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Glaucoma is one of the world’s primary causes of blindness. Russia is following the global increasing trends of glaucoma and its leading position among ophthalmic pathologies that cause irreversible loss of vision. Elevated intraocular pressure (IOP) is the only modifiable risk factor of glaucoma, so treatment strategies specifically focus on reducing IOP by suppressing the production of intraocular fluid and boosting its outflow. The current review presents new medications aimed at glaucoma and high IOP control that have recently appeared at the international market as well as the drugs under the different stages of development, from experimental to clinical studies. These include both the developments of agents belonging to the existing classes and of entirely new drugs intended to control IOP. In an attempt to reduce the side effects of locally administered drugs and prolong their action, in parallel with the development of new drugs, there is also evidence of alternative methods of drug delivery: intraocular implants, injectable forms and obturators, combinations of polymers and colloidal systems.

In nearly all Russian regions, glaucoma ranks first among the causes of disability due to ophthalmic pathology, which is in line with global trends of glaucoma incidence growth and its leading position among the causes of irreversible blindness. Treatment of glaucoma is aimed at lowering intraocular pressure (IOP). This review presents the main current trends in the treatment of glaucoma: drug therapy, laser surgery, fistulizing, drainage and non-penetrating surgery, as well as the latest micro-invasive glaucoma surgery (MIGS).Currently, the pharmaceutical market offers many antihypertensive drops. Fixed-dose combinations of drugs have been proposed to increase treatment adherence, and effective drug delivery methods are being developed, which lower IOP with minimal side effects. Further development of laser surgery makes it both a method of choice for the initial treatment (selective laser trabeculoplasty) and expands its capabilities for various stages of glaucoma (micropulse cyclophotocoagulation). All this significantly reduces the frequency of classical macroinvasive antiglaucoma operations. The previously existing gap between conservative medical therapy and antiglaucoma surgery is filled by the newest MIHG procedures. In recent years, at all stages of primary open-angle glaucoma therapy, the emergence of new pharmaceuticals, methods and implants has been noted. These constitute the purpose of this publication.

Retinitis pigmentosa (RP) ranks first in the structure of hereditary retinal diseases. Vasoconstriction is one of the main ophthalmoscopic indications of PR. Laser speckle flowgraphy (LSFG) is a new non-invasive method that allows quantitative assessment of blood flow in the posterior pole of the eye.Purpose: to evaluate changes in blood flow as determined by the LSFG method in the area of the optic nerve head (ONH) and the macular area in PR patients.Material and methods. The study included 16 patients with PR aged 25 to 70 years. The control group consisted of 40 healthy volunteers, comparable in gender and age. Blood flow was determined using an LSFG-RetFlow device (Nidek), the main indicator of blood flow determined was MBR (Mean Blur Rate), which was measured for the entire study area, as well as separately for large vessels, and for the microvasculature. A wide range of pulse wave parameters determined by the tool instrument was also analyzed.Results. This study revealed a significant decrease in blood flow in PR patients compared with healthy individuals in different age groups and at different stages of the disease (p d 0.05). In patients with low visual acuity, the deficit of blood flow in the macular area was found to be more pronounced.Conclusion. LSFG is an effective method for determining ocular blood flow in PR patients. The data may indicate that a decrease in blood flow is an independent pathogenetic factor in the development of PD. In the future, the method can be used to assess the effectiveness of therapy of patients with PR.

Glaucoma is the top leading cause of ophthalmic-related disability in almost all Russian regions. It is a chronic lifelong disease which requires regular monitoring (once a year or more often) in a medical facility. Since the population is aging, the prevalence of glaucoma is steadily increasing, which hampers access to medical care. Advances in telecommunications and diagnostic technologies have given rise to programs of TV glaucoma, which are used to pass the basic glaucoma parameters on to a specialist working remotely for interpretation. The Federal Law No 242-FZ on telemedicine came into force on January 1, 2018, but the COVID-19 pandemic sped up the development of information technologies in medicine in general and telemedicine communication in particular. The review presents the data on TV glaucoma programs which point to their effectiveness and provides practical advice. Potentially, telemedicine can facilitate access to medical care. The analysis of the economic factors shows that remote consulting is more cost-effective than traditional face-to-face examination of the patient. TV glaucoma programs often help detect glaucomatous changes in the ONH, so more patients with suspicion of glaucoma are referred for screening.. Publications focused on the experience in using active programs contribute to their further development and introduction to the public health system, which will eventually facilitate the access to quality medical care for patients with glaucoma.

