[Application of artificial intelligence in glaucoma. Part 1. Neural networks and deep learning in glaucoma screening and diagnosis]. / Primenenie metodov iskusstvennogo intellekta pri glaukome. Chast' 1. Neiroseti i glubokoe obuchenie v skrininge i diagnostike glaukomy.

This article reviews literature on the use of artificial intelligence (AI) for screening, diagnosis, monitoring and treatment of glaucoma. The first part of the review provides information how AI methods improve the effectiveness of glaucoma screening, presents the technologies using deep learning, including neural networks, for the analysis of big data obtained by methods of ocular imaging (fundus imaging, optical coherence tomography of the anterior and posterior eye segments, digital gonioscopy, ultrasound biomicroscopy, etc.), including a multimodal approach. The results found in the reviewed literature are contradictory, indicating that improvement of the AI models requires further research and a standardized approach. The use of neural networks for timely detection of glaucoma based on multimodal imaging will reduce the risk of blindness associated with glaucoma.

[Optical coherence tomography and optical coherence tomography angiography for detecting glaucoma progression. Part 2. Clinical and functional correlations, monitoring of advanced glaucoma and limitations of the method]. / Opticheskaya kogerentnaya tomografiya i opticheskaya kogerentnaya tomografiya-angiografiya v opredelenii progressirovaniya glaukomy. Chast' 2. Kliniko-funktsional'nye korrelyatsii, monitoring na pozdnei stadii i ogranicheniya metoda.

The purpose of this study is to analyze the literature on the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in the diagnosis of glaucoma. This review considers the structural and functional correlations observed during the progression of glaucomatous optic neuropathy, as well as the capabilities of the method in late glaucoma, describes the strengths and weaknesses of OCT and OCTA, and pays particular attention to the role of OCT in assessing the effectiveness of treatment. Optical coherence tomography is the main method for determining the progression of glaucoma, which plays a key role in the choice of treatment algorithm. However, the use of OCT in far advanced glaucoma has certain particularities and limitations. OCTA can be helpful in overcoming this problem.

[Optical coherence tomography and optical coherence tomography angiography for detecting glaucoma progression. Part 1. Study methods, measurement variability and the role of age-related changes]. / Opticheskaya kogerentnaya tomografiya i opticheskaya kogerentnaya tomografiya-angiografiya v opredelenii progressirovaniya glaukomy. Chast' 1. Metody issledovaniya, variabel'nost' pokazatelei i rol' vozrastnykh izmenenii.

This paper reviews the literature on the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in the diagnosis of glaucoma and considers the significance of evaluating retinal nerve fiber layer and ganglion cell complex in assessment of glaucoma progression, variability and reproducibility of the method, as well as the influence of age-related retinal changes on the results, analyzes the role of OCTA in glaucoma monitoring. Optical coherence tomography is a modern standard for glaucoma diagnosis and monitoring, and OCTA shows high potential as an auxiliary diagnostic tool.

[Predictors of the success of laser peripheral iridotomy and lensectomy in the early stages of primary angle closure disease]. / Prediktory uspekha perifericheskoi lazernoi iridotomii i lensektomii pri nachal'nykh stadiyakh zabolevaniya pervichnogo zakrytiya ugla perednei kamery.

The article reviews literature data on the search for predictors of the success of laser peripheral iridotomy (LPI) and lensectomy in the early stages of primary angle closure disease (PACD) and presents a trend analysis of the studies conducted on individuals identified as primary angle closure suspects (PACs) and those with primary angle closure (PAC). The concept of the review was determined by the ambiguous choice of treatment for patients at the stage of PAC onset. Determining the success predictors of LPI or lensectomy plays a key role in optimizing the treatment of PACD. The results of literature analysis are contradictory, which indicates the need for further research taking into account modern methods of visualization of the eye structures such as optical coherence tomography (OCT), Swept Source OCT (SS-OCT), and the use of uniform criteria for evaluating the effectiveness of treatment.

[The value of lamina cribrosa in the diagnosis and treatment of glaucoma. Remodeling of lamina cribrosa collagen and approaches to its therapeutic treatment]. / Znachenie struktury reshetchatoi membrany sklery v diagnostike i lechenii glaukomy. Remodelirovanie kollagena reshetchatoi membrany i puti terapevticheskogo vozdeistviya na nego.

