[Role of point-by-point light sensitivity in the assessment of glaucoma progression]. / Rol' potochechnoi svetochuvstvitel'nosti v otsenke progressirovaniya glaukomy.

PURPOSE: This study analyzes changes in light sensitivity in each test point of the visual field in patients with different stages of glaucoma. MATERIAL AND METHODS: The data of a prospective analytical case-control study were analyzed. All patients underwent assessment of retinal light sensitivity and its variability in 54 points corresponding to the 24-2 program. Mean light sensitivity values were calculated in each point. Intergroup analysis was performed to evaluate changes in light sensitivity in each point. RESULTS: The range of light sensitivity decrease in the early glaucoma group compared to the control group was from 1.5 to 3.6 dB. The range of light sensitivity decrease in the moderate glaucoma group compared to the control group was from 2.1 to 11.5 dB, and compared to the early glaucoma group - from -0.9 to 7.9 dB. The most frequent decrease in light sensitivity was detected in the nasal sector and along the horizontal line in the upper half of the visual field. This trend persisted within the central 10 degrees of the visual field. The range of light sensitivity decrease in the advanced glaucoma group compared to the control group was from 14.1 to 28.0 dB, and compared to the early glaucoma group - from 11.35 to 26.08 dB, compared to the moderate glaucoma group - from 9.1 to 23.5 dB. The most frequent and severe decrease in light sensitivity was detected in the paracentral zone in the lower half of the visual field. CONCLUSION: The study analyzed the trends in the development of glaucoma from the early to the advanced stage. The most frequent and severe defect in light sensitivity in cases of verified advanced glaucoma was found in the lower half of the visual field. Points No. 32, 33 and 40 can be indicated as the area of interest in assessing the progression of glaucoma, as they were found to have the most profound changes in light sensitivity as glaucoma progressed.

[Minoxidil-induced ophthalmic hypertension (case report)]. / Indutsirovannaya minoksidilom oftal'mogipertenziya (klinicheskoe nablyudenie).

This article presents a case of a 31-year-old male patient who presented to the outpatient department of the Krasnov Research Institute of Eye Diseases with complaints of diplopia and increased intraocular pressure (IOP) up to 30 mm Hg. The patient had been using minoxidil topically for androgenic alopecia for 8 years. On examination, mild swelling of the bulbar conjunctiva in the upper fornix was revealed; optical coherence tomography showed thinning of the ganglion cell layer, most likely due to moderate myopia. The patient responded well to discontinuation of minoxidil and topical therapy with prostaglandin analogues. After 4 months, an attempt was made to replace topical hypotensive therapy with carbonic anhydrase inhibitors, but the previous hypotensive regimen had to be resumed due to an increase in IOP. During 10 months of observation, no signs of progression were detected according to optical coherence tomography and static perimetry.

[The effect of keratoconus-associated refractive errors on the results of tomographic methods of studying the posterior structures of the eye]. / Vliyanie opticheskikh narushenii pri keratokonuse na rezul'taty tomograficheskikh metodov issledovaniya struktur zadnego segmenta glaza.

