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Insufficient blood supply, vascular dysregulation, perfusion pressure and endothelial dysfunction may account for the pathogenic mechanism. OCT angiography (OCTA) measurements have been reported to be useful for glaucoma diagnostics. OCTA microvasculature could serve as a potential biomarker for glaucoma diagnosis. One of the important criteria for the treatment of NTG is the reduction of IOP, which is achieved by both conservative methods of treatment and laser and surgical interventions. With timely diagnosis, control of IOP and monitoring of morphofunctional changes in the eyes with NTG, it becomes possible to suspend the development of glaucoma optic neuropathy and preserve the patient’s vision for a long time.

In the modern world, glaucoma is one of the main causes of irreversible vision loss. Normal tension glaucoma (NTG) constitutes the major proportion of POAG, which is common in Asian populations. NTG is a disease resulted from the interaction of multiple genetic risk factors. But other factors are also important, such as thinning of the scleral lamina cribrosa and a lesion of the transmembrane pressure gradient. Central visual field defects and disc hemorrhage are characteristics finding that is highly associated with the progression of NTG.

Posterior eye segment involvement in COVID-19 has varied manifestations: vascular, inflammatory, and neuronal. All of them are triggered by SARS-CoV-2 virus but they cannot be viewed as exclusively specific to COVID-19. According to the literature, the mean age of the patients varies from 17 to 75 with the median of 50 years. The median duration between the appearance of ophthalmic symptoms and the detection of COVID-19 was 12 days. The disease affects both men and women equally. Direct exposure to the virus, immune-mediated tissue damage, activation of the coagulation system, the prothrombotic state caused by a viral infection, concomitant diseases and medications used in the treatment contribute to the development of eye pathologies. Ophthalmologists should be aware of the possible relations of posterior eye segment pathologies, orbit and neuro-ophthalmic disorders with SARS-CoV-2, as well as the possible exacerbation of chronic forms of inflammatory eye diseases and autoimmune disorders due to anti-COVID-19 vaccination.

In COVID-19, eye damage may develop at any stage of the disease. Viral ribonucleic acid has been found in ocular tissues, but the role of the eye as a route of infection is yet to be substantiated. Ophthalmic manifestations may be a typical feature of COVID-19 infection or they may develop several weeks after recovery. Ophthalmologists should be aware of possible relationships of an ophthalmic pathology with SARS-CoV-2 in order to obtain targeted case history, detect the specific signs, prescribe the necessary tests and thereby reduce the spread of the infection. These relationships are also important for early diagnosis and treatment of complications that threaten the patients’ life and vision. The first part of the review focuses on the possible involvement of the eye in SARS-CoV-2 infection and the spread of infection. Clinical manifestations of the anterior segment damage are considered.

Purpose. To evaluate the application of the principal component analysis (PCA) and DD-SIMCA in a comparative analysis of the surgical treatment of primary angle closure.Material and methods. The prospective study included 90 patients. Group 1 — 30 patients with primary angle closure (PAC) with planned laser peripheral iridotomy (LPI). Group 2 — 30 patients with PAC, with planned phacoemulsification with intraocular lens implantation (PE+IOL). Group 3 — 30 eyes without ophthalmic pathology. All subjects underwent SS-OCT. Thirty-seven parameters were analyzed, including intraocular pressure, choroidal thickness in the macula, anterior chamber depth, lens vault, iris curvature and thickness, angle opening distance, and iridotrabecular space at 500 µm and 750 µm from the scleral spur. Since all these parameters correlate with each other, machine learning methods were used: PCA and the DD-SIMCA one-class classification method. For this purpose graphs of scores and loads in the PCA model for groups 1 and 2 were plotted. In the score plot, patients with PAC with average and extreme eye parameters were identified, and in the loading plot, relationships between the parameters of patients with PM were used to analyze correlations in the future. In the DD-SIMCA method, group 1 is taken as representatives of the target class.Results. A classification model based on 2 principal components with a given type I error α = 0.01 demonstrated a sensitivity of 100 % for patients in its own group and a sensitivity of 93 % for patients in group 2. These results confirm similarity of group 1 and group 2. The specificity for the control group was 100 %, and this group located far from the target group.Conclusion. Machine learning methods make it possible to compare groups with multivariate and correlated parameters. PCA allows the identification of patients with extreme parameters and the evaluation of correlations between multiple parameters. DDSIMCA confirms the validity of comparing the results of treatment with LPI and FE + IOL.

