Ophthalmic Hypertension Research Articles

Pathogenesis of Increased Intraocular Pressure in Primary Open‑Angle Glaucoma: Literature Review

Introduction. Despite the high socio-economic significance of primary open-angle glaucoma (POAG), the etiotropic and pathogenetic treatment of this disorder has not yet been implemented, since the mechanisms of the development of this disease are not fully known and understood. One of the topical issues is the pathogenesis of ophthalmic hypertension in POAG.Purpose. To summarize the currently known mechanisms of ophthalmic hypertension in POAG to search for potential molecular targets for pathogenetic pharmacotherapy.Materials and methods. Analysis of publications on PubMed, Medline and eLibrary.Results. Ophthalmic hypertension in POAG emerges due to increased resistance to aqueous humor (AH) outflow. It is caused by increased stiffness of Schlemm’s canal endothelium and trabecular meshwork as a result of changes in the structure and biomechanical properties of its cells and extracellular matrix. These changes are determined by the interaction of signaling molecules in the form of a pathological circle, the main links of which are TGF-β2 and its receptor, Smad 2/3/4, YAP/TAZ, sFRP-1 and CTGF.Conclusion. The cause of ophthalmic hypertension in POAG is fibrosis of the trabecular meshwork. This pathological process is based on the interaction of proteins, the main of which are TGF-β2 and its receptor, Smad 2/3/4, YAP/TAZ, sFRP-1 and CTGF. These molecules can become promising targets for the pathogenetic pharmacological therapy of POAG.

Influence of the quality of viscoelastic removal on phacoemulsification results. Part 1. Type of the postoperative period course depending on the quality of viscoelastic removal in phacoemulsification

BACKGROUND: The reasons for the development of postoperative reactive inflammation under optimal conditions for the operation are errors in the surgical technique and the presence of viscoelastic residues. The likelihood of developing ophthalmic hypertension exists with the use of viscoelastic of any type. Its incomplete evacuation can be explained by the difficult visualization due to its transparency. Analysis of the dependence of the postoperative period course on the quality of viscoelastic removal at phacoemulsification can be considered to be relevant and expedient.
 AIM: The aim was to study the type of the postoperative period course depending on the quality of viscoelastics removal at phacoemulsification.
 MATERIALS AND METHODS: 104 eyes of randomly chosen patients who underwent femto-laser assisted phacoemulsification, divided into 2 groups according to ophthalmic viscoelastics characteristics (colored or transparent). Both groups were split into 2 subgroups each depending on method of viscoelastics removal. Tonometry and biomicroscopy were performed 3 hours after phacoemulsification and on the post-op Day 1. Patients with Tyndall effect were examined daily until its disappearance.
 RESULTS: At comparable preoperative IOP indices, its elevation 3 hours after surgery took place in subgroups 2a and 2b, the highest being in subgroup 2a. The greatest number of eyes with Tyndall effect, at all follow-up periods, was found in subgroup 2a, the lowest in subgroup 1b. The total number of eyes with keratopathy (as epitheliopathy) observed 3 hours after surgery was 7, four of them being from subgroup 2a.
 CONCLUSIONS: The conducted research showed that the type of early postoperative period course of phacoemulsification depends on visualization possibility of the viscoelastic and of the method of its removal. Minimal changes of hydrodynamics and maximal number of eyes with absence of inflammation took place when using colored viscoelastic and impulse irrigation method.

