[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.

[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.

[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.

[Pigmentary glaucoma: yesterday, today, tomorrow]. / Pigmentnaya glaukoma: vchera, segodnya, zavtra.

Pigment dispersion syndrome (PDS) is a condition that mostly affects young men with myopic refraction. PDS is characterized by the presence of Krukenberg spindle, peripheral iris defects, significant trabecular meshwork pigmentation, as well as convex iris configuration. Such configuration can cause friction of iris's posterior pigment layer on its ligaments, which leads to the release of pigment and its accumulation mostly in the structures of the anterior chamber. Over time PDS can progress into pigmentary glaucoma (PG), which in turn can lead to permanent loss of vision. This review analyzes available data on diagnosis and treatment of PDS and PG.

[Functional rehabilitation of a patient with central opacification of the intraocular lens optic (clinical case)]. / Funktsional'naya reabilitatsiya pri pomutneniyakh v tsentral'noi zone opticheskoi chasti intraokulyarnoi linzy (klinicheskoe nablyudenie).

The authors present a clinical case of central opacification of the intraocular lens (IOL) optic associated with a significant uncorrectable visual acuity decrease. Due to high surgical risks of IOL exchange, corectopia was achieved through sectoral laser photomydriasis. Stable dilation of the lower nasal sector of the pupil enabled the optical zone to be shifted outside the opaque area of the IOL. As shown by the perimetry results, the visual field borders enlarged through sectoral laser photomydriasis were comparable with the topography of the asymmetrically dilated pupil.

[Diode and argon trabeculoplasty in primary open-angle glaucoma treatment]. / Diodnaia i argonovaia trabekuloplastika v lechenii pervichnoi otkrytougol'noi glaukomy.

Laser trabeculoplasty is one of the methods used to decrease intraocular pressure (IOP) as part of comprehensive glaucoma treatment. Argon laser trabeculoplasty (ALT) and diode laser trabeculoplasty (DLT) are two of the most widely used laser trabeculoplasty techniques. The mechanism of its hypotensive action is based on the effect that laser emission photocoagulate has on trabecular meshwork and subsequent outflow facilitation, but the difference in wavelength and emission energy determine the difference in direct laser action and the features of postoperative clinical appearance. The efficacy of both methods has been verified in many studies; however, relatively few of them have made comparative analysis of the two techniques. The article reviews publications dedicated to comparing the efficacy of ALT and DLT, including their hypotensive effect, safety, as well as data on laser surgery tolerance and complications.

[Results of intraocular lens implantation on top of the anterior capsule in cases of phaco complications].

UNLABELLED: Posterior capsule rupture during cataract extraction requires that the intraocular lens (IOL) implanted on top of the capsular bag was stable and well-centered. The objective of this study was to evaluate the results of Rayner C-flex aspheric and M-flex aspheric (United Kingdom) IOLs implantation on top of the capsular bag and their stability in patients with phaco complications. MATERIAL AND METHODS: A total of 2556 phacoemulsification cases were analyzed. Posterior capsule rupture as a complication occurred in 7 cases, that is 0.27%. In all patients Rayner C-flex (5) and M-flex (6) IOLs were implanted on top of the capsular bag according to the initial calculations and with no modifications in the procedure. The 2nd-year follow-up included measurement of the corneal compensated intraocular pressure (IOP) and B-mode and 3D grey-scale ultrasound in order to assess the structures of the anterior segment and to check the position of the IOL. RESULTS: All surgeries yielded positive clinical results. In 2 years after the intervention uncorrected visual acuity averaged 0.7-0.13, corrected-- 0.91+0.07; clinical refraction: sphera-- +0.46 +/- 0.26 diopters, cylinder-- 0.71 +/- 0.29 diopters. The shape and other parameters of Rayner IOLs contribute to their long-term stability. Postoperative lOP in the treated eye was higher than in the fellow nonoperated eye (13.9 +/- 0.76 and 11.8 +/- 0.59 mmHg correspondingly) but the difference lied within the range of normal asymmetry. CONCLUSION: The 3D ultrasound technology is an informative mean of monitoring the position of the IOL in case of its extracapsular implantation; a comparatively higher IOP in the operated eye does not exceed the range of normal asymmetry between the two eyes; Rayner C-flex and M-flex IOLs remain stable and well-centered after being implanted on top of the capsular bag.

[Current techniques of laser therapy in glaucoma]. / Sovremennye tekhnologii lazernogo lecheniia glaukom.

The role of new technologies in glaucoma treatment, related with the use of semi-conductor laser irradiation, is described. Indications for laser therapy in glaucoma of different types have been significantly enlarged. Diode laser trabeculoplasty (DLTP) is a qualitatively new surgery based on the traction and perforation components. Diode transscleral cyclocoagulation (DTCC) enabled treatment of late stages glaucoma (sub-terminal and terminal ones), which previously was not subject to laser therapy. A combined method (DLTP and DTCC) ensured, in many cases, an effective treatment of resistant and already-operated glaucoma.

[The outlook for the use of diode laser radiation for trabeculoplasty in treating primary open-angle glaucoma]. / Perspektivy primeneniia izlucheniia diodnogo lazera dlia trabekuloplastiki v lechenii pervichnoi otkrytougol'noi glaukomy.

Clinical efficacy of diode laser trabeculoplasty is assessed in 35 eyes of 30 patients with primary open-angle glaucoma during during the initial and well-developed stages of diseases. Changes in the anterior segment of the eye, intraocular pressure, ocular hydrodynamics, visual functions, and status of the optic nerve were assessed 6-12 months after the operation. Diode laser trabeculoplasty is characterized by areactive clinical course and leads to a significant decrease of intraocular pressure, stabilizes and improves visual functions, and ameliorates intraocular humor discharge. The treatment runs a smooth course without complications. The method is recommended for clinical practice and further studies.