PURPOSE: The study assesses the potential influence of refractive errors in keratoconus (KC) on the results of tomographic methods of studying the structures of the posterior eye segment. MATERIAL AND METHODS: The study included 30 patients with bilateral stabilized KC of stages I-IV in classification by M. Amsler. Spherical and cylindrical components of refractions were determined using automatic refractometry, keratometry measurements - based on scanning keratotopography with Scheimpflug analyzer. Aberrometry was performed to evaluate corneal wave front according to the following parameters: root mean square for lower order aberrations (RMS LOA), root mean square for higher order aberrations (RMS HOA), vertical trefoil, vertical coma, horizontal coma and spherical aberrations. Optical coherence tomography (OCT) and laser confocal scanning ophthalmoscopy (HRT 3) data was used in morphometric analysis of the optic nerve head and peripapillary retina. The following morphometric parameters were analyzed: optic nerve head (ONH) area, optic disc cup area, optic disc cup volume, ratio of optic disc cup area to ONH area, neuroretinal rim area, neuroretinal rim volume, peripapillary retinal nerve fiber layer (RNFL) thickness. All studies were performed first without correction, and 30 minutes after installing customized scleral hard contact lenses (SHCL). RESULTS: Compensation of the refractive errors characteristic for KC was achieved as expected with contact correction. OCT revealed a general trend for reduction in the area and volume of the optic disc cupping, ratio of area to volume of the optic disc cupping, as well as an increase in other parameters. As such, with correction the values for area and volume of the neuroretinal rim according to OCT were 2.2 and 13%, HRT 3 - 18 and 51.6%; comparable increase in mean RNFL thickness - 2.8 and 28.5%, respectively (p<0.001). According to HRT 3 data, the area and volume of optic disc cupping statistically significantly decreased (by 21 and 28%, respectively), while OCT showed statistically significant decrease only in cupping area (by 5.7%). The ratio of cupping to ONH area decreased by 6.6 and 23% relative to the initial data obtained with OCT and HRT 3, respectively. Significant decrease in ONH area amid SHCL correction was observed only with HRT 3. The revealed changes in morphometric parameters were analyzed using the fundamental principles of physiological optics. Changes in interference pattern and, consequently, morphometric parameters of structures of the eye fundus in KC are of multifactorial nature, and are mostly associated with refractive and wave artefacts occurring when the rays pass through the irregular corneal surface and cannot be optically compensated by the device. The use of SHCL as means for making the optic system relatively regular can significantly decrease the artefacts in morphometric measurements. CONCLUSION: The results obtained in this study demonstrate the practicality of tomographic examination in KC with contact correction. The optimal choice is custom-fit SHCL, which along with proper correction of refractive errors also ensures stable position of the lens on the cornea. In standard examination specialists should take into account the «false¼ decrease in parameters of the peripapillary retinal nerve fiber layer and increase in ONH cupping.

[Static automated perimetry in the diagnosis of glaucoma. Assessment of disease progression]. / Staticheskaya perimetriya v diagnostike glaukomy. Sposoby otsenki progressirovaniya.

There are several ways to assess glaucoma progression using standard automated perimetry. Most often, ophthalmologists evaluate the stability of visual functions manually when comparing several study protocols. The advantages of clinical assessment are ease of implementation and the ability to interpret data from any device. The main disadvantage of this method is its subjectivity. There are many available automated methods for assessing disease progression involving Humphrey Field Analyzer and Octopus perimeters. Event analysis allows determining glaucoma progression at the time of examination, with consideration of the possible physiological fluctuations in light sensitivity. Trend analysis of perimetric indices makes it possible to assess the rate of glaucoma progression and forecast the trend of changes in visual functions over the next five years. All these methods for assessing progression have certain advantages and disadvantages and cannot be considered ideal. Pointwise and cluster trend analysis are more sensitive in early glaucoma and are being actively researched and developed. These methods have great potential, although they are not yet sufficiently available in clinical practice.

[Contribution of Academician M.M. Krasnov to ophthalmological science and practice]. / Vklad akademika M.M. Krasnova v oftal'mologicheskuyu nauku i praktiku.

The scientific legacy of Professor Mikhail Mikhailovich Krasnov, Academician of the Russian Academy of Medical Sciences, is large and multifaceted. His name is associated with the whole epoch of establishment and development of new methods of diagnostics and treatment of eye diseases. The representative of the dynasty of ophthalmologists M.M. Krasnov is the author of more than 350 scientific works, 80 inventor's certificates and 40 foreign patents.

[Modern achievements in the diagnosis and treatment of glaucoma]. / Sovremennye dostizheniya v diagnostike i lechenii glaukomy.