Современный взгляд на использование гониоассоцированной трабекулотомии

Purpose. Provide data on the use of gonioscopy-assisted transluminal trabeculotomy (GATT), reflecting its effectiveness and safety when using this technique in various patient models. Material and methods. To perform the review, literature sources which were searched through the PubMed and Scopus databases up to and including 2021, using the keywords "gonioassociated trabeculotomy", "minimally invasive glaucoma surgery", "primary open-angle glaucoma", "glaucoma", "secondary glaucoma". A total of 19 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 2013. Results. GATT can be used at various stages of glaucoma, but at the same time, the maximum effect of lowering intraocular pressure (IOP) is achieved in patients with an early or middle stage of glaucoma. There are also good results of using the GATT technique after vitreoretinal surgery, with the development of secondary glaucoma or ophthalmic hypertension. One of the advantages of GATT is that all manipulations are performed in the anterior chamber, which in turn makes it possible, if necessary, to perform reoperation after an unsuccessful ad-externo trabeculotomy without re-traumatizing the sclera and conjunctiva. It should be noted that the main complication in all studies is the hyphema, which is completely absorbed within a few days. Conclusion. Based on these studies, it can be concluded that the proposed GATT technique is relevant, and meets all modern standards of minimally invasive glaucoma surgery (MIGS): micro-incision, minimal trauma, is able to effectively reduce IOP, has a high level of safety and quick recovery. Key words: glaucoma, primary open-angle glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma

Tactics of Two-Stage IOL Implantation in Difficult Refractive Cases

In a number of complex refractive cases, the achievement of an accurate refractive result cannot be guaranteed. Simultaneous implantation of a toric or multifocal IOL for the correction of complex ametropias may be accompanied by a significant deviation from the target refraction. The tactics of two-stage implantation with the usage of an additional Sulcoflex IOL for the final correction of astigmatism and possible residual spherical ametropia allows achieving emmetropia. In our study, this method was used in 15 patients with difficult refractive cases. Toric, multifocal, and multifocal toric Sulcoflex IOL were used. Implantation of all Sulcoflex modifications was performed through a 2.4 mm temporal incision using wound assisted technology. In cases of high degree hypermetropia, preventive iridectomy was performed using a 23G vitrectome. The target refraction was achieved in the entire observation group. In the postoperative period, no significant level of ophthalmic hypertension was registered. No cases of introlens opacification, iridocyclitis, or rotational instability were registered either.The method of two-stage IOL implantation allows achieving the target refraction in difficult refractive situations with almost guaranteed accuracy. The calculation method provides good predictability of the refractive result. This technology significantly expands the indications for intraocular correction using toric and multifocal IOL, as well as the limits of correction of high degree astigmatism. Our Sulcoflex IOL implantation experience has shown their high efficiency and safety.

Comparative analysis of intraocular pressure dynamics after phacoemulsification with intraocular lens implantation in eyes with primary glaucoma

PURPOSE. To conduct a comparative analysis of changes in intraocular pressure (IOP) after cataract phacoemulsification with implantation of intraocular lens (IOL) in comorbidity with primary open-angle (POAG) and primary closed-angle glaucoma (PACG).METHODS. The study analyzed the dynamics of IOP changes after cataract phacoemulsification in 65 patients (89 eyes) with comorbid PACG and 46 patients (58 eyes) with comorbid POAG, aged 50 to 92 years. Thirty-five (53.85%) patients with POAG had history of glaucoma surgery, and 12 (20.69%) patients with PACG had been treated with laser iridectomy. The disease was in the initial stage in 14.6% of POAG patients and 5.15% of PACG patients; moderate stage — in 55.05% and 47.19%, respectively; advanced stage — in 30.34% and 24.14%. Intraocular pressure in POAG was compensated in 84.5% and subcompensated in 15.5% of patients; in PACG it was compensated in 77.6%, subcompensated in 12.6%, and uncompensated in 10.4% of patients. Compensation of IOP was achieved either by previous surgeries, or application of local antihypertensive medications. Patients with subcompensated and elevated IOP received the maximum possible amount of hypotensive medications. The follow-up period ranged from 1 month to 2 years.RESULTS. Patients were divided into three groups according to postoperative IOP levels: the first group with IOP equal to preoperative level, the second group — with IOP below the initial level, and the third group with IOP above the initial level. The IOP levels were consistent with preoperative values at all follow-up periods in most of study patients, and after 2 years their portion exceeded 70%, while in POAG it was somewhat higher than in PACG (77.42% against 71.43%). The IOP below the preoperative level was observed in eyes with initial and moderate open-angle and closed-angle glaucoma, with the amount decreasing with longer follow-up (from 63.16% at 3 months to 16.13% after 2 years in POAG, and from 62.74% to 19.04% in PACG). In the early postoperative period, number of POAG and PACG patients in this group was comparable, but after 8 months it included more PACG patients. Elevation of IOP in both forms of glaucoma was most often observed in faradvanced stage in the early post-op period after phacoemulsification, subsequently their number decreased and by two years it decreased by almost twice (6.45% vs. 11.84% in POAG and 9.53% vs. 15.69% in PACG). During the entire follow-up period, the number of patients with ophthalmic hypertension in PACG was 30% higher than in POAG.CONCLUSION. The study showed that in most cases phacoemulsification has a stabilizing effect in patients with cataracts in combination with glaucoma. The hypotensive effect of the operation was observed in initial and advanced stages of glaucoma, when the drainage system of the eye was still preserved, and in the long term it was observed in a larger percentage of cases in angle-closure glaucoma compared to open-angle glaucoma. An increase in intraocular pressure relative to the preoperative level was observed in advanced glaucoma throughout the entire follow-up period, and the number of patients with angleclosure glaucoma was one-third higher than the number of patients with open-angle glaucoma. The obtained ambiguous results of intraocular pressure measurements after phacoemulsification of cataract with implantation of IOL in combination with various forms of glaucoma dictate the need for further study of this problem.

