National Journal glaucoma / Национальный журнал глаукома
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Отечественный опыт применения препаратов дженериков при лечении больных с глаукомой
Get PDFOver the last thirty years a few original antihypertensive drugs with different mechanisms of action have been developed and introduced in glaucoma practice. Today almost all of these drugs have several analogs. The problem of the generic drug interchangeability with the original is relevant to every practicing ophthalmologist. On one hand, the pharmaceutical and pharmacokinetic equivalence of the original and the generic drug is a requirement for the realization of the generic on the market, on the other hand - pharmaceutical trials are not conducted for the generic drugs is not generic clinical trials conducted so there is scientifically no proven data on their therapeutic efficiency and safety. Due to the development of pharmaceutical market of glaucoma drugs analogues and the absence of uniform requirements to their quality, safety and efficacy in Russia, the practitioner needs to have current data on their therapeutic equivalence. Our review analyzes the domestic publications of the past five years on the efficacy and safety of glaucoma drugs analogues. The results of the antihypertensive effectiveness of generics in monotherapy and in their combined use are also presented
Изучение роли аутоиммунного воспаления орбиты в развитии офтальмогипертензии
No full textPURPOSE: To study the role of autoimmune inflammation of the orbit in the development of ocular hypertension in patients with endocrine ophthalmopathy (EOP) and Graves’ disease (GD). METHODS: 317 patients with GD and EOP were included in the study. All patients underwent endocrine and ophthalmological examination. Ophthalmologic study included visometry, perimetry, tonometry, ophthalmoscopy and exophthalmometry. Orbit structure was examined with the help of multispiral computed tomography. Endocrinological study combined measuring the levels of thyroid hormones, TSH and rTSH antibodies with thyroid ultrasound. The dynamic study was carried out during a one-year period of thyroid diseases (surgical and radioiodine therapy) and endocrine ophthalmopathy (38 patients, 76 eyes) treatment. Patients were monitored every 6 months or more often in cases of necessity (in patients with a highly active progressive ophthalmopathy). RESULTS: The disease activity score estimation in patients with ophthalmopathy revealed a close, direct and statistically significant connection between the ocular tonus and the inflammation activity index. The orbital inflammation activity had a direct correlation with the level of IOP. The distribution frequency analysis of different IOP indices in patient groups with low-, moderate-, and highly active forms of EOP showed that ocular hypertension develops more rarely in patients with low inflammation activity than in patients with a highly active inflammatory process (e.g. 3.3% versus 50%, p 25.0 mm Hg) on the first visit. In general, the ocular hypertension group was represented by 86.1% patients with orbital inflammation clinical activity score (CAS)≥3. The treatment with glucocorticoids led to a reliable decrease in the ocular tonus. Maximum therapeutic effect was achieved by a combination of intravenous pulse therapy and retrobulbar injections. CONCLUSION: A statistically significant direct correlation was revealed between the ocular tonus and inflammatory activity index. The endocrine disease treatment resulted in both the decrease in inflammatory activity in the orbit and a hypotensive effect
Состояние и динамика первичной и повторной инвалидности вследствие глаукомы взрослого населения Алтайского края
Get PDFPURPOSE: the study of the dynamics of primary and repeated disability due to glaucoma in the adult population of the Altai Territory for the 2004-2013 period. METHODS: We analyzed the data provided by the Central Bureau of Medical and Social Expertise of the Altai Territory over the 2004-2013 period. The analysis was conducted for three age groups of the adult population according to the criteria of the №7-social security form. RESULTS: Among the causes of primary and repeated disability in adults in the Altai region the class of eye and adnexa diseases held the 9-10th ranking places. Glaucoma consistently ranked first in the nosological structure of primary disability (PD) due to eye diseases. In case of repeated disability (RD) within the analyzed time span glaucoma moved from the third to the first place, thus increasing its share in causes of repeated disability due to diseases of the eye and adnexa by a factor of 2.1. The population of primarily disabled due to glaucoma was equally formed by male and female patients, from both urban and rural population, mostly presented by elderly patients with