Purpose — to study morphological and functional changes in the detection of primary glaucoma progression.Patients and methods. 128 patients (128 eyes, among them — 64 eyes with primary open angle glaucoma (POAG) and 64 with primary angle closure glaucoma (PACG)) with the initial MD of –6.0 dB were examined at the Ophthalmology Center of the FMBA of Russia from May 2016 to November 2019. The values of corneal-compensated IOP were also considered: minimal (IOPmin), peak (IOPmax) and its fluctuations (IOPfluct). The progression was measured using standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). During the observation period, each patient received the average of 8.42 ± 2.08 SAP and SD-OCT. Progressive thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated using SD-OCT. If RNFL and/or GCC had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The correlation between the rate of progression detected by SAP (ROP1) using thinning of RNFL (ROP2) and GCC (ROP3) with other clinical parameters was analyzed.Results and discussion. Glaucoma progression was detected in 73 eyes. While the isolated use of SAP did not allow detecting progression, it was possible to detect it in 39 % cases by SD-OCT. The combination of both methods allowed detecting progression in 57 %. In both forms, ROP1 correlated with IOPmin: in PACG r = 0.41, p = 0.023 and in POAG r = 0.43, p = 0.016. In PACG, ROP2 and ROP3 correlated with the foveal choroid thickness: r = 0.46, p = 0.019 and r = 0.47, p = 0.009, respectively. At the same time, ROP3 was associated with peak IOP (r = –0.402, p = 0.025); the correlation of peak IOP with its fluctuations amounted to 0.7 (p < 0.001).Conclusion. SD-OCT is more informative than SAP in determining the progression of the initial primary glaucoma. The combination of these two methods 1.5 times increases the possibility of detecting progression in comparison with the isolated use of SD-OCT. The choroid thickness, associated with the IOP fluctuations, plays an important role in the progression of PACG.

The purpose of this work is to review the literature data on the role of optical coherence tomography in the diagnosis of diseases of the closed angle of the anterior chamber. The analysis of the use of modern technical devices — optical coherence tomography of the posterior segment, models with a frequency-modulated source (Swept Source) is presented. The emergence of new imaging technologies such as SS-OCT contributes to understanding the pathogenesis of primary angle closure diseases in terms of involvement of the choroid in the process. A thicker choroid in the macular area may be an anatomical risk factor for closed angle disease. The expansion of an abnormally thick choroid in combination with the structural features of the anterior segment in eyes with a short axial length, including against the background of psychoemotional stress, can lead to an attack of angle closure. Visualization of the structures of the posterior segment of the eye is an important part of the strategy aimed at solving the problem of identifying risk factors, diagnosing, monitoring and evaluating the effectiveness of treatment of diseases of primary angle closure. Qualitative and quantitative data analysis based on optical coherence tomography significantly increases the diagnostic accuracy, allows to determine its progression and to predict its course. This plays a key role in the choice of treatment tactics for the anterior chamber angle closure. The review considers the effect of local antihypertensive eye drops on the choroid.Conclusion. Optical coherence tomography is a standard in modern diagnostics and evaluation of the effectiveness of treatment of diseases of primary angle closure, allowing a better understanding of the pathogenesis of the disease and its complex nature. Imaging improves the ability to accurately diagnose and choose the right treatment strategy.

The purpose of this work is to review the literature data on the role of optical coherence tomography in the diagnosis of diseases of the closed angle of the anterior chamber. An analysis of the modern technical devices use — optical coherence tomography of the anterior segment (AS-OST) and models with a frequency-modulated source (Swept Source) is presented. The advent of new imaging technologies such as SS-OCT is advancing the understanding of the pathogenesis of primary angle closure diseases. Visualization of the structures of the anterior segment of the eye is an important part of the strategy aimed at solving the problem of identifying risk factors, diagnosing, monitoring and evaluating the effectiveness of treatment of diseases of primary angle closure. Qualitative and quantitative data analysis based on optical coherence tomography significantly increases the diagnostic accuracy, which undoubtedly plays a key role in the choice of treatment tactics for the closed angle of the anterior chamber. The interpretation of research results should take into account the strengths and weaknesses of traditional methods and newly developed technologies.Conclusion. Optical coherence tomography of the eye’s anterior segment is a standard in modern diagnostics and evaluation of the effectiveness of treatment of diseases of primary angle closure, taking into account pathogenetic mechanisms.

Relevance. Choroidal effusion is a complication accompanying both surgical interventions and ophthalmopathies of predominantly inflammatory etiology. The release of proteins from choriocapillaries lumen and decrease of intraocular pressure relative to the pressure in the episcleral veins lead to the chor oid detachment.Purpose. To analyze the causal link between choroidal effusion and topical application of carbonic anhydrase inhibitors using a clinical example.Material and methods. The paper describes a clinical case of the development of unilateral recurrent choroidal effusion 13 years after sinus trabeculectomy associated with the use of carbonic anhydrase inhibitors. The first episode of choroidal effusion was induced by a fixed combination of brinzolamide with timolol, while the use of dorzolamide caused the repeated episode. The clinical picture was accompanied by significant decrease in visual acuity related to acute hypotension and severe folds of the descemet’s membrane. Ultrasonic B-scanning revealed the choroid detachment. The dechallenge of carbonic anhydrase inhibitors, the use of anti-inflammatory and cycloplegic drugs contributed to achieve the choroid adherence.Results. This clinical case clearly demonstrates a causal link between choroidal effusion and topical application of carbonic anhydrase inhibitors. The timely drug therapy made it possible to avoid surgical intervention. Intraocular pressure increased later. Brimonidine was prescribed to reduce it, the intraocular pressure was normalized, and the clinical picture stabilized.Conclusion. Ciliochoroidal effusion may occur in the eyes with primary angle-closure glaucoma even several years after surgical treatment in the setting of the use of this group of hypotensive drugs. It is necessary to take a balanced approach to the use of carbonic anhydrase inhibitors in each particular case, i ncluding in primary angle-closure glaucoma.