Among the first structures suffering damage with an increase in intraocular pressure (IOP) and in early stage of glaucoma are the lamina cribrosa (LC) and peripapillary sclera (ppScl). Changes in these structures occur at the molecular and cellular level. Extracellular matrix (ECM) is the basis of connective tissue, provides mechanical support for the cells, facilitates intercellular interactions and transport of chemicals, including in LC and ppScl. Mechanical stress causes remodeling and disorganization of the ECM, which leads to changes in the structure of the tissue itself, an increase in its rigidity and a decrease in elasticity. Taking into account the molecular and cellular mechanisms of damage to LC and ppScl, various researchers have developed strategies and tactics for therapeutic intervention on these structures, contributing to a decrease in ECM secretion and, as a consequence, suspension of their remodeling. These approaches may in the future form the basis for the treatment of glaucomatous optic neuropathy.

[Late diagnosis of rhinocerebral mucormycosis in patients with COVID-19 (case studies)]. / Pozdnyaya diagnostika rinotserebral'nogo mukormikoza u bol'nykh COVID-19 (klinicheskie nablyudeniya).

From the beginning of the COVID-19 pandemic, the incidence of secondary infections (both bacterial and fungal) has increased due to immune suppression associated with the use of corticosteroids or broad-spectrum antibiotics as a part of COVID-19 treatment protocol, which may exacerbate a pre-existing fungal disease or cause a new infection. Ophthalmologists are often involved in taking medical and surgical decisions in these complex cases. In this regard, a strong clinical suspicion should be applied to possible secondary fungal infections in COVID-19. Their early diagnosis and treatment may reduce mortality due to COVID-19 associated rhinocerebral mucormycosis (ROCM). This article describes two clinical cases of late detection of ROCM with two different scenarios, and compare the features of these cases with the literature data.

[Neuroprotective properties of latanoprost]. / Neiroprotektornye svoistva latanoprosta.

Glaucoma is the main cause of irreversible blindness in the world. Latanoprost - an ester prodrug of prostaglandin F2α (PGF2α) - was the first prostaglandin analogue used to treat glaucoma. The review shows that latanoprost possesses direct neuroprotective properties such as blocking the entry of calcium ions into neurons and inhibiting the action of caspase-3, inhibiting the activity of cyclooxygenase and activation of polypeptide 2B1 (OATP2B1) and Klotho protein. It is emphasized that when the drug is instilled into the eye, the concentration of the drug inside the vitreous body is twice as high as what is required to ensure the survival of retinal ganglion cells.

[Comparative study of retinal microcirculation in primary angle closure disease and early primary open-angle glaucoma]. / Sravnitel'noe issledovanie retinal'noi mikrotsirkulyatsii pri zabolevanii pervichnogo zakrytogo ugla i nachal'noi pervichnoi otkrytougol'noi glaukome.

PURPOSE: To compare microcirculatory changes in patients with early stages of primary angle closure disease (PACD) and primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study retrospectively analyzed the clinical data of 60 eyes with PACD, 30 with initial POAG, and 30 eyes without any ophthalmic pathologies. Vessel density (VD) in the optic nerve head and peripapillary retina (wiVD Disc), as well as in the inner layers of fovea and parafovea (wiVD Macula) and their different sectors were determined in all patients by optical coherence tomography angiography (OCTA). The correlation of VD with axial length (AL), anterior chamber depth (ACD), lens thickness (TL), and corneal-compensated intraocular pressure (IOPcc) was assessed. RESULTS: The wiVD Disc in PACD (42.47±4.23%) was lower than in POAG eyes (47.46±2.10%), p<0.001, but the difference for wiVD Macula was not significant: 41.71±4.55% and 39.29±2.46%, respectively (p=0.47). In both PACD and POAG, all OCTA parameters were lower than in normal eyes: p=0.000 for both wiVD Disc and wiVD Macula. WiVD Disc correlated with ACD both in PACD (r=0.724, p=0.012) and in POAG (r= 0.685, p=0.012), but a correlation with IOPcc was found only in PACD (r= -0.670, p=0.033). The largest number of inverse correlations was found between TL and VD both for wiVD Disc (r= -0.714, p=0.006) and the parameters of macular area (in para- and perifovea). CONCLUSION: OCTA parameters differ significantly from the norm even in the early stages of both PACD and POAG. In PACD, there was a significant decrease in microcirculation in the peripapillary retina compared to POAG, which had an inverse correlation with IOPcc; there was also an inverse correlation of OCTA parameters in the optic nerve head and macula with lens thickness.

