National Journal glaucoma / Национальный журнал глаукома
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Применение каннабиноидов в медицине и офтальмологии
Get PDFThis article presents a review of terminology, history of appearance, legislative regulation, pharmacokinetics and pharmacodynamics of cannabinoids, as well as the research results of cannabis use in the treatment of oncologic patients, reducing chemotherapy symptoms (intensive pain syndrome, nausea) and neurologic pathology (disseminated sclerosis, Alzheimer's disease, schizophrenia). The research results of systemic cannabis administration for reducing intraocular pressure in healthy population and patients with different forms of glaucoma are discussed. The review reports on the latest research of the interrelation of the endocannabinoid system with the intraocular fluid flow regulation, as well as its vasodilating and neuroprotective effects. It sums up with recounting the official standpoint of international ophthalmology associations, who do not recommend the use of cannabis in glaucoma treatment due to its short-term hypotensive effect and poor system safety level.В обзоре дается описание терминологии, истории, законодательного регулирования, фармакодинамики и фармакокинетики каннабиноидов, а также результаты исследований их применения в терапии онкологических заболеваний, связанной с химиотерапией симптоматики (интенсивный болевой синдром, тошнота) и неврологических заболеваний (рассеянный склероз, болезнь Альцгеймера, шизофрения). Приведены результаты исследований системного применения каннабиноидов по снижению внутриглазного давления у здоровых лиц и пациентов с различными формами глаукомы. Описаны данные последних исследований взаимосвязи эндоканнабиноидной системы и регуляции тока внутриглазной жидкости, а также сосудорасширяющего и нейропротекторного эффектов. Приведены официальные позиции международных офтальмологических сообществ, не рекомендующих применение каннабиноидов в терапии глаукомы по причине краткосрочного гипотензивного эффекта и низкого системного уровня безопасности
Циклоспорин А в хирургическом лечении глаукомы: перспективы и возможности
Get PDFPostoperative scarring is one of the main reasons of glaucoma surgery failure. At different times it has been proposed to use various drainage implants, intra- or postoperative medications in order to prevent scarring. Mitomycin-C and 5-fluorouracil are widely used today for this purpose. These medications are effective in glaucoma surgery but often lead to severe complications. Nowadays investigations are being carried out in order to find a safer but not less effective substitution to them. Some foreign authors have proposed to use Cyclosporine-A (CsA) as an alternative. CsA selectively affects T-cells causing Interleukin-2 (IL-2) synthesis inhibition. IL-2 is one of the key inflammatory mediators triggering inflammatory cascade leading to fibroblast proliferation. The review deals with pathological bases of scarring after glaucoma surgery as well as possible methods of its modulation, provides results of investigations of CsA effectiveness and safety in glaucoma surgery
Особенности местного и системного цитокинового статуса у здоровых разного возраста и пациентов с начальной стадией первичной открытоугольной глаукомы
Get PDFОбъемные показатели офтальмогемодинамики при миопии и сопутствующей глаукоме с «нормализованным» давлением
Get PDFPURPOSE: To study volumetric measurements of ocular hemodynamics in patients with myopia and primary open-angle glaucoma with statistically normal IOP on hypotensive medication. METHODS: The study included 326 eyes (206 patients) with myopia and glaucoma with IOP < 21 mmHg. All patients were divided into two groups depending on their age and axial length (AL) of the eye. Group 1 consisted of 132 eyes on hypotensive treatment with IOP exceeding their individual norm. Apart from standard ophthalmological examination all patients underwent flowmetry by means of Ocular Blood Flow Analyzer to determine the volumetric measurements of their ocular hemodynamics. RESULTS: The study revealed the volumetric blood flow in eyes with myopia and non-progressive glaucoma to be equal to or insignificantly differ from the calculated norm if actual IOP is inferior to or equals the individual ocular pressure norm. A statistically significant