Topical and systemic carbonic anhydrase inhibitors (CAIs) are widely used in the treatment of glaucoma for reducing intraocular pressure. This part of the review describes the characteristics of systemic CAIs, their side effects and the ways to overcome them, as well as contraindications. The use of CAIs during pregnancy is considered. Particular attention is paid to the antioxidant activity of CAIs and the promising development of hybrid forms based on the existing CAIs as a part of a multipurpose glaucoma treatment strategy.

Purpose. To evaluate the effectiveness and the factors predictive of long-term failure of selective laser trabeculoplasty (SLT) in patients with the initial stage of primary angle-closure (PACG) and primary open angle glaucoma (POAG).Materials and methods. 65 PACG patients (65 eyes) and 65 POAG patients (65 eyes) were observed for 6 years. SLT was considered to be successful if its hypotensive effect consisted in an IOP decrease ³ 20 % achieved without any additional hypotensive treatment by antiglaucoma drop instillations or any hypotensive intervention (repeated SLT, antiglaucoma surgery, cataract phacoemulsification). The effectiveness was assessed using the Kaplan — Meier survival analysis. To determine the factors predictive of SLT, one-factor Cox proportional hazards regression analysis was used. Results. The hypotensive effect of SLT achieved was, for PACG and POAG, respectively, (1) 82 and 84 % one year after surgery; (2) 62 and 68 % two years thereafter, (3) 59 and 63 %, three years thereafter, (4) 34 and 42 %, four years thereafter, (5) 26 and 38 %, five years thereafter, (6) 4 and 8 % thereafter (log rank test, p = 0.234). The predictors of SLT failure were common for both forms of glaucoma in Cox regression analysis, namely: initial IOP > 24 mm Hg (OR = 1.184, p = 0.029 for PACG and OR = 1.156, p = 0.010 for POAG), corneal hysteresis < 9,5 mm Hg (OR = 1.441, р = 0.022 for PACG and OR = 1.486, р = 0.030 for POAG), corneal thickness < 540 μm (OR = 1.586, р=0.021 for PACG and OR =1.648, p =0.030 for POAG), reduced thickness of the retinal nerve fiber layer < 90 μm (OR = 1.231, p = 0.014 for PACG and OR =1.194, p = 0.027 for POAG) and age > 68 years (OR = 1.162, p = 0.040 for PACG and OR = 1.167, p = 0.000 for POAG). The additional failure predictors for PACG were the span of exposure to SLT < 180 0 (OR = 1.686, p = 0.004) and lens thickness > 4.86 mm (OR = 4.841, p = 0.001). Hypertension, diabetes mellitus, trabecular pigmentation degree and the type of antiglaucoma drugs taken before SLT were not found to be significant predictors of SLT effectiveness.Conclusion. SLT is an effective method of treating initial POAG and PACG after laser iridotomy. The long-term effect of SLT in both forms of glaucoma is affected by the initial IOP, glaucoma stage, and the patient’s age. The most important role in PACG is played by the span of SLT exposure and the size of the lens..

Purpose: to investigate the average speed and risk factors for the glaucomatous optic neuropathy (GON) progression during longterm observation. Patients and methods. The 10-year data of 750 patients were analyzed. The average GON progression rate was calculated on the basis of perimetry and optical coherent tomography data. Further, according to inclusion and exclusion criteria 128 patients were included into the group of retrospective analysis. Resultes. The following risk factors were established: initial cornealcompensated IOP (IOPcc) > 23.6 mm Hg (AUC 0.7), IOPcc after 5 years > 19.8 mm Hg (AUC 0.83), age > 69.5 years (AUC 0.6), corneal hysteresis < 9.9 mm Hg (AUC 0.6) and retinal nerve fiber layer < 92 μm (AUC 0.6). Patients with pseudoexfoliation syndrome, and patients taking systemic calcium channel blockers (p = 0.01) also had the higher risk of GON progression. Its rate was lower in patients with arterial hypertension (p = 0.015), and in patients who received prostaglandin analogues (risk was 5 times reduced, p = 0.04) and fixed combinations (risk was 2 times reduced, p = 0.018). IOPcc of higher than 17.6 mm Hg in the long-term period is the most pronounced risk factor for the progression of GON. It was determined that the average ROP of glaucoma progression among the patients was 0.6 dB/year for ROP1, 0.62 ± 1.09 μm/year for ROP2 and 0.95 ± 3.28 μm/year for ROP3, also each 1 dB/year decrease in photosensitivity (in group with glaucoma progression) was associated with further loss of RNFL (3.9 µm/year). Conclusion. The use of prostaglandin analogues and fixed combinations reduces this risk.