Гипотензивный эффект микроимпульсной лазерной циклофотокоагуляции при гемофтальме с высоким внутриглазным давлением

Purpose. To study the effectiveness of micropulse laser cyclophotocoagulation (CPC) use in the treatment of hemophthalmos with ophthalmic hypertension. Materials and methods. Examination and treatment of 11 patients (11 eyes) with fresh hemophthalmos with secondary uncompensated ophthalmic hypertension were carried out. Antiglaucoma surgery was considered inappropriate due to the high threat of serious hemorrhagic complications. To normalize intraocular pressure (IOP), patients underwent micropulse laser CPС. Results. After microimpulse CPС, all patients on the first day showed a decrease in IOP to an average of 26.6 mm Hg, after 7 days - up to 20.1 mm Hg. After 1 month, 7 patients (7 eyes), against the background of conservative treatment of hemophthalmos with a normalized IOP level (15-20 mm Hg), showed positive dynamics: the hemophthalmos was practically resorbed, an increase in visual acuity was achieved (from 0.3 to 0.8). In 4 patients (4 eyes) there was a decrease in the IOP level to 18-25 mm Hg. All patients underwent a successful vitrectomy with a high functional result, visual acuity ranged from 0.4 to 0.8. Conclusion. The use of micropulse laser CPС is pathogenetically justified and safe in patients with hemophthalmos in combination with high IOP. The use of this approach made it possible to achieve stable normalization of ophthalmotonus, increase the effectiveness of conservative therapy for hemophthalmos, and achieve restoration of visual functions in the examined patients. Key words: hemophthalmos, micropulse laser cyclophotocoagulation, intraocular pressure, ophthalmic hypertension.

Эффективность и безопасность различных лекарственных форм бримонидина при глаукоме и офтальмогипертензии

Purpose. To present data on the mechanism of action, efficacy, and side effects of various brimonidine dosage forms in the treatment of glaucoma and ocular hypertension. Material and methods. To perform the review, literature sources were searched through the PubMed and Scopus databases up to and including 2021, using the keywords «brimonidine», «efficacy», «safety», «glaucoma medication». A total of 36 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 1995. Results. Brimonidine, an alpha2-adrenoceptor agonist, effectively reduces intraocular pressure and can be used as monotherapy, adjuvant and replacement therapy. The effectiveness of brimonidine is similar to that of timolol and prevails over betaxolol but inferior to prostaglandin analogues. The new drug formulation brimonidine-purite 0.15% has a more favorable safety and tolerability profile than the original brimonidine 0.2% while maintaining similar efficacy. However, most patients require two or more hypotensive medications to maintain target IOP. In this context, brimonidine is one of the most appropriate drugs because of its pr oven efficacy when combined with other classes of hypotensive drugs. Conclusion. Brimonidine can be used as monotherapy for glaucoma and ophthalmic hypertension. Experimental and clinical studies have shown a potential neuroprotective effect of brimonidine, which is associated with a direct effect on retinal cells, regardless of the effect of the drug on intraocular pressure. Key words: glaucoma, brimonidine, hypotensive drops, intraocular pressure.

