National Journal glaucoma / Национальный журнал глаукома
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Имплантация мультифокальной ИОЛ с асимметричной оптикой у больных первичной глаукомой
Get PDFPURPOSE: We assessed visual outcome in patients with and without glaucoma, who underwent multifocal Lentis MPlus lens implantation. METHODS: 78 patients (100 eyes) aged over 50 years without concomitant glaucoma and 20 patients (24 eyes) with early stages of glaucoma were implanted with the «Lentis MPlus» IOL. Each subject underwent preoperative examination to determine near and distance visual acuity and best corrected visual acuity. Postoperative examination included measurement of best corrected and uncorrected near (33 cm) and distance visual acuity along with the intermediate visual acuity using the near chart (60 cm). Monitoring of patients was carried out for one year. RESULTS: Patients showed quite high distance and near vision acuity on the third day postoperatively. In 1 year uncorrected visual acuity of two thirds of the patients was 0.8-1.0. 25% of the patients required distance vision correction of -0.5 - -0.75 D with the near vision acuity of 0.9-1.0. Near vision acuity of all patients 1 year postoperatively was above 0.5. Vision 0.4 at an average distance was observed in 100% of patients, and 0.5 in 78% of patients. Postoperative results in patients with glaucoma were comparable to the control group. CONCLUSION: Multifocal «Lentis MPlus» lens implantation provides high distance visual acuity and convenient intermediate and near vision. Lens implantation in patients with cataract on the background of glaucoma allows to achieve high functional results
Изменение топографии переднего отрезка глаза и показателей увеосклерального оттока у больных первичной глаукомой при факоэмульсификации катаракты
Get PDFPURPOSE: To identify changes in the parameters of the anterior segment of the eye and uveoscleral outflow indicators in patients with primary glaucoma during cataract phacoemulsification surgery. METHODS: The study included 153 patients (153 eyes) with cataract and primary open-angle glaucoma. All patients were divided into three groups: 51 patients (51 eyes) with cataract without glaucoma (first group), 51 patients (51 eyes) with cataract and the initial stage of primary open-angle glaucoma (second group), 51 patients (51 eyes) with cataract and advanced stages of primary open-angle glaucoma (third group). Before and after surgery patients underwent pneumotonometry, tonography with vacuum compression (unit Glau-Test60) and were examined by means of Pentacam anterior segment analyzer (Oculus). All patients underwent cataract phacoemulsification with implantation of a posterior chamber intraocular lens. The observation period duration was 6 months. RESULTS: Cataract phacoemulsification with intraocular lens implantation decreases IOP. More pronounced hypotensive effect can be noted in patients with an advanced stage glaucoma and patients not suffering from glaucoma. Topographic relations of the anterior segment structures undergo more changes after the operation in the eyes of patients with advanced-stage glaucoma. The post-surgical uveoscleral outflow increase in the presence of trabecular outflow block is more expressed in patients with initial stage of glaucoma and in patients without glaucoma. The share of uveoscleral pathway in the intraocular fluid outflow both before and after surgery is prevalent in patients with advanced-stage of glaucoma. CONCLUSION: The hypotensive effect of cataract phacoemulsification in patients with primary glaucoma is due to topographical changes in the structures of the anterior segment of the eye and possibly to increasing uveoscleral outflow of intraocular fluid
Клинико-фармакологические аспекты сочетанной патологии: сердечно-сосудистые заболевания и глаукома
Get PDFThe review presents clinical and pharmacological aspects of treating glaucoma patients with cardiovascular diseases and current epidemiology of cardiovascular diseases in Russian Federation. It discusses the most widespread cardiovascular diseases and medications for their treatment (organic nitrates, systemic beta-blockers etc.). The article describes the effects of anti-glaucoma medications (beta-blockers, alpha2-adrenoceptor agonists, prostaglandins, carbonic anhydrase inhibitors) on cardiovascular system (heart rate, blood pressure) and the course of treatment of cardiovascular diseases, including cardiovascular mortality. Authors enumerate the main absolute and relative contraindications to different groups of anti-glaucoma medications: prominent forms of cardiovascular pathology (atrioventricular block II-III degree, decompensation of chronic heart failure, marked bradycardia). The impact of the medications for cardiovascular diseases (antihypertensive drugs, organic nitrates, antiplatelet medications) on intraocular pressure and the course of glaucoma is also described in the review. It emphasizes the necessity of developing a rational systemic antihypertensive regimen to avoid the episodes of nocturnal arterial hypotension that promote the progression of glaucoma. The article also presents examples of possible clinically significant drug-drug interactions in patients with combined pathology. The authors provide recommendations on improving treatment efficiency and pharmacotherapeutic safety in patients with glaucoma in combination with cardiovascular diseases
Возможности применения ExPRESS-шунта в лечении вторичной глаукомы, вызванной эмульгированием силиконового масла у пациентов после витреоретинальных вмешательств
Get PDFСостояние и прогноз заболеваемости глаукомой взрослого населения Алтайского края