Prostaglandin analogues (PAs) are the drugs of choice in the treatment of primary open-angle glaucoma (POAG). However, they have pro-inflammatory properties and may cause macular edema. Tafluprost is the first PA to be free of preservatives. The efficacy and safety of tafluprost, as well as that of tafluprost/timolol fixed combination (FC), was demonstrated in randomized multicenter trials. However, there are no literary data concerning the effect of tafluprost and its FC on the thickness of the macula. Purpose. To assess the effect of tafluprost and tafloprost/timolol on the retinal thickness in the macular area in patients with POAG. Material and methods. The retinal thickness (RT) was measured with an interval of a week in 36 patients (36 eyes) with a newly diagnosed initial stage of POAG, 12 of whom were prescribed taflotan, 12 patients received tafluprost/timolol FC, and 12 eyes represented the control group (no drugs were prescribed). The measurements were performed in the macular area using a spectral domain optical coherence tomography (SD-OCT) by means of the RtVue xR Avanti with the AngioVue OCT angiography function. The change in the intraocular pressure (IOP) and RT from the inner limiting membrane (ILM) to the inner plexiform layer (inner retina) and to the pigment epithelium (PE) in fovea and parafovea in total and by sectors were estimated by comparing paired repeated observations using the median growth analysis. Results. In the tafluprost group, a 19.4 % IOP decrease was revealed and in the tafluprost/timolol group the decrease achieved 43 % with respect to the reference level. In patients receiving tafluprost, an increase in the RT in parafovea was noted: median growth 2 μm (p = 0.035); and in patients receiving tafluprost/timolol — in the inner layers of parafovea: median growth 3 μm (p = 0.031), and its inferior half: median growth 2.5 μm (p = 0.023). These changes were obtained in 10 patients out of 12 in each treated group. In untreated patients, the RT remained unchanged. The visual acuity did not change in any group of patients. Conclusions. In patients with glaucoma, a thickening of both the inner layers and the entire macular retina occurred within a week after treating with tafluprost or its FC, leaving no clinical manifestation. This fact should be taken into account in patients likely to develop macular edema.

Purpose to develop a new algorithm for treatment of primary angle closure glaucoma (PACG) based on laser peripheral iridotomy (PI) and selective laser trabeculoplasty (SLT) and to determine its indications and contraindications. 68 eyes with PACG were observed for 6 years. These patients had undergone PI and then SLT. The control group included 74 POAG eyes of the same age and stage of glaucoma. The effectiveness of SLT was assessed using the Kaplan-Meier survival analysis. The risk factors for SLT failure in the long-term period were studied to determine the indications and contraindications for this treatment algorithm, and the condition of corneal endothelium in dynamics was investigated using confocal microscopy. The hypotensive effect of SLT in PACG was worse than in POAG: 90 and 93% respectively one year after SLT, and 16 and 21% six years after SLT (log rank test, p=0.195). The following factors of SLT failure were common for both forms of glaucoma: IOP 24 mm Hg, corneal thickness 540 m, corneal hysteresis 7 mm Hg and age of patients 68 years. The extension of laser action 1800 and lens thickness 4.8 mm were additional predictors of SLT failure in PACG. In both forms of glaucoma, diabetes mellitus, age of patients and duration of the disease before SLT had a negative effect on the condition of corneal endothelium. The anterior-posterior axis and the presence of pigment deposition on the endothelium were significant in PACG. The proposed algorithm for PACG treatment, including the initial performance of PI and then SLT, is an effective method of treating this form of glaucoma, provided that the opening of the anterior chamber angle is sufficient (at least half) and the lens thickness is no more than 4.8 mm. The initially high IOP, the age of patients over 68 and a thin cornea (540 m) worsen the SLT prognosis. Moreover, diabetes mellitus and the presence of pigment deposition on the endothelium along with long-term glaucoma history increase the risk of corneal endothelium damage after SLT.