Методы коррекции афакии при силиконовой тампонаде витреальной полости

The purpose of this study is to conduct a comparative analysis of the correction of aphakia by various models of intraocular lenses using silicon oil tamponade (SO) of the vitreous cavity. Materials and methods. The studies were conducted on 16 eyes of patients aged from 56 to 75 years (65.5±12 years) with aphakia and pathology of the vitreal cavity. The duration of the silicone tamponade was 2-3 months. Depending on the use of the type of IOL, all patients were divided into 2 groups. Results. When using an anterior chamber intraocular lens (IOL), the presence of ophthalmic hypertension was revealed in 75% of cases, which is 2.02 times higher than when using transcleral IOL fixation. In 37.5% of cases, the SO output to the anterior chamber is determined, in contrast to the group where IOL hemming was used. A higher percentage of SO migration to the anterior chamber of the eye in group 2 patients is due to a violation of the anatomy of the anterior chamber barrier and the vitreal cavity. Conclusion. Thus, in patients who underwent transcleral IOL fixation, visual acuity is 2.1 times higher than in patients who were implanted with an anterior chamber IOL. Transcleral fixation of the IOL can form the necessary barrier between the anterior and posterior chambers of the eye, and is also the closest IOL position to the physiological one. Key words: intraocular lens, silicone oil, transcleral fixation.

Особенности толщины центральной зоны роговицы у здоровых детей и больных врожденной глаукомой

Background. Ophthalmic hypertension is one of the most important diagnostic criteria for congenital glaucoma. The «gold standard» for measuring intraocular pressure (IOP) is the applanation tonometry (Maklakov and Goldmann methods). However, the thickness of the central corneal zone has a significant effect on the value of IOP measured by these methods. The aim of this study was to compare the central corneal thickness (CCT) in children with congenital glaucoma and in healthy children. Material and methods. We examined 15 children aged from 7 months to 14 years (22 eyes) with congenital glaucoma. In the healthy children group, 26 subjects from 7 to 17 years old (51 eyes) were examined. CCT was measured in all subjects using the optical coherence tomograph Carl Zeiss Cirrus HD-OCT 5000 with an external lens for cornea scanning. The examination was carried out in pachymetry mode; the average thickness of the central ring having a diameter of 2 mm was evaluated. Results. Central corneal thickness in children with glaucoma ranged from 471 to 771 microns, the average value was 561.5±72.26 microns. In the group of healthy children, CCT was in the range of 480-597 microns with an average value of 529.88±29.33 microns. Thus, we noted a higher average value of the central corneal thickness and its higher variability in children with glaucoma in comparison with the group of healthy children. Conclusion. All children with glaucoma and suspected glaucoma should routinely perform pachymetry prior to applanation tonometry. One should consider the central corneal thickness when assessing intraocular pressure. Key words: congenital glaucoma, pachymetry, optical coherence tomography, central corneal thickness, applanation tonometry, intraocular pressure.

