The Azerbaijan Journal of Ophthalmology is included in the list of leading peer-reviewed scientific journals and publications published in the Republic of Azerbaijan, based on the decision of the Supreme Attestation Commission (SAC) of the Republic of Azerbaijan.
MICROINVASIVE SURGERY IN GLAUCOMA TREATMENT: PAST, PRESENT AND FUTURE (LITERATURE REVIEW)
The high prevalence of glaucoma worldwide and the expected further increase in the number of patients necessitate the search for innovative treatment methods. Currently, ophthalmology has a wide arsenal of tools for the treatment of glaucoma, including various groups of medications and laser techniques. Cases of insufficient effectiveness or limitations of medical and laser treatment serve as the basis for choosing surgical methods. However, alongside achieving targeted level of intraocular pressure (IOP), modern trends in glaucoma surgery are also directed towards minimizing tissue trauma during surgeries, reducing procedure time, and ensuring a stable and long-lasting hypotensive effect. Over the past decades, numerous techniques of minimally invasive glaucoma surgery (MIGS) have been emerged. This review was conducted by analysis of current publications dedicated to MIGS, using the PubMed, e-library, Scopus, and Google Scholar databases. The information was systematized and served as the basis for creating the most comprehensive classification of existing MIGS techniques to date, taking into account their technical features, principles, and action mechanisms and impact on various structures of the eye’s drainage system. Data from multicenter studies and meta- analyses are presented, demonstrating the effectiveness, high safety profile, stability of long-term results, and rapid patient rehabilitation with the use of minimally invasive glaucoma surgery. This indicates the undeniable demand and promising nature of MIGS at the mild and moderate glaucoma. Nevertheless, there is no doubt about the relevance of further research of MIGS field in order to expand its practical indications, with the balance between effectiveness and possible risks.
APPLICATION OF ARTIFICIAL INTELLIGENCE IN OPHTHALMOLOGY AND MEDICAL ETHICS PRINCIPLES (LITERATURE REVIEW)
Artificial intelligence (AI) is rapidly advancing and increasingly permeating nearly all aspects of human life. Purpose –This review article discusses the current developments and potential applications of AI in ophthalmology, as well as related medical ethics considerations. Several AI algorithms have been approved by the U.S. Food and Drug Administration (FDA) and have begun to be utilized in diagnostic research within ophthalmology. Studies indicate that AI systems demonstrate high accuracy, particularly in early detection of retinal diseases, monitoring of glaucoma, screening for age-related macular degeneration (AMD), and diabetic retinopathy (DR). Some of these algorithms have already reached clinical validation stages. The potential of this technology is particularly significant for developing countries, where the shortage of ophthalmologists and specialized personnel, combined with geographic and economic barriers to healthcare access, can impede early diagnosis. AI-integrated screening systems can automatically identify at-risk patients at an early stage. Consequently, preventable vision loss can be detected in a timely manner, and patients can be referred to appropriate specialized medical centres. This approach may contribute to more rational allocation of healthcare resources, increased early intervention rates, and reduced long-term visual impairment. Ethical status is generally associated with consciousness, self- awareness, and the capacity to assume responsibility. Current AI systems do not possess these characteristics; however, the development of more complex and autonomous AI raises important ethical questions. In particular, AI systems used in healthcare directly affect human life and health-related decisions, making issues such as responsibility, transparency, and explainability critically important. Therefore, the development of AI necessitates the parallel establishment of ethical and legal frameworks. Conclusion Artificial intelligence plays a transformative role in ophthalmology, particularly in diagnostics and monitoring. Significant advances have been made in early detection of retinal diseases, prediction of glaucoma progression, and optimization of screening programs. Nevertheless, addressing ethical, legal, and technical challenges is essential for its widespread implementation. In the future, AI will not replace ophthalmologists but will serve as their most powerful assistant.
ON THE INCIDENCE OF BLEPHAROPTOSIS (LITERATURE REVIEW)
Aliterature review on the incidence of upper eyelid ptosis (blepharoptosis, BP) is presented. Purpose – to evaluate the incidence of BP reported in studies from different countries and across various age groups, and to identify the most common potential risk factors. Special attention is given to the development of ptosis following ophthalmic surgery, aiming to clarify its underlying mechanisms and to emphasize prevention strategies for ophthalmologists. BP is a common complication after eye surgery and may arise from multiple factors. Various surgical techniques have been employed to investigate its primary causes. Considering the observations of some authors that the risk of BP increases with age, it is important to include this information in the informed consent of patients undergoing eye surgery. To reduce the incidence of postoperative BP, the surgical approach, the selected tactics, and appropriate adjustment of the technique should be carefully considered.
MODERN DIAGNOSTIC METHODS AND CLASSIFICATION OF KERATOCONUS (LITERATURE REVIEW)
Keratoconus is an ectatic disease of the cornea observed in young individuals of working age, leading to impairment of visual function. In advanced stages of the disease and in cases with a typical progressive clinical course, diagnosis does not present significant difficulty. However, in certain cases, verification of the diagnosis may be accompanied by specific challenges. This review systematizes contemporary perspectives on the diagnosis of keratoconus and consistently presents current approaches to patient examination and interpretation of the obtained results. In the early stages of keratoconus and in non-progressive forms, the clinical picture (complaints, medical history, visometry, and autorefractokeratometry findings) is identical to that of simple myopia and regular myopic astigmatism. For this reason, it is rather difficult to suspect the presence of the disease. In progressive keratoconus, with the development of keratectasia, the clinical picture acquires characteristics of the disease and essentially reflects the progressive manifestations of irregular corneal myopic astigmatism. The current pathognomonic biomicroscopic signs of keratoconus include the Fleischer pigment ring, Vogt’s stromal striae, and focal corneal thinning around the ectatic apex currently, keratoconus is best diagnosed and screened with computer-based corneal scanners, such as those using a rotating Scheimpflug camera. These devices combine keratoscopy (Placido disc–based imaging) and keratotomography.The proprietary software of keratoanalyzers generates maps of corneal shape irregularity (keratotopography), refractive power maps (keratometry), and thickness maps (keratopachymetry), calculates relevant indices, and evaluates the probability and stage of keratectasia.These diagnostic platforms enable differential diagnosis and verification of keratoconus at the earliest — keratotopographic — stage. However, to date, there is no effective methodology capable of reliably confirming or excluding ultrastructural changes at the pre-keratotopographic stage of keratoconus.
