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Retinopathy of prematurity (ROP) is a complex and unresolved problem in pediatric ophthalmology, leading to visual disability. Low birth weight and prematurity are the main risk factors, and they form the basis of clinical recommendations for screening for ROP in all children under 35 weeks of gestational age and weighing less than 2000 g. However, many researchers point to other risk factors that can be divided into maternal, prenatal and perinatal. In this review, we consider maternal diabetes mellitus as a risk factor for ROP. Changes in the retina in premature infants and mothers with diabetes mellitus have some common features, since pathological angiogenesis occurs at the basis of these diseases. In addition, diabetes is a risk factor for preterm birth, and prematurity is a leading cause of neonatal morbidity, including the development of ROP. This suggests that maternal diabetes mellitus may have both direct and indirect effects on the development of ROP. To develop predictive models, an understanding of risk factors for ROP, the pathophysiology of retinal vascular diseases, and diseases of prematurity is necessary.

The purpose of the review is to evaluate the interaction of angiotensin-converting enzyme inhibitors in patients with glaucoma and concomitant arterial hypertension using literature data. Glaucoma is the main cause of blindness and visual impairment, as well as the main cause of irreversible blindness worldwide. Pharmacotherapy, laser or surgical treatments are used to reduce IOP levels, as well as prevent deterioration of visual field defects. However, 40 % of patients develop glaucomatous neuropathy despite ongoing therapy. This prompts the investigation of alternative causes of damage to the optic nerve, and abnormal blood pressure levels, both too low and too high, are considered as a possible risk factor. Arterial hypertension occurs in 48–65 % of patients with glaucoma and is the most common systemic disease in patients with glaucoma. Currently, angiotensin converting enzyme (ACE) inhibitors are considered the “gold standard” in the treatment of arterial hypertension, in the pathogenesis of which activation of the renin-angiotensin system (RAS) plays an important role. The renin-angiotensin system (RAS) is a hormonal system responsible for regulating blood pressure and fluid and electrolyte balance in the body. Local tissue-specific RAS were found, including in the structures of the eyeball: cornea, aqueous humor, iris, ciliary body, vitreous body, retina. These data indicate that the local RAS plays an important role in the regulation of the physiology of the eye and may become a target in the development of new antiglaucoma drugs. Animal studies, as well as studies in various patient groups, show that systemic antihypertensive drugs that inhibit the RAS, such as ACE inhibitors, reduce IOP. These studies support the concept that RAS inhibitory drugs may be potential antiglaucoma drugs in the future, as ACE inhibitors can improve the outflow of intraocular fluid, thereby reducing IOP.

To prevent the spread of COVID-19, to ensure the safety of ourselves and others, personal protective equipment — various types of masks — has firmly entered our daily lives. Purpose to conduct a clinical and sociological study of the severity of the dry eye syndrome in medical personnel and medical students against the background of the use of personal protective equipment and to assess the possibilities of its correction using tear replacement therapy. Materials and methods. 138 medical staff and 149 students were analyzed. A survey was conducted to identify risk factors for the development of the dry eye syndrome. The total tear production was determined using the Schirmer I test at the beginning and after 8 hours of the working day in medical personnel and students before and after a 6-hour lesson. To study the possibility of correcting the dry eye syndrome, students were offered instillations of the tear substitute Gylan 0.18 % 3 times a day. At this stage of the study, 2 questionnaires were used to assess the severity of DES symptoms: OSDI and DEQ, Schirmer I test. Results. Most of the study participants noted the constant wearing of masks (86.4 % of doctors and 84.8 % of nurses). At the beginning of the study, 45.1 % of doctors and 51.9 % of nursing staff, 45.6 % of students had indicators of total tear production below the reference values. At the end of working hours, doctors (90.9 %), nurses (88.6 %) and students (69.2 %) showed a decrease in the total tear production of varying severity. The use of a tear substitute made it possible to increase the indicators of total tear production: 10 days after treatment, an increase was observed in 45.7 % of cases (but the values were in the range of 10—14 mm), in 31.4 % of cases they reached 15 mm or more and exceeded the initial values (p < 0.05); reduce the symptoms of dry eye: the number of students with DEQ questionnaire syndrome dry eye at the beginning of the study (62.9 %) decreased by 3.2 times. Conclusions: the conducted study allows us to speak about the currently available riskfactorfor the development of the dry eye syndrome: personal respiratory protective equipment has a negative impact on the indicators of total tear production. Appointment of tear replacement therapy allowed to improve the functional indicators of tears and quality of life. It is necessary to develop and implement measures aimed at identifying and preventing the development of the dry eye syndrome not only among medical personnel, but also among the population as a whole.