The effectiveness of subtenon triamcinolone injection for the treatment of macular edema in children with retinitis pigmentosa

Aim: This study aimed to assess the functional and anatomical results of subtenon triamcinolone injections in children with retinitis pigmentosa (PR) and cystic macular edema (CME), refractory to local carbonic anhydrase inhibitors.
 Material and methods: We examined 11 children (9 girls, 2 boys) aged 9 to 17 years who underwent subtenon injections of triamcinolone (22 eyes). The follow-up period ranged from 1.6 to 33.1 months (average 9.711.6 months), the number of triamcinalone injections ranged from 1 to 11, averaging 3. Before and after injection, best corrected visual acuity (BCVA), the thickness and structure of the retina in the macular zone (optical coherence tomography [OCT] was performed by using the NIDEK RS-3000, Japan or the Spectralis, Heidelberg Engineering, Germany), and intraocular pressure (IOP) were assessed.
 Results: The CME height at the end of the observation period decreased in 10 cases (45.5%), and the average central retinal thickness decreased from 70 to 594 m (on average, 219.1183.4 m). In 12 eyes (54.5%), the CME height at the end of the observation period did not change significantly. BCVA improved in two eyes (9.1%) and did not change in the other cases. Two children (18%) developed ophthalmic hypertension in both eyes after two injections of triamcinalone. In one child, IOP returned to normal on the background of hypothetical therapy. In another child, due to non-compensation of IOP at the maximum hypotensive mode, sinus trabeculectomy was performed in both eyes, and IOP normalization was achieved.
 Conclusion: Subtenon injection of triamcinolone in children with CME against a background of PR is in most cases is an effective and safe method of treatment and can be recommended if carbonic anhydrase inhibitors are ineffective at reducing/ resorbing edema and maintaining or improving visual function. Considering that the action of triamcinolone is short lived, and its repeated injection is required, and the resorption of CME and an increase in visual acuity are not always achievable, it is necessary to continue the search for more effective treatment methods.

Frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries

To study the frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries depending on several factors. The study retrospectively analyzed 87 outpatient records and case histories of patients with primary open-angle glaucoma (POAG). All subjects had undergone standard trabeculectomy. The indication for surgical treatment was deterioration of visual function associated with increased intraocular pressure (IOP). During the follow-up, an assessment was made of intraoperative and early postoperative complications, as well as factors leading to their development. During the observation period, the most frequently developing complications were found to be ciliochoroidal detachment - in 22 (25.8%) patients, and hyphema - in 12 (13.8%). One of the reasons for these complications is a significant, sometimes critical change in intraocular pressure when cutting open the eye. Isolated intraocular hypotension without signs of ciliochoroidal detachment was detected in 15 (17.24%) patients. Postoperative hypertension was found in 18 (20.68%) patients. Scarring of the newly created outflow tracts of intraocular fluid was the obvious cause of ophthalmic hypertension in 5 patients. In 16 (18.4%) cases, pronounced vascularization was found at the site of surgical intervention. The most significant factors that have a possible impact on the outcome of glaucoma surgery - specifically, its hypotensive effect - are: age, duration of local antihypertensive therapy, comorbid somatic pathology, and the initial IOP level.

Динамика внутриглазного давления и толщины роговицы у больных открытоугольной глаукомой в ближайшие сроки после факоэмульсификации катаракты

A study of IOP and ССТ in patients with open-angle glaucoma in the dynamics after cataract phacoemulsification, the timing of normalization of these indicators was performed. An increase of IOP was noted in 50.0 % of patients, which required increased hypotensive therapy, in 18 % of patients antiglaucoma surgery was performed against persistent decompensation of pressure. Key words: open-angle glaucoma; cataract phacoemulsification; reactive ophthalmic hypertension.