Purpose. To evaluate an efficiency of selective laser trabeculoplasty (SLT) in treatment of patients with primary angle closure glaucoma (PACG) following a YAG laser peripheral iridotomy (PI) compared with primary open angle glaucoma (POAG) in long-term follow-up period.Material and methods. The SLT hypotensive efficiency was evaluated in 68 eyes with the initial PACG after PI performed not earlier than one month before SLT and in 74 eyes with initial POAG. The quantity of necessary hypotensive medication to decrease IOP ≤21 mm was also considered. Rate of progression (ROP) of glaucoma optic neuropathy was assessed using the MD index, RNFL and GCC thickness. Follow-up period lasted 6 years.Results. The IOP was decreased significantly after SLT in both groups in long-term period. However, hypotensive effect was more pronounced in PACG – 41.18% compared to POAG – 28.38%. After 6 years, a significantly less quantity of hypotensive eye drops was required to achieve a hypotensive efficacy in PACG than in POAG: 0.68±0.92 and 1.18±0.75, respectively (р=0.035). There was no significant difference in ROP between PACG and POAG: -0.06±0.65 dB/year and -0.14±0.48 dB/year, respectively for MD (р=0.461); -0.57±1.82 μm/year and -0.62±1.59 μm/year for RNFL (р=0.372); -0.60±2.36 μm/year and -0.71±1.98 μm/ year for GCC (р=0.292).Conclusion. The SLT is a safe and effective laser treatment method for the initial stage of PACG after peripheral laser iridotomy. Hypotensive effect of SLT in case of PACG is higher than in POAG, especially 2 and 6 years after the procedure. The SLT in the initial stages of POAG and PACG allows to stabilize glaucoma optic neuropathy.

To assess the blood supply to the peripapillary area in patients with primary open-angle glaucoma (POAG) using optical coherence tomography with the function of amplitude decorrelation angiography (OCT-A). Material and Methods. 65 eyes of POAG patients (the main group) and 22 eyes of age-matched healthy subjects (the control group) were examined. Spectral OCT (SD-OCT) technique with AngioVue OCT function was used to measure the average value of amplitude decorrelation (Peripapillary Flow Index), peripapillary vessel density, the parameters of the ganglion cell complex (GCC), including the focal loss volume (FLV) and the global loss volume (GLV), and the retinal nerve fiber layer (RNFL). Results. We revealed that blood flow reduction in the peripapillary retina, detected by OCT-A, precedes not only the functional but also the structural loss, determined by OCT and SAP. Conclusions. The new noninvasive technique for the examination of retinal blood flow, OCT-A, determines the reduction of hemoperfusion in peripapillary retina even at an early POAG stage and can serve as an important diagnostic method for early glaucoma detection // Russian Ophthalmological Journal, 2016; 3: 34-41. doi: 10.21516/2072-0076-2016-9-3-34-41.

There are two different points of view on the role of ocular microcirculation in glaucoma. According to one of them, ocular hemoperfusion reduction is a consequence of nerve tissue atrophy. Other authors suggest that the retinal microcirculatory bed can already be damaged at early stages of the disease, causing the death of neuronal structures. However, little is known today about retinal microcirculation in glaucoma. The introduction of optical coherence tomography angiography (OCTA) has opened prospects in understanding the connection of microcirculatory and structural damages in glaucoma. The paper provides the data on the anatomy and physiology of microcirculatory bloodstream of the retina and optic disc, which were obtained using OCTA. For citation: Kurysheva N.I. OCT angiography and its role in the study of retinal microcirculation in glaucoma (part one). Russian ophthalmological journal. 2018; 11 (2): 82-6. doi: 10.21516/2072-0076-2018-11-2-82-86 (In Russian).

A new diagnostic method of ocular microcirculatory bloodstream - optical coherence tomography angiography (OCTA) has helped obtain new information on the anatomy and physiology of microcirculatory bloodstream of the retina and the optic disc. The review provides literary data on the reduction in peripapillary and macular blood flow in various glaucoma stages. These changes are shown to correlate with structural and functional disorders. It is emphasized that OCTA is a prospective method for early detection of glaucoma and for glaucoma monitoring. For citation: Kurysheva N.I. OCT angiography and its role in the study of retinal microcirculation in glaucoma (part two). Russian ophthalmological journal. 2018; 11 (3): 95-100 (In Russian). doi: 10.21516/2072-0076-2018-11-3-95-100

