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Purpose: Primary open-angle glaucoma (POAG) is a common ocular disease, associated with abnormalities in aqueous humor circulation and an increase in intraocular pressure (IOP), leading to progressive optical neuropathy and loss of vision. POAG pathogenesis includes alterations of the structural properties of the sclera, especially in the optic nerve head area, contributing to the degeneration of the retinal ganglion cells. Abnormal sclera biomechanics hinder adequate compensation of IOP fluctuations, thus aggravating POAG progression. The proteomic basis of biomechanical disorders in glaucomatous sclera remains poorly understood. This study is aimed at revealing alterations in major scleral proteins, associated with POAG, at different stages of the disease and with different IOP conditions., Methods: Samples of sclera were collected from 67 patients with POAG during non-penetrating deep sclerectomy and from nine individuals without POAG. Scleral proteins were extracted with a strong lysis buffer, containing a combination of an ionic detergent, a chaotropic agent, and a disulfide reducing agent, and were separated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The major scleral proteins were selected, subjected to in-gel digestion, and identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF)/TOF mass spectrometry (MS), coupled with tandem mass spectrometry (MS/MS). The specific POAG-associated alterations of the selected proteins were analyzed with SDS-PAGE and confirmed with western blotting of the scleral extracts, using the respective antibodies. The group of POAG-associated proteins was analyzed using Gene Ontology and genome-wide association study enrichment and protein-protein interaction network prediction., Results: A total of 11 proteins were identified, among which six proteins, namely, vimentin, angiopoietin-related protein 7, annexin A2, serum amyloid P component, serum albumin, and thrombospondin-4, were found to be upregulated in the sclera of patients with advanced and terminal POAG. In the early stages of the disease, thrombospondin-4 level was, on the contrary, reduced when compared with the control, whereas the concentration of vimentin varied, depending on the IOP level. Moreover, angiopoietin-related protein 7 manifested as two forms, exhibiting opposite behavior: The common 45 kDa form grew with the progression of POAG, whereas the 35 kDa (apparently non-glycosylated) form was absent in the control samples, appeared in patients with early POAG, and decreased in concentration over the course of the disease. Functional bioinformatics analysis linked the POAG-associated proteins with IOP alterations and predicted their secretion into extracellular space and their association with extracellular vesicles and a collagen-containing extracellular matrix., Conclusions: POAG is accompanied by alterations of the scleral proteome, which represent a novel hallmark of the disease and can reflect pathological changes in scleral biochemistry and biomechanics. The potential mechanisms underlying these changes relate mainly to the structure of the extracellular matrix, protein glycosylation, and calcium binding, and may involve fibroblast cytoskeleton regulation, as well as oxidative and inflammatory responses., (Copyright © 2020 Molecular Vision.)

Introduction: Ocular inflammation is a key pathogenic factor in most blindness-causing visual disorders. It can manifest in the aqueous humor (AH) and tear fluid (TF) as alterations in polyunsaturated fatty acids (PUFAs) and their metabolites, oxylipins, lipid mediators, which are biosynthesized via enzymatic pathways involving lipoxygenase, cyclooxygenase or cytochrome P450 monooxygenase and specifically regulate inflammation and resolution pathways., Objectives: This study aimed to establish the baseline patterns of PUFAs and oxylipins in AH and TF by their comprehensive lipidomic identification and profiling in humans in the absence of ocular inflammation and comparatively analyze these compounds in the eye liquids of rabbits, the species often employed in investigative ophthalmology., Methods: Ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used for qualitative and quantitative characterization of lipid compounds in the analyzed samples., Results: A total of 28 lipid compounds were identified, including phospholipid derivatives and PUFAs, as well as 22 oxylipins. Whereas the PUFAs included arachidonic, docosahexaenoic and eicosapentaenoic acids, the oxylipins were derived mainly from arachidonic, linoleic and α-linolenic acids. Remarkably, although the concentration of oxylipins in AH was lower compared to TF, these liquids showed pronounced similarity in their lipid profiles, which additionally exhibited noticeable interspecies concordance., Conclusion: The revealed correlations confirm the feasibility of rabbit models for investigating pathogenesis and trialing therapies of human eye disorders. The identified metabolite patterns suggest enzymatic mechanisms of oxylipin generation in AH and TF and might be used as a reference in ocular inflammation studies.

The clinical observation of a patient with a rare pathology - "nutcracker syndrome". Difficulties of diagnosis verification are described.