In the modern world, myopia continues to be one of the most common refractive errors and is considered a socially signifi cant problem, since it is a common cause of decreased vision. In connection with the growth of myopia, the risk of developing complications in the fundus increases, leading to the development of degenerative changes in the retina and an irreversible decrease in visual functions in young and middle-aged people. One of these complications is myopic choroidal neovascularization, which leads to a progressive, irreversible decrease in visual acuity and poor prognosis, and the process is often bilateral in nature. The tactics of managing patients with such complications has been determined: antiangiogenic therapy is used – intravitreal therapy with anti-VEGF drugs, which is currently the fi rst choice therapy for this pathology. But in some cases, antiangiogenic therapy is contraindicated, and the question arises about the tactics of managing such patients. The aim: to study treatment options for myopic choroidal neovascularization in patients with myopia in different situations.Material and methods. The paper presents two clinical observations of patients with mChNV, considers the tactics of their management. The patients underwent standard ophthalmological examination, optical coherence tomography (OCT) and OCT-Angio (OPTOPOL Technology, Poland).Conclusions. Women with myopia planning pregnancy need a thorough examination not only by a clinician, but also by an ophthalmologist, since it is necessary to take into account not only the degree of myopia and choose the optimal delivery method, but also to study the state of the retina for the timely diagnosis of degenerative changes in the fundus.

Aim — to study of gene polymorphisms affecting the effectiveness of timolol treatment of primary open-angle glaucoma.Patients and Methods. The study included 39 Russian patients (29 women and 10 men) aged 53 to 89 years old with a diagnosis of primary open-angle glaucoma (POAG). Intraocular pressure (IOP) was measured before the start of therapy and after 2 weeks during treatment. Сoefficient of decrease in IOP was calculated in percentage of its initial level (∆D). Patients were genotyped according to the polymorphic loci MMP1-160insG, MMP12A-82G, TIMP1C536T, ADRB1Arg389Gly, ADRB1Ser49Gly, NAT2Lys268Arg, GSTP1Ile105Val using the corresponding SNP-express reagent kits (NPF Lytech, Moscow).Results. No effect of MMP12A-82G, TIMP1C536T, ADRB1Arg389Gly, NAT2Lys268Arg polymorphisms on efficiency of reduction of IOP under action of thymolol in “best” eyes was revealed. The carriage of a homozygous genotype GSTP1Ile105Ile resulted in the best ophthalmic hypotensive effect of a timolol (∆D ≥ 20 %), which probability was 5.63 times higher in comparison with ∆D < 20 %. In the “worst” eyes, the association of carriage of a combination of wild genotypes GSTP1Ile105Ile×NAT2Lys268Lys with the best response of patients to timolol was revealed. The ophthalmic hypotensive effect of 10 ≤ ∆D < 20 % in such carriers was more than 11 times more likely than ∆D < 10 %.Conclusion. The carriage of the wild genotype GSTP1Ile105Ile determines the best ophthalmic hypotensive effect of timolol and can be a prognostic marker for the effective treatment of patients with POAG. The combination of wild genotypes GSTP1Ile105Ile×NAT2Lys268Lys can contribute to the better therapeutic effect of timolol, and mutant ones can prevent it.

Purpose: study of the effect of dosed pneumatic vasocompression (DPVС) as part of complex therapy on functional indicators in patients with primary open-angle glaucoma (POAG) depending on the characteristics of the individual profibrinolytic response of the vascular wall. Patients and methods. An additional analysis of data that was obtained earlier in 20 patients of the main group with stage II POAG was performed. Patients of this group, along with conservative drug therapy at the inpatient stage, underwent a course of DPVС, including 4 sessions of pneumocompression of the upper extremities (see previously submitted to print work — Non-pharmacological enhancement of fibrinolysis in the treatment of primary open-angle glaucoma. Part 2). According to the results of assessing the severity of the profibrinolytic response to pneumocompression, patients were conditionally divided into two groups: 1st group — with a high response to a single external mechanical effect, documented by an increase (∆) of t-PA / PAI 1 ≥1.00 (Me 1.57; 95 % CI 1.12–3.83); 10 patients, and the 2nd group — with a low response with ∆t-PA / PAI 1

Purpose: to study the effect of dosed pneumatic vasocompression (DPVK) on the functional parameters of the organ of vision in patients with primary open-angle gluacoma in the complex therapy of this form of pathology.Patients and Methods. The study included 39 patients with stage II POAG, which were randomized into two groups: main and control. All patients received a conservative complex drug therapy. Patients of the main group were additionally conducted DPVK sessions — twice a week (only 4 procedures during the entire course of treatment). All patients underwent standard ophthalmologic examination, hemostasis and fibrinolysis.Results. In the main group of patients, 1 hour after the end of compression, an increase (from baseline) in t-PA level (by median — 1.4 times) was observed while reducing the content of PAI-1 (by median — 2.7 times); improvement of hydrodynamic indicators (improvement of the outflow lightness coefficient, by 19.04 % in OD and 20.0 % in OS, decrease in KB by 24.7 % in OD and by 22.3 % in OS from the initial level) and retinal sensitivity (decrease the number of cattle type 1 in both eyes: 1.70 times on OD and 2.14 times on OS, decrease in type 2 cattle by 2.70 (OD) and 2.30 times (OS). In this regard, an increase sites of normal retina’s photosensitivity in 1.14 times on the OD and 1.19 times on the OS, in contrast to patients in the control group, where no significant changes were found.Conclusion. The obtained preliminary results of the study indicate the prospects for non-pharmacological stimulation of fibrinolysis in the inpatient stage of the addition of conservative therapy in patients with POAG, achieved with a course of dosed pneumatic vasocompression.