Features of the Eye Hydrodynamics on the Background of Thyroid Dysfunctions

Purpose: to study the features of eye hydrodynamics in patients with thyroid dysfunctions.Patients and methods. The material for this study was the results of a survey of 43 patients (86 eyes) with thyroid dysfunctions: 23 people (46 eyes) with primary untreated hypothyroidism (PGT) and 20 people (40 eyes) with primary untreated thyrotoxicosis (PTT). There weren’t ophthalmic hypertension and glaucoma There weren’t signs of ophthalmic hypertension and glaucoma in the patients included in this study at the stage of primary ophthalmologic diagnostics.Results. Correlation analysis revealed a causal relationship between the ratio of T4 / TSH hormones, on the one hand, and indicators of secretion of aqueous humor per unit of time and ease of outflow, on the other hand. In the group of patients with hypothyroidism, a weak linear inverse correlation was found between the ratio of free thyroxine and thyroid stimulating hormone and the minute volume of aqueous humor: according to the regression model, an increase in the ratio of T4 / TSH hormones by 1 was accompanied by a decrease in the minute volume of aqueous humor by 3 units. In patients with thyrotoxicosis, a statistically significant inverse linear correlation was found between the ratio of the T4 / TSH hormones and the coefficient of ease of outflow. According to the regression model, with an increase in the ratio of hormones T4 / TSH by 1, the coefficient of lightness of outflow decreases by 5 units. The presence of thyroid receptors in the cytoplasm and nuclei of the endothelium cells of the trabecular apparatus, the nuclei of fibroblasts forming the stroma of the trabeculae, as well as in the nuclei of the pigment and non-pigment epithelium of the processes of the ciliary body substantiates the molecular basis of the causal connection of thyroid dysfunctions with hydrodynamic disorders The conducted studies confirm the modern concept that the control of regulation of the tissue and organ homeostasis is carried out by the coordinated interaction of 3 systems: nervous, endocrine, and immune. Regression modeling clearly shows a pronounced causal relationship between thyroid dysfunctions and hydrodynamic processes in the eye.Conclusion. The results of clinical studies demonstrate the fact of controlling regulation by hydrodynamic processes at the eye level by the endocrine system, explain the possible mechanism on a morphological basis, and reveal the potential of a new therapeutic strategy.

STRETCHING SYNDROME OF THE ANTERIOR SEGMENT OF THE EYEBALL WITH MYOPIA

To assess the relationship between the anterior chamber structures, eye hydrodynamics disorders and the accommodation disorders in patients with myopia. 235 patients (235 eyes) with myopic refraction of various degrees were examined. With myopic refraction, an anterior stretch of the eyeball was marked, which is more expressed in patients with high myopia and is more often accompanied by ophthalmic hypertension and excessive accommodation strain syndrome.

Comparison of the Clinical Efficacy of Draining Autovalve Limbosclerectomy and Trabeculectomy in the Treatment of Primary Open-Angle Glaucoma with Long-Term Follow-Up

Purpose: to evaluate the immediate and long-term hypotensive efficacy, the number of complications, and the clinical benefits of a draining autovalve limbosclerectomy (DALS) performed using a kit of disposable instruments in patients with POAG of various stages in comparison with trabeculectomy (TE).Patients and Methods. The study is based on the analysis of the clinical and functional condition of 127 eyes of 127 patients with primary open-angle glaucoma (stage I POAG was detected in 2 eyes, stage II in 30 eyes, stage III in 88 eyes and stage IV in 7 eyes). Patients were divided into groups: the main group—76 people who underwent DALS using a set of disposable instruments, and the control group—51 people who underwent TE. The average age of patients is 68.9 ± 10.3 years. Before and within 24 months after surgery, all patients underwent standard diagnostic examinations. The initial level of IOP against the background of the maximum antihypertensive mode varied from 24 to 50 mm. Hg. According to gonioscopy, the angle of the anterior chamber was open in all cases (III–IV degree). Patient exclusion criteria: history of laser or surgical treatment of glaucoma, cataract treatment.Results. After 24 months of follow-up after DALS, the level of IOP in patients with stage I–II of POAG was 14.19 ± 1.83 mm Hg and with III–IV stage of POAG 14.95 ± 2.15 mm Hg, compensation was achieved in 88.2 % of patients without the use of antihypertensive drops. After TE, compensation was received in 72.6 % of patients, the IOP level was 16.9 ± 2.21 and 17.78 ± 2.31 mm Hg. respectively (p < 0.01). After DALS surgery, a decrease in the number of complications was revealed in comparison with TE: a decrease in сiliochoroidal detachment by 9.1 %, hyphema by 2.5 %, ophthalmic hypertension in the early p/o period by 3.2 %, cystic changes in the filtering bleb by 7.1 %.Conclusion. The standardized DALS operation using a disposable tool kit is a new highly effective and safe method for the surgical treatment of glaucoma. DALS may be the operation of choice in the treatment of POAG of all stages.