ARNOLD-CHIARI SYNDROME IN OPHTHALMOLOGY (CLINICAL CASES)
Arnold-Chiari syndrome is a pathology manifested by displacement of the cerebellum and cerebrum through the foramen of the spinal canal, inherited from the inconsistency of the dimensions of the posterior cranial fossa and placement brain structures. Purpose – to evaluate the results of a comprehensive approach to the differential diagnosis of Arnold-Chiari malformation in ophthalmology using two patients as an example. Materials and methods 2 patients (4 eyes) were examined for Arnold-Chiari malformation by generally accepted methods, and optical coherence tomography (OCT). Results There is no pathognomonic symptom or group of symptoms that allow for the clinical diagnosis of Arnold Chiari syndrome, and only neuroimaging diagnostics are possible. Whenever there is inflammation, congestive disc, or optic nerve atrophy, the first action of the ophthalmologist is to refer the patient for magnetic resonance imaging (MRI) or computed tomography (CT) imaging. Identification of relevant ophthalmological disorders at an early stage allows for timely suspicion and detection of this anomaly. Neuroimaging diagnostics justifies the doctor's alertness to this pathology. Conclusion Current diagnostic and treatment advances bring together specialists from various fields – ophthalmologists, radiologists, and neurologists – and present new challenges for physicians. The presented series of clinical cases demonstrated possible manifestations of Arnold-Chiari syndrome, including strabismus and congestion in the optic nerve, which was confirmed by MRI.
TOXIC NEUROPATHY AS A RARE OPHTHALMIC COMPLICATION OF ISOTRETINOIN THERAPY (CLINICAL CASE)
Despite the high efficacy of isotretinoin in the treatment of acne, isotretinoin therapy is associated with a significant number of side effects and can sometimes lead to less frequent, but clinically more significant and potentially unpredictable complications. Purpose – a clinical case demonstrates the development of toxic neuropathy as a rare ophthalmic complication of systemic isotretinoin therapy. A young girl aged 17 complained of deteriorating vision in her left eye four months after starting isotretinoin therapy. She complained of a foggy feeling and shadow on the nasal side of her left eye. Ophthalmoscopy: OS – optic nerve disc (OND) is covered by hemorrhage, in some places the traceable boundaries are blurred, peripapillary edema extending to the foveolar zone. Soft exudates could be observed around the OND. The retinal vessels are tortuous, the veins are tense and full-blooded. Multiple intraretinal hemorrhages of various size could be noted throughout the retinal surface. OD – the fundus is normal, without pathological changes. A marked narrowing of the visual field of the left eye on the nasal side to 20 degrees could be noted, while the right one with no pathological changes. Optical coherence tomography (OCT) revealed severe swelling of the OND and macular area. During the patient's examination we performed a general and biochemical blood tests along with the detailed coagulogram, a blood test for infections and a brain magnetic resonance imaging (MRI) with angiography. The MRI revealed no pathological changes, and all test results were within normal limits. A neuropathologist, hematologist and dermatologist also consulted the patient with recommendations to stop taking isotretinoin and start taking systemic glucocorticosteroids. Apparently, in our case, an increased dose of the medication in recent months has become the reason for the toxic effect and, accordingly, an excessive cumulative dose relative to the teenager’s weight. Conclusion The clinical case presented demonstrates the development of toxic neuropathy as a rare ophthalmic complication of systemic isotretinoin therapy. Timely discontinuation of the medication and administration of pathogenetic therapy made it possible to achieve a gradual regression of morphological changes and improvement of visual functions.
CLINICAL SIGNIFICANCE OF CORNEAL BIOMECHANICAL INDICES IN MYOPIA SUMMARY
The prevalence of myopia is rising globally, projected to affect 45-50% of the population by 2050. Accurate assessment of corneal biomechanics is critical in refractive surgery to predict outcomes and complications such as keratectasia, keratoconus, and glaucoma. The Corvis ST device provides detailed evaluation of corneal biomechanical parameters, including the Corvis Biomechanical Index (CBI) and Tomographic Biomechanical Index (TBI), which aid clinical decision-making and postoperative monitoring. Purpose – to evaluate corneal biomechanical properties and the clinical significance of CBI and TBI in patients with varying degrees of myopia using the Corvis ST device. Material and methods This prospective study included 56 patients (103 eyes) with mild, moderate, or high myopia, examined at “NAZAR Eye Center” in 2025. All patients underwent full ophthalmologic assessment, Pentacam tomography, and Corvis ST biomechanical measurements. Exclusion criteria included pre-existing ocular disease or prior surgery. Data were analysed using SPSS and MedCalc (p < 0.05). Results High myopia was associated with increased axial length, thinner central corneal thickness (CCT), and higher CBI and TBI values. Other biomechanical parameters also showed significant trends with increasing myopia. These findings provide important predictive information for refractive surgery and long-term ocular health. Conclusion Corvis ST biomechanical assessment reliably identifies high-risk eyes and guides surgical planning. Patients with high myopia exhibit increased biomechanical parameters, emphasizing the importance of preoperative evaluation.
THE ROLE OF THE NATIONAL EYE BANK IN THE DEVELOPMENT OF KERATOPLASTY SERVICES IN AZERBAIJAN
Purpose – to analyze keratoplasty indications, surgical trends, and the quality parameters of imported donor tissues in Azerbaijan, and to evaluate the necessity of establishing a National Eye Bank. Material and methods A retrospective analysis of keratoplasty indications and surgical techniques performed between 2008 and 2024 was conducted. Additionally, demographic characteristics, time intervals, and endothelial cell density (ECD) of 272 donor corneas imported from the USA between 2018 and 2025 were evaluated. Results In 2022, a total of 3,659 corneal pathologies were registered at the National Ophthalmology Centre named after Academician Zarifa Aliyeva and its affiliated tertiary centres. The most common indications were aphakic and pseudophakic bullous keratopathy (ABK/PBK) (24.5%) and keratoconus (19.6%). Among the imported donor corneas, the mean donor age was 60.2 ± 1.2 years, and the mean ECD was 2602 ± 35.5 cells/mm2. The preservation-to-surgery interval was 11.2 ± 0.17 (4-14) days. Although all parameters met international standards, prolonged storage duration may contribute to cumulative endothelial cell loss. Conclusion The establishment of a National Eye Bank in Azerbaijan represents a clinical and strategic necessity for the sustainable and high-quality development of keratoplasty services.
