[Effectiveness and safety of a hypotensive preservative-free drug in long-term therapy of glaucoma]. / Effektivnost' i bezopasnost' primeneniya gipotenzivnogo beskonservantnogo preparata pri dlitel'noi terapii glaukomy.

PURPOSE: To investigate the condition of the ocular surface and the effectiveness of Taflotan for long-term therapy in patients with newly diagnosed primary open-angle glaucoma in real clinical practice. MATERIAL AND METHODS: This publication presents data form a retrospective observational study that analyzed newly diagnosed glaucoma patients that have been using 1 drop/day of Taflotan in the evening for 12 months. All patients were examined at baseline, and after 1 month and 12 months of treatment, recording intraocular pressure (IOP), retinal photosensitivity indicators (MD, PSD), thickness of the retinal nerve fiber layer (RNFL), and assessing the condition of the ocular surface by Schirmer test, tear breakup time (TBUT), ocular surface disease index (OSDI) questionnaire, as well as measurement of the lacrimal meniscus height and corneal staining with lissamine green. RESULTS: IOP effectively decreased in all patients using Taflotan, reaching the target pressure by 1 month after therapy initiation. IOP decreased from 25±4 mm Hg at baseline to 17±3mm Hg after 1 month with further decrease down to 16±3 mm Hg after 12 months of therapy. Retinal photosensitivity (MD and PSD) and RNFL thickness did not differ from baseline, and correlated to glaucoma stage. The indicators of the condition of the ocular surface had no significant differences between the baseline, 1-month and 12-month time points. CONCLUSION: Taflotan effectively decreases IOP in newly diagnosed glaucoma patients, maintains stable automated perimetry indices and RNFL thickness, and does not affect the ocular surface throughout 12 months of therapy.

[Effect of retinal protective therapy on optical coherence tomography angiography (pilot study)]. / Vliyanie retinoprotektornoi terapii na pokazateli opticheskoi kogerentnoi tomografii s funktsiei angiografii (pilotnoe issledovanie).

PURPOSE: To assess the influence of the frequency of retinal protective therapy courses on the indicators of regional hemodynamics of the eye. MATERIAL AND METHODS: The study included 17 patients (34 eyes) with a diagnosis of primary open-angle glaucoma (POAG), advanced stage. The patients were divided into 2 groups: the first group received a course of retinal protective therapy with Retinalamin every 3 months, the second group received a course of retinal protective therapy with Retinalamin every 6 months. All patients underwent standard ophthalmological examination including standard automatic perimetry according to the 24-2 program, optical coherence tomography angiography (OCT-A) of the macular area and optic disc. RESULTS: The comparison of hemodynamic parameters of all vascular plexuses of the retina at the beginning and at the end of the study, as well as intergroup comparison did not reveal any statistically significant differences (p>0.05). However, when studying the density and fractal dimension of the vascular bed, multidirectional trends were observed. Specifically, in the peripapillary region, there was a decrease in the length from 19.8 (1/mm) to 19.0 (1/mm) (p=0.37) and the density from 36.6% to 35.7% (p=0.63) of the vascular bed of the peripapillary capillary plexus of the retina in patients of the first group. In the superficial vascular plexus, the trend in the density of the vascular bed in both groups slightly changed (in group 1 - 38.1% and 38.3%, p=0.97; group 2 - 37.8% and 38.7%, p=0.46). The fractal dimension of the vascular bed in the first group tended to increase during treatment from 18.8 (1/mm) to 19.1 (1/mm) (p=0.5), while in the second group, on the contrary, it had tendency to decrease from 18.6 (1/mm) to 17.9 (1/mm) (p=0.63). In the deep vascular plexus, the density of the vascular bed trended to decrease in both groups, but in group 2 (42.5% and 42.4%, p=1.0) it was more pronounced than in the first group (42.5% and 42.6%, p=0.82). However, the fractal dimension of the vascular bed increased in group 1 (21.0 (1/mm) and 21.3 (1/mm), p=0.43) and showed a slight tendency to decrease in group 2 (21.5 (1/mm) and 21.0 (1/mm), p=0.86). CONCLUSION: The general trend of changes in hemodynamic parameters demonstrates a potential positive effect, especially in the data related to the deep vascular plexus.

[Current state of ophthalmic tonometry]. / Sovremennoe sostoyanie oftal'motonometrii.

Currently, the level of intraocular pressure (IOP) can be assessed with a large number of tonometers, which differ in the principle of action, the place of application and the degree of invasiveness. All the methods in use - except for direct manometry - allow only indirect judgement of the level of ophthalmotonus. The quality of tonometric measurement is influenced by many factors, from the choice of tonometer to the analysis of the results obtained by the doctor. The use of complex methods for assessing the level of intraocular pressure provides additional information that increases its diagnostic value. This article summarizes current information about modern methods of tonometry, and describes their features.