Glaucoma is one of the most difficult and significant ocular conditions. The chronic asymptomatic course of glaucoma progression leads to irreversible deterioration of visual functions. Many aspects of its pathogenesis, the features of its clinical presentation, diagnosis and treatment have been identified in recent years. The results of diagnostic methods: tonometry, perimetry, optical coherence tomography - with glaucoma do not have high specificity due to the large diversity of the population. When determining the target intraocular pressure (IOP), we look at the indicators of the choroidal blood flow and biomechanical stress of the cornea and sclera (fibrous membrane of the eye). Studying visual functions is important in the diagnosis and monitoring of glaucoma. The creation of a modern portable device based on a virtual reality helmet allows examination of patients with low central vision. Structural changes in glaucoma affect the optic disc and the inner retinal layers. The proposed classification of atypical discs allows determining the earliest characteristic changes in the neuroretinal rim for glaucoma in cases of difficult diagnosis. The complexity of the diagnosis of glaucoma is also associated with concomitant pathologies in elderly patients. In cases with comorbidity of primary glaucoma and Alzheimer's disease the structural and functional changes revealed by modern research methods for glaucoma are explained by both the process of secondary transsynaptic degeneration and the death of neurons as a result of an increased IOP. The starting treatment is and its type are fundamentally important for preserving visual functions. Drug therapy with prostaglandin analogues contributes to a significant and persistent decrease in the level of IOP, and mainly by utilizing the uveoscleral outflow pathway. Surgical treatment of glaucoma is an effective way to achieve the target IOP values. However, postoperative hypotension affects the bloodstream both in the central and peripapillary retina. Optical coherence tomography angiography helped establishe that the strongest factor that determines postoperative changes is the difference in IOP, not its absolute level.

[Comparative evaluation of hypotensive effectiveness of topical monotherapy and selective laser trabeculectomy]. / Sravnitel'naya otsenka gipotenzivnoi effektivnosti topicheskoi monoterapii i selektivnoi lazernoi trabekuloplastiki.

PURPOSE: Comparison of the hypotensive effects of selective laser trabeculoplasty (SLT) and drug therapy in patients with newly diagnosed primary open-angle glaucoma (POAG) and ocular hypertension. MATERIAL AND METHODS: Thirty patients (30 eyes) with newly diagnosed ophthalmic hypertension or POAG were observed. Patients of the 1st group (15 eyes) underwent standard SLT as a starting treatment, patients of the 2nd group (15 eyes) were prescribed monotherapy with a prostaglandin analog. Corneal compensated intraocular pressure (IOPcc) was measured for each patient using Ocular Response Analyzer («Reichert Technologies¼, USA). The observation period lasted 6 months. RESULTS: During the 6-months follow-up, tafluprost was found to effectively reduce IOP in 93.3% of cases, SLT - in 73.3% of cases. There were no statistically significant differences in hypotensive effectiveness between the two compared treatments, which amounted to 27.9-28.5% reduction from the baseline values. CONCLUSION: Selective laser trabeculectomy and topical drug therapy have shown similar hypotensive effectiveness during the 6-months follow-up when used as the initial therapy for POAG.

[Gerontological aspects of eye diseases]. / Gerontologicheskie aspekty zabolevanii organa zreniya.

The global rate of aging is rapidly rising due to the increase in life expectancy, and the number of age-related diseases - including eye diseases - is increasing. The most common eye conditions affecting people over 50 years old are age-related macular degeneration, cataract, glaucoma and diabetic retinopathy. Timely and effective treatment of age-related eye diseases requires a deeper understanding of the cellular mechanisms of aging.

[Ocular hypertension after intravitreal injections]. / Oftal'mogipertenziya vsledstvie intravitreal'nykh in"ektsii.

Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) for the treatment of age-related macular degeneration with choroidal neovascularization have become much more popular nowadays. Anti-VEGF therapy is generally well-tolerated; however, one of its possible side effects is ocular hypertension - elevation of intraocular pressure (IOP) above the accepted norm, but without structural and functional changes in the retina and optic nerve common for glaucoma. The average duration of IOP elevation is 30 to 60 minutes, but it can increase when the patient has primary open-angle glaucoma (POAG). There is currently no uniform understanding of the pathogenesis of elevated IOP after IVI, as well as the effect of IOP fluctuations on the functional prognosis and the condition of the ocular tunics. This review considers the main causes and mechanisms of IOP elevation after IVI, analyzes recent publications on the consequences of ocular hypertension for the neurosensory part of the retina and the optic nerve, and examines the conditions for transition of IOP fluctuations into clinically significant ocular hypertension or POAG.

[Prostaglandins in ophthalmology]. / Prostaglandiny v oftal'mologii.

