[Biomechanical properties of the cribriform lamina in glaucoma-induced atrophy of the optic nerve and after decompression operations on the scleral canal].

The authors made a mathematical and clinical analysis of the cribriform lamina (CL) of the optic nerve and nerve fiber bundles passing through its foramens in glaucoma-induced optic neuropathy. It was shown that in elevated intraocular pressure, there was a significant CL deformity leading to the compression and deformity of nerve fibers. The important biomechanical characteristic of CL deformity is the tangent of the angle between the longitudinal axis of the scleral canal and the perpendicular to the CL surface.

[Clinical and morphological characteristics of the scleral drainage area in normotensive glaucoma].

The ocular drainage system in normal intraocular-pressure glaucoma was studied by fluorescence lymphoangioscopy of the anterior ocular segment on 24 eyes and by histomorphological analysis of the drainage zone on 12 eyes. The study revealed the increased volumetric lymph flow in the drainage zone, which suggests the higher tissue drainage that correlates with intraocular pressure and agrees with the histomorphological findings. Patients with normotensive glaucoma were found to have ischemic and destructive changes in the drainage zone and vascular system of the anterior ocular segment.

[Controlled cytostatic therapy in the early periods after surgery for glaucoma: preliminary results].

A procedure is proposed to contrast a clear solution of the cytostatic agent 5-fluorouracil during subconjunctival administration early after surgery for glaucoma in order to prevent hyperscarring. For this, after dissolution of 5-fluorouracil with 0.1% dexamethasone solution, 0.

[Morphological rationale for autografting of musculus rectus ocularis fibers at revascular optic nerve decompression surgery].

The authors made a morphological study of the early proposed and clinically tested revascular optic nerve decompression operation developed to improve blood supply to the initial portion of the optic nerve in glaucoma-induced optic neuropathy. An experiment was carried out on 11 rabbits. The operated and control eyes were enucleated 1, 4, and 6 months after surgery.

[Methods of digital differential fluorescein study of the ocular drainage tract].

Intraocular fluid contrasting is achieved via subconjunctival injection of 0.1 ml of 1% sodium fluorescein solution then diffusing along the outflow tract through the anterior chamber. Then the area concerned of the drainage tracts is photographed by means of a slit lamp completed with a digital camera operating in the infrared photographing mode and with a system of special filters, which makes it possible to enhance the sensitivity of the system to the spectrum of fluorescein irradiation.

[An experimental-and-morphological substantiation of non-perforating profound sclerectomy with trabeculosuturization].

The causes of ineffectiveness of primary non-penetrating profound sclerectomy were analyzed on the basis of filtration-zone biopsy materials obtained in repeatedly made antiglaucomatous procedures. The authors believe that the above ineffectiveness is preconditioned by inconsistency of the drainage-zone internal wall resulting from its dystrophic changes due to tissue ischemia, cell apoptosis, collagen changes with fiber's degradation and fibers' colliquative necrosis. It was demonstrated experimentally that the monofilament suture, when applied to the filtration zone, enhances the hypotensive effect of the non-penetrating procedure due to the ability of filtration canals (shaping around sutures) to dose the outflow of lachrymal fluid through the anterior chamber into the subscleral and subconjunctival spaces as well as by activation of the uveoscleral outflow paths.

[Use of cytostatic therapy with 5-fluorouracil in surgery of glaucoma].

Possibilities, conditions and outlooks of using a 5% fluorouracil solution, as subconjunctival injections after antiglaucomatous interventions and as intraoperative applications in the trabecular area, were studied in 131 patients (143 eyes) with uncompensated developed and advanced glaucoma. The results of clinical examinations showed a high efficiency of using fluorouracil after antiglaucomatous interventions to ensure a long-lasting hypotensive effect. Two injections made in the early postoperative period did not entail any complications and were sufficient to maintain the surgical effect.

[Determination of individually endurable intraocular pressure (pressure of target) in primary glaucoma].

On the basis of ocular perfusion pressure a new method was suggested for determining an individually endurable intraocular pressure (IOP), i.e. pressure of target.

[Results and mechanism of action of non-perforating deep sclerotomy in intraoperative monitoring of the hypotensive effect].

A total of 45 patients (45 eyes) were operated on by using the technique of non-perforating deep sclerotomy (NDST). A conclusion on the action mechanism, efficiency and indications for NDST was made on the basis of determining the retention degree and of the intraoperative monitoring of tonometry and tonography parameters. Perforations of various scopes were proven to have an impact on the surgical hypotensive effect; finally, intraoperative measures were suggested in case of NDST inefficiency.

[Pathophysiological basis for decompression surgeries and their effect on the optic nerve scleral duct in cases of primary glaucoma].

The visual functions and hemodynamics of the optic-nerve and retina were examined before and after decompression surgeries in the optic nerve. The methods of ophthalmodynamometry and ultrasound dopplerography were used to study the optic-nerve hemodynamics. The results showed an essential improvement in the visual field and blood circulation of the optic nerve in 80.

[Revascularization decompression of the optic nerve: a new surgery of the optic nerve in progressive glaucomatous optic neuropathy].

A new operation on the optic nerve scleral canal, revascularization compression of the optic nerve, was carried out in 21 patients (21 eyes) in order to improve the visual functions and stabilize the glaucomatous process. The operation combines the advantages of decompression of the optic nerve by dissection of the posterior scleral ring with creation of an additional source of blood supply to the optic nerve from the myovascular bundle of the internal rectal muscle. Good functional effect and notable improvement of hemoperfusion of the optic nerve and retina were attained (period of observation up to 2 years).