decrease in the volumetric blood flow was detected in eyes with myopia and progressive glaucoma if actual IOP exceeded the individual ocular pressure norm. The blood supply deficiency was significantly more pronounced if AL exceeded 25 mm. CONCLUSION: Patients on with myopia and glaucoma have shown a build-up in blood supply deficiency if their actual IOP on hypotensive medication exceeded the individual ocular pressure norm, as opposed to the patients whose actual IOP was compensated in relation to the individual norm. At the same time, the excess rate of IOP over the individual norm was lower than the blood supply deficiency, which leads us to believe, that the blood supply deficiency depends on both: the excess of IOP and the individual specifics of the vascular system in eyes with combined pathology (myopia and glaucoma)
Клинико-функциональные результаты глубокой склерэктомии с имплантацией ксеноколлагенового дренажа у больных с неоваскулярной глаукомой
Get PDFPURPOSE: The analysis of the results of deep sclerectomy with xenocollagen drainage implantation in patients with neovascular glaucoma during dynamic observation process. METHODS: The study included 80 patients (80 eyes) with neovascular glaucoma. All patients were divided into two groups depending on the surgical technique: group I (main group) included 40 patients after a deep sclerectomy with xenocollagen drainage implantation (DSE with XDI), group II (control group) - 40 patients after standard deep sclerectomy. All patients underwent a standard eye examination including visometry, perimetry, tonometry, tonography, biomicroscopy, gonioscopy, ophthalmoscopy, A-, B- scan («А/В 3D-OTI Scan 2000», Canada), ultrasound biomicroscopy («Paradigm Model P60™ UBM», USA). RESULTS: There was a significant difference in the persistence of post-operative hypotensive effect in the two studied groups. IOP decompensation rate in the control group exceed that in the study group (15 vs 3%, respectively) in long-term follow-up. Statistically significant positive changes in the visual functions were noted in the main group within 1 month after surgery, which remained stable during the 12 months of the observation period. The scarring of the filtration area was the main cause of glaucoma relapse in patients of the control group. CONCLUSION: According to the observation data, there was a statistically significant improvement in clinical and functional indicators in patients of the main group, which remained stable during late postoperative period, as compared to the control group. Using the modified operation technique with xenocollagen drainage implantation in the treatment of neovascular glaucoma promotes the stabilization of the clinical and functional results
Влияние разгрузочных медикаментозных проб на биомеханические параметры корнеосклеральной оболочки глаза у больных с впервые выявленной глаукомой
Get PDFPURPOSE: To determine the effect of the drug-induced stress-relief tests on the corneal biomechanical properties in patients with newly diagnosed glaucoma. METHODS: The study included 68 patients (119 eyes) with newly diagnosed glaucoma. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) were obtained using an ocular response analyzer (ORA) before and after the instillation of eye drops (Arutimol 0.5%, Cosopt, Azopt) for 49 eyes of 27 patients with normaltension glaucoma (NTG), 70 eyes of 41 patients with primary open-angle glaucoma (POAG). Tolerable intraocular pressure (tIOP) was determined on a Blood Flow Analyzer (Paradigm, USA). RESULTS: Drug-induced stress-relief tests with different drugs caused statistically significant changes in corneal biomechanical properties of the eye: after a significant decrease in IOPcc and IOPg corneal resistance factor (CRF) decreased and corneal hysteresis (CH) increased. CONCLUSION: When IOPg was used as a reference as opposed to IOPcc obtained on Ocular Response Analyzer, 34.7% eyes were be incorrectly qualified as normal-tension glaucoma (NTG). That proves the lower corneal resistance in NTG patients and can lead to underestimation of the true IOP level. Additional research of tIOP by Blood Flow Analyzer confirmed the NTG diagnosis in these patients
Морфометрические показатели как критерии оценки действия инфузий ядросодержащих клеток пуповинной крови при глаукомной оптической нейропатии