[Primary anterior chamber angle closure: progression from suspect to glaucoma. Part 1. Frequency and rate of transition from suspected primary angle closure to true angle closure and primary angle closure glaucoma]. / Pervichnyi zakrytyi ugol perednei kamery: progressirovanie ot podozreniya do glaukomy. Chast' 1. Chastota i skorost' perekhoda podozreniya na pervichnyi zakrytyi ugol v istinno zakrytyi ugol i pervichnuyu zakrytougol'nuyu glaukomu.

OBJECTIVE: To review the literature devoted to the problem of primary anterior chamber angle closure (PAC) and the development of this pathology from glaucoma suspect to primary angle closure glaucoma. The paper includes a trend analysis of the studies concerning primary angle closure suspects (PACS). The concept of this review is conditioned by the conflicting strategies for treating patients with initial PAC without glaucomatous optic neuropathy. Solving the problem of angle closure plays a key role in preventing the development of PAC glaucoma, which is the world's leading cause of irreversible blindness. This part of the review provides information on the frequency and rate of disease progression in PACS. The analyzed literature data is contradictory and indicates the need for further search that would consider a standardized approach to defining the concept of PAC disease, demographic factors and unified examination methods for generalizing and systematizing data in order to draw out unified treatment recommendations.

[Primary anterior chamber angle closure: progression from suspect to glaucoma. Part 2. Predictors of primary angle closure]. / Pervichnyi zakrytyi ugol perednei kamery: progressirovanie ot podozreniya do glaukomy. Chast' 2. Prediktory pervichnogo zakrytogo ugla.

OBJECTIVE: To review the literature devoted to the search of predictors of primary angle closure (PAC) progression as an important link in the pathogenesis of primary angle-closure glaucoma. This part presents a cluster analysis, describes the mechanisms of PAC development, and considers the studies aimed at discovering the risk factors for the progression of primary angle closure suspect into true angle closure. The results of the analyzed literature are ambiguous, indicating the need for further research that would involve strict inclusion criteria, and a standard approach to defining the primary angle closure disease and expanding the diagnostic parameters, in which a key role belongs to anterior segment optical coherence tomography (AS-OCT).

[Providing eye care during the COVID-19 pandemic]. / Osobennosti okazaniya oftal'mologicheskoi pomoshchi v usloviyakh pandemii COVID-19.

The review presents the data on characteristic features of the new coronavirus infection caused by SARS-CoV-2 and the possibility of its transmission through the eye surface and lacrimal fluid, analyzes the information on eye damage caused by COVID-19, and provides the results of a systematic meta-analysis on the subject. The author describes the system for organizing ophthalmological care in the settings of unfavorable epidemiological situation associated with the COVID-19 pandemic, and considers the preventive measures of infection transmission between patients and medical personnel. The article also gives recommendations for sterilizing medical equipment.

[Morphology of outer retinal tubulations in the outcome of exudative age-related macular degeneration according to optical coherence tomography angiography]. / Morfologiya naruzhnykh retinal'nykh tubulyatsii v iskhode vlazhnoi formy vozrastnoi makulyarnoi degeneratsii po dannym opticheskoi kogerentnoi tomografii s funktsiei angiografii.

