[Three-component tear substitute as preoperative support in glaucoma surgery]. / Primenenie trekhkomponentnogo slezozamenitelya v meditsinskom soprovozhdenii khirurgii glaukomy.

PURPOSE: This study investigates the effect of preoperative preparation with the three-component tear substitute Stillavit on the outcomes of glaucoma surgery in patients on long-term topical glaucoma therapy. MATERIAL AND METHODS: The study included 63 patients (63 eyes) with glaucoma, among them 30 (30 eyes) were women and 33 (33 eyes) were men. Group 1 consisted of 33 patients (33 eyes) receiving long-term topical antihypertensive therapy with preservatives and tear substitute Stillavit 3 times a day for 1 month as preoperative preparation. Group 2 included 30 patients (30 eyes) receiving similar antihypertensive therapy who were not prescribed preoperative medications. All patients underwent a comprehensive ophthalmological examination and computer tomography of the filtering blebs (FB) on Visante system (Carl Zeiss Meditec, Germany) before surgery, as well as 1 week, 1, 3, and 6 months after surgery. RESULTS: Mean intraocular pressure (IOP) elevation at 6 months postoperatively was significantly higher in the group that did not undergo preoperative preparation with a tear substitute, compared to the group of patients who received the tear substitute Stillavit preoperatively. According to anterior segment optical coherence tomography, a greater number of favorable diffuse FB were noted in the group that received the tear substitute Stillavit in preparation for surgery - 87.9%, while in group 2 (without preparation) - 66.7%. Odds ratio calculation between the two groups revealed that preoperative preparation with the tear substitute Stillavit reduced the odds of IOP elevation to 20 mm Hg or higher at 3 months postoperatively by more than 10 times. CONCLUSION: The use of tear substitute Stillavit in preparation for anti-glaucoma surgery reduces the chances of IOP elevation in the early postoperative period by more than 10 times, which may indicate a reduction in the rate of FB scarring due to the beneficial effect of the drug's components on the precorneal tear film.

[Studying the condition of filtering bleb after glaucoma surgery using optical coherence tomography]. / Opticheskaya kogerentnaya tomografiya v issledovanii sostoyaniya fil'tratsionnoi podushki posle antiglaukomnoi khirurgii.

PURPOSE: To compare the optical coherence tomography (OCT) findings on the condition of filtering bleb (FB) in patients with primary open-angle glaucoma (POAG) who used different local therapy before glaucoma surgery. MATERIAL AND METHODS: The study included a total of 82 patients (82 eyes) followed up after glaucoma surgery: 50 patients (50 eyes) who received preservatives-containing drugs before glaucoma surgery; 32 patients (32 eyes) - who were on preservative-free drug treatment before glaucoma surgery. The examinations were carried out 7 days, 1 and 3 months after micro-invasive sinus trabeculectomy. The condition of filtering bleb was studied using the Visante AS-OCT device, as well as with a slit lamp for clinical observation. Corneal-compensated intraocular pressure (IOPcc) was determined by bi-directional pneumatic applanation of the cornea using the Ocular Response Analyzer (ORA). RESULTS: After 3 months post-op, a functioning FB and intraocular pressure below 15.0 mm Hg were observed in 38 eyes out of 50 (76%) in group 1, in 12 eyes (24%) the FB was nonfuncitonal. In Group 2, 25 eyes out of 32 (78%) had functioning FB and intraocular pressure lower than 15.0 mm Hg; in 7 eyes (22%) the FB was nonfuncitonal. Needling was needed 3 months after the operation in 7 eyes out of 32 (22%) in group 2. The need for needling according to OCT findings in patients of group 1 occurred already one week after surgery for 4 eyes out of 50 (8%), after one month - for 14 eyes (28%). CONCLUSION: In patients on pre-operative drug therapy with preservative-containing medications, the process of scarring in the FB is faster. The OCT method allows early detection of the initial signs of scarring, as well as determining the need for needling.

[Methods of assessing the condition of filtering bleb after glaucoma surgery]. / Metody otsenki sostoyaniya fil'tratsionnoi podushki posle khirurgii glaukomy.

Currently, there is a need to assess the condition of structures at the surgery site after glaucoma intervention due to the necessity to decide further treatment tactics after performed operations, as well as the possibility of developing more advanced methods of surgical treatment of glaucoma. Despite the fact that there are several methods of examining the filtration bleb (FB), some of them have both clear advantages and significant disadvantages. This article reviews the possibilities of using optical coherence tomography (OCT), ultrasound biomicroscopy (UBM), thermography, confocal microscopy, and the Hyperemia-3 program for assessing the structural and functional state of the FB.

[Persistent hyaloid artery in an adult (a case report)]. / Persistiruyushchaya arteriya steklovidnogo tela u vzroslogo (klinicheskoe nablyudenie).