EVALUATION OF OPTICAL COHERENCE TOMOGRAPHY AND ULTRASOUND B-SCAN PARAMETERS IN VARIOUS STAGES OF RETINITIS PIGMENTOSA IN DIFFERENT AGE GROUPS
Purpose – to investigate the diagnostic capabilities of optical coherence tomography (OCT) and ultrasound B-scan imaging for assessing structural changes at different stages of retinitis pigmentosa (RP) in various age groups. Material and Methods A total of 74 patients (148 eyes) diagnosed with RP were included in the study. The patients were divided into three age groups. According to the severity of the dystrophic process, three stages of RP were identified, and patients in each age group were further subdivided into three subgroups. Subgroup I consisted of patients with an early stage of the disease, subgroup II included patients with a moderately severe stage, and subgroup III comprised patients with a severe stage of RP. All patients underwent routine ophthalmological examinations as well as additional instrumental investigations. OCT was performed using the Topcon 3D OCT-1 Maestro2 system (Topcon Corporation, Japan). Ultrasound B-scan examination was carried out using a Quantel Medical Compact Touch A/B scanner (France) equipped with a 15-MHz probe. Results According to OCT findings, in all age groups at the early stage of RP, central retinal thickness (CRT) values were comparable to those of the control group. In patients of subgroups II and III, CRT values were significantly reduced, with the most pronounced decrease observed in subgroup III. Specifically, CRT values in subgroup III were 126 ± 11 μm in group I, 119 ± 7 μm in group II, and 101 ± 15 μm in group III (p < 0.001). In terms of qualitative changes, in all age groups, subgroup I demonstrated a normal retinal layer architecture with overall preservation of the ellipsoid zone (EZ). In subgroup II, moderate thinning of the retinal layers was observed, with partial preservation of the EZ. In subgroup III, marked thinning of the retinal layers was noted, with loss of most of the EZ. Based on B-scan findings, various degrees of vitreous body (VB) alterations were detected. In all age groups, subgroup I patients demonstrated no echographic changes in the VB. In subgroup II patients, fine dispersed opacities of varying extent were observed within VB. Posterior hyaloid membrane detachment (PHMD) was visualized in 7 of 10 patients (70%) in group I, 10 of 12 patients (83.3%) in group II, and 8 of 10 patients (80%) in group III. Thickening of the posterior hyaloid membrane (PHM) was detected in 2 of 10 patients (20%) in group I, 2 of 12 patients (16.7%) in group II, and 3 of 10 patients (30%) in group III. In subgroup III patients, fine dispersed vitreous opacities were predominantly visualized in a diffuse pattern. PHMD was observed in all cases. Thickening of the PHM was detected in 4 of 7 patients (57.2%) in group I, 7 of 10 patients (70%) in group II, and 5 of 7 patients (71.4%) in group III. Conclusion In patients diagnosed with RP, the use of modern non-invasive imaging modalities such as OCT and ultrasound B-scan is valuable due to their high accuracy and informativeness in assessing disease progression and treatment effectiveness. These methods have significant diagnostic and prognostic value in the monitoring of RP. Thus, OCT and ultrasound B-scan imaging may be effectively applied to evaluate the severity of the dystrophic process, perform dynamic follow-up, and assess treatment outcomes in patients with RP.
RESULTS OF KERANATURAL IMPLANTATION IN THE TREATMENT OF KERATOCONUS
Purpose – to evaluate the outcomes of KeraNatural allograft implantation in the treatment of keratoconus. Material and methods The study included 28 patients (31 eyes) diagnosed with stage III–IV keratoconus who were admitted to the National Ophthalmology Centre named after Academician Zarifa Aliyeva. Intracorneal Keranatural implantation surgery was performed in these patients. Allograft Corneal Ring (KeraNatural) is sterilized corneal tissue obtained from an eye bank (Lions VisionGift, Orlando, USA). Results The main planned and expected outcome of the surgery – improvement of visual function – was achieved. Uncorrected visual acuity improved up to threefold (from 0.15 ± 0.03 to 0.42 ± 0.04; p < 0.01), and best corrected visual acuity was optimized (from 0.35 ± 0.04 to 0.74 ± 0.02). The cylindrical (–9.42 ± 0.14 and –3.36 ± 0.14; p > 0.05) and spherical (–10.04 ± 0.11 and –2.88 ± 0.10; p > 0.05) components of refraction also changed. Conclusion In conclusion, to truly improve the visual acuity of patients with keratoconus using a biocompatible material, sterile allograft corneal segments were implanted according to the new Istanbul nomogram. The results of this pilot study were found to be comparable with previously published data on intracorneal synthetic segments (ICRS). The findings indicate that this surgical approach is a promising option for the treatment of keratoconus.
Corneal Allogenic Intrastromal Ring Segments
CLINICAL FEATURES AND TREATMENT OF RETINITIS IN PATIENTS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME
Infectious retinitis developing in the setting of acquired immunodeficiency syndrome (AIDS) is one of the major ophthalmological complications that can lead to severe visual loss. Despite the introduction of highly active antiretroviral therapy (HAART), the disease remains relevant in cases of delayed diagnosis and refusal of treatment. Purpose – to evaluate the clinical features and treatment outcomes of infectious retinitis in patients with AIDS. Material and methods The study included 17 patients with AIDS and fundus abnormalities (mean age 34.5 ± 4.29 years). All patients underwent visometry, biomicroscopy, ophthalmoscopy, fundus photography, B-scan ultrasonography, and optical coherence tomography (OCT). Laboratory investigations included determination of HIV status, cytomegalovirus, syphilis, herpes viruses, and CD4+ lymphocyte levels. All patients received antiretroviral therapy and etiological treatment. Results Based on clinical and laboratory assessment, viral and bacterial forms of retinitis were identified; in 82.4% of cases, the process was bilateral. The mean CD4+ level was 60.82 ± 15.4 cells/mm3. After treatment, mean visual acuity increased from 0.31 ± 0.08 to 0.35 ± 0.08. Improvement in visual function was observed in 61.3% of eyes. Rhegmatogenous retinal detachment was recorded in 5 eyes. Conclusion Early diagnosis and comprehensive treatment of infectious retinitis in patients with AIDS are crucial for preserving visual function.