[The influence of long-term retinal protective therapy on glaucoma progression according to structural and functional tests]. / Vliyanie dlitel'noi retinoprotektornoi terapii na progressirovanie glaukomy po dannym strukturno-funktsional'nykh issledovanii.

PURPOSE: To evaluate the influence of prolonged neuroprotective therapy on disease progression in patients with primary open-angle glaucoma (POAG) with compensated intraocular pressure (IOP). MATERIAL AND METHODS: The study included 147 patients with stages I-II POAG (249 eyes) who were randomized into the main (69 patients, 119 eyes) and control groups (78 patients, 130 eyes). Patients of the main group underwent retinalamin treatment course every 6 months. Patients were examined before enrolling and then every 3 months during the 24-months follow-up including optical coherence tomography (OCT; RNFL - retinal nerve fiber layer, NRR - neuroretinal rim, GCL - ganglion cell layer) and static perimetry (MD - mean deviation, PSD - pattern standard deviation). RESULTS: Visual acuity and refraction did not change in either group (p>0.05). IOP increased in the control group (p=0.033). There was no difference between the groups by the 24th month (p=0.87). No MD changes were noted in the main (p=0.45) and control groups (p=0.27). PSD changed in the main (4.84±3.21 and 6.01±2.584 dB in the beginning and the end, respectively, p=0.0004) and the control groups (3.46±2.23 and 5.86±2.26 dB, respectively; p<0.0001). The groups differed in MD and PSD initially (p=0.15; p=0.02) and became equal by the end (p=0.59; p=0.53). RNFL did not change significantly in the main group (p=0.078) and decreased from 83.5±22.47 to 76.7±20.7 µm in the control group (p=0.001); no differences between the groups were noted in the beginning (p=0.276) or in the end of the study (p=0.524). NRR increased in the main group from 222±88.94 to 231±99.3 (p=0.012), and decreased in the control group from 248±87.09 to 234±96.2 (p=0.0006); no differences were found between groups in the beginning or in the end of the study (p=0.109; p=0.909). GCL thickness did not change either in the main, or in the control group (p=0.211; p=0.16), with no difference between the group noted in the beginning or the end of the study (p=0.44; p=0.51). CONCLUSION: Regular treatment with retinalamin arrests the development of glaucomatous optic neuropathy. Longer-term research is required to study its influence on the visual function and the quality of life.

[Effectiveness of antihypertensive conservative-free therapy with fixed combination of bimatoprost and timolol (intermediate results)]. / Effektivnost' gipotenzivnoi beskonservantnoi terapii fiksirovannoi kombinatsiei bimatoprosta i timolola (promezhutochnye rezul'taty).

INTRODUCTION: The effects of antihypertensive therapy are often determined by patient compliance with the prescribed treatment plan. Acceptance of conservative-free forms of drugs leads to a decrease in the frequency and severity of side effects, reduces the need for the use of artificial tears, which lowers the cost of treatment for the patients. PURPOSE: to evaluate the hypotensive effectiveness of a fixed combination of bimatoprost (0.03%) and timolol (0.5%), and its effect on the ocular surface in patients with newly diagnosed advanced glaucoma. MATERIAL AND METHODS: The study was conducted during February-November 2018, and included 46 patients (76 eyes) with newly diagnosed POAG and healthy volunteers (control group). All patients underwent visometry, ICare rebound tonometry (Tiolat, Finland), elastometry with Maklakov tonometer (using 5 g, 10 g and 15 g loads), automated perimetry (AP) (Octopus-600, Haag-Streit diagnostics, Switzerland), optical coherence tomography (OCT) of the macular zone and optic nerve head, pachymetry (Spectralis OCT, Heidelberg Engineering, Germany). At the start of the study and one month after the start of treatment with the drug Ganfort (Allergan, USA), patients were examined to evaluate the state of their ocular surface: Norn's test, Schirmer's test, vital staining with lissamine green, and an OSDI questionnaire. RESULTS: At the start of treatment, administration of a fixed combination of bimatoprost and timolol led to a decrease in intraocular pressure by 7.9 (37.7%) mm Hg (V=271, p=5.496e-05) after 2 weeks of the use of Ganfort (Allergan, USA). During this period, the observation group did not exhibit statistically significant changes in the state of the ocular surface, which was comparable to the control group according to the data of the Norn's test, Schirmer's test, vital staining with lissamine green and the OSDI questionnaire (p>0.05). CONCLUSION: The use of a fixed combination of bimatoprost and timolol, while effectively reducing IOP, did not result in statistically significant changes in the ocular surface. Some improvement of both objective and subjective indicators of the state of ocular surface associated with the use of the Ganfort drug was noted in patients of the observation group.