The article presents a clinical case of a functioning hyaloid artery in a 69-year-old patient. The results of OCT-angiography made it possible to detect the presence of blood flow in the projection of the persistent hyaloid artery (PHA) on the cross-section and en-face images. The vascular bed of PHA spreading along the posterior surface of the lens in the form of separate branches was visualized by slit-lamp biomicroscopy. The uniqueness of this clinical case lies in the low probability of such findings in the elderly. The presence of a developing cataract indicates the need for an individual approach in determining treatment strategies. In our opinion, the consistent use of laser coagulation technologies and laser photodestruction of PHA will minimize the risk of hemophthalmos and tractional retinal detachment during the upcoming cataract surgery.

[Effects of artificial tears on ocular surface in glaucomatous patients with long-term instillation of preserved antiglaucoma eye drops]. / Vliianie slezozamenitelei na sostoianie poverkhnosti glaza pri dlitel'nom ispol'zovanii gipotenzivnykh sredstv s konservantami.

PURPOSE: To study the effects of long-term instillation of 0.18% sodium hyaluronate artificial tears VISMED multi on ocular surface in glaucomatous patients with long-term instillation of preserved anti-glaucoma drops. MATERIAL AND METHODS: The study included 79 patients (40 female and 39 male; 79 eyes in total) with primary open-angle glaucoma (POAG) divided into 3 groups according to disease stage: mild or early (stage I) glaucoma - 15 patients (15 eyes), moderate (stage II) glaucoma - 30 patients (30 eyes), advanced or severe (stage III) glaucoma - 34 patients (34 eyes). Conjunctival and corneal changes were assessed with Norn's test, Schirmer I test and corneal fluorescein staining test. All patients completed Ocular Surface Disease Index (OSDI) questionnaire. Corneal compensated intraocular pressure (IOPcc) was measured using Ocular Response Analyzer (ORA) (Reichert Optics Inc., USA). In addition to hypotensive therapy, all patients received instillations of 0.18% sodium hyaluronate (VISMED multi) three times every day. After 14 days, all examinations were repeated. RESULTS: The condition of eye surface in patients with moderate and advanced (stage II and III) glaucoma depends on the degree of IOPcc compensation. As glaucoma increases in severity, the pathological changes in the ocular surface progress. Instillations of 0.18% sodium hyaluronate solution lead to significant improvement of the test results in all groups, and in early glaucoma patients it restores all objective indicators to normal values. CONCLUSION: Treatment with 0.18% sodium hyaluronate solution (VISMED multi) leads to statistically significant (p<0.05) improvement of ocular surface condition in glaucoma patients with long-term instillation of preserved antiglaucoma eye drops.

[A case of progressive glaucoma against the background of chronic constipation]. / Sluchai prog-ressivnogo techeniia glaukomy na fone khronicheskoi obstipatsii.

The authors describe a case of severe glaucoma in the only seeing eye of a patient with venous circulation disturbance resulting from a chronic anal fissure complicated with progressive anal stenosis, severe sphincter spasm, and pain syndrome. The article presents the results of multiple clinical ophthalmological tests and instrumental examinations performed before and after surgical intervention that evidence the importance of venous circulation disturbances for glaucoma development.

[Changes in biomechanical properties of the ocular fibrous tunic in patients with primary open-angle glaucoma in response to drug-induced stress-relief tests]. / Biomekhanicheskie parametry fibroznoi obolochki glaza na fone provedeniia razgruzochnykh prob pri pervichnoi otkrytougol'noi glaukome.

AIM: To determine the effect of drug-induced stress-relief tests on biomechanical properties of the ocular fibrous tunic in eyes with early, moderate, or advanced primary open-angle glaucoma (POAG). MATERIAL AND METHODS: A total of 202 eyes of 150 patients with POAG of different severity (early, moderate, or advanced) and 36 eyes of 30 healthy controls were examined. The mean patient age was 62±8.2 years. All groups were standardized by age, sex, and the range of corneal-compensated intraocular pressure (IOP) at baseline (21-30 mmHg). All patients underwent a standard ophthalmic examination, including visometry, biomicroscopy, gonioscopy, ophthalmoscopy, and Humphrey visual field assessment. Corneal hysteresis (CH), corneal resistance factor (CRF), CH-CRF difference, corneal-compensated IOP (IOPcc), and Goldmann-related IOP (IOPg) were measured with Ocular Response Analyzer (ORA, Reichert, USA). The axial eye length was measured on an ultrasonic A-scan (Ocuscan RxP, Alcon, USA) in the 10 MHz mode. RESULTS: CH and CRF variability analysis was conducted to assess changes in biomechanical properties of the fibrous tunic due to an IOP decrease and a tendency toward compensation. For the first time, the ratio between CH and CRF changes (ΔCH/ΔCRF) was used to evaluate biomechanical properties of the fibrous tunic. This ratio provides understanding of the significance of CH and CRF changes after reduction of IOP. In early glaucoma patients, it differed inconsiderably from the control group (p>0.05) and averaged 1.62±0.9. In moderate glaucoma, CH changes were more pronounced than those of CRF: ΔCH/ΔCRF - 2.03±2.41 (under conservative treatment) and 2.12±1.07 (without treatment). In advanced glaucoma an opposite pattern was observed: the CH/CRF ratio got closer to 1.0 largely due to CRF changes, while CH changes became much less pronounced (or even negative, in some cases): ΔCH/ΔCRF - 0.27±0.32 (under conservative treatment), 0.16±1.29 (without treatment). CONCLUSION: While the IOP decreased as a result of drug-induced stress-relief tests, CH and CRF changes differed between the groups depending on the stage of POAG. In early and moderate glaucoma, CH undergoes greater changes than CRF. In advanced glaucoma, CRF changes are more pronounced, and, hence, the ΔCH/ΔCRF ratio shifts reliably as glaucoma progresses. The ratio has also been shown to depend on the duration of the disease and on whether or not eye drops were prescribed.