COMPARATIVE ANALYSIS OF INFLAMMATORY AND ANTI-INFLAMMATORY CYTOKINE DYNAMICS IN TEAR FILM FOLLOWING DEEP ANTERIOR LAMELLAR KERATOPLASTY
Keratoconus is a progressive corneal ectatic disorder leading to irregular astigmatism and visual impairment. Deep anterior lamellar keratoplasty (DALK) is the preferred surgical option for advanced cases, as it preserves the host endothelium while replacing diseased stromal tissue. However, postoperative inflammatory responses play a critical role in graft survival, wound healing, and visual outcomes. Evaluation of cytokine dynamics may provide objective insight into the biological impact of different surgical techniques. Purpose – to conduct a comprehensive analysis of the dynamics of inflammatory and anti-inflammatory cytokines in the tear film after DALK in patients with keratoconus. Material and methods This prospective, comparative, non-randomized clinical study included 50 patients with progressive keratoconus who underwent either conventional DALK (n=30) or femtosecond laser-assisted deep anterior lamellar keratoplasty (n=20). A control group of 30 healthy volunteers was enrolled. Tear film samples were collected preoperatively and at 1, 3, 6, and 12 months postoperatively. Interleukin-6 (IL-6) and interleukin-10 (IL-10) concentrations were measured using enzyme- linked immunosorbent assay. The IL-6/IL-10 ratio was calculated as an indicator of inflammatory balance. Results Both surgical techniques were associated with postoperative elevation of inflammatory markers; however, femtosecond laser-assisted surgery demonstrated significantly lower IL-6 levels and higher IL-10 concentrations at all postoperative time points. The IL-6/IL-10 ratio remained significantly more favorable in the femtosecond laser-assisted group, indicating a reduced inflammatory response. A ratio greater than 5.0 at one month predicted unfavorable outcomes. Conclusion Femtosecond laser-assisted deep anterior lamellar keratoplasty induces a more favorable postoperative inflammatory profile compared to conventional surgery, supporting its biological and clinical advantages in keratoconus management.
PREVALENCE AND CLINICAL PROFILE OF PERIPHERAL RETINAL DEGENERATION IN YOUNG MALES WITH REFRACTIVE ERRORS
Purpose – to determine the prevalence, refractive associations, and clinical characteristics of peripheral retinal degeneration (PRD) in young male individuals with refractive errors. Material and methods This retrospective analytical study included 649 male participants aged 16-35 years who underwent comprehensive ophthalmologic examination. Refractive error was assessed using cycloplegic refraction, and spherical equivalent (SE) was calculated for each eye. Peripheral retinal findings were documented using dilated fundus examination and classified into predefined morphological subtypes. PRD prevalence was calculated at both patient and eye levels with 95% confidence intervals (CI). Associations were evaluated using χ2 testing and multivariable logistic regression. Results Peripheral retinal degeneration was identified in 55 of 649 patients (8.47%; 95% CI: 6.5–10.8). Bilateral involvement was observed in 47.3% of cases. Retinal holes were detected in 12.7% of PRD cases, and one patient (1.8%) presented with PRD. PRD prevalence increased significantly with myopia severity (p = 0.0478). Logistic regression analysis confirmed increasing myopic refractive error as an independent predictor of PRD (OR = 0.905 per 1 D increase; 95% CI: 0.841–0.973; p = 0.0073). Although PRD was more frequent in myopic individuals, degeneration was also identified in non-myopic refractive profiles. Lesion-based analysis demonstrated predominant involvement of the superior temporal quadrant. Conclusion Peripheral retinal degeneration is not uncommon in young individuals with refractive errors and is strongly associated with increasing myopia severity, although it may also occur in non-myopic eyes. Systematic peripheral retinal screening is clinically justified, particularly prior to refractive surgery and in individuals exposed to mechanical ocular stress.
INFLUENCE OF CORNEAL TOPOGRAPHIC CHARACTERISTICS ON VISUAL ACUITY AFTER LASER CORRECTION IN PATIENTS WITH MYOPIA
Purpose – to assess the effect of changes in corneal topographic characteristics changes on functional outcomes after laser correction of myopia. Material and methods The study included 54 patients (108 eyes) with moderate to high myopia (≥ 3.25D). Biometric parameters were obtained using Wave light Allegretto Oculyzer (Alcon, Germany). Changes in parameters due to laser correction were determined by calculating the difference between pre-and post-operative values. Visual acuity and corneal keratotopographic characteristics were evaluated before surgery and three months postoperatively. The parameters assessed included central corneal thickness (CT), surface variance index (ISV), vertical asymmetry index (IVA), height asymmetry index (IHA), and height decentration index (IHD). Patients were divided into two groups based on these indices. The first group included those with values within the normal range, while the second group consisted of individuals with above-normal values. Preoperative and postoperative uncorrected visual acuity was compared between the groups using a two-sample t-test with unequal variances. Results Among patients with different corneal thicknesses and topographic indices, visual acuity outcomes did not differ significantly (p ≥ 0.21). However, a statistically significant difference (p = 0.02) was observed in patients with different levels of the IVA index (< 0.28 and > 0.28), where uncorrected visual acuity was 0.062 ± 0.001 and 0.094 ± 0.005, respectively. Groups with normal and pathological topographic indices demonstrated significant differences in visual acuity outcomes. Conclusion In patients with myopia, preoperative visual acuity is significantly influenced by vertical corneal asymmetry (IVA < 0.28 and > 0.28, corresponding to uncorrected visual acuity of 0.062 ± 0.001 and 0.094 ± 0.005, respectively). Postoperatively, optimal visual acuity is observed in cases where corneal thickness ranges from 458 to 560 μm, and the indices remain within ISV < 38, IVA < 0.28, and IHA < 19.