Relevance. The ability of antiglaucoma drugs to improve ocular hemoperfusion is an important aspect of their action. Tafluprost is the first prostaglandin analogue (PA) containing no preservatives. The efficacy and safety of tafluprost, as well as tafluprost/timolol fixed combination (FC), was demonstrated in randomized multicenter trials. However, there is no literature on the effect of tafluprost and it’s FC on peripapillary and macular blood flow.Purpose. to assess the effect of tafluprost and tafloprost/timolol on the microcirculation in the optic nerve head, peripapillary area and macula in patients with primary open-angle glaucoma (POAG) according to OCT angiography (OCT-A).Patients and methods. OCT-A was performed in dynamics with an interval of a week in 36 patients (36 eyes) with a newly diagnosed initial stage of POAG, 12 received tafluprost, 12 — tafluprost/timolol FCs, 12 eyes represented control group (no drugs were prescribed). The change in IOP, mean perfusion pressure (PP) of the eye, and vessel density (VD) inside the optic nerve head (ONH) (inside disc), as well as in the peripapillary retina and macula were evaluated by comparing paired repeated observations using the median growth analysis.Results. In the tafluprost group there was a decrease in IOP by 19.4 % and an increase in PP by 8.7 % from the reference level. In the tafluprost/timolol group, these figures were 43 % and 30.1 %, respectively. OCT-A values did not change reliably, except for VD inside Disc: in the tafluprost group, the median growth was –2.28 (p = 0.02), for the tafluprost/ timolol group — –1.82 (p = 0.03). These changes were obtained in 11 patients of 12 in each group under treatment. In patients who did not receive treatment, all indicators remained unchanged.Conclusions. The results of this study showed a decrease in the density of the microcirculatory bed in the ONH in patients with initial glaucoma against the background of the tafluprost and tafluprost/timolol treatment, which can be explained by the restoration of autoregulation of the ocular blood flow in conditions of pronounced hypotensive drugs effect.

The role of elevated intraocular pressure (IOP) in the progression of glaucoma optical neuropathy has emphasized repeatedly. The question about the role of elevated IOP as the underlying cause of glaucoma arose in the early 1960s. However, epidemiological studies have questioned the role of IOP as a diagnostic criterion for glaucoma, due to the relatively rare detection the disease among those with ocular hypertension and frequent detection of glaucoma with normal IOP. Multicenter studies determining the role of antihypertensive therapy in the treatment of glaucoma, have shown the importance of reducing IOP: decricing IOP at 1 mm Hg reduced the risk of developing glaucoma on 10-19%. In addition, it was found that the rate of glaucoma progression is very variable. It depends not only on the form of glaucoma, but also on other factors such as the stage of disease and therapy. Swedish study shown normal-tension glaucoma often progressed among the patients with more aggressive treatment such as argon laser trabeculoplasty or trabeculectomies. According to the study’s data, age is the most important risk factor for the progression of normal-tension glaucoma. Such questions as fluctuations in IOP, reduction of retrobulbar blood flow, antihypertensive treatment on the progression of glaucoma are still discussed. Despite the fact that the latter UKGTS multicenter study (2014) showed a decrease in the rate of progression of glaucoma in patients treated with latanoprost, a high percentage of non-treated patients didn’t have disease’s progression. In this regard, the role of IOP as main starting factor in glaucoma pathogenesis is still open.

Purpose: To evaluate the hemoperfusion of Optic Nerve Disk (OND), peripapillary and macular areas, and retrobulbar blood flow in patients with primary open-angle glaucoma using optical coherence tomography with angiography (OCT-A) and Сolor Doppler Imaging (CDI).Patients and Methods: 65 eyes of patients with primary open angle glaucoma (POAG) and 22 eyes of age-matched healthy subjects were examined using the SD-OCT-А (RtVue xR Avanti with the AngioVue software). Retinal Thickness and Angio Flow Density (AFD) were measured. AFD Disc and Peripapillary Flow Density were measured in OND and in peripapillary area. AFD Retina were evaluated in Macula inсluding Fovea- and Parafovea regions (superficial and deep) of the inner retinal layers. Ophthalmic Artery (OA), Central Retinal Artery (CRA), Posterior short Ciliary Arteries (PCA), Central Retinal Vein (CRV) and Vortex Vein (VV) were measured by CDI. Statistical analysis was performed using SPSS version 21 and MASS library of language R. The value of each diagnostic indicator (z-value) was calculated with the Wilcoxon-Mann-Whitney test and the area under the receiver operating characteristic curve (AUC).Results: Both OCT-A and CDI indicators were reduced in glaucoma compared to healthy eyes. The following indicators had the largest AUC and diagnostic value (z-value) to discriminate the early glaucoma from normal eyes: AFD Retina Superficial Whole En Face (z = 3,83, p

