[Determination of the individual normal range of intraocular pressure in differential diagnosis between pseudonormal tension glaucoma and ischemic optic neuropathies].

The study investigated the relation between the actual intraocular pressure (IOP) and its individual normal range in normal-tension glaucoma (NTG) and ischemic optic neuropathy (ION) outcome. A total of 39 patients (61 eyes) were examined. Group 1 included 19 patients (35 eyes) with newly diagnosed NTG, group 2--20 patients (26 eyes) with the ION outcome. Besides conventional tests, the ophthalmic assessment in all patients included determination of the individual normal range of IOP and evaluation of biomechanical properties of the cornea. It is showed that determination of the individual normal range of IOP may play a key role in confusing cases of differential diagnosis between NTG and ION. The average actual IOP in patients with NTG generally exceeds the individual normal range by 40% (more than 5 mmHg), whereas in patients with the ION outcome--by only 11.7% (less than 5 mmHg - buffer range). No statistically significant difference in IOP measurements by different tonometry methods was found in either NTG or ION patients with corneal compensated IOP less than 21 mmHg.

[Stargardt's disease and abiotrophy of Franceschetti (fundus flavimaculatus): pathogenetic, clinical, and molecular genetic characteristics].

The article presents a review of literature on Stargardt's disease and abiotrophy of Franceschetti. Etiopathogenetic, clinical and molecular genetic characteristics are covered. Clinical and genetic classifications of the diseases are provided.

[Morphological changes in retina and optic nerve head in patients with Leber's hereditary optic neuropathy].

OBJECTIVE: To study morphological changes of the macula and the peripapillary nerve fiber layer in patients with Leber's hereditary optic neuropathy (LHON). MATERIAL AND METHODS: A total of 21 patients (40 eyes) with LHON and 17 healthy volunteers (33 eyes) of the control group were assessed. Optical coherence tomography (OCT) on RTVue-100 for retina and optic nerve head assessment was performed in all cases. RESULTS: Thinning of the inner retinal layers in nasal and inferior parafoveal sectors takes place in the early acute period of the disease and then spreads to the rest of the macular area. The retinal nerve fiber layer (RNFL) in the early acute period is of more thickness in temporal, inferior, and superior sectors in comparison to controls, but later gradually becomes thinner, especially in the temporal sector. In the late period significant peripapillary RNFL thinning is present in all sectors. CONCLUSION: OCT reveals certain structural changes in the macular area and the peripapillary RNFL that are characteristic of Leber's hereditary optic neuropathy and together with clinical presentation can substantiate the diagnosis.

[Intraocular pressure and ocular blood flow features intravitreal infection of anti-vascular endothelial growth factor agents].

OBJECTIVE: to investigate intraocular pressure (IOP) and ocular blood flow (OBF) changes as well as the individual normal range of IOP in patients with age-related macular degeneration (AMD) with or without concomitant glaucoma after intravitreal anti-vascular endothelial growth factor (VEGF) therapy. MATERIAL AND METHODS: Group 1 included 34 patients (34 eyes) with AMD and no glaucoma, group 2-34 patients (34 eyes) with both AMD and glaucoma. In all patients the IOP and OBF were measured (with Ocular Blood Flow Analyzer) and the individual normal range of lOP calculated before the treatment, on the third day after the injection and at the 1-month follow-up visit. Statistical analysis was performed by STATISTICA 10. RESULTS: In group 1 there were no significant changes in ocular blood flow at different times after ranibizumab injection. In group 2 a considerable decrease in OBF was detected 1 month after the injection (p<0.001). In group 1 the intraocular pressure was at the same level before and after the treatment. In group 2 the IOP significantly decreased on the third day after the anti-VEGF injection (p=0.03) but was back to the initial level in 1 month. The individual normal range of lOP, when calculated on the third day after the injection, appeared to be much lower than before due to a moderate decrease in both IOP and OBF. At the 1-month follow-up the individual normal range of IOP was back to initial values in non-glaucoma patients but remained low in the glaucoma group due to reduced OBF. CONCLUSION: The established decrease in the individual normal range of IOP in the late period after an anti-VEGF injection should be taken into account when managing patients with both AMD and glaucoma.

[Differentiation of concomitant glaucomatous optic neuropathy in optic disc drusen].

Characteristics of ocular blood flow (OBF) in primary open-angle glaucoma (POAG) in eyes with optic disc drusen have been investigated. The study enrolled 21 patient (35 eyes) with optic disc drusen, of which 7 (8 eyes) were diagnosed with POAG. Besides the standard tests, the ophthalmological assessment included evaluation of OBF (flowmetry) and an individual normal range of intraocular pressure (IOP). The results showed that optic disc drusen are not associated with OBF changes. Concomitant POAG might be suspected in a patient with optic disc drusen whose OBF is significantly decreased and IOP is above the individual normal range. Differentiation of morphofunctional changes in chronic optic neuropathy, which might be due to either glaucomatous optic neuropathy or optic disc drusen, is complicated when actual IOP lies within the average normal range. Ocular blood flow evaluation by means of flowmetry with calculation of an individual normal range of IOP has been demonstrated as a highly effective predictor of concomitant POAG in patients with optic disc drusen.