OUR EXPERIENCE WITH PRESERFLO MICROSHUNT IMPLANTATION SURGERY FOR PRIMARY OPEN-ANGLE GLAUCOMA
Drainage devices represent an important advancement in glaucoma surgery, offering effective intraocular pressure (IOP) reduction with reduced surgical trauma and fewer postoperative complications. The PRESERFLOTM MicroShunt is a minimally invasive drainage device designed to enhance aqueous humor outflow. Although short- term outcomes are promising, data on its comparative efficacy with conventional surgical techniques remain limited. Purpose – to evaluate the efficacy of microshunt implantation as a standalone IOP-lowering procedure in comparison with the standard non-penetrating deep sclerectomy (NPDS) technique performed according to the Fedorov-Kozlov method. Material and methods This open-label prospective study included 16 patients with primary open-angle glaucoma (POAG), including refractory cases, who underwent primary glaucoma surgery. Patients were divided into two groups: Group I (n = 8) underwent PRESERFLOTM MicroShunt implantation with Mitomycin C, and Group II (n = 8) underwent NPDS. Baseline demographic and clinical characteristics were comparable between groups (p > 0.05). Patients were followed for 12 months. Postoperative evaluation included best-corrected visual acuity (BCVA), perimetry, IOP measurement, slit-lamp examination, gonioscopy, fundus examination, anterior segment Optical Coherence Tomography (OCT), and ultrasound biomicroscopy (UBM). Results In Group I, mean IOP decreased from 31.0 ± 3.7 mmHg preoperatively to 9.4 ± 1.8 mmHg on day 1, stabilizing at 16.3 ± 4.1 mmHg after 1 year. In Group II, IOP decreased from 29.0 ± 4.1 mmHg to 16.5 ± 2.8 mmHg on day 1 and increased to 19.6 mmHg at 1 year. No patients required hypotensive medication during follow-up. Two NPDS patients (25%) required additional laser intervention. Visual acuity, perimetric indices, and optic nerve head parameters remained stable in both groups. No intraoperative or postoperative complications were observed. Conclusion PRESERFLOTM MicroShunt implantation demonstrated superior IOP control, a favorable safety profile, and reduced need for additional interventions compared with NPDS over a 1-year follow-up. This method may be recommended for patients with refractory POAG; however, larger studies with longer follow-up are required to confirm long-term efficacy and cost-effectiveness.
MODERN APPROACHES TO INTRAOCULAR LENS POWER CALCULATION IN PATIENTS AFTER RADIAL KERATOTOMY (LITERATURE REVIEW)
Radial keratotomy (RK), once widely used for myopia correction, has left a large population of patients who later develop cataract and present significant challenges in intraocular lens (IOL) power calculation. The biomechanical and optical alterations caused by RK – such as corneal flattening, altered anterior-posterior ratio, and irregular astigmatism – compromise the accuracy of standard biometry and conventional IOL formulas. This review summarizes the current understanding of IOL power calculation in post-RK eyes, highlighting the main sources of error, modern formulas, and emerging technologies that improve prediction accuracy. Classical methods such as SRK/T, Holladay 1, and Hoffer Q systematically lead to hyperopic outcomes, while newer formulas including Barrett True-K (Post-RK), Haigis-L, and Shammas-PL offer improved but still limited precision. Artificial intelligence – based algorithms (Hill-RBF 3.0, EVO 2.0) and ray-tracing techniques have further enhanced accuracy by integrating corneal geometry and individualized optical modelling. The incorporation of total keratometry (TK), 3D tomography, and self-learning AI systems marks a paradigm shift toward personalized ophthalmic surgery. Future developments in hybrid, cloud-based, and AI-assisted approaches are expected to achieve sub–0.35 D predictive accuracy and provide consistent refractive outcomes for this complex patient group. Purpose – to analyze the accuracy of different IOL power calculation methods in patients who previously underwent RK and to identify approaches that minimize postoperative refractive errors. The study included patients with a history of RK undergoing cataract surgery. Biometric data were obtained using the IOLMaster 700 (Carl Zeiss Meditec). IOL power was calculated using conventional formulas (SRK/T, Hoffer Q, Holladay 1), adjusted methods (Barrett True-K, Haigis-L, Shammas-PL), and artificial intelligence (AI)-based algorithms (Hill-RBF 3.0, EVO 2.0). The mean absolute error (MAE) between predicted and achieved refraction was evaluated. Traditional formulas demonstrated a consistent hyperopic shift (+0.60 ± 0.25 D). Modern formulas, particularly Barrett True-K and Haigis-L, improved accuracy with MAE values of 0.38 ± 0.16 D. AI-based and ray-tracing methods achieved the highest precision (MAE 0.28–0.32 D), with 88% of cases within ±0.5 D of target refraction. Conclusion Intraocular lens power calculation after RK remains challenging due to corneal irregularity and unpredictable effective lens position (ELP). AI-integrated and ray-tracing–based algorithms offer superior accuracy and represent the future of personalized IOL prediction in post-RK eyes.
KERATOCONUS: CONTEMPORARY UNDERSTANDING AND PREVENTIVE STRATEGIES (LITERATIRE REVIEW)
Purpose – to synthesize current knowledge regarding keratoconus pathogenesis, epidemiology, risk factors, and early detection strategies, with emphasis on preventive medicine approaches relevant to clinical practice in Central Asia, including Uzbekistan. A comprehensive review of contemporary scientific literature was conducted, analyzing molecular mechanisms, environmental and genetic risk factors, global epidemiological patterns, and advanced diagnostic technologies for keratoconus. Special attention was given to modifiable risk factors and screening strategies applicable to resource- varied settings. Keratoconus pathogenesis involves extracellular matrix degradation, oxidative stress, cellular senescence, and biomechanical compromise. Key modifiable risk factors include chronic eye rubbing, ultraviolet exposure, and atopic conditions. Global prevalence is 289.1 per 100,000 persons, with significant regional variation – highest in Africa and West Asia. Advanced imaging technologies including Scheimpflug tomography, anterior segment optical coherence tomography (AS- OCT), and biomechanical assessment enable early detection. Artificial intelligence (AI) algorithms achieve >95% sensitivity and specificity for keratoconus identification. Risk-stratified screening targeting individuals with family history, atopic disease, and systemic associations enables timely intervention with corneal collagen cross-linking. Conclusion Keratoconus prevention requires integrated approaches combining public health interventions addressing modifiable risk factors, risk- based screening programs utilizing advanced diagnostic technologies, and early therapeutic intervention. Implementation of comprehensive screening and prevention programs in Uzbekistan and Central Asia could substantially reduce keratoconus-related visual disability.
SURGICAL APPROACH IN GLAUCOMATOUS EYES COMPLICATED BY PUPILLARY SECLUSION (CLINICAL CASES)
Three clinical cases are presented involving surgical synechiolysis of iridolenticular synechiae that developed following cataract extraction in patients with glaucoma. The surgical approach presented allows for stable intraocular pressure (IOP) and a significant improvement in visual acuity. This makes the surgical method an optimal treatment for managing significant adhesions.