Prostaglandins are widely used in medicine as active physiological agents that form a new class of drugs for treatment of cardiovascular diseases, some forms of bronchial asthma, as well as in gynecology and ophthalmology. Development of aseptic inflammation is an example of intracellular process, in which the produced prostaglandins are able to and do cause vasodilatation, increased vascular permeability, pain and fever. These effects of prostaglandins and leukotrienes characterize the classic picture of inflammation, including the aseptic one. The use of non-steroidal anti-inflammatory drugs (NSAIDs) can provide therapeutic effect via inhibition of prostaglandin secretion. Prostaglandins play a special role in glaucoma treatment. Prostaglandin analogues are powerful agents that decrease IOP by 20-40% with a unique mechanism of action. Prostaglandin analogues have a well-balanced safety profile, which is why they are considered as a first line of therapy. However, patients with inflammatory diseases in anamnesis, such as uveitis, herpes, keratitis, as well as patients with planned cataract extraction should be careful when using prostaglandin analogues.

[Professor Eduard Sergeevich Avetisov (to the 100th anniversary of his birth)]. / Professor Eduard Sergeevich Avetisov (k 100-letiyu so dnya rozhdeniya).

Domestic ophthalmology has many bright names in its history, which have become the pride and heritage of the country. One of them is the name of the outstanding Soviet ophthalmologist Professor Eduard Sergeyevich Avetisov. This year marks the 100th anniversary of the scientist's birth, but his contribution to Soviet medical science has become more and more visible over the years, has not lost its academic relevance, social importance and relevance, remaining a solid foundation for the development of modern trends in the field of vision protection for children.

[Current trends in studying pathogenesis of glaucoma]. / Sovremennye napravleniya v izuchenii patogeneza pervichnoi glaukomy.

Glaucoma is a group of neurodegenerative disorders comprising one of the main causes of irreversible blindness. Glaucoma-related blindness is a globally relevant problem. By now, many aspects of glaucoma pathogenesis have been studied: impact of increased intraocular pressure (IOP) on the development of optic neuropathy, ischemia and reperfusion of the retina, most of the direct mechanisms of neuronal death (excitotoxicity, oxidative stress, etc). However, the only effective glaucoma treatment is lowering the IOP, while early glaucoma diagnosis is based on determining structural and functional retinal defects. Therefore, it is important to emphasize further research on the insufficiently studied aspects of glaucoma pathogenesis - such as neuroinflammation, translaminar pressure, genetic factors, association of glaucomatous damage with changes in the brain, mitochondrial pathologies, and others. The article reviews the most perspective directions in research of the pathogenesis of glaucomatous optic neuropathy.

[Static automated perimetry in the diagnosis of glaucoma. Part 1: Basic principles]. / Staticheskaya perimetriya v diagnostike glaukomy. Chast' 1. Bazovye printsipy.

Static automated perimetry is an indispensable tool in the diagnosis of glaucoma. It is used to study the differential light sensitivity of the retina in different points of the visual field. The most important is the central zone of the visual field, many perimetric programs and strategies have been developed for its examination. Using standard background brightness, we can vary sizes, location methods and the type of stimulus delivery. The proper use of standard achromatic perimetry is crucial for the correct management of glaucoma patients. This review analyzes literature on the basic principles of static perimetry in the examination of differential photosensitivity of the retina.

[Static automated perimetry in the diagnosis of glaucoma. Part 2: Research protocol, glaucoma classifications, perimetric defects through the prism of structural-functional correlation]. / Staticheskaya perimetriya v diagnostike glaukomy. Chast' 2. Protokol issledovaniya, klassifikatsii glaukomy, perimetricheskie defekty cherez prizmu strukturno-funktsional'noi korrelyatsii.

Examination of the central visual field is currently required for glaucoma diagnosis. Modern computer perimeters make it possible to qualitatively and quantitatively evaluate defects of light sensitivity. Perimetric indices are calculated showing the severity of the defects. This allows the use of perimetric results to create universal classifications of glaucoma. Recently, new perimeter programs based on optical coherence tomography data have appeared. The possibility of personalizing perimeter programs are being tested. This review attempts to systematize data on the capabilities of computer perimeters in assessing functional defects, presents the widely used glaucoma classifications, and describes ways of developing static perimetry programs for earlier diagnosis of glaucoma with respect to structural and functional correlations.