Purpose: To study the hypotensive efficacy and safety of Travapress (0.004% travoprost) in patients with primary open-angle glaucoma (POAG)., Material and Methods: The study included 50 patients (91 eyes) aged 45 to 74 years. The first group consisted of 23 patients (41 eyes) who received monotherapy with Travaprost. Patients of the second group (27 patients, 50 eyes) Travaprost was added to therapy with timolol 0.5% (17 patients, 32 eyes) or dorzolamide 2% (10 patients, 18 eyes). Travaprost was given for a period of 6 months. IOP was determined in 2 weeks, 1, 3 and 6 months from the beginning of treatment and daily IOP measurement was at 10.00, 12.00, 14.00 and 16.00. Subjective symptoms were evaluated in points by special scales., Results: The study was completed by 42 patients (84%, 79 eyes). Two patients (4.7%) has stopped to use Travapress due to the side effects. Local side effects were observed in 9 patients (21.4%) with mild hyperemia being the most common and seen in 5 patients (11.9%). In the first group, the maximum IOP decrease was recorded for 3 months of the study and amounted to 7.3±1.2 mm Hg (27.5%) compared to baseline. By 6 months, IOP decreased by 6.8±1.5 mm Hg on average (25.6%). In the second group in the subgroup with timolol 0,5% IOP decreased by 4,9±1.7 mm Hg (20%) compared to baseline, in the subgroup with dorzolamid 2% - by 4,3±1,3 mm Hg (16,9%) compared to baseline. Evening use the drug was accompanied by significantly lower levels of daily IOP fluctuations compared with morning intake (3.0±1.2 and 3.8±1.7 mm Hg, respectively, p = 0,002)., Conclusion: Travapress was established as highly efficient and safe. It can be recommended for wide use in the treatment of patients with POAG.

Purpose: To assess the effect of latanoprost and fixed combination of dorzolamide/timolol on ocular hemodynamics in patients with primary open-angle glaucoma (POAG)., Material and Methods: The study examined 34 patients (56 eyes) aged 51 to 69 years (average - 62.4±9.7 years) diagnosed with POAG in the initial (31 eyes) or advanced stage (25 eyes). Patients of the first group (20 patients, 36 eyes) were receiving latanoprost (Glauprost, Rompharm Company, Romania). The second group (14 patients, 20 eyes) was assigned to receive a fixed combination of dorzolamide/timolol (Dorzopt plus, Rompharm Company, Romania). Patient examination before and at 6 and 12 months included tonometry (ICare PRO), perimetry (Heidelberg Edge Perimeter), HRT and OCT of the optic nerve (Heidelberg Retina Tomograph 3 and Spectralis OCT2), as well as measurement of the density of surface (SVL) and deep (DVL) vascular plexus, and the Bruch's membrane opening minimum rim width (BMO-MRW). Additionally, we evaluated microcirculation in the choroid (MC) according to our original technique that uses Spectralis OCT2, and calculated rheographic index (RI) and stroke volume using transpalpebral rheoophthalmography., Results: The decrease in IOP in the Latanoprost group was on average 27% and in the control group receiving timolol and dorzolamide - on average 22% and remained stable until the end of the study. The value of the area and volume of the disc rim band, BMO-MRW did not exhibit statistically significant changes in both groups by the 12th month of observation. A tendency to increase the RI from 51.5±24.5 to 62.2±19 (p=0.084) and the median of the index of microcirculation of the choroid (MC) from 16476 up to 23767 (p=0.062) in 1st group was observed., Conclusion: The study confirms the feasibility of using latanoprost and a fixed combination of dorzolamide and timolol in ocular hypotensive therapy of glaucoma thanks to their pronounced hypotensive effect. Patients were noted to have a tendency for improvement of ocular hemodynamics when using latanoprost.

Purpose: To determine optimal design parameters of a transpalpebral tonometry sensor (the weight and diameter of the rod) based on experimental simulation., Material and Methods: The study has been conducted in situ at the forensic analysis department with 12 eyes of 5 men and one woman aged 49 to 71 years. Comparison between the tonometric pressure and the true pressure measured with direct manometric technique ensured the accuracy of transpalpebral tonometry data and helped select optimal sensor parameters. For this purpose, an experimental assembly was designed and produced, comprised of a testing stand with a system of tubes filled with distilled water, an indicating pressure gauge calibrated by the height of the water column, a millimeter scale on a holder, as well as a needle with connecting tubes and two valves., Results: No statistically significant differences between the tonometric and manometric level of pressure in the eye were observed when using a sensor weighing 16 g with rod diameter of 1.5 or 3 mm. Only an insignificant dependence of the tonometry data on the thickness of the eyelid was noted at high levels of intraocular pressure (IOP)., Conclusion: The experimental study conducted on the developed assembly has allowed us to substantiate the choice of optimal design parameter for a transpalpebral IOP measurement sensor. A transpalpebral tonometer with such sensor characteristics can be recommended for comparative clinical study, as well as for determination of its effectiveness in dynamical monitoring of the IOP levels.

