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Clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma V.E. Korelina1, Z.M. Nagornova2, I.A. Bulakh3, A.V. Kuroyedov4,5, D.A. Baryshnikova6, A.B. Galimova7, A.M. Getmanova8, V.V. Gorodnichy5, S.A. Zubasheva9, U.R. Karimov10, S.V. Kosmynina11, E.B. Parova4, A.V. Seleznev2, I.I. Semenova12, T.V. Chernyakova4,13, A.P. Shakhalova14 (Scientific Avant-garde Research Group of the Russian Glaucoma Society, 2011–2023©) 1North West State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation 2Ivanovo State Medical University, Ivanovo, Russian Federation 3Ivastramed Medical Center LLC, Ivanovo, Russian Federation 4Pirogov Russian National Research Medical University, Moscow, Russian Federation 5P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 6Sectoral Clinical Diagnostic Center of the Gazprom PJSC, Moscow, Russian Federation 7Bashkir State Medical University, Ufa, Russian Federation 8Bryansk Regional Hospital No. 1, Bryansk, Russian Federation 9Treatment and Diagnostic Center No. 9, Moscow, Russian Federation 10Syr Darya Regional Ophthalmic Hospital, Gulistan, Republic of Uzbekistan 11Pavlov-Med LLC, Murmansk, Russian Federation 12Mogilev City Hospital of the Emergency Medical Care, Mogilev, Republic of Belarus 1352 Advisory and Diagnostic Center of the Ministry of Defense of the Russian Federation, Moscow, Russian Federation 14Tonus Amaris Medical Clinical Center, Nizhny Novgorod, Russian Federation Aim: to determine the clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma (POAG) with different duration of the disease, timing and treatment regimens. Patients and Methods: the final protocol of the cohort scientific clinical combined multicenter study included the case monitoring results in 115 patients (115 eyes) with advanced and severe stages of POAG; according to duration of the verified medical history, they were divided into two groups: 0.72 [0.32; 0.92] and 2.7 [1.9; 3.8] years. The indicators and characteristics (age, the disease stage, medical history, intraocular pressure level, hypotensive regimen and treatment satisfaction according to the Treatment Satisfaction Survey for Intraocular Pressure/TSS-IOP questionnaire) that may represent POAG treatment efficacy and tolerability criteria were studied. Results: age, intraocular pressure (IOP) level at the diagnosis verification timepoint and final examination in POAG patients were comparable in both groups. In spite of a significant decrease in IOP level due to local hypotensive therapy, morphometric parameters decreased. Patients experienced from one to five changes of treatment regimens. This was associated with both the IOP level and morphometric changes. The maximum hypotensive therapy was the most efficient and longest one, while monotherapy with beta-blockers showed the worst efficiency. TSS-IOP data analysis showed that, despite local adverse effects of antiglaucoma therapy, visual functions is a priority for the majority of patients. Conclusion: the study showed that tolerance to POAG treatment develops in a large number of patients at a fairly early stage. Initial monotherapy becomes ineffective in 79.6% of patients during the first six months of the treatment. A stepwise (conventional) approach to hypotensive glaucoma therapy is ineffective in patients with advanced and severe stages of POAG. The longer antihypertensive treatment duration, the more changes in local hypotensive therapy regimens were performed. Keywords: glaucoma, intraocular pressure, tolerance, duration of treatment, maximum hypotensive therapy. For citation: Korelina V.E., Nagornova Z.M., Bulakh I.A., Kuroyedov A.V., Baryshnikova D.A., Galimova A.B., Getmanova A.M., Gorodnichy V.V., Zubasheva S.A., Karimov U.R., Kosmynina S.V., Parova E.B., Seleznev A.V., Semenova I.I., Chernyakova T.V., Shakhalova A.P. (Scientific Avantgarde Research Group of the Russian Glaucoma Society, 2011–2023©). Clinical manifestations of treatment tolerance disorders in patients with primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2024;24(4):159–169 (in Russ.). DOI: 10.32364/2311-7729-2024-24-4-1