[Peculiarities of ocular blood flow in ischemic optic neuropathy and normal tension glaucoma].

Characteristics of ocular hemodynamics in ischemic optic neuropathy (ION) outcome and normal tension glaucoma (NTG), the conditions that are difficult to be differentially diagnosed, have been investigated. The study enrolled 32 patients (40 eyes) with ION outcome, 26 patients (46 eyes) with NTG, and 20 patients (32 eyes) with no ocular pathology. Besides the standard ophthalmological examination, color Doppler imaging of ocular vessels, evaluation of ocular blood flow volume and individual normal range of intraocular pressure (flowmetry) were performed in all cases. The results showed that an excess of the actual intraocular pressure (IOP) over the individual normal range was much higher in patients with NTG than in patients with ION (39% and 14.5% correspondingly). It was also found that NTG is associated with a more significant decrease of ocular blood flow volume (30.1% in average) in comparison to ION outcome (11%). In both conditions a decrease in velocity parameters of the blood flow in main ocular vessels was registered, however, ocular hemodynamics changes appeared to be more severe in patients with glaucomatous optic neuropathy. A statistically reliable correlation between volumetric and velocity parameters of ocular blood flow has been discovered.

[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.

[Influence of genetic mutations on clinical presentation of subretinal neovascularization. Report 2: The impact of HTRA and VEGF genes polymorphism].

A detailed analysis of influence of HTRA (serine peptidase) and VEGF (vascular endothelial growth factor) genes mutations is presented. The presence of one gene copy with allele of A- polymorphism rs1120638 of HTRA1 gen, T- polymorphism rs10490924 and de11443in54 of ARMS2 gene increases the risk of CNV in patients with AMD. The feature of clinical presentation in patients with CNV associated with (-625) A mutation of promoter region of HTRA1 gene in two chromosomes was fulminant course of the disease from exudative to scarring processes with fibrous tissue formation not just with sub-, but also intra- and preretinal localization. Genetic screening showed that combination of studied mutations (402H, (-625) A and (-251) A in both gene copies of CFH, HTRA and IL-8) results in the most severe and rapidly progressing form of the disease. Two new mutations were revealed in promoter region of VEGF gene: G > A replacement in position of (-72) nucleotide from transcription start and G > A replacement in 5'-nontranslated region of the 1st gene exon in position of (+31) nucleotide from transcription start.

[Influence of genetic mutations on clinical presentation of subretinal neovascularization. Report 1: The impact of CFH and IL-8 genes polymorphism].

Genetic analysis was performed in patients with subretinal neovascularization (CNV). The results showed significant association of CFH (compliment factor H) gene polymorphism with increase (rs1061170, rs514943 and rs380390) or decrease (rs529825, rs7524776, rs1831281, rs2274700, rs1576340, rs12144939, rs7540032) of CNV development risk. The incidence of IL-8 gene mutation was significantly (p = 0.008) higher in patients after chorioretinitis. Apparently -125 > A polymorphism in patients with chorioretinitis increases risk of CNV development, thus promoting raise of proangiogenic factors concentration in eyes with inflammatory background. The clinical presentation in patients with AMD and myopic disease associated with (-125) A mutation of promoter region of IL-8 gene was similar to that of patients with chorioretinitis. The features are the following: focal pattern, no drusen and RPE detachment, predominantly classic form of CNV (without occult pattern), formation of well-organized newly developed vessels.

[Up to date methods of optic nerve evaluation in patients with optic neuropathy of various etiology].

132 patients (188 eyes) with proven optic neuropathy of non-glaucomatous origin were examined using static perimetry, visual evoked potential (flash and pattern types), optic coherent tomography of papilla and thickness of peripapillary nerve fiber layer. Sensitivity/ specificity of methods for identification of optic nerve diseases in acute stage were 92/75%, 92/84%, 90/92% respectively. Combination of these three methods let us identify optic neuropathy in 100% of cases, including latent forms.

[Results of clinical evaluation of a new screening method for determining the individual normal level of intraocular pressure].