Get PDFPURPOSE: To assess retinal and optic nerve head morphometric parameters as criteria for efficacy of cord blood nucleated cells infusions for glaucomatous optic neuropathy treatment. METHODS: The study included 21 patients (27 eyes) with primary open-angle glaucoma (POAG) aged 38-80 years. Apart from standard ophthalmological examination all patients underwent optic nerve head (ONH) parameters and retinal nerve fiber layer (RNFL) thickness assessment by means of OCT (Stratus ОСТ 3000) and НRТ (“Heidelberg Engineering”). Research data was added to Microsoft Office Excel 2011 database (version 14.0.0) and sorted according to the study tasks. For each data sequence, the minimum and maximum were determined. Nonparametric statistical methods were used due to non-Gaussian value distributions. RESULTS: Comparison to a normative database revealed significant deviations of most ONH and RNFL morphometric parameters confirming POAG diagnosis. All patients had a para- and perifoveal inner retinal layers and RNFL thinning (р<0,001; Mann-Whitney test). All these parameters showed a statistically significant correlation with POAG stage. CONCLUSION: Neuroprotective therapy with cord blood nucleated cells infusions helps stabilize visual functions in glaucoma patients with progressive glaucomatous optic neuropathy. ONH morphometric parameters progression analysis is hindered in patients with advanced glaucoma. KEYWORDS: primary open-angle glaucoma, optical coherence tomography, optic nerve head, retinal nerve fiber layer, stem cells.><0,001; Mann-Whitney test). All these parameters showed a statistically significant correlation with POAG stage. CONCLUSION: Neuroprotective therapy with cord blood nucleated cells infusions helps stabilize visual functions in glaucoma patients with progressive glaucomatous optic neuropathy. ONH morphometric parameters progression analysis is hindered in patients with advanced glaucoma. ЦЕЛЬ. Оценить морфологические показатели сетчатки и зрительного нерва в качестве критериев эффективности лечения глаукомной оптической нейропатии (ГОН) инфузиями ядросодержащих клеток пуповинной/ плацентарной крови. МЕТОДЫ. Обследован 21 пациент (27 глаз) в возрасте от 38 до 80 лет с первичной открытоугольной глаукомой (ПОУГ). Наряду с обычным офтальмологическим обследованием проводили оценку состояния слоя нервных волокон сетчатки (СНВС) методами оптической когерентной томографии (ОКТ) (Stratus ОСТ 3000) и Гейдельбергской ретинальной томографии (НRТ) («Heidelberg Engineering»), а также исследовали показатели диска зрительного нерва (ДЗН). Все результаты, полученные в ходе обследования, были внесены в базу данных Microsoft Office Excel 2011 (версия 14.0.0) с сортировкой в соответствии с задачами настоящей работы. Для всех рядов данных выявляли минимум и максимум. Распределение значений не соответствовало гауссовому, поэтому для оценки полученных данных применяли непараметрические методы статистического анализа. РЕЗУЛЬТАТЫ. Cравнение с нормативной базой приборов выявило значительные отклонения большинства морфометрических параметров ДЗН и слоя нервных волокон, что подтверждает выставленный диагноз ПОУГ. У всех пациентов в пара- и перифовеолярной зонах было выявлено истончение сетчатки за счет истончения ее внутренних слоев, а также истончение СНВС (р<0,001; критерий Манна – Уитни). Все эти параметры достоверно коррелировали со стадией глаукомы. ЗАКЛЮЧЕНИЕ. Применение ядросодержащих кле- ток плацентарной крови для лечения ПОУГ в качестве нейропротекторной терапии способствует стабилиза- ции зрительных функций в случае прогрессирующей ГОН. Кроме того, анализ прогрессирования морфоме- трических параметров ДЗН и слоя нервных волокон сетчатки затруднен у пациентов с далеко зашедшей стадией глаукомы. КЛЮЧЕВЫЕ СЛОВА: первичная открытоугольная глау- кома, оптическая когерентная томография, диск зритель- ного нерва, слой нервных волокон, стволовые клетки.>< 0,001; критерий Манна – Уитни). Все эти параметры достоверно коррелировали со стадией глаукомы. ЗАКЛЮЧЕНИЕ. Применение ядросодержащих клеток плацентарной крови для лечения ПОУГ в качестве нейропротекторной терапии способствует стабилизации зрительных функций в случае прогрессирующей ГОН. Кроме того, анализ прогрессирования морфометрических параметров ДЗН и слоя нервных волокон сетчатки затруднен у пациентов с далеко зашедшей стадией глаукомы.
