Accounting for the dominant component of elastotonometric IOP rise may improve the accuracy of tonometry and assessment of the biomechanical status of the eye in the postoperative period.

PURPOSE. To identify heterogeneity in the structural parameters of the ocular fibrous tunic and functional changes in normal-tension glaucoma (NTG).

METHODS. The study included 20 patients (40 eyes) with NTG. Corneal topography, static perimetry, and optical coherence tomography with assessment of the lamina cribrosa (LC), peripapillary retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) were performed.

Based on differences in corneal topography, patients were divided into groups with a biomechanically stable cornea (group 1) and a biomechanically unstable cornea (group 2).

RESULTS. In group 1, central corneal thickness (CCT) was 531.0 (530–538) µm and minimum thickness (THK_min) was 525.5 (524–533) µm. In group 2, the cornea was thinner: CCT was 487.0 (480–494) µm (p=0.002), and THK_min was 480.5 (475–489) µm (p<0.001).

Group 2 showed a trend toward greater maximum corneal curvature (p>0.05) and a lower anterior surface asymmetry index (1.21 and 2.10; p=0.009). Elevation of the anterior and posterior surfaces was higher in group 2.

Group 2 had greater LC depth (540 (487–582) µm vs 392 (341–561), p < 0.05), a thinner LC (77 (57–96) µm vs 126 (99–152), p < 0.05).

With comparable global reduction in light sensitivity, group 2 had more local defects (24-2 program, p=0.041; 10-2 program, p=0.029). Central and paracentral defects predominated in group 1, corresponding to GCC involvement, whereas arcuate and nasal defects predominated in group 2, corresponding to RNFL involvement.

CONCLUSIONS. Comprehensive assessment of the cornea, LC, and optic nerve allows different NTG phenotypes to be identified. Some patients show signs of biomechanical corneal instability accompanied by more pronounced LC changes, RNFL involvement, and arcuate and nasal visual field defects typical of primary open-angle glaucoma (POAG). Others have predominantly “classic” NTG, with preferential GCC involvement and central or paracentral scotomas.

Some cases of NTG may represent normal-tension POAG, in which tonometry does not reflect the actual load on the optic nerve because of corneal biomechanical features.

PURPOSE. To identify clinical and functional correlations between risk factors for primary open-angle glaucoma (POAG) and changes in visual field sensitivity and color perception parameters.

METHODS. A total of 170 individuals were examined and divided into groups according to POAG stage and degree of myopia.

Group 1 included 30 students (60 eyes) with low myopia. Group 2 included 30 patients (60 eyes) with moderate myopia. Group 3 included 80 patients (120 eyes) with POAG. The control group included 30 students (60 eyes). All participants completed a questionnaire designed to identify modifiable and nonmodifiable risk factors for glaucoma. The presence of systemic disease was determined from medical records. All participants also underwent a standard ophthalmological examination, including visual acuity testing, autorefraction, and tonometry.

Static perimetry was performed using the Humphrey 30-2 program with the SITA Standard algorithm.

Color perception was assessed using the Farnsworth– Munsell 100 Hue test (FM 100).

RESULTS. Clinical and functional correlations were identified between risk factors for POAG and changes in visual field sensitivity and color perception parameters depending on the degree of myopia. In low myopia, dry eye syndrome showed an inverse correlation with mean deviation (MD) and a direct correlation with color order (CO). In moderate myopia, tearing showed an inverse correlation with MD and CO; hypertension showed an inverse correlation with pattern standard deviation (PSD) and the number of errors on the FM 100 test.

CONCLUSION. The study findings support the feasibility of identifying clinical and functional predictors of POAG in students with myopic refraction.

PURPOSE.  To evaluate the clinical and functional outcomes of surgical treatment in patients with traumatic cataract complicated by phacolytic glaucoma using scleral fixation of an intraocular lens (IOL).

METHODS. This was a retrospective study that included 34 patients (34 eyes) with traumatic cataract and phacolytic glaucoma who underwent surgery at the Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy in 2019–2024. All patients underwent cataract extraction with simultaneous scleral fixation of a posterior chamber IOL using a suture technique with 8-0 polypropylene. Changes in visual acuity and intraocular pressure (IOP), as well as the incidence of intraoperative and postoperative complications, were assessed. The follow-up period was 12 months.