[Spatial contrast sensitivity in patients with primary open-angle glaucoma and ocular hypertension]. / Prostranstvennaia kontrastnaia chuvstvitel'nost' pri otkrytougol'noi glaukome i oftal'mogipertenzii.

Up to now, there has not been a comparison of spatial contrast sensitivity (SCS) in patients with primary and pseudoexfoliation open-angle glaucoma (POAG; PEG) and ophthalmic hypertension (OH). PURPOSE: To study the characteristics of SCS in patients with POAG, PEG (as well as in the paired eye without glaucoma) and OH. MATERIAL AND METHODS: The work was performed in the period from 2011 to July 2017. Analytical, observational case-control study data was analyzed. The study included 1380 patients under dynamic observation; in accordance with inclusion and non-inclusion criteria, 290 patients (540 eyes) with POAG, PEG, OH, as well as healthy people were included in the study. SCS was measured using 'Zebra v 3.0' software developed by the laboratory of clinical physiology of vision named after S.V. Kravkova in collaboration with 'Astroinform SPE' LLC. Patients were shown vertical achromatic (black and white) and colored (red, green, and blue) gratings of specific spatial frequencies (0.5; 1; 2; 4; 8; 16 cycles/degree). Among the patients of the study, 243 (83%) were female and 47 (17%) were male. The average age of all patients at the time of inclusion in the study was 67.75 (62.8; 74.5); 67.84±8.7 years. RESULTS: The study revealed an increase of SCS in patients with OH and their tendency for a slight increase in the contralateral eye with unilateral PEG in comparison with measurements taken from patients of POAG and PEG groups. CONCLUSION: The revealed increase of SCS is likely to be a consequence of increased or preserved hemodynamic characteristics in the vessels of the eye and orbit in patients with hypertension and in the contralateral eye in unilateral glaucoma, as described in our previous publications. At the same time, generalized changes in the vascular wall in patients with 'PEG-' on the paired eye only predetermine a tendency for an increase of SCS indices.

[The effect of preservative-free treatment of primary open-angle glaucoma on the state of ocular surface in combination therapy (intermediate results)]. / Vliianie beskonservantnoi terapii pervichnoi otkrytougol'noi glaukomy na sostoianie glaznoi poverkhnosti pri kombinirovannom lechenii (promezhutochnye rezul'taty).

The goal of antihypertensive therapy is to reduce intraocular pressure (IOP). Sometimes it can only be achieved by using two or more drugs, which can lead to undesirable side effects on the ocular surface. The use of drugs that do not contain preservatives leads to fewer undesirable side effects, while also reducing the need for instillations of artificial tears, making it economically beneficial for patients. PURPOSE: To assess the state of ocular surface in patients with POAG when switching to preservative-free carbonic anhydrase inhibitor (ICA) containing 0.18% sodium hyaluronate in combination with prostaglandin analogues and beta-adrenergic blocking agents. MATERIAL AND METHODS: The study was conducted in 2019; according to selection criteria, it included 46 patients (80 eyes) with POAG and a control group of healthy persons. At the start of the study and one month later, after a change of treatment to uninterrupted ICA containing 0.18% sodium hyaluronate, the patients had state of their ocular surface examined: Norn's test (tear break-up time; TBUT), Schirmer's test, vital staining with lissamine green and an Ocular Surface Disease Index (OSDI) survey. RESULTS: Replacing the ICA with benzalkonium chloride in the combination therapy of glaucoma with a preservative-free ICA containing 0.18% sodium hyaluronate - Dorzolan Solo (Solopharm, Russia) - expectedly did not lead to additional decrease of IOP, but resulted in a decrease in the width of the confidence interval according to both Maklakov's and Icare tonometers, which may be associated with increased treatment adherence. At the same time, the state of ocular surface in the observation group was statistically significantly improved according to Norn's test - from 3.57±1.3; 3.0 (3.0; 5.0) to 4.9±2.5; 5.0 (3.0; 6.0) (V=16.5; p=0.0039). CONCLUSION: According to Schirmer's test and vital staining with lissamine green, no statistically significant changes have occurred. OSDI survey did not reveal changes in the study patients during 4 weeks of the follow-up, while the control group exhibited improvement.

[Efficacy of serosomyotomy in esophagogastroplasty]. / Éffektivnost' serozomiotomii pri ézofagogastroplastike.