Изменение морфометрических параметров ДЗН на фоне острого повышения ВГД после интравитреальных инъекций
Get PDFPURPOSE: To determine whether transient intraocular pressure (IOP) acute elevation alters optic nerve head structural parameters using spectral domain optical coherence tomography (SD-OCT). METHODS: Twenty-five eyes of 25 patients (aged 63-81) with wet age-related macular degeneration (AMD) were included in the study. Patients received anti-VEGF intravitreal injection for wet AMD. Ophthalmic examinations included visual acuity and autorefractor testing, slit-lamp examination, ocular biometry, fundus photography and angiography. IOP was measured using a rebound tonometer (Icare Tonolab®, Icare Finland Oy), optical coherence tomography (OCT) of the optic disс was conducted prior to and after antiVEGF injection. We measured horizontal and vertical cup disk ratio (CDR) and anterior lamina cribrosa insertion (ALI) in two perpendicular scans. Intravitreal injections were administered in the operating room by the same surgeon according to a standard technique. RESULTS: There was a statistically significant (p=0.004) increase of IOP level to 36.4 mm Hg (confidence interval 30.8÷44.1) immediately after the injection. There was a statistically significant widening of the horizontal CDR with its median increase by 20.0 pm (confidence interval 3.0÷25.0). Vertical CDR also underwent statistically significant changes, but to a lesser extent, the median increased to 12.0 pm (confidence interval 3.0÷22.5). The rest of the studied parameters remained unchanged. Findings on the perpendicular scan differed from the first one. While horizontal CDR expansion median increased by 28.0 pm (confidence interval 9.0÷40.0), vertical CDR, width of the Bruch's membrane opening and ALI did not change significantly. CONCLUSION: Transient intraocular pressure (IOP) acute elevation after anti-VEGF injections may cause changes in superficial optic disc structures without statistically significant reliable changes in lamina cribrosa
Топография вновь созданных путей оттока при антиглаукомных операциях неоваскулярной глаукомы по данным ультразвуковой биомикроскопии
Get PDFPURPOSE: The study of UBM capacity in drainage structures control after surgical treatment of neovascular glaucoma. METHODS: The study included 80 patients (80 eyes) with neovascular glaucoma. The mean age of the patients was 60.7±1.9. All patients were divided into two groups depending on the surgical technique: group I (main group) included 40 patients after a deep sclerectomy with xenocollagen drainage implantation (DSE with XDI), group II (control group) - 40 patients after standard deep sclerectomy (DSE). All study subjects underwent standard ophthalmological examination as well as ultrasound biomicroscopy (UBM) (“Paradigm Model P60™ UBM”, USA). The following parameters: filtration bleb - height, area, volume; scleral flap - thickness; intracleral cavity - height, area, volume and anterior chamber depth, anterior chamber angle were measured with the help of ultrasound biomicroscopy. RESULTS: Ultrasound biomicroscopic study helped identify the morphological components of each structure respon sible for postoperative drainage function of the eye after deep sclerectomy with implantation of xenocollagenic drainage in patients with neovascular glaucoma. UBM data research of the anterior segment of the eye in early and long-term follow-up revealed that the proposed modified method of deep sclerectomy with xenocollagen drainage implantation allows forming new constructed ways for intraocular fluid outflow from the anterior chamber in supraciliar, sub-Tenon’s space and subconjuctival spaces. This leads to unobstructed filtration of intraocular fluid and helps prevent scarring of the operation zone. CONCLUSION: Using the ultrasound biomicroscopy in patients with neovascular glaucoma allows monitoring the condition of the drainage system of the eye in the postoperative period in order to ensure the prevention of the postoperative hypertension
Значение аутоиммунных механизмов в патогенезе первичной открытоугольной глаукомы
Get PDFPURPOSE: To evaluate the role of cytokines IL-17, IL-6, TGF-B1 and TGF-B3 in the immune response in patients with primary open-angle glaucoma (POAG). METHODS: Using specific ELISA test systems «R&D Diagnostics Inc.» (USA), we investigated blood serum and tear fluid of 110 subjects (80 POAG patients and 30 healthy subjects). Mean age was 57.0±3.2 years (78 years in women and 37 - in men). From 42 patients diagnosed with glaucoma, 38 had advanced and terminal stages. Patients were subdivided into 2 subgroups: with POAG only and POAG combined with chronic pathology (hypertensive disease, type 2 diabetes, myopia). RESULTS: All patients demonstrated high levels of IL-17, IL-6 and low levels of TGF-B1 and TGF-B3 in blood serum and lacrimal fluid. The study revealed varied changes in inves- tigated biological fluids. Thus, IL-6 production was higher in the systemic circulation compared to the local, while the production of IL-17, on the contrary, was higher in the lacrimal fluid. Anterior chamber examination also revealed high local hypercytokinemia (IL-6, IL-17). Reduced concentration of the TGF-B cytokine group may be associated either with its utilization during hyperergic inflammatory reactions or with insufficient response. Similar immunological changes were also observed in the combined pathology subgroup (POAG with hypertension, type 2 diabetes, myopia) due to the similarity in the pathogeneses of these diseases: genetic, vascular, neuroendocrine