RESULTS.  The mean age of the patients was 47.3±12.8 years; 25 patients were men and 9 were women. Baseline visual acuity was 1.84±0.42 logMAR, and IOP was 38.6± 5.2 mm Hg. At 12 months, visual acuity improved to 0.38± 0.21 logMAR (p < 0.001), and IOP decreased to 18.3±2.4 mm Hg (p < 0.001). IOP normalization without hypotensive medications was achieved in 29 patients (85.3%). Intraoperative complications included vitreous hemorrhage in 2 cases (5.9%) and hypotony in 1 case (2.9%). Postoperative complications included transient ocular hypertension in 4 cases (11.8%) and cystoid macular edema in 2 cases (5.9%). IOL centration was assessed as excellent in 30 eyes (88.2%) and satisfactory in 4 eyes (11.8%); no IOL dislocation was observed.

CONCLUSION.  Scleral IOL fixation using 8-0 polypropylene is an effective and safe method of surgical rehabilitation in patients with traumatic cataract complicated by phacolytic glaucoma. The technique provides sustained IOP normalization, high visual function, and a low complication rate.

PURPOSE. To analyze the effectiveness and safety of Preserflo microschunt implantation during the 12-month follow-up period.

METHODS. Thirty patients (30 eyes) underwent surgery (14 men and 16 women; mean age, 55.8±15.3 years); among them 24 patients (80%) had moderate glaucoma, and 6 patients (20%) — advanced glaucoma. Before surgery, mean intraocular pressure (IOP) was 22.9±5.3 mm  Hg, and the number of antihypertensive drugs used was 2.1±1.0. In 26 patients (86.67%) microshunt implantation was performed as the first surgery, in 6 cases (6 eyes, 20%) it was combined with cataract phacoemulsification and IOL implantation, and 4 patients (13.33%) had a history of glaucoma surgery; the average period after surgery was 2.3±1.2 years.

All patients underwent a comprehensive ophthalmological examination before surgery, as well as at 1 and 7 days, and at 1, 3, 6 and 12 months postoperatively. Additionally, the patients underwent anterior segment OCT to determine the horizontal and vertical dimensions of the filtration bleb (FB) and the position of the microshunt tube in the anterior chamber.

RESULTS. On postoperative day 1, IOP decreased by 49.78% to 11.5±1.2 mm Hg, remained stable throughout the follow-up period, and reached 12.7±1.8 mm Hg by month 12, corresponding to a 44.6% reduction from baseline. Complete success was achieved in 26 patients (86.67%) and partial success in 4 patients (13.33%). Hypotony ≤6 mm Hg during the first days after surgery was observed in one patient, a shallow anterior chamber was noted in one other case, no ciliochoroidal detachment was detected. The position of the drainage tube relative to the cornea and iris remained stable. In all cases, posterior diffuse FBs formed (their horizontal size increased from 1878.9±394.47 µm on day 1 to 2497±658.49 µm by month 12, vertical size — from 286.32±70.68 to 368.68±90.92 µm, respectively), which underwent transformation from multilayered to microcystic and avascular.

CONCLUSION. Microshunt implantation, as a new minimally invasive subconjunctival filtration procedure, addresses an unmet need in glaucoma surgery by providing effective IOP reduction with a good safety profile and may be a method of choice in early and moderate glaucoma, as well as in some cases of advanced glaucoma.

PURPOSE. To improve treatment outcomes in primary open-angle glaucoma (POAG) using the fixed-combination glaucoma drug Dorzoprost (K.O. Rompharm Company S.R.L., Romania) (dorzolamide 2% + latanoprost 0.005%).

METHODS. The study was conducted at the Orenburg Branch of the S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery” in 2024–2025. The study included 30 patients (55 eyes) aged 55–75 years with early-stage and moderate-stage POAG. The effectiveness of Dorzoprost was evaluated in patients with newly diagnosed glaucoma who had not received previous antihypertensive therapy (group 1) and in patients with insufficient effectiveness of monotherapy with prostaglandin analogs (group 2). The follow-up period was 3 months. Intraocular pressure was measured using applanation, noncontact, and rebound tonometry.

RESULTS. After 1 week of therapy, intraocular pressure decreased statistically significantly from baseline by 32% (p=0.00013) in group 1 and by 20% (p=0.000132) in group 2. After 4 weeks of treatment, both groups showed an even more pronounced hypotensive effect, with a statistically significant IOP reduction of 36% (p=0.00006) and 24% (p=0.000089), respectively, compared with baseline values. During the subsequent 3-month treatment period, stabilization of the achieved parameters was observed.

Analysis of diurnal IOP changes (at 8:30, 12:30, 16:30, and at 8:30 a.m. on the following day) showed that the mean fluctuation amplitude did not exceed 3 mm  Hg in either group throughout the study period (after 1 and 4 weeks, and 3 months of therapy).