Get PDFPURPOSE: To analyze the prevalence and incidence of glaucoma in the Altai region during the period of 2003-2012 and model an incidence forecast for 5 - and 10-year periods. METHODS: The analyzed data was based on annual statistics of glaucoma among the adult population for the said period gathered in medical institutions of Russia and Altai region. Glaucoma prevalence and incidence were calculated using classical formulas per 100 000 population. Predictions of possible changes in incidence rates were calculated using mathematical modeling and forecasting methods. RESULTS: Altai region had the highest glaucoma incidence rate among adult population during the entire study period. Out of 83 subjects of the Russian Federation, Altai region ranks 11th in absolute glaucoma prevalence (absolute number of patients with glaucoma) and 12th in prevalence per 100 000 population. In the Siberian Federal District, Altai region ranks first in the absolute number of patients with glaucoma and second after the Omsk region in incidence per 100 000 population. During the study period from 2003 to 2012 glaucoma prevalence increased by 60.6% and incidence - by 17.8%. Forecasts modeled for 2017 and 2022 predict a further increase in glaucoma incidence and prevalence. CONCLUSION: Analysis of glaucoma prevalence, dynamics as well as incidence and prevalence forecasts for the adult population of the Altai Region show negative trends
Сравнительный анализ результатов трабекулотомии ab intrerno и микроинвазивной непроникающей глубокой склерэктомии в комбинированной хирургии катаракты и глаукомы
Get PDFРоль возникновения задней отслойки стекловидного тела в патогенезе первичной закрытоугольной глаукомы
Get PDFСосудистая теория патогенеза глаукомной оптиконейропатии: обоснование с позиций анатомии и физиологии глазного кровотока. Часть 1
Get PDFThe review presents data on ocular blood flow anatomy and physiology that is directly related to glaucoma pathogenesis. Specifics of the ocular arterial, venous and capillary vascular bed have been comprehensively examined. Differences in blood supply to different parts of the optic nerve have been pointed out with particular focus on the fact that the posterior ciliary arteries are the only source of blood supply to the prelaminar and lamina cribrosa zones of the optic nerve, as well as the major source of blood supply to the retrolaminar zone. The amount and location of posterior ciliary arteries are individual. Particular attention has been paid to the comparison of retinal and choroidal blood flow with an emphasis on the regulation of these two sources of blood supply to the retina and optic nerve. The characteristic of “watershed areas”, which explain the features of the visual field defects in glaucoma, has been given. Features of the hemato-ophthalmic barrier, in particular the role of retinal capillaries and the retinal pigment epithelium, have been discussed. It is pointed out that the blood-optic nerve barrier, which is strong in all zones of the optic nerve, is nevertheless permeable in the optic nerve’s prelaminar zone. В обзоре приведены данные анатомии и физиологии глазного кровообращения, имеющие непосредственное отношение к патогенезу глаукомы. Рассмотрены особенность артериального, венозного и капиллярного сосудистого русла глаза. Подчеркнуты различия в кровоснабжении разных отделов зрительного нерва, в частности акцентируется внимание на том, что задние цилиарные артерии (ЗЦА) являются единственным источником питания преламинарного и решетчатого отделов зрительного нерва, а также главным источником питания и ретро- ламинарного отдела. Количество и локализация ЗЦА носят строго индивидуальный характер. Особое внимание уделено ретинальному и хориоидальному кровотоку в сравнительном аспекте и с акцентом на регуляцию этих двух источников кровоснабжения сетчатки и зрительного нерва. Описаны особенности артериол и капилляров сетчатки, а также специфичность капилляров перипапиллярной сети. Приведена характеристика «зон водораздела», наличие которых объясняет особенности дефектов полей зрения при глаукоме. Обсуждаются особенности гематоофтальмического барьера, в частности, роль ретинальных капилляров и пигментного эпителия сетчатки. Подчеркивается, что барьер кровь — зрительный нерв, прочный во всех отделах зрительного нерва, оказывается тем не менее проницаемым в его преламинарном отделе.
Динамика гибели ганглиозных клеток сетчатки при глаукоме и ее функциональные маркеры
Get PDFThe review presents various aspects of structural and functional disorders of the visual system in humans and experimental animals associated with physiological involution and the development of glaucoma, which are organized by visual structures and types of change. Particular attention is given to alterations of retinal ganglion cells (RGC). Age-related changes in the RGCs and their central projections are compared with changes occurring in glaucoma. Literature data on the sequence of events occurring in RGC death, including changes in the inner plexiform layer of the retina (the dendritic and synaptic plasticity, reduction of the complexity of dendritic branching and degeneration of the processes), dysfunction and degeneration, a change in the morphology and apoptosis of RGC soma are discussed in the review. The problem of the sensitivity of axons and dendrites of the RGC for a variety of cell types (belonging to parvocellular and magnocellular systems) and their subclasses (on-, off- and on-off-cells) is analyzed. A comparative analysis of the possibilities of modern technologies in perimetry, structural imaging of the retina and electrophysio-logical studies in the diagnostics of primary glaucoma and their prospects in the context is presented. The necessity to standardize a set of parameters of functional and morphological examinations to identify early stages of RGC death in glaucoma patients and patients with suspected POAG is substantiated. Such a set of parameters would allow an adequate assessment changes in dendritic processes, axon dysfunction and degeneration as well as soma death, facilitating a timely and adequate choice of targeted therapy