Purpose: to study the vascular platelet hemostasis parameters in primary open-angle glaucoma (POAG).Patients and methods: ophthalmic examination, plasma level of spontaneous and induced platelet aggregation and von Willebrand factor (vWF) were performed in 67 patients with high pressure glaucoma (HPG), 41 patients had normal tension glaucoma (NTG) and 38 were in control group. Period of study was 36 months. The statistical analysis included standard methods of variation statistics. The threshold P value for statistical significance was 0.05.Results: platelet aggregation was increased in glaucoma (adrenalin-induced aggregation in HPG was 63,34 %±20,42 %, р = 0,043, in NTG 62,35 %±11,53 %, р = 0,047, in comparison with control group — 49,71 %±15,96 %; ristocetin-induced aggregation in HPG was 79,45 %±28,63 %, р = 0,015, in NTG 68,98 %±12,42 %, р = 0,022, and in control group 53,56 %±8,80 % accordingly); the mean level of vWF was increased in HPG (113,25 %±24,31 %, р = 0,009) and NTG (106,85 %±21,02 %, р = 0,012) in comparisonwith control group (93,86 %±17,13 %). Patients with normal level of vWF did not have a progression of glaucoma optical neuropathy. Patients with normalized level of vWF under treatment had significant improvement of MD in 6 months (from –4,916±5,121 to –4,103±4,658, р = 0,037) and were stable in the further follow up period. Patients with increased level of vWF had deterioration of MD in 36 months (from –4,616dB±8,426 dB to –5,974dB±8,852 dB, р = 0,042), increase of cup / disk ratio (from 0,59±0,21 to 0,66±0,24, р = 0,041) and thinning of average RNFL according to HRT and OCT (from 0,21±0,09 μm to 0,17±0,08 μm, р = 0,04; from 74,37±15,34 μm to 69,44±15,12 μm, р = 0,04).Conclusion. The obtained results indicate the importance of the vascular platelet hemostasis in POAG pathogenesis and the perspectives of its correction in glaucoma treatment.

Purpose: to study the informativeness of pseudoexfoliation syndrome (PES) signs for early diagnosis improvement.Methods: 250 patients with PES were included in the study. Exclusion criteria consisted of aphakia, pseudophakia, previous eye surgery and diseases which can complicate PES diagnostics (uveitis, corneal pathology, ocular injury etc.). Each patient underwent complete ophthalmic examination, including slit-lamp examination under mydriasis, gonioscopy. Confocal microscopy was used as an additional diagnostic method in several patients (Confoscan-4, Nidek).Results: Pseudoexfoliation material was found at the pupillary margin in 64.8% of patients, and on the lens capsule (central disc) in 71% of the test subjects. Peripheral depositions were present in almost all PES patients under mydriasis. Pupil dilation has been allowed to establish the diagnosis of PES additionally in 16% of patients. At the «mini-PES»-stage PES material was most frequently found in the superior-nasal quadrant of lens capsule (85.6%). Clinical asymmetry of several signs (pupil diameter, anterior chamber angle pigmentation, IOP level) should be taken into consideration in early PES diagnostics.Conclusion: Examination under mydriasis and knowledge of PES micro-signs in some cases has been allowed to suspect PESeven at the preclinical stage.

Purpose: to determine whether there is any difference in autonomic innervation of the cardio-vascular system in normal tension glaucoma (NtG) patients and primary open angle glaucoma (POAG) patients.Methods: 30 NtG patients, 30 POAG patients and 22 control group patients underwent photoplethysmography following cold provocation testing. Several parameters showing cardio-vascular innervation have been evaluated and compared in three groups.Results: the three selected parameters demonstrated the dominance of the sympathetic nervous system over parasympathetic nervous system in both glaucoma groups (NtG and POAG) and not in the control group. In contrast to POAG and the control group, the NtG patients showed strong increase in sympathetic nervous system activity following the cold provocation test.Conclusion: Our studies revealed the dominance of sympathetic innervation in glaucoma patients in general. the cold provocationtest results strongly suggest primary vascular dysregulation in NtG patients.

Aim. Comparative study of choroidea, retina ganglion cell complex (GCC) and regional hemodynamics in primary open angle (POAG) and pseudoexfoliative glaucoma (PEG) patients.Materials and methods. 40 POAG patients and 36 PEG patients with the same disease stage were observed. MD –1.52±0.27 in POAG group and –2.38±0.35 in PEG group (p = 0. 069). Subjects were age-matched (ranged from 60 to 70 years: 69.41±1.207 66.32±0.75 in PEG group;p = 0.32) and comparable for axial eye length (24.08±0.38 in POAG group, 23.48±0.27 in PEG group; p = 0.208).Results. Significant difference in focal loss of retinal ganglion cells (FLV) between POAG and PEG groups was revealed (1.875±0.399 and 3.535±0.684, respectively; p = 0.035). Choroidea thickness decrease was discovered in PEG patients as compared with POAG patients: 219.55±17.81 and 266.93±15.9, respectively, at the fovea (p = 0.048);and 117.1±10.1 and 158.3±14.8, respectively, at the peripapillary area (p = 0.026). The reduction of blood flow velocity in ophthalmic artery (29.08±2.38 cm / sec), central retinal vein (5.22±0.29 cm / sec) and superior ophthalmic vein (5.22±0.29 cm / sec) were observed in PEG group as compared with POAG group (34.10±1.47, 7.54±0.53 and6.47±0.33 cm / sec, respectively). The significance of these differences is confirmed by the following data: p = 0.05 (for Vsyst in ophthalmic artery), р = 0.012 (for Vsyst in central retinal vein) and p = 0.007 (for Vmean in superior ophthalmic vein).Conclusion. At the same disease stage, PEG is characterized by greater choroidea thinning, GCC damage and reduced blood flow in large retrobulbar vessels as compared with POAG.