No local or systemic adverse reactions were recorded, and no functional abnormalities of organs or systems were observed.

CONCLUSION. The findings indicate high and sustained antihypertensive effectiveness of Dorzoprost in POAG, both as initial therapy and after switching from monotherapy with prostaglandin analogs.

Weakness of the lens zonular apparatus (zonulopathy) is one of the key risk factors for intraoperative complications in cataract surgery and the main cause of late dislocation of the intraocular lens IOL–capsular bag complex. With increasing life expectancy and the growing number of phacoemulsification procedures, the problem of zonulopathy and late IOL dislocation is becoming increasingly relevant.

PURPOSE. To analyze and systematize current data on the morphology, ultrastructural biology, and molecular genetics of the zonular apparatus, and to form a comprehensive understanding of the pathogenetic mechanisms of zonulopathy.

METHODS. This literature review on the pathogenesis of zonulopathy addresses the following objectives: 1 — to characterize the ultrastructural organization and molecular composition of zonular fibers; 2 — to analyze the role of genetic defects in the microfibrillar scaffold (mutations in fibrillin and associated proteins) in the development of primary zonulopathy; 3 — to consider mechanisms of secondary zonular damage in pseudoexfoliation syndrome, inflammation, and age-related and myopic matrix remodeling; 4 — to assess the contribution of mechanical and iatrogenic factors to weakening of the zonular apparatus.

The search was performed in PubMed, Scopus, and Web of Science using combinations of English and Russian keywords: Zinn’s zonule, lens zonules, fibrillin, microfibrils, zonulopathy, pseudoexfoliation, pseudoexfoliation syndrome, zonular weakness, lens subluxation, intraocular lens dislocation, FBN1, Marfan syndrome.

CONCLUSIONS. Weakness of the lens zonular apparatus is a multifactorial condition whose pathogenesis involves 3 main processes: primary structural defects of microfibrils (genetic mutations in fibrillin, abnormal assembly, TGF-β dysregulation), secondary damage to microfibril bundles and their attachment sites (deposition of pseudoexfoliative material, inflammation, proteolysis, involutional and myopic remodeling), and chronic or acute mechanical impact on the weakened scaffold. This supports preoperative risk stratification, the use of support devices and preventive approaches in the presence of risk factors, and opens prospects for the development of molecularly targeted approaches to prevention and treatment of zonulopathies.

Current technologies for glaucoma diagnosis show substantial variability and subjectivity in parameters such as intraocular pressure, perimetry findings, and ophthalmoscopy data, raising questions about the accuracy of these tests. Although optical coherence tomography (OCT) remains an objective standard, new methods are emerging, including OCT angiography, laser speckle flowgraphy, analysis of biomarkers in tear fluid and intraocular fluids, genetic markers, and improved structural and functional parameters that expand the possibilities for early and accurate diagnosis of glaucoma. This review discusses biomarkers such as structural parameters of the retina and optic nerve, as well as electrophysiological, vascular, mitochondrial, and molecular biomarkers. Currently, the availability of classic, generally accepted clinical biomarkers provides a basic level of diagnosis and follow-up in patients with glaucoma. However, new information on the pathophysiology of glaucomatous optic neuropathy, together with continuous technological advances in structural and functional diagnostic methods, necessitates consideration of new glaucoma biomarkers with higher sensitivity and specificity. This is particularly important for early diagnosis and prediction of glaucoma progression.

Glaucoma in patients with diabetes mellitus (DM) is a clinically and diagnostically challenging condition whose formation and detection are complicated by the combined influence of metabolic, vascular and neurodegenerative factors. This review summarizes current data on glaucoma as a comorbid condition in diabetes mellitus, as well as on secondary neovascular glaucoma developing in the setting of diabetic retinopathy. The article discusses mechanisms of increased intraocular pressure in chronic hyperglycemia, including impaired aqueous humor secretion and outflow, trabecular meshwork remodeling, and endothelial dysfunction. This study places particular emphasis on the diagnostic limitations of standard examination methods and analyzes in detail how changes in corneal biomechanical properties affect the reliability of transcorneal tonometry. It also discusses the difficulties of interpreting optical coherence tomography and standard automated perimetry findings in patients with DM, which are caused by diabetesassociated morphofunctional changes in the retina and optic nerve and by the consequences of laser treatment for diabetic retinopathy. These changes may mask or mimic signs of glaucomatous optic neuropathy, creating a risk of diagnostic errors and incorrect assessment of disease progression. The article emphasizes the need for a comprehensive approach to glaucoma diagnosis in patients with DM that takes metabolic status into account, as well as the need to develop diagnostic criteria with better specificity.