[Follow up results and pathogenetic substantiation of the effect of decompression surgery on the optic nerve in glaucomatous optic neuropathy].

Retrospective analysis of the efficiency of optic nerve decompression in progressive glaucomatous optic neuropathy in patients with normalized intraocular pressure showed widening and/or stabilization of the visual field in remote periods (6-11 years) in 83.3% patients. Study of the hemodynamics after optic nerve decompression showed a significant improvement of the hemodynamic parameters in the orbital artery-central retinal artery system: increased bloodflow velocity in the central retinal artery, increase of ophthalmic blood pressure and perfusion pressure, dilatation of the arteries, and constriction of veins, which indicates improvement of hemoperfusion in the initial portion of the optic nerve and retina after decompression surgery on the optic nerve.

[Comparative assessment of hemodynamic risk factors of glaucomatous optic neuropathy progress].

Comparative evaluation of the significance of hemodynamic factors of risk of progress of glaucomatous optic neuropathy has been carried out: blood flow velocity, blood flow resistance, blood pressure in the orbital artery-central retinal artery system, perfusion ocular pressure in connection with stabilization of glaucomatous process, and intraocular pressure were analyzed for a period of up to 16 years. The most significant factors were blood pressure in the orbital artery-central retinal artery system and perfusion ocular pressure, but not blood flow velocity. The leading factor indicating the risk of progress of optic neuropathy in primary glaucoma is ocular perfusion pressure.

[The surgical treatment of normotensive glaucoma].

The efficacy of surgical treatment of low (normal)-pressure glaucoma is validated on the basis of analysis of the disease progress risk factors. The risk factors are inadequate intraocular pressure (IOP) and insufficient blood supply to the optic nerve and retina. For stabilizing the glaucomatous process, IOP is to be reduced below 14 mm Hg.

[Hemodynamics of optic nerve and retina in patients with unstable glaucoma and normal intraocular pressure].

The authors analyze the causes of the progress of glaucomatous atrophy of the optic nerve in normal ophthalmic tone. Ninety-four patients (105 eyes) with different stages of glaucoma were examined; intraocular pressure in them was normalized by drug therapy or surgery. In additional to functional studies, hemodynamics was assessed in all the patients by fluorescent angiography of the optic disk, vacuum ophthalmodynamometry, and ultrasonic dopplerography of the carotid artery, orbital artery, and central retinal artery.

[The clinico-morphological characteristics of the conjunctival and iridic microcirculations in open-angle glaucoma].

Thirty-three conjunctival and iridial biopsy specimens obtained during surgery from 23 patients with glaucomas and 10 with cataracts were examined by functional morphologic and morphometric methods. Fluorescent angiography of the anterior segment of the eye was carried out in 15 patients. Conjunctival and iridial biopsy specimens were embedded in epon, ultrathin sections stained with 1% toluidine blue and polychromic stains.

[Use of cytostatics as anti-cicatricial drugs after anti-glaucoma surgery in children, adolescents and young adults].

Anti-cicatricial cytostatic therapy with 5-fluorouracil and prospidin was carried out after antiglaucoma surgery in 78 eyes of 67 patients aged 6 to 42 (2/3 of the patients were aged from 21 to 40). Half (34) of the patients suffered from open-angle (pigmented in 3 cases) and 6 from closed-angle glaucoma, the rest patients presented with common hydrophthalmia, the Frank-Kamenetsky, Sturdge-Weber, Riger's syndromes, etc. The cytostatics were injected subconjunctivally.

[Clinical evaluation of the hypotensive effectiveness of Betoptic preparation].

Clinical trials of the hypotensive effect of 0.5% betoptic, an antiglaucoma drug manufactured by Alcon (USA), were carried out at three ophthalmologic hospitals. Similar results obtained in all the trials permit a conclusion on a high hypotensive efficacy of this drug in patients with primary open-angle glaucoma.

[Prospects of the use of decompression surgery of the optic nerve in atrophy of vascular etiology].

The technique of decompression surgery on the optic nerve in vascular atrophy has been developed. Optic disk staining grew more intensive, visual field widened, and vision acuity improved after such surgery. Results of fluorescent angiography of the fundus oculi and ultrasonic dopplerography evidence an essential improvement of the blood stream in the central retinal artery after the operation.

[Clinical method of the evaluation of postoperative scarring and preventive cytostatic therapy after glaucoma surgery].

Lymph microcirculation in the bulbar conjunctiva at the site of surgery was studied by fluorescent lymphangiography in 217 patients with primary glaucoma before and in various periods after trabeculectomy. Lymph vessels are changed after the operation; the pattern and intensity of these changes reflect the activity of cicatrization at the site of the operation and are closely related with the hypotensive effect in remote periods postoperation. In cases with the complete compensation of ophthalmic tone without extra hypotensive therapy a moderate narrowing of the lymph vessels was observed, parallelled by a compensatory increase of their quantity and of the volumic rate of the lymph flow.

[Decompression operations on the optic nerve in glaucoma].

The authors give theoretical grounds and experimental validation for surgery on the optic nerve to eliminate its atrophic changes in glaucoma. They suggest a technique of the direct intervention at the site of the optic disk, approaching it from the side of the eye cavity. A method for the optic nerve decompression at the site of its stem portion via an extraocular approach is suggested.