Purpose: To compare the effect of selective laser trabeculoplasty (SLT) in phacic and pseudophacic patients with glaucoma.Methods: A retrospective chart review was performed on 148 eyes of 139 patients with moderate primary open angle glaucoma (POAG). In the first group (pseudophacic group) 50 patients (50 eyes) underwent SLT at the period of 6 months and more after uneventful phacoemulsification cataract surgery, in the second (phacic group: 9 patients, 98 eyes) — 2‑3 months prior it. The post-laser follow up examinations were carried out at 1 day, 1 week, 1 month, 6 months and 12 months of follow-up. Average intraocular pressure (IOP), its decrease, and MD — mean deviation perimetric index — for phakic and pseudophakic eyes were compared statistically at each time period. A t-test was used to compare the IOP reduction between the phakic and pseudophakic groups.Results: IOP reduction in the pseudophakic group was statistically significant in the 1 month of follow up (from 28.3 mm Hg to 18.6mm Hg, p = 0.02), while in the phacic group its reduction was statistically significant in all steps of observation. The statistically significantdifference of IOP decrease level between groups was obtained in 1 week and 1 year after SLT. The MD perimetric index decreased by 3.89 dB (from –7.63 to –11.52) in the pseudophakic group and increased by 0.65 dB (from –4.31 to –3.66) in the phakic group.Conclusion: SLT is a safe and effective means of IOP reduction in pseudophakic glaucoma patients. However it seems to be more effective in lowering IOP if performed prior to cataract surgery: effect of SLT in pseudophakic eyes reduced through 6 months. SLT performed on phakic eyes might play a role in visual field improvement.

Purpose: to study the antioxidant activity of carbonic anhydrase inhibitors and timolol fixed combinations and to compare it with other fixed combinations.Methods: Antioxidant activity (AOA) of dorzolamide/timolol (Cosopt), dorzolamide/timolol (Dorzopt Plus), latanoprost/timolol, brimonidine/timolol, travoprost/timolol and bimatoprost/timolol fixed combinations was measured in vitro using the model of oxida- tive hemolysis.Results: Dorzolamide/timolol (Cosopt) AOA was higher than that of other fixed combinations and increased with the quantity of the drugs added to the model system: 40%, 52% and 75% in 30 μl, 60 μl and 90 μl respectively.Conclusion: these findings suggest that dorzolamide/timolol fixed combination has potential advantages over the other fixed combinations due to its high antioxidant activity and might be used as the neuroptotective agent for glaucoma treatment.

Purpose: to compare сhoroidal thickness (CT) in primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG).Methods: сhoroidal thickness was evaluated in 30 patients (30 eyes) with PACG, 30 patients (30 eyes) with POAG and 30 control subjects by means of optical coherence tomography (RTVue-100 OCT, Optovue, Inc., Fremont, CA) in fovea (CTf) and in peripapillary region (CTp). Patients in both groups were well matched for glaucoma stage (MD 1,46±1,73 dB in POAG and –1,89±2,34 dB in PACG, p = 0,44) and age: 70,0±6,64 in POAG and 68,0 ±4,68 in PACG (p = 0,29).Results revealed a statistically significant increase of CT in PACG patients in comparison to POAG: 372,81±126,83 μm and 251,25±79,56 μm (p = 0,002), respectively for CTf, and 204,56±115,9 μm and 29,0±61,48 μm (p = 0,03), respectively for CTp.Conclusion: Increased CT might be another anatomic characteristic of AC eyes. These findings may support the hypotheses that choroidal expansion is a contributing factor to the development of AC disease.

Purpose: To study the influence of venous blood flow on the ganglion cell complex (GCC) in patients with preperimetric and perimetric open angle glaucoma.Methods: 74 patients were included in the research. 59 eyes and 62 eyes were diagnosed with preperimetric and perimetric open angle glaucoma respectively. The mean age was 56.5±10.5 years. 22 (12 female and 10 male) healthy individuals constituted the control group. The ganglion cell complex and retinal nerve fibre layer were evaluated with the help of optical coherence tomography (RTVue-100 OCT, Optovue, Inc., Fremont, CA). Ocular blood flow was measured by Color Doppler Imaging (multifunctional VOLUSON 730 ProSystem). The statistical analysis included correlation between GCC and RNFL thickness in both glaucoma groups.Results: The results showed a statistically significant reduction of venous blood flow velocity in both glaucoma groups compared to the control group. No difference in venous blood flow parameters between two glaucoma groups was found, except resistance index, which was higher in perimetric group in comparison to preperimetric group. A correlation was also obtained between venous blood flow parameters and GCC and RNFL thickness in both glaucoma groups.Conclusion: Early GCC damage in glaucoma might occur due to venous blood flow reduction. This fact may be of great value in understanding glaucoma pathogenesis and search for novel treatment options.