Outer retinal tubulation (ORT) develops in the later stages of age-related macular degeneration (AMD). It is associated with low visual acuity, severe loss of photoreceptors, choroidal neovascularization (CNV), and geographic atrophy. Despite the frequent detection of ORTs by optical coherence tomography (OCT), their role in the process of outer retinal atrophy and degenerative changes in photoreceptors remains undetermined. PURPOSE: To investigate the evolution of ORT in patients with exudative and disciform-stage CNV. MATERIAL AND METHODS: The retrospective study included 340 patients with AMD, among them 235 (69%) women and 105 (31%) men with mean age of 76±7.4 years; in all, the analysis involved 267 eyes with dry AMD and 174 eyes with CNV: 92 eyes - with exudative AMD, 82 eyes - with disciform-stage disease). In addition to standard OCT, all patients underwent OCT-angiography (OCTA). In 10 cases, patients with exudative AMD were followed up after intravitreal injections of Aflibercept. RESULTS: ORTs were detected in 37 eyes of 32 patients (26%), all of them with CNV: 13 eyes with exudative AMD (group 1) and 24 eyes with disciform scar (group 2; p=0.013).The groups were similar in the type and morphology of ORTs. The most common were closed, i.e. fully formed ORT (92% of cases in group 1, and 88% in group 2). Destruction of the ellipsoid zone associated with ORT was observed in both groups. In one case, there was an increase in the size of ORT corresponding to the volume of cystic macular edema. Disappearance of ORT was noted only in one of ten patients 3 months after intravitreal injection of Aflibercept, but was not accompanied by visual acuity improvement. CONCLUSION: Outer retinal tubulations are more common in the later stages of AMD, being an indicator of a deep destructive process in photoreceptors. In exudative AMD, ORTs serve as a predictive marker for poor functional outcomes.

[Examination of patients with glaucoma during the COVID-19 pandemic]. / Metody obsledovaniya bol'nykh glaukomoi v period pandemii COVID-19.

PURPOSE: To evaluate the efficacy of the optimal examination technique for patients with glaucoma during the COVID-19 pandemic that includes one of the safest methods of tonometry [transpalpebral tonometry (TPT), contour dynamic tonometry (CDT) and Icare rebound tonometry (RBT)] in combination with spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA). MATERIAL AND METHODS: The study included 65 patients with primary open-angle glaucoma (POAG) who sought medical aid at the Ophthalmological Center of FMBA during the COVID-19 pandemic; they were examined using three tonometry methods: RBT, TPT and CDT. All patients underwent central corneal thickness measurement, perimetry, OCT and OCTA with assessment of vessel density (VD) of the superficial plexus in the macula (whole image macula) and peripapillary retina (PPR). RESULTS: High correlation was found between the results obtained with RBT, TPT and CDT. None of the methods showed a correlation between IOP and corneal thickness. The correlations between IOP and OCTA parameters were obtained: IOPTPT and VDPPR in the inferior temporal sector (r= -0.386, p=0.027), IOPRBT and VD whole image macula (r= -0.69, p=0.019), and in the macula inferior hemisphere (r= -0.75, p=0.008), as well as between the ocular pulse amplitude (OPA) and VD in the macular inferior hemisphere (r=0.380, p=0.039). The OCTA parameters had a moderate, but significant correlation with the perimetric indices. CONCLUSIONS: Tonometry methods (TPB, CDT and RBT) exhibit high correlation with each other and no correlation with corneal thickness. IOP parameters measured by different methods, especially using the Icare tonometer, correlate with OCTA parameters, and the latter - with perimetric indices. The combination of these tonometry methods with SD-OCT and OCTA is optimal for examining patients during the pandemic.

[The role of retinal microcirculation disorders in the progression of glaucomatous optic neuropathy]. / Rol' narushenii retinal'noi mikrotsirkulyatsii v progressirovanii glaukomnoi optikoneiropatii.

PURPOSE: To assess the progression of primary open-angle glaucoma (POAG) and to study the role of retinal microcirculation in its progression. MATERIAL AND METHODS: In this 2-year prospective study, the rate of POAG progression was determined using perimetry (ROP1) and spectral domain optical coherence tomography (SD-OCT) by thinning of retinal nerve fiber layer (RNFL) (ROP2) and ganglion cell complex (GCC) (ROP3). The vessel density of parafoveal superficial plexus (VD parafovea) and peripapillary retina (VD ppr) was assessed using OCT angiography, peripheral resistance index (RI), and blood flow velocity in the posterior short ciliary arteries (PSCA) and central retinal artery (CRA) with the use of color Doppler mapping. The predictive properties of each parameter were calculated using the area under receiver operating curve (AUC). RESULTS: Progression was detected in 9.8% cases by perimetry and in 19.7% cases by OCT. The combination of these two methods increased the detection up to 32.8%. Circulatory parameters - VD parafovea (AUC 0.70±0.07), VD ppr (0.715±0.07), PSCA RI (0.801±0.12), CRA RI (0.798±0.11) - had similar high predictive properties as IOP max (0.79±0.05), corneal hysteresis (0.755±0.07), thickness of inner parafoveal layers (0.728±0.07) and RNFL (0.692±0.06). The study revealed the following correlations: ROP1 with maximum IOP (p=0.01), ROP2 with blood flow velocity in PSCA (p=0.01), VD parafovea with corneal hysteresis (p=0.01), and GCC thickness with ocular perfusion pressure (p=0.01). CONCLUSION: The obtained data demonstrates the importance of combining perimetry with OCT for detecting the progression of glaucoma and indicates its relationship with reduced ocular hemoperfusion.