The paper presents the results of practical application of a new screening method for determining tolerant intraocular pressure (TIOP) on a Blood Flow Analyzer (Paradigm, USA). Studies were conducted on 331 eyes (205 subjects). Group 1 consisted of 80 patients (126 eyes) without glaucoma being found, with intraocular pressure (IOP) in the average normal range, but with a TIOP excess of 1-8 mm Hg (a risk group); Group 2 included 15 subjects (20 eyes) without glaucoma with normal IOP in whom TIOP exceeded the existing IOP by 1-7 mm Hg; Group 3 comprised 110 patients (185 eyes) with Stage I-III primary open-angle glaucoma (POAG) with compensated IOP. Morphofunctional studies revealed glaucoma in 95 (75%) eyes in the risk group: Stages II and I in 61 and 30%, respectively; and advanced glaucoma in 9%. At the same time, there was a close correlation of the probable detection of glaucoma with the existing degree of a TIOP excess. No cases of glaucoma were observed in Group 2. The determination of TIOP and morphofunctional changes over time in Group 3 revealed a stable glaucomatous process in 99% of cases in which IOP was lower than or equal to TIOP, as well as progressive glaucomatous neuropathy in 91% in which compensated LOP exceeded TIOP. The results of the study in Group 3 suggest that the index TIOP may be used as a guide of IOP in the treatment and monitoring of POAG. The presented data indicate that the determination of the level of TIOP is a required element of both standard ophthalmological examination and monitoring of glaucoma.

[Optic disc drusen. Communication 3. The possibilities of optic coherence tomography].

Twenty-six patients (45 eyes) (median age 55 years) with optic disc drusen (ODD) (a study group) and 24 healthy volunteers (47 eyes) (median age 53 years) (a control group) were examined. Nerve fiber layer thinning determined by optic coherence tomography (OCT) was found in 65% of the ODD. In 20% of the patients with ODD, nerve fiber layer thinning, as evidenced by OCT, was observed with the normal field of vision, which suggests the higher sensitivity of a morphometric study of the retinal nerve fiber layer. According to OCT data, 11% of the patients with pathological changes in the field of vision had increased retinal nerve fiber layer thickness in some quadrants or from the mean value. These changes may be associated with the large-sized optic disc in these patients.

[Results of combination surgical treatment for open-angle glaucoma and cataract].

The results of 257 combined, pathogenically oriented operations were analyzed in 181 patients with cataract concurrent with open-angle glaucoma (OAG). A system of pathogenically oriented combined surgical interventions was shown to be highly effective in patients with cataract concurrent with OAG. The proposed procedure for intraoperative determination of the retention of intraocular fluid allows a pathogenically oriented antiglaucomatous component of combined surgery to be chosen in patients with cataract and OAG. Increased visual acuity and stable stabilization of the glaucomatous process were achieved in all cases during a follow-up of less than 3 years.

[Current morphofunctional studies of the optic nerve and retina in difficult diagnostic cases].

Thirty-four patients (53 eyes) with suspected optic nerve and retinal diseases were examined. For differential diagnosis, the authors used current studies of the ocular neurosensory apparatus, such as retinal tomography, computer static perimetry, and electrophysiologial techniques, including multifocal electroretinography. The complex use of structural and functional studies of the retina and optic nerve established the valid diagnosis in all difficult clinical cases.

[Diagnostic value of macular morphometry in patients with primary open-angle glaucoma].

In this article the results of practical use of central retinal zone (CRZ) tomography in primary open-angle glaucoma (POAG) measured with RTA (Retinal thickness Analyzer, Talia Technology Ltd., Israel) are presented. 460 patients (790 eyes) aged 45-85 years old were included into the study. Significant decrease of CRZ minimal thickness and perifoveal region thickness (p < 0.05 and p = 0.01 respectively) was revealed in patients with POAG compared with control group. Morphometric data showed correlation with decrease of light sensitivity and visual field defects detected with static perimetry. This fact confirms information value of central retinal morphometric changes for glaucoma diagnosis.

[A new screening method for determining tolerant intraocular pressure].

The authors proposed a new screening for determining individual tolerant intraocular pressure (TIOP). The investigation covered 107 individuals (167 eyes). All the examinees were divided into three groups. Groups 1 and 3 comprised healthy volunteers without the signs of vascular changes and glaucoma; Group 2 included patients with new-onset glaucoma with uncompensated intraocular pressure (IOP). There was a regression relationship of ocular blood flow (OBF) to the length of the anteroposterior ocular axis (APOA), which showed a high correlation between OBF and APOA. To determine TIOP, the authors proposed the calculation formula: TIOP = P x K/K(n), where P is the tonometric IOP (mm Hg); K is the flowmetric value of OBF (microl/sec); K(n) is the individual normal OBF value (microl/sec) determined by the nomogram developed by the authors, by taking into account the value of APOA (mm). It is suggested that the eye has a certain buffer range of excessive tolerant pressure within which increased ophthalmotonus results in abnormal sequels. The patients with TIOP that is lower than the existing IOP in the absence of glaucoma symptoms should be classified as a risk-group.

[Evaluation of the efficiency of hydromonitoring phacofragmentation versus ultrasound phacoemulsification on the morphometric parameters of the central retinal region].

Morphometric studies using a laser retinal thickness showed great differences in the impact of hydromonitoring phacofragmentation and ultrasound phacoemulsification on the thickness of the central retinal region. Unlike ultrasound phacoemulsification, hydromonitoring phacofragmentation caused no transient increase in the thickness of the central retinal area. The performed studies revealed no correlation between the equivalent time of ultrasound and ultrasound phacoemulsification and the changes in the thickness of the central retinal region and fovea.