[Objective functional monitoring of retinoprotective treatment in diabetic retinopathy]. / Ob"ektivnyi funktsional'nyi kontrol' retinoprotektornogo lecheniya diabeticheskoi retinopatii.

In recent years, there has been a growing interest in the contribution of neuroretinal degeneration to the pathogenesis of diabetic retinopathy (DR). PURPOSE: This study assesses the effect of the drug Retinalamin on the functional state of the retina in patients with DR using the Diopsys NOVA Vision Testing System that utilizes electrophysiological (EP) technology. MATERIAL AND METHODS: The study included patients with type 1 and 2 diabetes mellitus (DM) with DR of any stage without macular edema. Patients underwent standard ophthalmological examination and objective functional examination of the retina using the Diopsys NOVA Vision Testing System. The control group consisted of patients with type 1 and 2 DM with DR who did not receive Retinalamin. RESULTS: Significant changes in pattern electroretinography and flash electroretinography parameters were recorded in patients who received a course of Retinalamin. Two clinical examples are presented, which can be designated as the first experience of objective functional monitoring of treatment of patients with DR with Retinalamin. CONCLUSION: Retinoprotective therapy is necessary already at the early stages of DR. Electroretinography is an objective tool for functional analysis of the earliest changes in retinal cells in DR. It is necessary to use the identified "therapeutic" window for the appointment of retinoprotective agents.

[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.

[Structural and functional changes in the retina of patients with primary open-angle glaucoma and compensated intraocular pressure while undergoing retinoprotective therapy]. / Strukturno-funktsional'nye izmeneniia setchatki u patsientov s pervichnoi otkrytougol'noi glaukomoi pri kompensirovannom vnutriglaznom davlenii na fone retinoprotektornoi terapii.

PURPOSE: To evaluate the efficacy and safety of intramuscular Retinalamin for retinoprotection in patients with open-angle glaucoma and normalized intraocular pressure (IOP). MATERIAL AND METHODS: The study included 180 patients (355 eyes) randomized into the main (n=90) and control groups (n=90). The patients of the main group received intramuscular Retinalamin injections; the course was repeated 6 months later. Patient examination was performed at 1, 3, 6, 7, 9 and 12 months. RESULTS: Vision acuity did not change in the main group after the treatment courses (p=0.3732, p=0.6862), nor in the control group (p=0.7751). IOP didn't have significant changes during the whole course of the study neither in the main group (p=0.7632), nor in the control group (p=0.3921). MD index in the main group has increased from -5.52±2.76 to -4.82±2.73 dB (measurements from 6 visits: p=0.0391, p=0.0201, p=0.0302, p=0.3708, p=0.0151, p=0.0353). Control group showed negative MD trend (from -3.51±1.84 to -4.60±2.61 dB; p=0.0012). PSD index has changed from 4.63±1.60 to 4.05±1.43 dB (p=0.0081) in the main group, and from 3.73±1.19 to 4.29±1.53 dB (p=0.0027) in the control group. Average thickness of retinal nerve fiber layer (RNFL) and the volume of neuroretinal rim were stable in both the main (p=0.8039, p=0.9005) and the control groups (p=0.7448, p=0.9620). Ganglion cell complex (GCC) thickness remained stable in the main group (p=0.0377), but has decreased in the control group (p=0.0250). P50 amplitude and latency were stable in the main group (6.54±2.61-6.53±2.64 µV, p=0.0479; 48.39±3.69-50.86±4.09 ms, p=0.0271), while in the control group P50 amplitude has decreased (p=0,0031) and the latency has increased (p=0,0194). In the main group, N95 amplitude has stabilized (p=0.0141) with worsened latency (p=0.0492). N95 amplitude in the control group has worsened (p=0.0195), while latency has stabilized (p=0.3401). CONCLUSION: Systemic use of Retinalamin has significant retinoprotective effect confirmed by the dynamics of morphological and functional parameters in patients with POAG and IOP compensation.

[Structural and functional changes in the retinal layers in patients with primary glaucoma and possible means of retinoprotection]. / Strukturno-funktsional'nye izmeneniia sloev setchatki pri pervichnoi glaukome i vozmozhnye puti retinoprotektsii.

Glaucoma is one of the most severe forms of ophthalmic pathology which can lead to low vision and blindness. Therapy aimed only at reducing intraocular pressure (IOP) may be insufficient in patients with this disease. PURPOSE: To study the structural and functional changes occurring in the retina and the effect of peptide bioregulator on the state of various retinal layers in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study included 62 patients (123 eyes) with POAG. The control group consisted of 25 people (50 eyes) of the same age. After the initial examination, patients of the glaucomatous group were divided into two equal subgroups. Patients of the first subgroup received 10 intramuscular injections of the peptide bioregulator; in the second subgroup, patients did not receive any retinoprotective therapy. The state of the visual analyzer was assessed using spectral optical coherence tomography (SOKT), electrophysiological research methods (ERG, PERG, flicker ERG), photostress test. RESULTS: Patients with POAG were found to have current and developing changes in the thickness and the configuration of various layers of the retina in the macular area as the disease progresses - particularly, in the nerve fiber layer (p=0.02), ganglion cells (p=0.002), inner nuclear layer (p=0.003) and the layer of pigment epithelium (p=0.049). Electrophysiological research methods helped reveal statistically significant changes in the functional parameters reflecting the generation and conduction of nerve impulses in retinal layers in patients with glaucoma. The patients undergoing peptide bioregulator therapy showed statistically significant positive changes in the state of ganglion cells observed as a decrease in the latency of the PERG N-95 wave (p=0.002) and stabilization of the structural indicators of SOCT (RNFL peripapillary zone). CONCLUSION: Patients with POAG exhibit progressive decrease in the thickness of not only the inner, but also the outer layers of the retinal macular area. According to objective structural and functional criteria, retinoprotective therapy leads to stabilization of the glaucomatous process.