A.V. Seleznev1,2, U.L. Amashova1, A.Yu. Brezhnev3, Z.M. Nagornova1, A.C. Egorova1, A.V. Kuroyedov4,5 1Ivanovo State Medical Academy, Ivanovo, Russian Federation 2Ivanovo Regional Clinical Hospital, Ivanovo, Russian Federation 3Kursk State Medical University, Kursk, Russian Federation 4Pirogov Russian National Research Medical University, Moscow, Russian Federation 5P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation The selection of management strategy for closed globe injury with massive submacular hemorrhage (SMH) remains a pertinent issue, particularly in the context of the advent and improvement of surgical techniques. These patients typically maintain an active lifestyle and are highly demanding with regard to vision. Moreover, existing observational approaches and passive management of SMH are unacceptable for them. This paper describes two patients with closed globe injuries accompanied by SMH and significant vision loss. The active management strategy employed for these patients (pneumodislocation plus enzymatic lysis) was analyzed based on the results of optical coherence tomography, eye fundus photography, and visual acuity measurement. The intravitreal injection of drugs and a gas-air mixture resulted in a significant improvement of visual acuity due to the displacement of the subretinal blood clot to the extramacular area, reduction in the height and area of hemorrhage, and elimination of the toxic effect of blood elements on the retinal pigment epithelium and photoreceptors. This management strategy for SMH helps improve vision in a short time interval and to reduce potential negative effects of this condition. Keywords: subretinal hemorrhage, closed globe injury, choroidal rupture, intravitreal injection, tissue plasminogen activator, commotio retinae. For citation: Seleznev A.V., Amashova U.L., Brezhnev A.Yu., Nagornova Z.M., Egorova A.C., Kuroyedov A.V. Contemporary approach to the surgical management of traumatic submacular hemorrhage with choroidal rupture (case series). Russian Journal of Clinical Ophthalmology. 2024;24(2):94–100 (in Russ.). DOI: 10.32364/2311-7729-2024-24-2-9.

N.E. Fomin1,2, P.Ch. Zavadskiy3, A.V. Kuroedov1,2, A.V. Seleznev4, Z.M. Nagornova4, D.A. Baryshnikova5, R.V. Avdeev6, A.M. Getmanova7, I.A. Glushnev8, A.A. Gusarevich9, D.A. Dorofeev10, S.V. Kosmynina11, O.S. Myakonkaya12, N.A. Rebenok8, Yu.I. Razhko8, I.I. Semenova13, T.V. Chernyakova14 1P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation 3 Karelia Ophthalmological Center, Petrozavodsk, Russian Federation 4Ivanovo State Medical Academy, Ivanovo, Russian Federation 5Sectoral Clinical Diagnostic Center of the PJSC "Gazprom", Moscow, Russian Federation 6 N.N. Burdenko Voronezh State Medical University, Voronezh, Russian Federation 7 Bryansk Regional Hospital No. 1, Bryansk, Russian Federation 8Republican Scientific Practical Center of Radiation Medicine and Human Ecology, Gomel, Republic of Belarus 9 Clinical Hospital "RZD-Medicine" of the city of Novosibirsk, Novosibirsk, Russian Federation 10 City Clinical Hospital No. 2, Chelyabinsk, Russian Federation 11 P.A. Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russian Federation 12Volgograd Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd, Russian Federation 13 Mogilev City Hospital of the Emergency Medical Care, Mogilev, Republic of Belarus 14 Multidisciplinary Medical Center of the Bank of Russia, Moscow, Russian Federation Aim: to identify certain risk factors and their associations, which determine the prognosis of primary open-angle glaucoma (POAG) in patients with different disease stages. Patients and Methods: the final protocol of this clinical research combines multicenter study included the results of dynamic follow-up of 293 patients (293 eyes) with different stages of POAG. The mean age at the time of diagnosis was 65 (59; 70) years. The duration of verified POAG history was 3 (1; 6) years. Age, medical history, disease stage, IOP levels, IOP-lowering medications, comorbidities, other (social) factors (in total, 23 entities considered potential causes of refractory glaucoma) were investigated. All participants were divided into two groups (non-refractory glaucoma and refractory glaucoma) that included six subgroups according to current guidelines on achieving target IOP in various treatment approaches. Results: at the time of verified diagnosis and final examination of POAG patients, IOP levels were higher in the refractory glaucoma group and patients with advanced glaucoma (p Conclusion: our study has demonstrated that IOP levels at the time of verified diagnosis directly correlate with the stage of newly diagnosed glaucoma and IOP levels in the setting of glaucoma treatment and predetermine future refractory disease. Moreover, PEX, PDS, DED, CHD, prior myocardial infarction, and disability resulting from a general illness are additional factors determining POAG resistance to treatment. Keywords: glaucoma, intraocular pressure, refractory, risk factors, progression. For citation: Fomin N.E., Zavadskiy P.Ch., Kuroedov A.V. et al. Risk factors affecting progression and course of primary open-angle glaucoma in patients with different disease stages (multicenter study). Russian Journal of Clinical Ophthalmology. 2022;22(2):80–90 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-80-90.