[Application of Retinalamin for the treatment of glaucomatous optic neuropathy].

A case of Retinalamin (peptide-based drug) use in a patient with newly diagnosed glaucoma and therapeutically normalized intraocular pressure is reported. The results of visual field test (Humphrey Field Analyzer) and optic nerve examination (Heidelberg Retina Tomograph) as well as electrophysiological indices before and 1 and 3 month after the course of Retinalamin (10 parabulbar injections) are presented.

[Hemodynamic changes in myopia of different degrees].

A total of 78 patients (143 eyes) with low, medium and high degree myopia were assessed. Apart from standard ophthalmological tests, flowmetry and duplex ultrasound of ocular vessels were performed in all cases to evaluate volumetric and velocity parameters of ocular blood flow in relation to the length of anterior-posterior axis and the degree of myopia. It is found that both parameters of regional blood flow progressively decrease as the anterior-posterior axis increases.

[Effect of vasoactive drugs on visual functions and ocular hemodynamics in patients with primary open-angle glaucoma].

The effect of cavinton forte on visual functions and ocular hemodynamics was studied in patients with primary open-angle glaucoma (POAG). Fifty-three patients (97 eyes) aged 45 to 75 years (mean age 66.3 +/- 3.7 years) who had POAG were examined. A study group comprised 38 patients (67 eyes, including 24 with Stage Ia POAG, 27 with Stage IIa, 16 with Stage IIIa). All these patients took cavinton forte (10 mg) thrice daily for 2 months. A control group consisted of 15 patients (30 eyes) receiving no vasoactive agents. In these patients, intraocular pressure was normalized and it was in the range of 15 to 21 mm Hg after Goldmann. The use of the vasoactive drug cavinton forte improved and stabilized visual functions in POAG patients with normalized intraocular pressure, which is particularly important with advanced POAG. Increased blood flow velocity in the ocular arteries after a course of therapy with cavinton forte suggests a better retinal blood supply, which is a favorable marker for the prediction of the disease.

[Relationship of changes in visual functions and optic disk in patients with glaucoma concurrent with myopia].

Forty-nine myopic patients (70 eyes) aged 2 to 12 years (mean 7 +/- 4.2 years) with primary open-angle glaucoma (POAG) were examined. In patients with glaucoma concurrent with myopia, enlarged peripapillary retinal atrophy is one of the first signs of a progressive process, long optical axis in particular. Reduced visual functions were detectable in fewer cases than were changes in the optic disk and peripapillary retina. The most sensitive methods are in the following order: distant contrast discrimination (DCD), critical flicker fusion frequency (CFFF), Bjerrum's zones, statitic perimetry with a blue object on the Friedman analyzer, automatic static permentry on the Peritest, isoptoperimetry. In patients with POAG and in the majority of POAG concurrent with myopia with an anteroposterior axis (APA) of < 25 mm, excavation was shown to progress depthward and/or widthway with simultaneous narrowing of the neuroretinal rim. In patients with POAG concurrent with myopia at an APA of > 25 mm, peripapillary atrophy initially increased (usually in the temporal quadrant), excavation also widthway in the temporal direction. It is evident from the foregoing that increased peripapillary atrophy may be considered to be a marker of progression of the glaucomatous process in patients with myopia.

[A comparative analysis of hemodynamic parameters within the evaluation of the glaucomatous process in patients with myopia]. / Sravnitel'nyi analiz gemodinamicheskikh parametrov v otsenke sostoianiia glaukomnogo protsessa u patsientov s miopiei.