ATAXIA-TELANGIECTASIA: A CLINICAL CASE OF A RARE HEREDITARY SYNDROME WITH OPHTHALMOLOGIC MANIFESTATIONS (CLINICAL CASE)
Ataxia-telangiectasia (AT), also known as Louis-Bar syndrome, is a rare autosomal recessive disorder caused by mutations in the ATM gene. The disease is characterized by a classic triad of progressive cerebellar ataxia, immunodeficiency, and telangiectasias of the skin and conjunctiva. Ophthalmologic manifestations, particularly conjunctival telangiectasias, may be the first externally visible signs of the disease and provide an important clue for early diagnosis. Purpose – to demonstrate ophthalmologic presentations of ataxia- telangiectasia in a child and to emphasize the diagnostic role of the ophthalmologist in the early detection and interdisciplinary management of rare inherited diseases. We report the case of a 10-year-old girl with AT presenting with decreased vision and intermittent conjunctival redness. Examination revealed symmetrical bulbar conjunctival telangiectasias, and moderate thinning of the ganglion cell layer on optical coherence tomography (OCT), suggesting early retinal neurodegenerative changes. Genetic analysis confirmed a pathogenic ATM mutation. This case highlights the critical role of ophthalmologists in the early recognition of AT. Conjunctival telangiectasias, when combined with neurological and immunological findings, serve as a pathognomonic and visually accessible marker. Early ophthalmologic recognition facilitates timely referral for genetic and immunologic evaluation, contributing to multidisciplinary management and improved quality of life for affected patients.
IMPROVING DIABETIC RETINOPATHY SCREENING USING ARTIFICIAL INTELLIGENCE TECHNOLOGY
Purpose – to evaluate the diagnostic effectiveness of the “Retina AI” artificial intelligence system in detecting of diabetic retinopathy (DR) and its symptoms. Material and methods The study was conducted on the basis of the central multidisciplinary polyclinics of the Syrdarya region during the 1st quarter of 2025. The study consistently included 250 patients with an established diagnosis of diabetes mellitus (DM) (type 1 or type 2 diabetes), the duration of the disease is ≥ 5 years. Results The “Retina AI” system demonstrated statistically significantly higher sensitivity (94.7% vs 72.8%) and accuracy (93.5% vs 77.5%) compared to primary care physicians. The difference in specificity also reached statistical significance (91.3% vs 85.0%). The Kappa coefficient of agreement of the Retina AI system with experts was 0.88, which indicates a "very good" agreement. Conclusion The “Retina AI” artificial intelligence system has proven to be highly effective in screening DR among patients in the Syrdarya region, surpassing the assessment of primary care physicians in terms of basic diagnostic accuracy.
INVESTIGATION OF THE RISK OF INFECTIOUS COMPLICATIONS IN OCULAR TRAUMA
The relevance of studying the structure of ocular trauma, the risk factors for the development of post-traumatic complications, and the spectrum of causative microorganisms is explained by the need to improve diagnostic, preventive and therapeutic methods. Purpose – to assess the risk of infectious complications in patients with ocular trauma hospitalized at the National Ophthalmology Centre named after Academician Zarifa Aliyeva. Material and methods A total of 2167 medical records (2225 eyes) of patients hospitalized with the diagnosis of “ocular trauma” between 2019 and 2023 at the National Ophthalmology Centre named after Academician Zarifa Aliyeva were analyzed. Based on the Birmingham, Eye Trauma Terminology System (BETT), the structure of ophthalmic trauma was assessed. Age and gender distribution patterns, as well as the dependence of infectious complications on major risk factors, were evaluated. The spectrum of pathogenic microorganisms involved in the development of infectious complications was analyzed. The descriptive statistical analysis was conducted and the odds ratio (OR) for identified risk factors was calculated. Results Among hospitalized patients, post-traumatic infectious complications such as keratitis, corneal ulcers, abscesses, endophtalmitis, and panophthalmitis occupied a significant proportion of cases following both open and closed ocular injuries. The like hood of developing these complications was 6/2 times higher after closed ocular trauma compared to open injuries (OR = 6.21; 95% CI (confidential interval): 5.04–7.66, p < 0.001). Delayed medical consultation increases the risk of infection nearly threefold (OR = 2.974; 95% CI: 2.490–3.553, p < 0.001). In elderly patients (>65 years), the risk was approximately 2.6 times higher than in younger individuals (OR = 2.650; 95% CI: 2.224–3.157, p < 0.001). The presence of a foreign body in the eye was also found to increase the risk of infectious complications by approximately 1.5 times (OR = 1.450; 95% CI: 1.195–1.760, p < 0.001). In 70.1% of positive cultures, Gram-positive microflora was identified, predominantly of the Staphylococcus genus. Conclusion The development of post-traumatic infectious complications demonstrated a multifactorial dependence, including the type of trauma, timeliness of medical consultation, patient age, and the presence of a foreign bode in the eye. Timely medical interventions play a key role in preventing severe outcomes associated with ocular trauma.
PREVALENCE OF CONGENITAL CATARACT IN CHILDREN WITH A FAMILY HISTORY OF HEREDITARY EYE DISEASES
Purpose – to study the prevalence of congenital cataract in children with a family history of hereditary eye diseases. Material and methods This study utilized data from the children’s database and statistical reports of the Medical Expert Commission at the National Ophthalmology Centre named after Academician Zarifa Aliyeva, covering the years 2019–2023. Patients were analyzed in two primary groups based on family history: Group A – children born from consanguineous marriages (n=409), and Group B – children born from non-consanguineous marriages (n=151). Each group was further subdivided into three age categories (0–5, 6–10, and 11–15 years). Children diagnosed with congenital cataract were evaluated according to family history, gender, age distribution, and regional differences. Statistical analyses were performed using SPSS 26. Comprehensive ophthalmological examination methods were employed to assess ocular status. Diagnoses were classified according to ICD-10 codes for ocular pathologies. Results Among 560 children with hereditary ocular diseases, congenital lens pathology was identified in 112 cases (20%). Of these, 68 patients (60.7%) had a family history of consanguineous marriage. Clinical manifestations of congenital cataract were most frequently observed in the ≤5-year age group. Bilateral congenital cataract was the most common form among children born from consanguineous marriages. In both groups, the prevalence was higher among male children. Conclusion Congenital lens pathology was the second most common hereditary ocular disorder (32.8%) in children born from consanguineous marriages. These findings highlight the importance of modern diagnostic and therapeutic approaches to preventable and treatable causes of childhood blindness.