Z.M. Nagornova1, A.V. Kuroyedov2,3, A.V. Seleznev1 1Ivanovo State Medical Academy, Ivanovo, Russian Federation 2 Central Military Clinical Hospital named after P.V. Mandryka, Moscow, Russian Federation 3Pirogov Russian National Research Medical University, Moscow, Russian Federation Currently, various glaucoma medications are available at the pharmaceutical market. Among them, fixed-dose combinations are of special importance which are considered as first-line agents for some patients (i.e., with advanced glaucoma or high intraocular pressure). Fixed-dose combinations are superior to individual components through the comfortable regimen with less instillations which improves treatment compliance. Moreover, IOP-lowering effect of fixed-dose combinations is similar or even greater than that of individual components due to the lack of washout phenomenon and less toxic effect of preservatives on the ocular surface. However, there are several disadvantages of fixed-dose combinations, e.g., dosing and regimen are inflexible and cannot easily be regulated. The paper discusses the results of clinical trials which compare the efficacy and safety of the most common fixed-dose combinations and their individual components. Thus, fixed-dose combinations of prostaglandin analogues and timolol maleate demonstrate similar IOP-lowering effect as compared with individual components and less side effects. Keywords: primary open-angle glaucoma, fixed-dose combination, glaucoma, combined therapy, treatment efficacy. For citation: Nagornova Z.M., Kuroyedov A.V., Seleznev A.V. Comparative analysis of the efficacy and safety of fixed-dose combinations versus their individual components for open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2019;19(1):13–19.

Z.M. Nagornova1, A.V. Seleznev1, P.Ch. Zavadsky2, A.V. Kuroyedov3,4 1 Ivanovo State Medical Academy, Russian Federation 2 High-tech Cataract Treatment Center «New Vision», Minsk, Republic of Belarus 3 Central Military Clinical Hospital named after P.V. Mandryka, Moscow, Russian Federation 4 Pirogov Russian National Research Medical University, Moscow, Russian Federation Aim: to study effectiveness of different regimens of primary open-angle glaucoma (POAG) therapy, choice and change algorithms of ophthalmic treatment components in conditions of real clinical practice. Patients and Methods: results of 398 patients (641 eyes) with different stages of POAG, diagnosed at least 6 months ago, were included in this study. At the time of enrollment in the study, a stage of the disease was verified according to current classification of glaucoma with intraocular pressure (IOP) measurement, analysis of morphometric and functional indices. Results: a mean level of IOP (all stages of the disease) at the time of glaucoma diagnosis was 28.00 (26.00; 30.00) mm Hg. It was established that a number of patients with IOP compensation is inversely proportional to a stage of the disease. All patients with the glaucoma (641 eyes) had 44 different regimens (therapy, lasers, surgery). IOP levels were analyzed in the patients with different stages of POAG who received these different regimens of therapy. Those patients in whom an advanced stage of the disease was diagnosed had significantly higher IOP at the time of diagnosis than patients with a second and first stage of the disease. An analysis of dependence of therapy regimen content on glaucoma history duration in the different stages of POAG was carried out, and the most “popular” regimens used were established. Conclusion: IOP level at the time of POAG diagnostics can determine a stage of the disease and serve as a prognostic sign of a disease course. To achieve a target IOP is possible at an early stage of the glaucoma in 95.86% of cases, at a moderate and advanced — in 74.14% and 35.95% of cases, respectively. There is a tendency to be chosen as a starting regimen for the early glaucoma of monotherapy with beta-blockers, while prostaglandin analogues are prescribed for duration of the disease for more than a year. With higher-level stages of the glaucoma, combinations of drugs and penetrating glaucoma surgery prevail. Key words: glaucoma, intraocular pressure, beta-adrenoblockers, prostaglandin analogues, combination therapy, therapy regimens. For citation: Nagornova Z.M., Seleznev A.V., Zavadsky P.Ch., Kuroyedov A.V. Choice regularities of antihypertensive therapy regimens of primary open-angle glaucoma in conditions of real clinical practice. RMJ “Clinical ophthalmology”. 2018;3:116–123.