[Comparative study of central and peripapillary retina in primary open-angle glaucoma using spectral-domain optical coherence tomography].

The aim of the study was to compare outer retinal layers in primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (OCT). 15 patients (27 eyes) and 16 normal subjects (32 eyes) were examined. Patients were examined using OCT Spectralis ("Heidelberg Engineering", Germany) in order to analyze outer retinal layers and evaluate beta-zone extent. Significant difference such as thining of retinal pigment epithelium/Bruch's membrane (RPE/ BrM) complex was found in OCT images of outer retinal layers. Negative correlation of RPE/BrM complex thickness and peripapillary beta-zone extent was found. Changes of central and peripapillary retina detected using spectral-domain OCT may be considered for diagnosis and monitoring of POAG.

[Comparative analysis of retinotomographic and histological examinations of retina in health and primary open-angle glaucoma].

Comparative analysis of retinal structure was performed in patients with POAG and control healthy group using spectral OCT and histology. An apparent similarity of tomographic and histological patterns of retinal changes was found in patients with POAG. These results make OCT potentially appropriate method for vital examination of retinal structure in glaucomatous eyes including early stages of the disease. Degeneration of all retinal layers is revealed. Blood flow deficiency due to sclerosis and hyalinosis of uveal vessels is considered to be an immediate cause of outer and intermediate retinal layers degeneration.

[Minimal compression-load ophthalmoplethysmography in health and in primary open-angle glaucoma].

The investigation was undertaken to study intraocular blood flow in health and in primary open-angle glaucoma, by applying ophthalmoplethysmography with the minimum compression load on the eyeball. Sixty-nine patients (129 eyes) with primary open-angle glaucoma and 41 healthy individuals (82 eyes) were examined. In healthy individuals, the ophthalmoplethysmographic parameters of ocular volumetric blood flow averaged 7.3 mm3 for pulse volume and 493 mm3 for minute volume. There was a noticeable drop in volumetric ocular blood flow parameters in early primary open-angle glaucoma and their further decrease as a glaucomatous process progressed. The patients with primary open-glaucoma showed an inverse correlation of the volumetric hemodynamic parameters with the intraocular pressure. Worse temporary plethysmographic parameters were found in patients with normal intraocular pressure, which is an indirect indication of impaired choroidal blood microcirculation in glaucoma even within the normal range of intraocular pressure.

[Involutional changes in the human eye accommodative apparatus as evidenced by ultrasound biometry and biomicroscopy].

The paper presents the results of studying involutional changes in the accommodative apparatus of the eye in presbyopia by ultrasound biometry and biomicroscopy. Persons aged 40-70 years who had presbyopia and emmetropic refraction and without concomitant eye disease were examined. In addition to routine studies, all the examinees underwent ultrasound biomicroscopy and ultrasound biometry. The age-related lenticular enlargement was established to be accompanied by a considerable reduction in the orbicular space of the posterior chamber of the eye to the extent of its transformation to a slotted space. The presbyopic patients were found to have a significantly diminished tone in the middle and posterior portions of the lenticular ligamentous apparatus to the extent of its sag, with the altered direction of their passage between the crystalline lenticular equator and the ciliary body crown, i. e. from meridional to radial. The revealed significant age-related topographic and anatomic changes in the orbicular portion of the posterior chamber of eye and in ligamentous tone, which are associated with the involutional increase in the size of the crystalline lens point to the great importance of decreasing the working accommodation distance in the development of presbyopia.

[The use of ticlid in diabetic retinopathy]. / Primenenie tiklida pri diabeticheskoi retinopatii.

A clinical trial has been conducted of antiaggregation effects of tiklid in 100 diabetes mellitus patients with preproliferative and proliferative retinopathy. Tiklid was found to improve blood rheology, to promote partial recovery of retinal function. As such effects contribute to prevention of progression of the proliferative alterations, tiklid can be recommended for treatment of preproliferative and proliferative retinopathy in patients with diabetes mellitus.

[Dynamic rigidometry]. / Dinamicheskaia rigidometriia.

A new method for assessment of the rigidity of corneoscleral membrane is offered: dynamic rigidometry permitting assessment of the real rigidity of the sclera (Eo). The studies were carried out in 106 normal subjects and 154 patients with glaucoma. In normal controls Eo coefficient was 0.0044 +/- 0.0008 on an average, whereas in glaucoma patients it was two times higher (0.0109 +/- 0.0018). This coefficient virtually did not depend on the level of intraocular pressure. A relationship between Eo and glaucoma stage was detected.

[Studies on ocular rigidity]. / K voprosu issledovaniia rigidnosti glaza.

An ophthalmo-sphygmographic method for assessment of ocular rigidity is suggested. Rigidity coefficient E is estimated from changes in intraocular pressure and eye volume connected with systolic increment of blood volume. The mean E value in normal subjects (n = 123) was 0.0214 +/- 0.005. The results of the suggested method for E coefficient assessment and Friedenwald's method were in good correlation (r = 0.72). Use of Schiotz's constant weight impression sensor helped do without differential tonometry and therefore simplify the method and rule out the errors typical of the traditional methods.