Проблемы лечения первичной открытоугольной глаукомы при сочетании с тромбозом центральной вены сетчатки

Patients with primary open-angle glaucoma (POAG) and ophthalmic hypertension have an increased likelihood of developing occlusions (thrombosis) of the central retinal vein. Different groups of antihypertensive drugs differ in their mechanism of action and may affect concomitant ocular pathology, in particular, retinal edema, which occurs, for example, in occlusion of the central retinal vein. Used in most patients with glaucoma, prostaglandin analogs can contribute to the long-term preservation of macular edema due to the effect on the permeability of the vascular wall. Preparations of other pharmacological groups, reducing the production of aqueous humor, on the contrary, may contribute to its regression. Therefore, the question of choosing a drug for antihypertensive therapy in patients with primary open-angle glaucoma and concomitant macular edema is relevant and is for further study.

Choroidal blood flow in glaucoma patients in conditions of ophthalmic hypertension and compensated intraocular pressure

Purpose. To evaluate changes in chorioretinal blood flow in the early postoperative period after non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG) and determine their relationship with the level of Goldman intraocular pressure (IOPg). Material and methods. The study included 36 patients with primary open-angle glaucoma of stage 1–2, with an IOP level above 21 mm Hg at the maximum hypotensive mode. All patients underwent glaucoma surgery (NPDS) by a single surgeon. IOP measurement was performed by dynamic bidirectional applanation using the Ocular Response Analyzer (Reichert Inc., USA). When evaluating the results, the Goldman IOP indicators (IOPg) were taken into account. The ophthalmic examination included optical coherence tomography of the optic disk and macular area, as well as assessment of the blood flow of these structures using optical coherence tomography in angio mode (OCTA) (RTVue XR Avanti, Optovue Inc., США). The thickness of the choroid was estimated using crossline protocols performed through the center of the fovea in the horizontal and vertical meridians. Results. Based on the assessment of changes in the indicators of ocular blood flow in the postoperative period, all patients were divided into 2 groups: group 1 – 28 patients (28 eyes) who showed improvement in OCTA after surgery, group 2 – 8 patients (8 eyes) who, according to OCTA data, showed no changes or decreased indicators of ocular blood flow after surgery. In patients of both groups, the level of IOPg before surgical treatment was comparable. On the 3rd day after NPDS IOPg in the group 1 decreased to 9.3 ± 1.2 mm Hg, while in group 2 hypotonia was detected (IOPg 3,6 ± 1,3 mm Hg, р = 0,001). All patients showed an increase in the thickness of the choroid in the central area and peripapillary after glaucoma surgery: in group 1 by 23 and 26 %, in group 2 by 48 and 62 %, respectively. In group 2 there was a significant increase in the large vessels caliber and the vascular membrane thickness as a whole to 115.4 % of the original. In group 1 patients, against the background of normalization of ophthalmotonus, there was a tendency to increase the capillary density of the superficial vascular plexus (from 40.9 ± 5.38 to 41.1 ± 3.56 %) and the deep vascular plexus (from 43.9 ± 6.1 to 44.7 ± 5.97 %). There was a positive trend of increasing capillary density in the radial peripapillary plexus (from 46.6 ± 8.9 to 47.2 ± 9.0 %). In patients of group 2, capillary density significantly decreased: from 39.9 ± 3.64 to 37.6 ± 2.48 % in the superficial vascular plexus and from 41.1 ± 4.72 to 38.7 ± 3.51 % in the deep vascular plexus. Conclusion. A decrease in the level of ophthalmotonus after NPDS was accompanied, in most cases, by a moderate increase in the thickness of the choroid and a tendency to improve blood flow in the retinal plexuses. Postoperative hypotension is characterized by dysregulation of choroidal blood flow, decompression violation of topographic relationships, which generally leads to the formation of choroidal effusion and vascular detachment.