According to various studies, treatment adherence of patients with primary open-angle glaucoma ranges from 5% to 80% and significantly influences the effectiveness of the therapy. Some authors report higher levels of adherence in patients receiving preservative-free medications., Purpose: To study the influence of treatment adherence in patients receiving preservative-free and preserved medications on the progression of primary open-angle glaucoma (POAG)., Material and Methods: This prospective multicenter non-interventional study was conducted in clinical setting and included 504 patients with primary open-angle glaucoma receiving drug therapy; 51 ophthalmologist was involved in the management of patients' diaries., Results: The percentage of patients who did not reach target IOP was three times lower in the group with high adherence, in comparison to patients with medium and low adherence (7% against 22%, respectively). Development of side effects was one of the factors influencing treatment adherence, their rates and expressiveness were much lower in the preservative-free group compared with the group receiving preserved medication (13.9% against 35.4%). The rate of patients who did not reach target IOP was two times lower in the group of preservative-free medication (10% against 21%)., Conclusion: The study confirms that preservative-free glaucoma medication promotes higher adherence to treatment in clinical setting predominantly due to the reduction of quantity and severity of side effects leading to treatment gaps, which results in increased effectiveness and better stabilization of glaucoma.

The purpose of the study was to develop a new algorithm of aqueous humor dynamics assessment in glaucomatous eyes, which would take into account the shape of the tonographic curve and individual elastic properties of the corneoscleral capsule. Basic ophthalmic examination supplemented with tonography and differentiated tonometry was performed on 33 patients with primary open-angle glaucoma (POAG), 8 POAG suspects, and 9 healthy controls. Obtained data were processed in accordance with the developed algorithm. A new formula for calculating the coefficient of outflow facility and several additional parameters describing the condition of aqueous pathways were proposed. In POAG patients these parameters significantly differed from those in healthy controls.

The goal of the investigation was to study the changes of scleral matrix collagen in progressing primary open-angle glaucoma (POAG). In scleral samples of 16 patients aged 52-81 years with different stages of POAG amino acid composition, collagen content and cross-linking ratio characterizing tissue rigidity were estimated. Collagen I was found to be the dominant type in sclera of glaucomatous and normal eyes, though as POAG progressing the content and cross-linking increase, that underlies the scleral rigidity increase and permeability decrease. Similar ratio of collagen cross-linking with age and glaucoma progression give evidence of specific pathologic changes of the dominant matrix component, that may be one of significant pathogenic factor of POAG.

In patients with ischemic heart disease, the administration of contrast agents iodixanol, ioversol and gadobutrol improves (due to the effect of dilution) the aggregation of erythrocytes in vivo, but does not change their deformation ability and the percentage of different morphological forms of erythrocytes (discocytes and ehinocytes) in the blood. The effect of gadobutrol on the aggregation of erythrocytes is characterized by more expressed antiaggregant effect due special molecular properties of this drug.

It is established that the x-ray contrast agents urografin (76 %), omnipaque-300, optiray-350, ultravist-300, and visipaque-270 produce a dose-dependent decrease in the deformation properties of human erythrocytes in vitro. The degree of manifestation of this negative influence increases with the osmotic activity of agents in the following order: visipaque = ultravist < or = omnipaque < or = optiray < urografin. The effect of these x-ray contrast agents on the deformation of erythrocytes is reversible. Erythrocytes restore their normal deformation properties upon removal of the osmotic pressure induced by the x-ray contrast agents.

This study was designed to analyse dynamic characteristics of planned and emergency surgical care provided to patients with chronic tonsillitis (CT) in 3 large hospital of Moscow during the period between 2002 to 2006. The number of planed surgical interventions for the treatment of chronic tonsillitis performed during 5 years decreased almost two-fold. In contrast, the total number of urgent operations for surgical drainage of paratonisillar abscess in all clinics of the city during the last 10 years increased by a factor of 2. Results of bacteriological studies of species composition of microflora in patients with CT suggest the relationship between the incidence of this pathology and acute rheumatic fever. Analysis of activities aimed at the prevention of chronic tonsillitis (based in the first place at specialized dispensary facilities) has demonstrated that the number of patients involved in relevant monitoring programs is rather small and those in need of radical sanation of inflammatory CT foci are not referred for surgical treatment at the early stages of the disease as required by the current diagnostic and therapeutic algorithm for the management of chronic tonsillitis.