[Long-term use of latanoprost in the treatment of glaucoma]. / Dolgosrochnoe primenenie latanoprosta v lechenii glaukomy.

Glaucoma is the main cause of irreversible blindness in the world. Latanoprost - an ester prodrug of prostaglandin F2α (PGF2α) - was the first prostaglandin analogue used in the treatment of glaucoma. The present review shows that latanoprost is the most balanced prostaglandin analogue in terms of efficacy-safety. Its use improves the quality of life of glaucoma patients, provides reliable IOP reduction, has high patient compliance, and helps with the long-term preservation of visual functions. The review also reveals the possibility of long-term (more than five years) use of the drug, as well as effective combined treatment using latanoprost and beta-blockers, considers the pediatric use of latanoprost, and discusses its neuroprotective properties.

[Biomechanical properties of the cornea as predictors of the effectiveness of selective laser trabeculoplasty]. / Biomekhanicheskie svoistva rogovoi obolochki glaza kak prediktory éffektivnosti selektivnoi lazernoi trabekuloplastiki.

PURPOSE: To study the changes in central corneal thickness (CCT) and corneal hysteresis (CH) after selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI) and to determine their effect on the prognosis of the surgery. MATERIAL AND METHODS: The prospective study involved 68 eyes with initial PACG after LPI and 74 eyes with initial POAG observed for 6 months. Corneal-compensated IOP (IOPcc), corneal resistance factor (CRF), CH and CCT were studied as the predictors of SLT, which was considered successful when IOPcc decreased by 20% or more from the baseline without additional hypotensive therapy and/or repeated SLT. RESULTS: In both forms of glaucoma, CCT increased within the first hour after SLT: 567±24.08 µm (p=0.001) in POAG, and 572±21.41 µm (p=0.000) - persisting for over a month - in PACG. CCT correlated with laser energy at all stages of the examination both in POAG and PACG patients. The following predictors of SLT failure were determined: CH (p=0.000 in PACG and p=0.001 in POAG), as well as initial IOP (p=0.010 in PACG and p=0.016 in POAG) and CRF (p=0.003 in PACG and p=0.005 in POAG) and CCT (p=0.023 in PACG and p=0.026 in POAG). The value of anterior chamber angle (ACA) was a predictor only for PACG (p=0.011). CONCLUSION: SLT leads to an increase in CCT, which lasts longer in PACG after LPI than in POAG and correlates with the level of laser energy. Lower CH and initially higher IOP are the common predictors of SLT failure in the long term for both forms of glaucoma. Smaller ACA have a negative prognostic sign in POAG.

[Comparative study of factors associated with the progression of primary open-angle and angle-closure glaucoma]. / Sravnitel'noe issledovanie faktorov, assotsiirovannykh s progressirovaniem pervichnoi otkrytougol'noi i zakrytougol'noi glaukomy.