Clinical Analyses of Efficiency of Multicomponental, Vitreoretinal Surgery of Eye Trauma

Eye trauma is one of the leading causes of blindness and low vision in young working age people. It gives this particular group of diseases a special social significance. The absence of a universal surgical treating tactic is explained by the variety of traumatic agents and the various types of injuries. Penetrating wounds with the introduction of a foreign body, accompanied by detachment of the retina, vascular membrane, hemorrhagic and infectious complications are the most difficult in the clinical plan.Material and methods: 103 with penetrating eye injuries were operated during the period from 2015 to 2017. 29 of them were involving the introduction of foreign bodies, which were removed at different times: 18 eyes (62 %) — at 7–10 days, 8 eyes 27.5 %) — 14–28 days after injury and 3 eyes (10.3 %) — more than 1 month. In all cases, subtotal vitrectomy 25G (68.9 %) was performed, in some cases, 23-hedge vitrectomy was preferred (31 %) due to pronounced fibro-proliferative changes in the vitreous body. In the case of a foreign body impacted into the shells with dimensions greater than 4 mm, the real cavity was tamped with PFOS.Results. The adherence of the detached retina was achieved in 14 cases, adherence of the choroid — 4 cases. Uveitis was observed in 5 cases, ophthalmic hypertension in 12 patients in the early postoperative period. Hypertension was compensated by using the antihypertensive regimen. 5 patients at the time of hospitalization had a Vis = 0, the operation was of a diaphragm-preserving nature, since a foreign body that was not removed was the cause of the development of subatrophy of the eyeball in 16 % of cases. The remaining patients had stable, positive dynamics of visual functions in the postoperative period.Conclusion: Surgery tactics for extensive eye injuries are individual, and the amount of intervention depends largely on the parameters of the traumatic agent, so planned surgery is preferable to emergency because it allows for detailed preoperative examination and to get valuable information about the condition of the eye. The exceptions are injuries with symptoms of acute endophthalmitis. Multi-unit operations provide optimal conditions for the preservation of the eye as an organ and contribute to the restoration of visual functions.

Morphofunctional Studies in the Early Diagnosis of Primary Open-Angle Glaucoma

Purpose:to study the relationship between the optic nerve structural changes and the electrophysiological parameters of visual analyzer in the early diagnosis of primary open-angle glaucoma (POAG).Patients and methods.68 people took part in the study. 48 patients (56 eyes) were diagnosed with ophthalmic hypertension, suspected glaucoma (age ranged from 35 to 67 years, the average age was 51 years) and 20 healthy subjects (40 eyes) who entered the control group (age 32 up to 63 years, the average age is 47 years). All patients underwent standard ophthalmologic examination, multifocal electroretinography (mEPHRG), confocal scanning laser ophthalmoscopy (KSLO), electrophosphhenes and CFCs. For all types of analysis of mEPHR indices (by rings, quadrants and 3D), normal topography and density of the biopotential of the central region of the retina were recorded in patients with suspected glaucoma. The indices of the electrosensitivity of the inner layers of the retina, the conductivity of the axial fasciculus of the optic nerve, and CFSC also corresponded to normal values. Analysis of CCEA results showed a significant decrease of NRF volume of and the thickness of the retinal layer of nerve fibers compared to the control group, while in the group of patients with suspected glaucoma in 71 % of cases, the decrease of indicators correlated with the abnormalities in the static perimetry that was carried out earlier. Conducted morphometric studies confirm the fact that the decrease in the volume of IUU and SNV begins at the early, preclinical stage of glaucoma, and this in patients with ophthalmic hypertension can provide valuable information on the early diagnosis of POAG.

Структурно-функциональные и гемодинамические характеристики при простой первичной и псевдоэксфолиативной открытоугольной глаукоме и офтальмогипертензии

Структурно-функциональные и гемодинамические характеристики при простой первичной и псевдоэксфолиативной открытоугольной глаукоме и офтальмогипертензии