[The role of vitreous body in pathogenesis of glaucoma]. / Rol' steklovidnogo tela v patogeneze glaukomy.

This literature review provides modern information on the unique structure of the vitreous body, its functions, and its role in the pathogenesis of glaucoma, describes the features of the vitreous morphology and metabolism, notes its biomechanical and trophic functions, outlines its role in healthy hydrodynamics and hemodynamics of the eye, as well as in aqueous humor outflow. The review presents clinical observations on the association of pathological changes in the vitreous body with glaucoma development and examines the role of involutional changes in the vitreous in the pathogenesis of glaucoma. The article also discusses possible pathogenetic mechanisms of glaucoma development in terms of pathological changes in the vitreous.

[Challenges of long-term glaucoma therapy]. / Problemy dlitel'noi terapii glaukomy.

Primary open-angle glaucoma (POAG) is among the most common causes of irreversible loss of visual functions, its early diagnosis and treatment present great difficulties. POAG development involves many mechanical, hemodynamic and metabolic factors. The main approach to its treatment is reduction and normalization of the intraocular pressure (IOP), starting with local antihypertensive therapy. But since glaucoma requires life-long management, lengthy topical therapy can itself become the cause of many serious issues. Most often, they include achieving consistent normalization of IOP, systemic and local adverse events, difficulties with patient compliance, decreased quality of life, increased risks of the glaucoma surgeries. Ophthalmological practice and research continue to demonstrate the need for changing the paradigm of POAG treatment.

[Frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries]. / Chastota i kharakter intra- i rannikh posleoperatsionnykh oslozhnenii posle antiglaukomnykh operatsii.

PURPOSE: To study the frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries depending on several factors. MATERIAL AND METHODS: The study retrospectively analyzed 87 outpatient records and case histories of patients with primary open-angle glaucoma (POAG). All subjects had undergone standard trabeculectomy. The indication for surgical treatment was deterioration of visual function associated with increased intraocular pressure (IOP). During the follow-up, an assessment was made of intraoperative and early postoperative complications, as well as factors leading to their development. RESULTS: During the observation period, the most frequently developing complications were found to be ciliochoroidal detachment - in 22 (25.8%) patients, and hyphema - in 12 (13.8%). One of the reasons for these complications is a significant, sometimes critical change in intraocular pressure when cutting open the eye. Isolated intraocular hypotension without signs of ciliochoroidal detachment was detected in 15 (17.24%) patients. Postoperative hypertension was found in 18 (20.68%) patients. Scarring of the newly created outflow tracts of intraocular fluid was the obvious cause of ophthalmic hypertension in 5 patients. In 16 (18.4%) cases, pronounced vascularization was found at the site of surgical intervention. CONCLUSION: The most significant factors that have a possible impact on the outcome of glaucoma surgery - specifically, its hypotensive effect - are: age, duration of local antihypertensive therapy, comorbid somatic pathology, and the initial IOP level.

[Thermography of ocular surface tissues in the assessment of aseptic postoperative inflammation]. / Termografiya tkanei glaznoi poverkhnosti v otsenke asepticheskogo posleoperatsionnogo vospaleniya.

PURPOSE: To determine the thermographic parameters of ocular surface tissues in various types of anti-glaucoma operations. MATERIAL AND METHODS: The study included 70 patients with glaucoma (140 eyes) and 28 patients (56 eyes) with cataract and planned phacoemulsification. All patients underwent dynamic infrared thermography of the eye surface to evaluate the aseptic inflammatory response before and after surgery. RESULTS: The increase in the temperature of the ocular surface tissues was longer after penetrating glaucoma surgery than after the non-penetrating type, which indicates a more prolonged inflammatory aseptic reaction in response to surgical intervention. CONCLUSION: The obtained results allow the development of a rational tactic of preoperative drug preparation and more effective postoperative management.

[The influence of long-term retinal protective therapy on glaucoma progression according to structural and functional tests]. / Vliyanie dlitel'noi retinoprotektornoi terapii na progressirovanie glaukomy po dannym strukturno-funktsional'nykh issledovanii.