I and II disability groups. The III disability group prevailed among young and middle-aged patients. The contingent of repeatedly disabled due to glaucoma was formed mainly by the elderly patients of I and II disability groups, coming equally from the urban and rural population, with twice as many men as women. CONCLUSION: The specifics of primary and repeated disability due to the diseases of the eye and adnexa over a 10-year period were defined. Glaucoma ranked first in both groups. The intensive index of primary disability due to glaucoma increased from 0.7 per 10 000 of the adult population in 2004 to 1.1 in 2005 (by 57%) with a further decrease to 0.4 by 2013 (by 63.6%). The level of repeated disability due to glaucoma increased from 0.6 per 10,000 adult population in 2004 to 0.9 in 2012-2013 (by 50%)
Лазерная реконструкция зоны непроникающей глубокой склерэктомии при ее блокаде корнем радужки
Get PDFPURPOSE: To study the effectiveness of laser reconstruction of the non-penetrating deep sclerectomy (NPDS) zone blocked by peripheral iris. METHODS: The study was based on the analysis of 95 cases (95 patients) of postoperative trabeculo-Descemet’s membrane (TDM) blockade with a part of peripheral iris: in 65 patients (65 eyes) — after NPDS in 30 patients (30 eyes) — after laser descemeto-goniopuncture (DGP). IOP level at the time of NPDS zone blockade diagnosis averaged 27.04±5.20 mmHg. All patients underwent laser reconstruction of the surgical zone, which included laser gonioplasty, iridectomy and, if possible, DGP. RESULTS: In 10 out of 65 cases of NPDS zone blockade, a suspension of formed elements was found in the anterior chamber fluid, in 3 of these cases patients presented with a 2 mm hyphema. In 27 cases (41.5%) NPDS zone blockade was not completely eliminated. On the 1st day after laser surgery, IOP decreased to an average of 17.34±3.50 mmHg. A 3 mm hyphema was observed in 2 cases of post-DGP blockade. Patients of the 2nd group had an average IOP level of 18.65±4.65 mmHg. It was possible to remove the operation zone blockade in 21 cases (70%), with 19 cases of partial and 2 cases of complete blockade. In other cases the blockade remained in more than 2/3 of the TDM length. CONCLUSION: One of the main predisposing factors of NPDS zone blockade onset is TDM perforation intraoperatively or during laser DGP. ЦЕЛЬ. Оценить эффективность лазерной реконструкции зоны непроникающей глубокой склерэктомии (НГСЭ) при ее блокаде корнем радужки. МЕТОДЫ. Исследование базировалось на анализе 95 случаев (95 пациентов) блокады зоны операции корнем радужки, среди которых 65 пациентов (65 глаз) с блокадой трабекулодесцеметовой мембраны (ТДМ) корнем радужки после проведения НГСЭ и 30 пациентов (30 глаз), у которых контакт корня радужки с ТДМ был диагностирован после лазерной десцеметогониопунктуры (ДГП). Уровень ВГД (Po) в момент диагностики блокады зоны НГСЭ в среднем составил 27,04±5,20 мм рт.ст. Всем пациентам была проведена лазерная реконструкция зоны операции, которая включала лазерную гониопластику, иридэктомию и при возможности выполнения — ДГП. РЕЗУЛЬТАТЫ. У пациентов с блокадой зоны операции после НГСЭ в 10 случаях из 65 наблюдалось появление взвеси форменных элементов в передней камере, из которых в 3 случаях визуализировался уровень гифемы до 2 мм. В 27 (41,5%) случаях устранить блокаду зоны НГСЭ полностью не удалось. В 1-е сутки после лазерной операции ВГД в среднем снизилось до 17,34±3,50 мм рт.ст. На глазах с блокадой зоны операции после ДГП гифема до 3 мм наблюдалась в 2 случаях, а еще в 4 случаях визуализировалась взвесь форменных элементов. У пациентов 2-й группы ВГД в среднем составило 18,65±4,65 мм рт.ст. Устранить блокаду зоны операции удалось в 21 (70%) случае, из которых в 19 случаях частичная, а в 2 — полная блокада. В остальных случаях блокада сохранялась на протяженности более 2/3 ТДМ. ЗАКЛЮЧЕНИЕ. Одним из основных предрасполагающих факторов к возникновению блокады зоны НГСЭ является интраоперационная перфорация трабекулодесцеметовой мембраны и перфорация трабекулодесцеметовой мембраны в ходе лазерной ДГП
Оценка эффективности стального спирального экспандера шлеммова канала Кумара 2-го поколения в снижении внутриглазного давления у пациентов с рефрактерной глаукомой
Get PDFЭкономическая эффективность селективной трабекулопластики