Circulatory disorders in eye vessels play an important role in the development of ophthalmic pathologies, in particular socially significant diseases such as glaucoma, age-related macular degeneration, diabetic retinopathy, and retinal vascular occlusion. Eye hemodynamics features are an important diagnostic criterion for both ocular and systemic diseases. A comprehensive assessment of blood flow in various structures of the eyeball offers additional information on the pathogenesis of the diseases and helps develop new approaches to monitoring the effectiveness of treatment and vascular pathology prognostication. Thanks to the improved technologies, we have today a variety of invasive and non-invasive techniques for examining ocular hemoperfusion, including those intended for retrobulbar blood flow and intraocular blood circulation evaluation. The review article is focused on the state-of-the-art techniques: fluorescein angiography, ultrasound examination involving blood flow assessment by colour Doppler mapping and Dopplerography, optical coherence tomography in the angiographic mode and laser speckle flowgraphy. The role of these techniques in the diagnosis of vascular pathology and their advantages and disadvantages when used in ophthalmological practice is considered.

The challenge of the coronavirus pandemic, and the research into the mechanism of development of the symptom complex that appears in patients who had COVID-19 (post-COVID syndrome), is a topical issue of modern medicine. Obviously, as the incidence of COVID increases, the number of patients suffering from the post-COVID syndrome increases, too. According to recent estimates, 10 to 20 % of patients who have experienced an acute symptomatic phase of SARS-CoV-2 suffer from the effects of the disease over 12 weeks from the primary diagnosis. COVID-19 has been shown to have a variety of long-term effects on virtually all body systems, including the eye. The ocular surface can serve as a gateway for the virus to enter the body, so that patients experience nonspecific changes in the conjunctiva, cornea, retina, and eye vessels. Thus, the issues of diagnosis and treatment of the COVID-19 infection itself and, notably, its complications and conditions that have arisen and continue after the disease, are of essential research and clinical interest. SARS-CoV-2 has a negative impact on the state of the vascular wall and contributes to the development of hypercoagulable conditions, which increases the risk of thrombosis and possible complications in the cardiovascular system. The review summarizes the analyses of eye vessels blood flow in patients who have undergone COVID-19.

Purpose: a comparative study of the efficacy and safety of the combination drug Brinzopt Plus and the original drug Azarga used as adjunctive therapy in patients with primary open-angle glaucoma (POAG) previously treated with latanoprost.Material and methods. 30 patients (42 eyes) with advanced and far advanced POAG were randomly divided into 2 groups of equal size. The patients of the main group (21 eyes) received Brinzopt Plus, those of the control group had the original drug Azarga, one instillation 2 times a day. The target points were intraocular pressure (IOP), visual acuity, perimetric indices (MD, PSD), mean retinal nerve fiber layer thickness, minimal neuroretinal rim width, retinal nerve fiber layer thickness in the macula, ganglion cell layer thickness in the macula, inner plexiform layer thickness, as well as the number of adverse events. The observation period was 12 weeks. IOP was measured at 4 and 12 weeks.Results. After 2 weeks, both groups showed a statistically significant decrease in IOP, which remained stable after 4 and 12 weeks. The average decrease in IOP in Brinzopt Plus recipients was 25% and revealed no statistically significant differences with the original drug at any control point. A positive dynamic of visual acuity, static perimetry and optical coherence tomography values, which showed no significant intergroup differences, was recorded. Among the adverse events, manifestations of mild local discomfort were recorded in 4 out of 15 patients of the main group and in 3 out of 15 patients of the control group. No serious or systemic adverse events were noted.Conclusion. Brinzopt Plus has an efficacy comparable to the original drug and a favorable safety profile.

Disorders of ocular perfusion are associated with huge amout of diseases, including such socially significant as diabetic retinopathy and glaucoma. To date, there is no gold standard for measuring ocular perfusion. An innovative method for two-dimensional assessment of eye blood flow — laser speckle flowgraphy (LSFG) — has been developed recent years and implemented in ophthalmological practice.Purpose: to evaluate the possibilities of LSFG for determining ocular blood flow and to find out the age dependence of the obtained indicators of ocular blood flow.Materials and methods. The study includes 60 healthy volunteers. The examined persons were divided into 3 groups of 20 people depending on their age — 20–40 years old, 41–60 years old, and over 61 years old. All examined persons had high visual acuity and normal blood pressure. The study was carried out on an LSFG-RetFlow device (Nidek). The shape of the pulse wave, its qualitative and quantitative characteristics including the main parameter of LSFG - MBR (Mean Blur Rate) were determined.Results. A significant decrease with age of most studied parameters of blood flow volume was revealed, the changes were significant (p £ 0.05). The highest MBR parameters were noted in the group of 20–40 years old. In the macular area, MBR values decreased more significantly in the group after 60 years age, while for the optic nerve head (ONH), a decrease has been already noted after 40 years age. In average, the decrease was 25–34 % for the ONH area and 33–38 % for the macular area. Changes of the other parameters of the pulse waveform had a similar trend.Conclusion. LSFG is a reliable method for quantifying ocular blood flow. Our data support that LSFG-derived MBR and pulse wave measurements may be useful biomarkers for ocular perfusion changes. The identified age-related blood flow changes should be taken into account during the analysis of patients data.