PURPOSE: To evaluate the influence of prolonged neuroprotective therapy on disease progression in patients with primary open-angle glaucoma (POAG) with compensated intraocular pressure (IOP). MATERIAL AND METHODS: The study included 147 patients with stages I-II POAG (249 eyes) who were randomized into the main (69 patients, 119 eyes) and control groups (78 patients, 130 eyes). Patients of the main group underwent retinalamin treatment course every 6 months. Patients were examined before enrolling and then every 3 months during the 24-months follow-up including optical coherence tomography (OCT; RNFL - retinal nerve fiber layer, NRR - neuroretinal rim, GCL - ganglion cell layer) and static perimetry (MD - mean deviation, PSD - pattern standard deviation). RESULTS: Visual acuity and refraction did not change in either group (p>0.05). IOP increased in the control group (p=0.033). There was no difference between the groups by the 24th month (p=0.87). No MD changes were noted in the main (p=0.45) and control groups (p=0.27). PSD changed in the main (4.84±3.21 and 6.01±2.584 dB in the beginning and the end, respectively, p=0.0004) and the control groups (3.46±2.23 and 5.86±2.26 dB, respectively; p<0.0001). The groups differed in MD and PSD initially (p=0.15; p=0.02) and became equal by the end (p=0.59; p=0.53). RNFL did not change significantly in the main group (p=0.078) and decreased from 83.5±22.47 to 76.7±20.7 µm in the control group (p=0.001); no differences between the groups were noted in the beginning (p=0.276) or in the end of the study (p=0.524). NRR increased in the main group from 222±88.94 to 231±99.3 (p=0.012), and decreased in the control group from 248±87.09 to 234±96.2 (p=0.0006); no differences were found between groups in the beginning or in the end of the study (p=0.109; p=0.909). GCL thickness did not change either in the main, or in the control group (p=0.211; p=0.16), with no difference between the group noted in the beginning or the end of the study (p=0.44; p=0.51). CONCLUSION: Regular treatment with retinalamin arrests the development of glaucomatous optic neuropathy. Longer-term research is required to study its influence on the visual function and the quality of life.

[Peptide bioregulators: delivery and efficacy]. / Peptidnye bioregulyatory: sposob vvedeniya i effektivnost'.

PURPOSE: To compare the neuroprotective properties of retinalamin administered in different ways among open-angle glaucoma patients with compensated intraocular pressure. MATERIAL AND METHODS: The study included 498 patients (eyes) with initial, moderate and advanced stages of glaucoma. Patients were divided into 3 groups: group I (n=110) received 5 mg intramuscular and 5 mg retrobulbar injections of retinalamin; group II (n=171) received 5 mg retrobulbar injection of retinalamin; group III received 5 mg intramuscular injection of retinalamin. The overall treatment dose contained 50 mg of retinalamin. All the patients underwent tonometry and static perimetry. Patients of group II with initial glaucoma and patients of group III with moderate glaucoma also underwent contrast sensitivity tests. The examinations were conducted before the treatment, and on months 3 and 6. RESULTS: Visual acuity did not change significantly. In group I, after 3 months of treatment total threshold retinal sensitivity increased by 122 dB in patients with initial glaucoma, by 166 dB in moderate and by 124 dB in advanced glaucoma. Positive trend was observed in patients with initial and moderate stages of glaucoma by month 6. In group II, total threshold retinal sensitivity increased by 123 dB in initial glaucoma and by 110 dB in moderate; the result did not change by month 6. No significant changes were observed in patients with advanced glaucoma. In group III, total threshold retinal sensitivity increased by 142 dB in initial glaucoma, by 274 dB in moderate and by 148 dB in advanced glaucoma. Regression began on the sixth month. In group II, patients with initial glaucoma were observed to have decreased sensorimotor reaction times to achromatic stimuli within the studied areas of central visual field. In group III, patients with advanced glaucoma were also observed to have decreased sensorimotor reaction times to achromatic stimuli detected within 1° and 5° areas from the fixation point, but not in the 10° area. CONCLUSION: Retinalamin is most effective in initial and moderate glaucoma stages. Intramuscular, retrobulbar and combined administration methods have comparable efficacy.