AIM: To evaluate an effectiveness of serosomyotomy in isoperistaltic esophagogastroplasty. MATERIAL AND METHODS: Our analysis shows that serosomyotomy improves the results of isoperistaltic esophagogastroplasty. RESULTS: Esophagogastrostomy by using of proximal graft with adequate blood supply reduced the risk of anastomosis failure. The incidence of this complication was 12.2% (n=6) and 3% (n=1) in control and main groups respectively.

[Laser doppler flowmetry in esophagogastroplasty].

AIM: To present the results of laser Doppler flowmetry for assessment of gastric wall microcirculation. MATERIAL AND METHODS: The study enrolled 22 patients who underwent esophagogastroplasty. The changes in gastric microvasculature during tubular isoperistaltic transplant formation are described. Significant markers of impaired circulation in stomach transplant 5-6 cm apart from right gastroepiploic artery termination were revealed. RESULTS: Esophagogastrostomy at this level and more proximally increases the risk of anastomosis failure and cicatrical stenosis.

[Efficacy of the use of remnant stomach in esophagoplasty].

In the period from 2001 till 2010 there were 117 extirpations of the oesophagus with single-stage plasty of the stomach in 94 patients and plasty of the large intestine--in 23 cases. Gastric resections were performed earlier in 50 (42.7%) patients, though gastrectomy took place in 39 (78%) patients. The accumulated experience allowed making an assessment of immediate and long-term results of esophagoplasty to patients, who had earlier the gastric resection. The incompetence of oesophagogastric anastomosis was noted in 2 times more frequent and the formation of stenosis of given anastomosis in 3 times more often. I order to improve the results of esophagoplasty, the method of serousmyotomy was applied in the cases of remnant stomach.

[A model of primary open-angle glaucoma: manifestations and outcomes].

OBJECTIVE: To determine the expected duration of the disease and the age of the patients with different stages ofprimary open-angle glaucoma complicated by pseudoexfoliation syndrome (PES) and/or patients with pseudoexfoliation glaucoma (PEG). METHODS: The study protocol included data from 120 patients (50 males (41.7%), 70 females (58.3%)); 189 eyes; 102 right eyes; 87 left eyes). The first study group (28 patients, 44 eyes) comprised patients with suspected glaucoma. The second group (53 patients, 84 eyes) consisted ofpatients with early glaucoma. The third group (21 patient, 33 eyes) included patients with advanced glaucoma, the forth group (18 patients, 28 eyes) comprised patients with terminal glaucoma. Mean age of the patients at diagnosis was 61.6 (58.4; 66.9) years and 66.9 (63.4; 72.8) years at the endpoint visit in 2013. In all cases, diagnosis was made in accordance with the differential diagnostics system and confirmed by special diagnostic techniques. The database included data from 3 qualified examinations taking account of the results of tonometry and static automated perimetry. RESULTS: The mean expected age of the patients age at the onset of blindness was 75.1 years. The occurrence of the event was limited to a period of 6.1 years. Mean age at the time of possible glaucoma development was 59.58 (56.14; 64.36) years. The disease itself could develop within 3.24 (-5.38; -1.2) years prior to diagnosis. CONCLUSION: Studies for glaucoma diagnosis should be focused on the age group of 55-60 years. The degree of IOP reduction in patients with advanced glaucoma does not agree with the Russian glaucoma society recommendations which accounts for progression of the disease.

[Choice of the method of video-thoracoscopic esophagectomy].

Video-thoracoscopic esophagectomy was performed in 51 patients including 25 patients with esophageal cancer, 18 -- with cicatricial stenosis of the esophagus and 8 -- with esophageal achalasia of stage IV. Video-thoracoscopic esophagectomy and laparotomy for gastroplasty may be performed simultaneously with 2 surgery teams that reduce time of surgery. Simultaneous thoracoscopic and transhiatal approaches to the esophagus permit avoiding conversion in severe periesophagitis.

[Clinico-morphologic characterization of mucoepidermoid carcinoma of the salivary glands]. / Kliniko-morphologicheskaia kharakteristika mukoépidermoidnoi kartsinomy sliunnykh zhelez.

64 cases of SGMC were studied. Clinical morphology of epidermoid carcinoma was studied according to the 2nd edition of the International histologic classification of the tumors of this site (WHO, Geneva, 1990). This allows to study not only incidence of this tumor depending on the site, sex and age, but to give new data on its biology. The malignancy of all the three types of this tumor (of low, moderate and high grade) was confirmed by means of histologic, histochemical, electron-microscopic (EM) and EM-histochemical methods. The previous assumption on benign character of the low-grade variant of the tumor was not confirmed.