The paper presents the results of experimental use of a polyglycolide material-based filling for temporary episcleral filling in retinal detachment. Thorough comparative morphological and biomechanical studies of 120 experimental eyes in different periods after scleroplasty, by using an inflatable balloon catheter, homoscleral and polyglycolide fillings, have indicated that the polyglycolide filling material is completely lysed by ocular tissues within 60-90 days, which rules out a repeated surgical intervention for removal of temporary filling (for example, an inflatable balloon catheter), by preserving the constancy of the depth of scleral pressing-in. The short existence of a chemically indifferent polyglycolide filling in the ocular tissues excludes its negative effect on the surrounding structures of the eye, minimizes the likelihood of the occurrence of early postoperative complications, but thereby leading to a substantial increase in the biochemical stability of the scleral-and-chorioretinal complex in the early postoperative periods and ensuring increased resistance to dynamic loads, by forming a stable scleral-and-chorioretinal adhesion 3 months after surgery. The findings suggest that the designed polyglycolide explant has advantages and that it is expedient to introduce the new Russian resolving polyglycolide fiber explants into clinical practice (for scleroplastic operations).

The electrosurface properties of track membranes made from poly(ethylene terephtalate) were determined by streaming potential (SP) and electron spin resonance (ESR) methods. The membrane pore diameters were in range from 20 to 200 nm. The pore electrical charge surface density values calculated with data obtained with methods mentioned differed dramatically. This difference was explained with the gel layer located at pore surface. The pore possesses a high large surface amassing a large electrical charge arising as a result of carboxylic groups dissociation. This charge cannot be detected with SP method due to high hydraulic resistance of the gel layer. In contrast to SP method, ESR detects all active centres parental of electrical charge at gel surface.

The morphology of taking in of synthetic transplants after scleroplasty is studied in 24 eyes of chinchilla rabbits. Polytetrafluorethylene-based materials (composite filtration fluoroplast membrane--Teflon) and polyester jersey with reticular structure (scleracod) were used for transplantation. Study of two materials showed common processes and differences in the grafts taking in. Implants made of both materials are characterized by good biocompatibility, which prompts further investigation of their probable use in sclera-fortifying treatment of progressive myopia.

The authors analyze the efficacy of treating patients with vitreoretinal diseases using a pathogenetically-based system of comprehensive medical rehabilitation and the results of ophthalmological examination recorded and processed in a special computer case history. Prognostic analysis making use of nonparametrical statistics method distinguished highly informative signs determining the results of medical rehabilitation in traumatic detachment of the retina. Basic methods of surgical rehabilitation are supplemented with preventive YAG laser surgery. Modern scleroplastic materials are offered. The authors emphasize the significance of two staged adequate postoperative rehabilitation during the immediate postoperative period with special emphasis on the agents regulating redox processes; later YAG lasers and other stimulators can be used. Other perspective trends of research are study of electroenesis and pathogenesis of vitreoretinal proliferation for drug development.

Nineteen case histories are analyzed: 1) 6 patients with postperforative detachment of the retina; 2) 8 patients with detachment of the retina after a penetrating wound with introduction of a foreign body; and 3) 6 patients with postcontusion detachment. The restoration of the alpha and beta ERG waves depended on the type of injury: after penetrating wounds, the changes in the retinal electrogenesis were the most manifest during the initial and early postoperative period; foreign bodies aggravated and decelerated the regeneration of visual function, contusion trauma of the eye is the most unfavorable factor complicating the restoration of visual functions; involvement of the paired (intact) eye is typical, as is changed functional reaction of the retina in injuries of all types.

Proliferative vitreoretinopathy (PVR) was induced in 25 rabbits by injection of autologous adenosine phosphate-activated platelets in the vitreous. Injury to the internal interface retinal membrane as a result of adhesion of aggregated platelets to it, followed by the formation of an epiretinal membrane, underlies the morphogenesis of experimental PVR. Proliferative processes in the retina were paralleled by destructive atrophic changes in it, which might be due to active physiological substances released in the course of aggregation. The development of PVR was inhibited by a synthetic peptide of cell adhesion with Arg-Gly-Asp-Ser amino acid sequence, which was injected simultaneously with autologous activated platelets. Possible receptor mechanisms underlying the phenomenon of inhibition of the proliferative process in the retina of experimental animals are discussed.