PURPOSE: To compare the factors associated with the progression of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). MATERIAL AND METHODS: This prospective study analyses clinical data of POAG and PACG patients followed up for 6 years. The progression of glaucomatous optic neuropathy (GON) was determined using perimetry and spectral optical coherence tomography (OCT). The value of each diagnostic indicator (z-value) was calculated using the Wilcoxon-Mann-Whitney test and the area under the ROC-curve (AUC) to identify the parameters reliably associated with the progression in both groups of patients. RESULTS: According to OCT, 47.3% of PACG patients and 52.46% of POAG patients had GON progressing, while according to perimetry, these figures were 21.8% and 23%, respectively. The common factors associated with progression of these glaucoma forms were age (AUC 0.7, z -1.9 in PACG and AUC 0.7, z -2.9 in POAG) and maximum IOP (0.7; -2.7 in PACG and 0.79; -5.4 in POAG). The progression of PACG is associated with lens size (0.7; -2.4), subfoveal choroidal thickness (AUC 0.8, z -3.3) and peripapillary choroidal thickness (0.79; -3.2), resistive index in the vortex veins (0.81; -3.3) and their end diastolic blood flow velocity (0.83; 3.2). The progression of POAG is associated with a thin peripapillary (0.75; 2.6) and subfoveal choroid (0.74; 2.5), increased resistive index in the posterior short ciliary arteries (0.8; -2.3), and initial retinal nerve fiber layer (RNFL) thickness: 0.69; 2.9. CONCLUSION: The progression of POAG and PACG has only two common factors - age and maximum IOP. The progression of PACG is mainly related to the lens size, venous dysfunction and the choroid expansion, while the progression of POAG is related to the initial RNFL thickness, reduced arterial blood flow and choroid thinning.

[Selective α2 agonists in the treatment of glaucoma: neuroprotective properties and impact on ocular blood flow]. / Selektivnye α-2-agonisty v lechenii glaukomy: neiroprotektornye svoistva i vliianie na glaznoi krovotok.

Glaucoma is the main cause of irreversible blindness in the world. The selective α2 adrenergic receptor agonist brimonidine holds an important place among the hypotensive eye drops. The second part of this review focuses on some important effects of brimonidine that characterizes it as a medication with direct neuroprotective multifactorial action, discusses its influence on ocular blood flow and highlights its capability to maintain normal autoregulation of ocular blood flow.

[Selective α2-agonists in the treatment of glaucoma: pharmacology, efficacy and safety]. / Selektivnye α2-agonisty v lechenii glaukomy: farmakologicheskie svoistva, éffektivnost' i bezopasnost'.

Glaucoma is the main cause of irreversible blindness in the world. Among the hypotensive eye drops, an important place belongs to the selective α2-adrenergic receptor antagonist brimonidine. This part of the review focuses on key pharmacological and therapeutic characteristics of brimonidine and its mode of action. The article also discusses the side effects of brimonidine and the methods of their prevention.

[Pattern visual evoked potentials and their relation to the peripapillary and retrobulbar blood flow in glaucoma]. / Patternzritel'nye vyzvannye potentsialy i ikh sviaz' s peripapilliarnym i retrobul'barnym krovotokom pri glaukome.

PURPOSE: To examine the relationship between the development of bioelectric response of retinal cell elements to pattern stimulus and the ocular blood flow. MATERIAL AND METHODS: Electrophysiological studies, including pattern-reversal visual evoked potentials (VEP) with large 1 degree (1°) and small 0.25° checks, Color Doppler imaging (CDI) of the retrobulbar vessels, and OCT Angiography in the area of the optic disc and peripapillary retina were performed in 48 patients with initial primary open-angle glaucoma (POAG), 47 patients with advanced POAG, and 42 control subjects. Authors also studied the correlations between VEP values and the parameters used in CDI and OCT-A examination. RESULTS: The most noticeable differences between the study groups were the amplitudes of P100 pattern VEP values for small and large patterns and the OCT-A parameters: Whole-image Disc Vessel Density (widVD), Peripapillary Vessel Density (pVD), Peripapillary Vessel Density Inferior Temporalis (pVD IT). In initial glaucoma, a strong correlation was observed between the amplitude of P100 pattern VEP 1° and pVD IT (r=0.75; p<0.0001); the blood flow rates in ophthalmic artery, central retinal artery, central retinal vein and short posterior ciliary arteries were below normal, while the blood flow in these vessels had statistically reliable correlation with the amplitude of P100 pattern VEP (p<0.05). No correlation was found in patients with advanced stages of glaucoma. CONCLUSION: Pattern VEP is an informative method of glaucoma diagnostics which accuracy can be enhanced by combining it with OCT-A blood flow examination.