One hundred and eighty (180) persons (363 eyes), mean age 63.7 +/- 5.2, mean follow-up--6.1 +/- 1.2, were investigated. Control group 1 comprised 46 patients (92 eyes) with emmetropia and different-degree myopia; control group 2 had 74 persons (148 eyes) with primary open-angle glaucoma (POAG). The main group had 60 patients (119 eyes) with POAG combined with myopia. The ocular hemodynamics parameters were found to reliably differ, in patients with myopia, without glaucoma and with the anterior-posterior eye axis of 25 mm, from the similar parameters in persons with emmetropia. The process aggravates in myopic patients with glaucoma due to reliably worsened ocular hemodynamics parameters and due to a higher intraocular pressure without any reliably changing systemic hemodynamics. The measuring of ophthalmoplethysmography parameters could be handy in examining the POAG patients with myopia in order to detect if glaucoma is progressing or not.

[Use of xalatan in unstable glaucoma in myopic patients]. / Primenenie salatana pri nestabilizirovannoi glaukome u bol'nykh s miopiei.

41 patients (79 eyes), their age averaged 66.9 +/- 4.5 years were divided into two groups. Group 1 consisted of 20 patients (39 eyes) with primary open-angle glaucoma (POAG), with refraction emmetropy (1.0 D, group 2 included 11 cases (22 eyes) in combination with myopia, group 3 included 10 patients (19 eyes) with normotensive glaucoma (NTG) and myopia. In the patients with unstabilized POAG in combination with myopia, NTG and myopia monotherapy with Xalatan (latanoprost) or combined therapy with xalatan with beta-blockers, and to a lesser extent, with Pilocarpine, was shown to stabilize the process in 35-53% of cases.

[The efficacy of the antioxidant preparation Histochrome in the treatment of hemophthalmos in hypertension and diabetes mellitus]. / Effektivnost' antioksidantnogo preparata "Gistokhrom" v lechenii gemoftal'mov pri gipertonicheskoi bolezni i sakharnom diabete.

Hemophthalmos in patients with essential hypertension and diabetes mellitus was treated by antioxidant agent Histochrome manufactured by the Pacific Institute of Bioorganic Chemistry, Far Eastern Division of Academy of Sciences, Vladivostok. The results were analyzed with reference to localization, volume, and period elapsed since hemorrhage into the vitreous body and by hemophthalmos index determined by biomicroscopy and echography of the vitreous body. Histochrome was the most effective in fresh hemophthalmos with 1-2 point index. Visual functions improved in patients with nonproliferative diabetic retinopathy without hemorrhagic syndrome.

[The antioxidant activity of the lacrimal fluid in patients with primary open-angle glaucoma]. / Antioksidantnaia aktivnost' sleznoi zhidkosti u bol'nykh pervichnoi otkrytougol'noi glaukomoi.

Antioxidant activity (AOA) of lacrimal fluid and blood plasma was studied in 10 normal subjects (20 eyes) and 35 patients with primary open-angle glaucoma (POAG) (67 eyes with glaucoma at different stages). The findings indicate that the progress of glaucoma is paralleled by a gradual decrease in the lacrimal fluid AOA, which becomes significant at the third stage of POAG. Plasma AOA also decreased significantly in the third far advanced stage. A course of total antioxidant therapy including oral aevit and vitamin complexes and intramuscular ascorbic acid normalized plasma AOA even in patients with far advanced glaucoma, while the lacrimal AOA did not normalize. Therefore, local antioxidants are preferable in glaucoma patients.

[Antioxidative activity of histochrome and some other drugs used in ophthalmology]. / Antioksidantnaia aktivnost' gistokhroma i nekotorykh lekarstvennykh preparatov, primeniaemykh v oftal'mologii.

The antioxidative activity (AOA) of histochrome (2,3,5,6,8-pentahydroxy-7-ethyl-1,4-naphthoquinone) and some other drugs with antioxidant properties used in ophthalmology has been studied in the hemoglobin--hydrogen peroxide--luminol system. The AOA of histochrome, ascorbate, dicinon, rutin, quercetin, and dihydroquercetin is comparable to that of trolox, the reference antioxidant in our studies. The drugs (in physiological concentrations) listed above are characterized by a high AOA. Cerebrolysin was 300 times less active than trolox, and emoxipin showed no antioxidant properties. Lacrimal AOA increased after a parabulbar injection of histochrome. Histochrome is believed to be a perspective antioxidant for the treatment of ocular diseases.

The effect of radial keratotomy on contrast sensitivity.

In the period after surgical correction of myopia and astigmatism in 30 patients (44 eyes) by radial keratotomy, contrast sensitivity deteriorated slightly. The disturbances, however, were transitory, and the general trend was toward restoration of function. Strict adherence to an adequate operative technique prevented a marked decline in contrast sensitivity. The decrease must be considered before surgery, particularly in patients who need a high degree of fine motor control.