Purpose. To study the type of relationship to the disease in patients with primary open-angle glaucoma of different age groups.Material and methods. The study involved 312 patients with primary open-angle glaucoma of the stages I –IV who were treated at the Regional Ophthalmological Hospital. The patients were divided into 3 groups: the group 1 had 104 patients of middle age (45–59 years old), of them: 44 male (42.3%) and 60 female (57.7%), the group 2 – 110 elderly people (60–74 years) of them: 46 male (41.8%) and 64 female (58.2%), the group 3 – 98 elderly patients (75 years and older) – 36 male (36.7%) and 62 female (63.3%). For a psychological diagnosis of types of attitude towards the disease, the ≪TOBOL≫ method was used.Results. Among the middle-aged patients, a harmonious and ergopathic type of attitude to the disease prevailed (21.95% and 20.14%, respectively) as well as a moderately pronounced sensitive type (11.23%). Among the elderly patients, a significant decrease was noted in indicators of a harmonious type of attitude to the disease, compared with the middle-aged patients (average indicators on a scale of harmony: 21.95±0.69 vs. 12.65±0.66; p≤0.05). Both males and females of advanced age were characterized by a high degree manifestation of anxious, hypochondriac, sensitive tendencies, with moderately pronounced neurasthenic and melancholic tendencies. Among the patients of senile age, a decrease in the harmonious type of attitude to the disease, a severity of hypochondriac and neurasthenic tendencies were also detected compared with the middle-aged patients.Conclusion. A comparative analysis of the types of attitude to the disease in patients with primary open-angle glaucoma of different age groups showed significant differences between individuals of the elderly and senile age compared with middle-aged people.

The article presents a review of studies on various aspects of vascular theory of primary open-angle glaucoma (POAG) development and progression. The data of foreign and domestic scientists on the influence of hemodynamic disturbances in the glaucoma pathogenesis, including various levels: Central, regional and microcirculatory. Violations of the universal mechanism of vascular tone regulation, namely endothelial dysfunction are described. Vascular endothelium is a barrier between vascular wall and blood plasma. When the endothelium is damaged, its antithrombotic properties are transformed into a powerful prothrombotic potential. This leads to an imbalance between vasoconstrictors (endothelin) and vasodilators (nitric oxide). In addition, the release of biologically active substances with local neurotoxic effects. The authors noted an increase in the concentration of endothelin-1, studied its interaction with nitrogen oxide and considered its role in the occurrence of ischemia and the impact on the death of retinal ganglion cells. Scientists have noticed an increase in the level of Willebrand factor and increased platelet aggregation in patients with progressive glaucoma. As a possible cause of hemodynamic disturbances and glaucoma progression, the authors consider changes in blood rheological properties. In addition, the state of the three closely interacting components: the wall of blood vessels (primarily endothelium and subendothelial structures); cellular elements of blood (primarily platelets) and plasma proteolytic systems ensure the normal functioning of the hemostatic system. Changes in of these components state may affect the hemostatic system. Therefore, further study of various directions of vascular theory will help in understanding the etiopathogenesis of glaucoma.

Purpose: To study primary and recurrent glaucoma-induced disability in senior working-age people in the Altai Territory over the period of 2004-2013. Material and methods. The data of the Bureau of medico-social examination for the period have been analyzed to determine the main parameters of disability: the intensive (primary disability prevalence per 10 thousand individuals) and the extensive markers (percentage distribution of primary disability causes). Results. Over the researched period, the number of Altai territory individuals registered as invalids for the first time due to diseases of the eye and adnexa decreased by 2.14 times, while the number of people classified as recurrent invalids showed a 1.4 - fold increase. In the nosological structure of primary disability due to diseases of the eye and adnexa, glaucoma consistently claimed rank 1, while in recurrent disability glaucoma rose from rank 3 to rank 1, and its share in the structure of repeated disability causes increased by 2.1 times. The cohort of primary and recurrent glaucoma-induced invalids mainly includes people older than the official working age, who claimed 87.4 % and 61.6 % in primary and recurrent disability, respectively. The proportion of invalids of group I (41.3 and 40.2 %) and group II (37.7 and 38.2 %), respectively for primary and recurrent disability, was significantly higher than the proportion of III group invalids (21 and 21.6 %, respectively). Conclusion. The dynamics and structure of primary and recurrent glaucoma-induced disability in senior working-age population showed that the tactics of prevention, concrete preventive measures, and rehabilitation procedures for glaucoma patients need to be developed. For citations: Makogon S.I., Makogon A.S. Primary and recurrent glaucoma-induced disability in senior workingage population in the Altai territory. Russian ophthalmological journal. 2017; 10 (3): 42-48. doi: 10.21516/2072-0076-2017-10-3-42-48 (in Russian).