Purpose: a comparative study of the efficacy and safety of the generic drug Dorzial Plus, an analogue of the original reference drug Cosopt®, in patients with primary open-angle glaucoma (POAG).Material and methods. The study involved 80 patients of both sexes aged 55–75 with newly diagnosed POAG of the initial and advanced stages with uncompensated intraocular pressure (IOP), of which 40 patients (study group) received Dorzial Plus and 40 patients (comparison group) received the reference drug (Cosopt®). Hypotensive efficacy of the drugs in both groups was assessed using a portable ophthalmic tonometer Icare PRO (Finland) by reducing IOP from the initial level after 1 week, 1 month and 3 months of treatment.Results. In both groups, the screening showed comparable average IOP values: 26.7 ± 3.2 mm Hg in the reference drug group and 27.4 ± 2.8 mm Hg in the Dorzial Plus group. After 1 week of therapy with Cosopt, IOP showed a significant decrease of 33% (reduction to 17.9 ± 3.2 mm Hg), while the group receiving Dorzial Plus demonstrated a 31% decrease (reduction to 18.9 ± 1.7 mm Hg). After 1 month of the instillation regimen, a slight increase in P0 (of about 3%) was recorded in both groups (increase to 18.7 ± 2.3 and 19.7 ± 2.0 mm Hg, respectively). By the end of the 3 months’ follow-up period, IOP decrease level with respect to the baseline remained practically the same, amounting to 30 and 29% (up to 18.6 ± 1.8 and 19.5 ± 2.3 mm Hg), respectively. The state of the ocular surface showed a slightly negative dynamics of tear film rupture time and OSDI index in the reference drug group, which could be observed throughout 3 months of therapy. In the study group, therapy with preservative-free drug containing a moisturizing agent (sodium hyaluronate) revealed a significantly changed OSDI index, manifesting itself in restructured severity of the evaluated features.Conclusion. Dorzial Plus reduces IOP in POAG patients by an average of 30% of the baseline, so that its hypotensive efficacy is comparable to the original fixed combination Cosopt. The tolerability analysis of the study drug demonstrates a significant positive dynamic of the state of the ocular surface as soon as 3 months after therapy start.

Purpose: to study the clinical signs and effectiveness of laboratory diagnostics of fungal corneal ulcer complicated by endophthalmitis aimed at treatment tactics optimization.Materials and methods. 15 patients aged 20–55 with severe monocular fungal ulcer complicated by endophthalmitis were examined by microscopy and culture of corneal scraping on Sabouraud Agar; microscopy and culture of intraocular fluid and corneal fragments, obtained during the surgical treatment. Corneal scrapings from the corneal ulcer and corneal fragments removed during keratoplasty were tested in polymerase chain reaction (PCR) for the presence of deoxyribonucleic acid (DNA) of Candida albicans and total Fungi DNA.Results. Before treatment start, 2.5 hours after the biomaterial was taken, PCR revealed Fungi DNA in all 15 cases. Symptoms of the severe fungal corneal ulcer complicated by endophthalmitis and caused by Aspergillus spp have been identified and described. Conservative therapy and total penetrating keratoplasty (PKP) helped retain the eye in 13 out of 15 patients (86.7 %) and partially restore the visual functions.Conclusion. Rapid laboratory diagnosis of ophthalmomycosis using PCR offers an advantage over the culturing technique: the results are ready within 2.5 hours instead of 10-14 days (culture method); it is highly sensitive and allows identifying the fungi not only in the tissue of the removed cornea, but also in the сorneal scrapings. The effective treatment tactics of fungal corneal ulcer complicated by endophthalmitis combining PKP with pre-operative and long-term postoperative antifungal therapy was proposed.