A method of intrascleral transplantation of foam gel providing the creation of stable chorioretinal adhesion at the site of the retinal defect has been experimentally developed and clinically tried. A special injector has been designed for the realization of the method, permitting stratification of the scleral capsule at a given depth. The suggested method is recommended for practical use in patients with rheumatogenic detachment of the retina in the initial and moderate degrees of vitreoretinal proliferation.

New textile-based material is suggested for scleroplastic surgery for detachment of the retina. Features of the design of the new material are described and the efficacy of the implants assessed. Textile-based implants are recommended for clinical practice.

A method for comprehensive microsurgical treatment of perforating wounds of the eyeball is described, and the criteria for assessing the efficacy of this surgical intervention are defined.

Diet therapy conducted in 135 patients with coronary heart disease resulted in the reduction (68.9% of cases) and normalization (49.6% of cases) of the total cholesterol level in the blood (TCS). The lowering of TCS level, as a rule, was combined with the diminution of triglyceride level in the blood and reduction of the initial excessive body mass. To correct the shifts in lipid metabolism, it was enough to make relatively insignificant changes in nutrition: to exclude the products too rich in cholesterol, to restrict the consumption of hard fats, to increase the content of vegetable oils and food fibres in the ration. A total of 13 out of 30 patients who were followed up by the dietitian during 1-7.5 months after the second visit returned to their routine type of nutrition that was attended by a rise in TCS content in the blood. No effect of the diet therapy was recorded in a small number of patients.

Introduction of new economic principles in the activities of medical research institutions helps extend the rights and responsibilities of the institutes' stuff and make them economically interested in the results of their activity; these principles provide high quality of treatment and prophylaxis work and permit concentrating all the resources on the priority trends in medical research. The authors discuss the pressing problems in introducing the cost accounting system in the activity of a research institute in ophthalmology.

A system for estimating labor consumption in, and quality of the therapeutic and diagnostic process, based on the medicosocial and economic analysis of the current ocular morbidity structure in Russia, is suggested. This estimation system may be useful in condition of cost accounting relations introduction in research institutions of ophthalmologic profile.

After prophylactic scleroplasty for high complicated myopia the patient developed bilateral detachment of the retina. Therapeutic strategy with this patient is followed up. The described clinical case evidences the necessity of a strict validation of the choice of this or that surgical modality, particularly in cases when it concerns the only eye with vision.

The system of estimating the cost of care of ophthalmologic patients improves out- and inpatient registration and helps assess the medical aid rendered to the patients; it permits an effective exploitation of the resources of therapeutic institutions and helps coordinate the activities of various departments.

Study of the clinical and immunological indicators in 101 patients with chronic recurrent pancreatitis has demonstrated that 98.5% of the examined were sensitized to pancreatic antigen (according to the data of the different tests of cell immunity). The total immunological responsiveness in chronic pancreatitis patients did not differ from that in normal subjects. After treatment with antipancreatic mechanically and chemically sparing diets containing 80-90 g fat, 300-350 g carbohydrates and 140-150 g protein (diet 1P) and 110-120 g protein (diet 2P) there was a positive time course of the clinical symptomatology and of a number of biochemical indicators, as well as a decrease in the sensitization to pancreatic antigen and an increase in the total immunological responsiveness. Application of the diet containing 110-120 g protein produced a more demonstrable reduction in the degree of specific sensitization, correlating with a more favourable time course of the patients' status. At the same time application of the diet containing 140-150 g protein gave rise to a more substantial rise of the total immunological responsiveness. The conclusion is made about high efficacy of the antipancreatic diets, particularly of the diet containing 110-120 g protein and about the advisability of the use of the immunological tests for the appraisal of the general status of patients, activity of the pathological process in the pancreas, and the efficacy of the treatment.

Lovastatin was investigated in a single-blind placebo-controlled trial in 150 patients with coronary atherosclerosis confirmed by coronary angiographic studies and those with nonfamilial hyperlipoproteinemia. After 3 months of treatment total cholesterol (TC) level was reduced by 36% (p less than 0.001), LDL cholesterol level by 48% (p less than 0.001), triglycerides level by 19% (p less than 0.001), VLDL cholesterol by 24% (p less than 0.01), whereas the HDL-cholesterol level was increased by 36% (p less than 0.001). Besides, concentration of apolipoprotein A-I increased by 19% (p less than 0.05), apolipoprotein B decreased by 22% (p less than 0.05) and the ratios of LDL cholesterol/HDL cholesterol and TC/HDL cholesterol decreased by 64% and 56%, respectively (p less than 0.001). The side effects of lovastatin were negligible. Thus, lovastatin is a highly effective and well tolerated hypolipidemic drug for the treatment of patients with IHD and hyperlipoproteinemia.