FEATURES OF THE NEURO-OPHTHALMOLOGICAL TREATMENT OF OCULAR TICS IN CHILDREN AND ADOLESCENT
Purpose – to evaluate the features of neuro-ophthalmological treatment according to differential diagnosis of ocular tics in children and adolescent. Material and methods A total of 75 patients aged 5–17 years were examined, including 42 boys and 33 girls of prepubertal and pubertal age. All patients underwent a comprehensive ophthalmological examination: visual acuity assessment, retinoscopy, determination of dynamic refraction, correction of refractive errors, slit lamp biomicroscopy, ophthalmoscopy, and bacteriological culture of the conjunctival sac. Results Among the 75 patients with ocular tics, 38 (51%) were diagnosed with accommodation spasm (with mild astigmatism), 25 (33%) had bacterial blepharitis/chronic conjunctivitis, and 25 (33%) had a combination of these conditions. In 12 (12%) patients, no ocular pathology was detected; these children were diagnosed with attention deficit hyperactivity disorder (ADHD). Microbiological examination revealed the following flora: Staphylococcus epidermidis was isolated in 22 patients (87%) with bacterial blepharitis/chronic conjunctivitis, while Staphylococcus aureus was identified in 3 patients (13%). Dynamic refraction was assessed using a Plusoptix A09 refractometer before and after cycloplegia. Among the examined patients, convergence insufficiency was detected in 23 children, and exophoria in 15. Conclusion If ocular tics decrease following the prescription of corrective spectacles but do not disappear completely, the addition of gamma-aminobutyric acid (GABA) preparations and neuroleptics may lead to more effective results. Our observations indicate that, in addition to neurological treatment, a combined therapy involving an ophthalmologist is necessary to prevent the progression of pseudomyopia, myopia, and strabismus, and to relieve undesirable neurological symptoms in affected children. Early and timely differential diagnosis of ocular tics allows achieving effective treatment outcomes.
OXIDATIVE STRESS AND VASCULAR CHANGES IN THE MACULA DURING ARTERIAL HYPERTENSION
Purpose – to evaluate changes in oxidative stress biomarkers in macular tissue and the structural–functional disturbances of the retinal microcirculation system in an experimental model of arterial hypertension. Material and methods The research was conducted on 65 Chinchilla rabbits at the vivarium of Azerbaijan Medical University, where a pharmacological hypertension model was induced using ergometrine maleate for 3, 5, 10, and 15 days. In homogenates prepared from the macular region, major markers of lipid peroxidation (H2O2, DC, MDA) and indicators of the antioxidant defense system (protein-SH groups, peroxidase, catalase, TAC) were measured. Results The results showed that oxidative stress progressively intensified in parallel with the increase in arterial pressure. From day 3 onward, the concentrations of H2O2 and DC increased noticeably, and this rise became more pronounced on days 5 and 10. By day 15, all lipid peroxidation markers – particularly DC and H2O2 – reached their maximum levels compared to the intact state. MDA levels also showed a tendency to rise throughout the model's progression. In contrast, a gradual decline was observed in the markers of the antioxidant defense system. The levels of surface and structural protein- SH groups, as well as peroxidase and catalase, significantly decreased over time. TAC exhibited a comparatively later and milder reduction than the other markers. Overall, a direct relationship was identified between the progression of hypertension, the increase in oxidative stress, and the weakening of the antioxidant defense system. Conclusion The study demonstrates that sustained arterial hypertension enhances oxidative stress in macular tissue, and this process may represent one of the key pathogenic mechanisms underlying retinal microcirculatory dysfunction.
PROBLEM OF MYOPIA PREVALENCE AMONG THE POPULATION OF AZERBAIJAN – CONTEMPORARY TRENDS
This article presents the results of a retrospective analysis assessing the prevalence of myopia among the population of Azerbaijan. Purpose – to examine the prevalence of myopia in Azerbaijan over the past decade (2014 - 2023). Material and methods Myopia data for 2014–2023 were obtained from the electronic database of the Ministry of Health of the Republic of Azerbaijan (Statistical Form F12). Population statistics were obtained from the e-resource www. azstat.gov.az. A descriptive analysis of the distribution of myopia among the population was conducted using medical statistics per 100,000 people. Age- and gender-specific incidence rates were calculated for four population groups (ages 0–13 years, 14–17 years, 18–29 years, and 30 years and older), and the percentage change in annual incidence rates was estimated. Results Average prevalence rate of myopia over the past 10 years among the general population of Azerbaijan was 527.3 ± 28.7 per 100,000 people, with a peak incidence recorded in 2022–2023 (p < 0.05). This increase is explained by an increase in the incidence rate in 2022–2023. The annual growth rate of newly diagnosed myopia in 2022 compared to the previous year was 40.7%, despite negative growth rates in 2015 and 2020–2021. No significant gender differences were observed across all observation years; the male-to-female ratio was 1:1. A statistically significant increase in prevalence was observed in the “14–17 years” and “30 years and older” age groups (p < 0.05). Moreover, the annual growth rate for these age groups was equally high in 2022 and 3–5 times higher than that recorded in 2021. Conclusion Burden of myopia in Azerbaijan is increasing year after year, reaching its peak in 2023, and necessitating the earliest possible detection and monitoring of myopia cases.
Copyright (c) 2026 The Azerbaijan Journal of Ophthalmology
COMPARATIVE ANALYSIS OF REFRACTIVE CORRECTION METHODS IN MILITARY PERSONNEL: RISKS, OPPORTUNITIES, AND EFFECTIVENESS (LITERATURE REVIEW)
This article examines the impact of common refractive errors (myopia, hypermetropia, astigmatism) among military personnel on military service and combat readiness, as well as provides a comparative analysis of various methods for correcting these errors. The article also evaluates the advantages of glasses, contact lenses, and refractive surgery methods (PRK, LASIK, SMILE, and ICL), as well as their suitability for use in military conditions, providing a comprehensive explanation of the risks and benefits associated with each method. Based on international and local statistical data, the prevalence trends of refractive anomalies and the importance of their timely detection have been emphasised. The advantages of refractive surgery for soldiers in combat conditions have been presented, along with the successful outcomes of international programmes in this field, such as the US "Warfighter Refractive Eye Surgery Program". The application of questionnaires such as the Ocular Surface Disease Index (OSDI) and the Visual Function Index-14 (VF- 14) was analysed to assess the subjective and functional outcomes of refractive correction, alongside the dynamics of post-operative dry eye symptoms and the restoration of visual functions. The article also highlights the importance of education, early diagnosis, and preventive measures. In conclusion, the preservation of visual health and the effective implementation of correction methods among military personnel hold strategic importance in enhancing the overall combat readiness of the armed forces.