Get PDFPURPOSE: To determine the structure of patients’ costs for POAG treatment and costs at each stage of the primary open-angle glaucoma treatment by means of SLT. METHODS: The study included 130 POAG patients, who underwent SLT: 62 women and 68 men aged 42.2-86.0 years (66.1±1.3 years, M±m). All patients were the residents of the Orenburg region. All patients underwent standard ophthalmologic examination before surgery. Selective laser trabeculoplasty was performed using Quantel Medical Optimis with Solutis device. Control examinations were performed at 1 day, 1 month, 3 months, 6 months and 1 year after surgery. The data was processed with Statistica 10 software. RESULTS: The study determined the overall cost for patients on the expenditure side. It showed that the average amount of expenses of a full treatment course per patient amounted to 22 449.0 rubles, with the largest share of the cost related to SLT treatment and repeated diagnosis within 1 year after surgery. The indicator “Price of drops for 1 year” (4 159.0±302.8 rubles, or 18.53%) was the most variable. We also analyzed the cost parameters of conservative treatment after SLT at 5 time stages and structural-cost analysis of prescribed antihypertensive drugs. CONCLUSION: The variability of the cost characteristics of each stage of POAG treatment by SLT proves the presence of a variety of approaches to the treatment of patients, associated with their individual peculiarities. However, conservative treatment of patients, divided into 5 time stages, taking into account its cost and relevance at each stage of the treatment, takes the first place in the variability of cost characteristics. ЦЕЛЬ. Определить структуру расходов пациентов на лечение первичной открытоугольной глаукомы (ПОУГ) и стоимостные характеристики на каждом этапе ее лечения с помощью селективной лазерной трабекулопластики (СЛТ). МЕТОДЫ. В исследование включены 130 пациентов с ПОУГ, жителей Оренбургской области (62 женщины и 68 мужчин в возрасте от 42,2 до 86,0 лет (66,1±1,3 года, M±m)), прооперированных методом СЛТ. Всем пациентам до операции проведено стандартное офтальмологическое обследование. СЛТ выполняли на установке Quantel Medical Optimis с приставкой Solutis. Контрольные осмотры проводили в сроки 1 сутки; 1, 3, 6 месяцев и 1 год после операции. Статистическую обработку исходных данных проводили с помощью программы Statistica 10. РЕЗУЛЬТАТЫ. В процессе исследования определены общие затраты пациентов по статьям расходов. Установлено, что в среднем сумма затрат полного курса лечения на одного пациента составила 22 449,0 рублей, причем наибольшая доля затрат была связана с проведением СЛТ и с повторной диагностикой в течение 1 года после операции. Показатель «стоимость капель за 1 год» (4 159,0±302,8 рублей, или 18,53%) являлся самым вариабельным. Также был проведен детальный анализ стоимостных показателей консервативного лечения после СЛТ на 5 временных этапах и структурно-стоимостный анализ назначаемых гипотензивных препаратов. ВЫВОДЫ. Вариабельность стоимостных характеристик каждого этапа лечения ПОУГ методом СЛТ свидетельствует о наличии разнообразия в подходах к лечению пациентов, связанного с индивидуальными особенностями пациентов. При этом первое место по вариабельности стоимостных характеристик занимает консервативное лечение пациентов, разделенное на 5 временных этапов, с учетом его стоимости и востребованности на каждом этапе лечения.
Сравнительный анализ морфологических изменений в зрительных центрах при первичной глаукоме и болезни Альцгеймера
Get PDFPURPOSE: A comparative analysis of morphological changes in the central part of the visual analyzer (lateral geniculate nucleus (LGN) and the visual cortex) in patients with glaucoma and Alzheimer’s disease. MATERIALS: Morphological material included brains of 7 patients: 2 patients with Alzheimer’s disease, 1 patient with glaucoma and 4 control patients without neurological and ophthalmic pathology. Nissl staining and Bilshovsky staining were applied to the autopsy material. A comparative analysis of the area sizes of the neurons and their nuclei as well as and the nuclear-cytoplasmic ratio in the LGN and the visual cortex in patients with glaucoma and Alzheimer’s disease was performed using morphometry software. Immunocytochemistry staining for-amyloid and tau-protein in the LGN and the cerebral cortex was perfomed in patients with glaucoma and Alzheimer’s disease. RESULTS: A marked reduction in the area size of neurons associated with Alzheimer’s disease and glaucoma was observed in all studied areas in comparison with the control group. Cross-sectional area of the nucleus in patients with Alzheimer’s disease on the contrary was substantially increased in the magnocellular and parvocellular layers and not significantly different from the control group in the visual cortex. No difference was found in the area size of the nuclei in the magnocellular layers of glaucoma patients compared to the control group, while in the parvocellular layers and the visual cortex their size was smaller. Immunocytochemistry analysis confirmed the presence of p-amyloid and tau- protein in the LGN and the cerebral cortex in glaucoma and Alzheimer’s disease. CONCLUSIONS: Morphological changes observed in visual centers in Alzheimer’s disease and glaucoma indicate transsynaptic distribution of the pathological process in the central nervous system structures