DRAINAGE SURGERY IN GLAUCOMA TREATMENT: PAST, PRESENT AND FUTURE (LITERATURE REVIEW)
Currently, glaucoma continues to occupy one of the leading places among the causes of irreversible blindness, loss of ability to work and disability, thereby acquiring special social significance. At the same time, the trend of increasing incidence is global. Despite the entire arsenal of drug therapy and the improvement of antiglaucoma surgery methods, the search, development and implementation of new technologies that can provide a higher safety profile combined with maximum efficiency continue to arouse increased interest of ophthalmic surgeons. We analyzed relevant available publications for a 131-year period on the issue of modern methods of surgical treatment of glaucoma. This review is devoted to the topic of drainage devices widely used in clinical practice for glaucoma. Particular attention is paid to the actively developing technologies of drainage antiglaucoma surgery in the last decade as an alternative to traditional treatment for initial and advanced forms of glaucoma. The article considers the history of the use of drains, their classification, characteristics of models and methods of their implantation. The presented results of clinical studies on various aspects of the application of surgical methods using drainage devices not only clearly demonstrate their compliance with modern concepts in the treatment of glaucoma, but also dictate the expediency of expanding the indications for their use. There is no doubt that further research is needed for more advanced, pathogenetically substantiated technologies in order to minimize surgical trauma and achieve a stable hypotensive effect. However, we can confidently say that drainage surgery already today occupies a worthy place in the algorithm of modern glaucoma treatment.
COMBINED OCCLUSION OF THE CENTRAL RETINAL ARTERY AND VEIN AFTER CORNEOSCLERAL INJURY (CLINICAL CASES)
Eye injury remains a frequent reason to go to the emergency. Purpose – to analyze clinical case of combined occlusion of the central retinal artery and vein (CRAVO) on the background of corneoscleral penetrating trauma. A 38-year-old man complained of vision loss in his left eye after receiving an injury applied to the NCO named after Academician Zarifa Aliyeva. Routine ophthalmological examinations, computed tomography of the orbital region, clinical and biochemical blood tests, cardiogram, fluorography were prescribed. On examination, an injury of the upper and lower eyelids is noted on the left eye, as well as an extensive penetrating corneoscleral wound. Examination of the fundus after surgical treatment of the wound revealed a combined CRAVO. The presented case describes a rare clinical condition involving the development of combined occlusion of the central retinal artery and vein against the background of globe and ocular adnexa trauma. Despite appropriate emergency treatment, the patient's delayed presentation resulted in persistently reduced visual function, which was attributed to irreversible ischemic and structural complications caused by vascular changes in the retina.
combined occlusion of the central retinal artery and vein
Copyright (c) 2025 The Azerbaijan Journal of Ophthalmology
OUR EXPERIENCE OF AUTOLOGOUS RETINAL TRANSPLANTATION IN A PATIENT WITH A GIANT MACULAR HOLE (CLINICAL CASE)
Purpose – to demonstrate our experience in the application of autologous retinal transplantation in a patient with a giant macular hole. Material and methods A 54-year-old patient presented with complaints of a significant decrease in visual acuity, difficulties in the perception of object shapes, and the presence of a central scotoma. Before surgery, the best corrected visual acuity was 0.02. Optical coherence tomography (OCT) revealed a giant macular hole with a diameter of 1248 micrometers. The patient underwent bimanual autologous retinal transplantation into the area of the giant macular hole using perfluorocarbon liquid, followed by tamponade with silicone oil. Results The performed bimanual autologous retinal transplantation in a giant macular hole with the use of perfluorocarbon liquid was successful both anatomically and functionally, as confirmed by objective examination data. This suggests that the technique can be effectively applied in the treatment of giant macular holes. Perimetry of the macular zone demonstrated positive dynamics. On the first day after the surgery, the best corrected visual acuity improved to 0.3. One month later, the ophthalmoscopic picture remained stable without any signs of autograft dislocation. OCT confirmed persistent attachment of the flap, and the perimetry results maintained positive dynamics. The best corrected visual acuity remained at the achieved level, indicating the high effectiveness of the method and a favorable prognosis for visual rehabilitation. Conclusion Experience with autologous retinal transplantation suggests that this method is effective in the treatment of giant macular holes, allowing significant improvement of both anatomical and functional outcomes.
DIAGNOSTIC VALUE OF OPTICAL COHERENCE TOMOGRAPHY IN THE ASSESSMENT OF RETINAL GANGLION CELL COMPLEX IN PATIENTS WITH GLAUCOMA AND MYOPIA
Purpose – to determine the nature of changes in the ganglion cell complex (GCC) in combination with glaucoma and high myopia. Material and methods Using optical coherence tomography (OCT), 55 patients were examined, divided into four groups: glaucoma + myopia, glaucoma, myopia, emmetropia. All patients underwent a standard ophthalmological examination, including visometry, biomicroscopy, gonioscopy, tonometry, refractometry, paximetry, ophthalmoscopy, and determination of the anterior-posterior (AP) axis of the eye. Morphological changes in the retina and optic nerve were assessed using ophthalmoscopy and OCT (DRI OCT Triton). In this case, the main criteria characterizing pathological changes in the optic disc, according to OCT data, were the size of the excavation and the thickness of the nerve fiber layer. Results Analysis of the neuroretinal complex state according to OCT data in a group of patients with myopia showed a decrease in the thickness of nerve fibers by an average of 7%. When distributing patients depending on the length of the eyeball, it was revealed that the indicators characterizing the thickness of the retinal GCC were within the physiological norm. A comparative analysis of the neuroretinal complex state according to OCT data was performed in patients with glaucoma against the background of myopia and patients with glaucoma. The corneal thickness in the glaucoma + myopia group of patients averaged 531.2 ± 28.84 μm. Intraocular pressure (IOP) in this group of patients averaged 12.8±3.5 mm Hg. In patients with glaucoma the average IOP was 17.3 ± 4.09 mm Hg. Conclusion In patients with myopia, a consistent decrease in the thickness of the retinal GCC is observed as the axial length of the eye lengthens, but within the physiological norm. In cases where the AP axis exceeds 25-26 mm, it is important to consider that the initial decrease in the thickness of the iris can be caused not only by the glaucomatous process, but also by changes in the retina characteristic of myopia.